Asthma and chronic rhinitis in pregnancy

[sciencepotato]

Hi all,

I've been wondering how those of you struggling with asthma and chronic nasal congestion managed during pregnancy.Did you continue use of nasal antihistamine and steriod spray in pregnancy too? My doctors officially advise only saline spray citing the lack of research on the medication but it's of course useless in my chronic condition. Any experience would be appreciated. I understand of course that it's just sharing the experience and not giving medical advice :)

@sciencepotato

Makes sense. After all, only you can know what helps you with your nose. Actually I am starting to think may nose just doesn't like uk climate. It all started here two years ago. Never had any issues when living on the continent... But we've got what we've got and have to work with it. I hope you can find something effective for you in the future, it truly is horrible suffering with breathing. Those who recommend only the saline solution will never get it.

Saline is rubbish. My baby is using a saline spray for a cold and it does nothing for her either 😂

[quote sciencepotato]@FeedMeSantiago any updates from asthma uk on your issues?[/quote]
Asthma UK agreed with me. They advised me to point GP surgery to their pregnancy and asthma guidance online.

They said Montelukast is safe in pregnancy if Mum to be is already taking it. They also said they advise pregnant women to take the lowest dose of asthma meds which manages their symptoms but that the most important thing is that the asthma is controlled.

They said they wouldn't advise anyone with two exacerbations in a short space of time to reduce their asthma meds.

They said if GP surgery don't want to prescribe me meds to ask for a referral to a respiratory consultant.

They also said to get asthma back under control again before I conceive, which was always my plan.

Haven't heard from the surgery today.

Hi all, so sorry to hear of all your experiences. And difficult choices about medications with pregnancy.

This won't be relevant for everyone, but @sciencepotato as you mentioned onset of asthma mid-30s, linked to allergies and not responding to treatment, I'm wondering if you've tried a low histamine diet to see if it helps with underlying triggers? As a neuroscientist I'm sure this sounds woo woo but I've got a PhD so hear me out.

I had similar experience, sudden asthma attacks mid-30s. GPs/ asthma nurses put me on loads of meds for 6+ months. Didn't get asthma under control, and developed new symptoms from the steroids. Was debilitated, couldn't leave house on my own, multiple days when couldn't get to work or had to leave early.

A weird food reaction got me researching and I discovered histaminiosis - recognised everywhere but the UK. Tried low histamine diet out of desperation. Results were dramatic. Instant reduction in inflammation. Was off all meds within 3 months. Followed diet for a year, gradually reintroduced foods in that time. No attacks since, haven't used preventer for a few years.

Obviously not relevant for non-allergic asthma or childhood onset. But as I'm sure you know, inflammatory conditions linked to overactive immune systems really common in women 35-55, and once it takes hold it's hard to stop. Often the meds are just dealing with symptoms but can't address cause.

Finally someone is talking sense. Everyones asthma is different and I too don't struggle with coughing or wheezing, my asthma symptoms is can't draw a deep breath as chest is tight and soon blood pressure rises as can't pull enough air and frankly dropping montelukast or a dose of ics would be really risky for me as that will destabilise my asthma. Try find a good gp and a consultant, wishing you all the luck!! ❤️

Thanks, I don't have any food related sensitivities and my asthma is mixed (allergy to cats and tree pollen as well as non allergic triggers). Good it worked for you though.

I spoke to the asthma nurse today. It seems the issue is with Fostair in pregnancy as one of the ingredients can only be used in pregnancy if the benefit to the mother outweighs the risk to the baby.

GP surgery think I should stay on the Fostair and Montelukast but don't want to make the final call and are referring me to a respiratory consultant to decide. So now I have to wait for that.

DH and I are grumpy as I have been on these meds since 2018 and have repeatedly told the asthma nurses that I want a baby. In late 2019/early 2020 I was discussing it with them as we planned to start TTC in summer 2020, once the 3 months had passed from a Caribbean trip (zika) and no-one said anything then about Fostair, nor did they refer me to a consultant.

Nor did anyone say anything two weeks ago at my last review when I mentioned planning a pregnancy and taking asthma meds. So it's all come out of the blue.

Just hoping I don't have to wait too long to be seen as we're keen to start trying soon due to my age.

