It's good to get info on side effects and pregnancy, but you should be
discussing this with medical professionals, too (although there are a
few, I think on this group).  Do you have an allergist?  If not, get one
and run this all by him/her.  Check whatever you find on the web or
newsgroups with the pros before changing medication in any way.  That's
your baby and she/he has no say in this, yet, so your job is be the
guardian.

Medications are classified into different risk groups for use in pregnancy:
A = Good studies in humans and animal have shown no increased risk.
B =  1) Studies in animals have shown no increased risk with no studies in
people.  Or:
       2) Animals studies have suggested a risk but studies in people have
not shown one.

Both of the above are generally considered safe in pregnancy.

C = Animal studies do show a risk and there are no good studies of risk in
people (and no evidence of significant risk in people).

It is generally considered acceptable to use a "C drug" if there is a clear
expectation of benefit to the health of the mother.

D = potential evidence of risk in studies of people.

It may be reasonable to use a "D drug" in pregnancy depending on an
assessment of the risks versus benefits.

X = evidence of a high risk of fetal abnormalities.

In general these medications are avoided at all costs - even to the point of
considering terminating the pregnancy rather than use them on a pregnant
women.

The thing to keep in mind is that poorly controlled asthma is dangerous to
both the mother and baby. The first goal is to control the asthma - always.
If your doctor suggets sacrificing control of the asthma for the sake of the
pregnancy then you need to immediately find another doc to manage the
asthma. I find that many (but not all or even most) OB's are incredibly
unenlightened about the use of meds in pregnancy and they basically just
tell the moms to stop all of them. Patients of these guys may need to see
the one doc for the pregnancy and another for the chronic condition (like
asthma).

That is not to say that the asthma treatment should go unchanged. It is
always a precept of asthma treatment to try to reduce the meds to the lowest
level possible. The start of the pregnancy can be a good prompt to review
the asthma and determine if a dose reduction is possible so the decrease of
meds in this case may have been reasonable. However, since you are now
having symptoms the treatment should be intensified.

It sounds like you should be on an inhaled steroid. Both of the components
of Advair (the salmeterol and fluticasone) are pregnancy category C. It
would be reaonable to use them if there is no other alternative, however,
there is one cat B steroid available in the US - budesonide (Pulmicort). It
might be reasonable to switch to this.

All of the dilators - including albuterol (Proventil, Ventolin, Proair) and
Xopenex and the long acting dilators (Foradil and Serevent) are pregnancy
category C. By all means use them if needed and at least have one of the
short acting inhalers on hand for emergency use but this does suggest that
the dose of Pulmicort should be optimised to reduce rescue inhaler use as
low as possible. If a lot of short acting inahler is being used then it
might be reasonable to add a long acting one to achieve better control.

In general the pills (Accolate, Singulair, Zyflo, theophylline) are to be
avoided if possible. Accolate and Singulair are labelled as pregnancy
category B so I guess one could argue to use them and reduce the use of the
cat C rescue inhalers but most experts feel that the higher blood levels of
the oral meds make inhaled meds more desirable despite the pregnancy
categories. Theophylline is category C and so could be used in some
situations but it is in general rarely used these days due to side effects
including high heart rates and reflux - both of which are common in
pregnancy.

Keep in mind that triggers of asthma such as nasal congestion and reflux
tend to get worse with pregnancy and so may need to be addressed. As always,
as much should be done in terms of avoiding allergens and reducing triggers
as possible. Claritin is a pregnancy category B drug so if you are having
allergy symptoms and they may be triggering your asthma then most doctors
would recommend taking it (or Zyrtec - also cat B). Nasal steroids are
probably safe in pregnancy but only one has been well studied and so given a
cat B designation (Rhinocort Aqua). Keep in mind that saline sprays and
rinses can be very effective and should be completely safe..

http://www.aaaai.org/patients/publicedmat/tips/asthmaandpregnancy.stm

http://www.aaaai.org/patients/topicofthemonth/0506/

http://www.uspharmacist.com/index.asp?show=article&page=8_1708.htm

http://www.webmd.com/allergies/news/20040826/fda-says-nasal-allergy-drug-safe-in
-pregnancy