Fostair during pregnancy?

[Durhamlark]

Hi all

Lifelong asthmatic, now 20 weeks pregnant. Have been generally fine taking Beclometasone (Clenil) and Salbutamol when needed.

I had an asthma review last week and the nurse wants to swap me to Fostair because I ordered more than two salbutamol inhalers in the last year and it’s now their policy that needing more than 2 means asthma is not well controlled (news to me!).

I’ve been doing some reading and am not particularly comfortable with using the Formoterol present in the Fostair inhaler because it is apparently tocolytic (causes uterus to relax) and shouldn’t therefore be used in the run up to delivery and labour. In addition the potential effects on unborn babies are not well studied so it’s a gamble.

My midwife is trying to find out more but says she can’t find many studies.

Does anyone have experience of Fostair in pregnancy? Or do you know of any studies I can read? Or can anyone suggest any alternatives?

[peege]

I can totally understand your need to do what's right for your baby - thank goodness I didn't use any drugs to worry about in my three (navy years ago). I think this one could be a query for the helpline, call 0300 222 5800 between 09.15 and 5pm Mon to Friday to speak to a professional

[Lysistrata Administrator Community Ambassador]

I agree with asking the helpline. Just FYI, the general guide for control is that if you need reliever more than about 2-3 times a week, you're not well controlled and are likely to need an increase in preventer medication. Though if the reason you ordered two in the last year was because you wanted a spare or one expired or something, then it's not really saying anything about how often you need it - they should really have asked how often you feel you need the Ventolin.

I'm not a healthcare professional and I don't know if it's a particular issue with Fostair or formoterol, but I know that there are smooth muscles in the uterus as well as round the airways (ie muscles that you can't control). Inhalers that act on the smooth muscles round your airways should be mostly localised to the lungs/airways, but I guess it's possible they could affect your uterus? I know magnesium sulphate which is used for acute severe asthma attacks is also used to stop premature labour by relaxing the uterus, but that's an IV medication rather than an inhaled one so would be expected to have a systemic effect. (And I don't know if the doses are the same - just that magnesium sulphate relaxes smooth muscle but in a different way from the way that the inhalers do it.)

As I said, it's definitely worth asking the helpline. I do know that it's considered best for the unborn baby to have the mother's asthma be as well controlled as possible, so that should also be taken into account with any treatment you may need for asthma while you're pregnant.

[Patk1]

Sorry I can't help but I'd suggest you don't change to anything you aren't happy with - don't be afraid to speak up + say so.x

[k0914860]

So there won't be huge amounts of data because there isn't lots of research conducted in pregnancy on purpose due to ethics etc. Being pregnant is a known risk factor for worsening asthma, and if your asthma is unstable now, you are at risk of a significant asthma attack in your third trimester, which is more risky for baby. I went through something very similar and ended up needing fostair in pregnancy, after I had a massive asthma attack at 33 weeks whilst on clonal. My delivery was absolutely fine. Obviously everyone has their own level of risk they are willing to take but just thought I would tell you my experience.

[Durhamlark in reply to k0914860]

Thanks for sharing your experience!

When you say your delivery was fine, would you be able to elaborate? Did you birth naturally or assisted? Were you induced?

[k0914860 in reply to Durhamlark]

I was on Clenil....sorry that was autocorrect! It was my third labour so things went smoothly, just a natural delivery. I was under the asthma team, after my admission and they said that the risk of an asthma attack during delivery is very low because your body produces steroids naturally anyway during labour. The risk of an asthma attack in the third trimester is low oxygen supply to growing baby. When I meant things went smoothly, I meant that I didn't go in to premature labour or have any issues regarding delivery that was due to Fostair!

[Durhamlark in reply to k0914860]

Thank you so much for sharing!

[Katy2212]

Hi, so glad you’ve raised this - did you get any answers from the helpline out of interest?

I’ve been on Fostair for a few years now and I wouldn’t be without it. My asthma has been completely under control and I haven’t been using my reliever at all. However, I’m worried that’s all going to change now I’m pregnant. Firstly, like you are, I’m worried about taking Fostair whilst I’m pregnant and the Asthma Nurse isn’t the most reassuring and secondly, I’ve noticed a few flair ups. My cough is coming back and I’ve had to use my reliever for the first time in years. I’m only in my first trimester so 2nd and 3rd is going to be very interesting.