Omg, what's wrong with these people 🙈 they sound like a nightmare.
when you rang asthma uk, did you mention fostair to them?
Also, what's in the fostair that makes your asthma nurse be so reluctant about it? Is it formoterol? Then Symbicort cannot be taken either, following this logic, as it also contains formoterol?

@FeedMeSantiago the advice on Fostair may have changed since then. When I was pregnant in 2019 I wasn't advised to stop using Fostair and given my asthma is relatively mild, I doubt that I would have counted for benefits outweighing risks. I didn't actually use it while pregnant of my own choice as my asthma is only symptomatic when doing heavy exercise when there's lots of pollen around so it wasn't necessary while pregnant!

That said, clearly that's different advice to what you've been told so I would try and find out more.

When I was prescribed fostair, I also asked if could use it in pregnancy and the specialist said sure, it's vital to control your asthma in pregnancy. I have a different consultant now, so need to run my meds by him soon but since I've been doing IVF, and just completed my second round now, nobody at my gp practice ever suggested it would be unsafe. Anyway, I am going to email my lung specialist for advice but so far using fostair as normal and happy with it.

Hopefully it is just a case of the advice changing. I mentioned Fostair to both asthma UK and my pharmacist (although focused on montelukast as I thought that was the issue) and neither expressed a worry about Fostair.

It is indeed the formoterol the asthma nurse worried about. Just have to see now how long it takes to see a consultant.

I'm also hoping I can get an allergy test from the consultant (I know I'm allergic to pollen due to hay fever and ibuprofen from having reacted to it and asthma nurses suspect a dust allergy but have never had an allergy test). I've had eczema since I was a baby too.

DH had an allergy test years ago due to his own rhinitis issues and was allergic to pollen which he already knew and also dust, which he had no idea of!

Hm yes, seems like a lot of mixed advice where you are. I guess I am really lucky to have a good gp practice. They also did my allergy tests, didn't need a consultant for that. As for nhs wait for a lung specialist here where I live it's horrible, I have been waiting since September for my asthma specialist, so if it takes longer than you can handle, I would seek an alternative doctor. Don't put life on hold! I really hope you sort this out very soon and continue with your meds if you are happy.

Oh and I would probably ask the nurse about why formoterol is bad in pregnancy. Links to research please!!

Update: fertility specialist approved all my pre pregnancy asthma drugs incl nasal spray dymista and claritin to use in pregnancy, at least for now to manage my allergies and asthma, am truly relieved as I can function fine and not worry about it.

That's great news.

Ah that's great news OP, must be a big relief to be able to take your meds as normal.

I went to order more montelukast today but couldn't as it's been removed from my list of repeat prescriptions! Have had to message the surgery to ask for it to be added back.

Argh, your gp surgery is really annoying. They can't do that unless have a serious justification. I am fighting now for increase in thyroid medication. Sent them the official NICE guidelines for pregnancy, but they are still doing their own thing, advising to wait and retest thyroid before dose adjustment. Luckily, the ivf specialist will do a private prescription and test if necessary. It's really annoying when the medical staff you depend on makes decisions based on some kind of medieval attitudes and legal conveniences, not on your practical needs and current research. Keep up your fight for your rights! 👍

I saw the asthma consultant last week. She was brilliant. She's on similar drugs to me for various conditions and she's cleared me to take Fostair and Montelukast in pregnancy. She also says I can continue with anti histamines for hay fever too. She will write to my GP to ask them to continue to prescribe.

I'm now CEV for Covid due to having two courses of steroids so close together so am now eligible for Covid treatments if I get Covid again. She's ordering a load of tests - lung function, FeNo, some type of blood test to look at my white blood cells and an allergy test.

I might also be eligible for a second booster (I've had two full jabs and one booster).

Great, so happy to hear that! It's truly worrying that local gp practices often look to cut meds for asthma people in pregnancy, thereby putting us under more risk for asthma attacks. I am 10 weeks now and my asthmatic ivf consultant recommended I keep taking all my asthma meds throughout pregnancy, which is at the moment fostair 4 times a day, dymista, claritin,.montelukast daily. Glad you can now get prescribed all you need too. Out of curiousity : are you getting spirometry with reversibility (bronchodilator probe test - lung function before and after)? My lung function tests were all normal but I know that I have asthma which causes symptoms and only my inhalers are helping but my consultant never ordered bronchodilator during spirometry which I find baffling tbh.