• Manage a woman who is pregnant like any other individual with asthma:
• Continue the use of all medication as normal in pregnancy, but do not start leukotriene receptor antagonists. However, if the woman is already taking a leukotriene receptor antagonist and it is considered essential, continue treatment.
• Advise women that the benefits of treatment with oral corticosteroids for an acute attack outweigh the risks.
• Advise women who smoke about the dangers that smoking poses to themselves and their children. Give appropriate support for stopping smoking.
• Encourage women with asthma to breastfeed their babies and use asthma medications as normal during breastfeeding.

In depth

• The decision to refer is influenced by local referral pathways, the individual, and the experience of the primary healthcare provider.
• In addition to respiratory physicians and paediatricians with a specialist interest in respiratory medicine, such specialists as dietitians, physiotherapists, occupational therapists, and respiratory nurse specialists may be involved in the management of asthma at any stage.
• Admit or refer adults for specialist assessment or further investigation in the following situations:
• The diagnosis is unclear or in doubt:
• Unexpected clinical findings (e.g. crackles, clubbing, cyanosis, cardiac disease).
• Persistent non-variable breathlessness.
• Monophonic, unilateral or fixed wheeze or stridor.
• Persistent chest pain or atypical features.
• Prominent systemic features e.g. weight loss, myalgia, fever.
• Persistent cough or sputum production.
• Spirometric or peak expiratory flow measurements that do not fit the clinical picture e.g. unexplained restrictive spirometry.
• Suspected occupational asthma.
• Non-resolving pneumonia.
• Inadequate response to maximum guideline treatment.
• Admit or refer children for specialist assessment or further investigation in the following situations:
• The diagnosis is unclear or in doubt (the younger the child, the more difficult it is to be sure that wheezing is due to asthma):
• Unexpected clinical findings (e.g. abnormal voice, focal chest signs, dysphagia, inspiratory wheeze, stridor).
• Symptoms present from birth, or perinatal lung problem.
• Excessive vomiting or posseting.
• Severe upper respiratory tract infection.
• Persistent productive cough.
• Family history of unusual chest disease.
• Failure to thrive.
• Parental anxiety.
• Inadequate response to maximum guideline treatment, particularly if oral corticosteroids are needed frequently, or use of the maximum dose of inhaled corticosteroids.

In depth