On a recent afternoon, Kelly Liartis is at Magee Women’s Hospital for a check-up. She’s talking to her doctor Hyagriv Simhan about her soon-to-be-born baby — and her frequent summer asthma flare-ups.
He's telling her that despite her fears, its actually OK to use her inhaler ... it's been used in pregnancy, as he says with a laugh, for a "bajillion years."
For the 10 to 12 percent of Americans with asthma, flare-ups mean their airways can get inflamed and then narrow, constricting breath and sometimes causing wheezing or coughing. A flare-up can be triggered by exercise, smoke, dust — or in Kelly Liartis’ case, hot muggy summer days.
In southwestern Pennsylvania, there is a higher prevalence of asthma and asthma hospitalizations than in other parts of the U.S. Hyagriv Simhan, chief of maternal fetal medicine at Magee, said it's not completely understood why that is.
"Many of the factors for asthma are prevalent in this area," Simhan said. "So particulate air pollution, smoking, obesity, nutritional contributors to asthma are more common here, and the presence of those risk factors tends to increase its frequency in general in the population, and we see the same thing in pregnancy."
Increasing scientific evidence also points to a big part of the puzzle: the air quality.
When the American Lung Association releases its annual State of the Air report, the Pittsburgh metropolitan region always ranks high on the lists of most polluted cities, whether looking at ozone, year-round particle pollution or short-term pollution. But historians and doctors say that’s nothing compared to the region’s past as "the smoky city," where as the famous anecdote goes, downtown street lights would come on mid-day because of the smog, soot and smoke in the air.
"That soot was in the air all the time, and there was dustfall, and supposedly you’d park your car out at night and in the morning you’d clean the grit off of the car," said Joel Tarr, an environmental historian at Carnegie Mellon University. "They had a hard time over the years linking up smoky air and air pollution per se with health issues, but the common sense knowledge was yes, your coughing all the time, this is not good for your health."
Simhan said asthma was prevalent then, but the ways of treating it weren’t quite developed.
"Severe asthma years and years ago generally precluded individuals from getting pregnant," he said. "The medications that were used to control asthma were far fewer, and if an individual had severe asthma and needed oxygen therapy and lots of hospitalizations and infections, it was far less common for those individuals to reproduce."
Simhan said now, because medications and strategies have helped women through the pre-reproductive years, they see many more asthmatic women getting to the point of becoming pregnant than he suspects they would have seen 50 or 75 years ago.
When asthmatic women get pregnant, it can go several ways, said Fernando Holguin, assistant director at the UPMC Asthma Institute.
"We call it the rules of three ... her asthma can get better, remain the same or get worse," he said.
Some of the drugs used to treat asthma are considered Class C or above, meaning the risks to a fetus are unknown. It's suggested pregnant women don’t use them, but Simhan said not controlling asthma can also be risky.
"Asthma flairs become more common because that woman is more susceptible to infections and respiratory infections," he said.
Women can be put on other drugs, but Holguin said the general rule is if a flare-up is happening, take the drug.
"What we know is that balancing things out the risk is very small, so it's better to take the medication and have the asthma controlled, because we know in those women uncontrolled asthma in pregnancy can lead to earlier deliveries and low birth weights and other complications," he said.
Jennica Liberatore is pregnant for the first time — with triplets. She has severe asthma, and the inhaler she takes is a Class C.
"In my particular case, they told me if I needed to take it then take it, because I needed the flow of oxygen to the baby than to risk not having that flow of oxygen," she said.
She’s made serious changes to her life in an effort to minimize risks. She stopped working as a mobile therapist who visits teen’s houses. "In most of them the parents or caregivers smoked on a regular basis, so there was always kind of second-hand smoke and poor air quality in the homes because of these conditions."
She said not being exposed to smoke has led to better health.
Simhan said this is one of the busier seasons, where they get more pregnant women hospitalized for asthma-related reasons.
