First-lineBudesonide (Pulmicort) / Fluticasone (Flixotide)
Inhaled Corticosteroids
Inhaled glucocorticoid preventer
Anti-inflammatory backbone of pregnancy asthma control.
Inhaled MDI / DPI / nebuliser
First-line for
- Persistent asthma in pregnancy (step 2+)
- COPD (fluticasone/budesonide combos)
Mechanism
Glucocorticoid receptor activation → ↓ inflammatory gene expression, ↑ β2 receptor density.
"Budesonide has the biggest pregnancy dataset"
- Do NOT stop ICS in pregnancy
- Rinse mouth, spacer to reduce oral candidiasis
- Add LABA before increasing ICS to high dose
Dosing
- Budesonide
- 200–800 μg BD
- Fluticasone
- 100–500 μg BD
Contraindications
- CautionUntreated oral candidiasis
Side effects
- Oral thrush
- Hoarseness/dysphonia
- High dose: adrenal suppression, ↓ BMD, bruising
Fetal & maternal notes
- • Budesonide has strongest safety data — MCM rate not elevated
- • Poor asthma control is more harmful than any ICS
Key interactions
Ritonavir / itraconazole
AvoidSystemic steroid exposure ↑ (Cushing's) with fluticasone
Clinical pearls
- 💡 Personalised Asthma Action Plan every trimester
- 💡 PEF diary in exacerbations
Content last reviewed: REPLACE_ME (e.g. 2026-07)
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