Rachel Meislin, MD, on structured asthma assessment and counseling in pregnancy

A structured approach that evaluates asthma comorbidities together, rather than in isolation, and reframes medication counseling around disease control is central to managing asthma in pregnancy, according to Rachel Meislin, MD, board-certified OB-GYN and maternal-fetal medicine specialist at the Icahn School of Medicine at Mount Sinai. The discussion continues Meislin's earlier conversation on asthma control as a fetal-protective strategy, drawn from a review she co-authored in the American Journal of Obstetrics and Gynecology.

Meislin described treating comorbidities as part of a single asthma assessment rather than as separate problems.

“In my practice, I treat this really as sort of an underlying structured asthma assessment, rather than treating each comorbidity sort of separately,” she said, noting that she screens all patients for allergic rhinitis, GERD, obesity, snoring or sleep apnea, and smoking or vaping.

She emphasized environmental triggers and medication factors as part of that assessment.

“Environmental triggers are very important, so things like cleaning products, other environmental inhalants that can happen both inside and outside the home,” Meislin said, adding that access to medication, adherence, and inhaler technique—including whether a patient needs a spacer—are equally important to evaluate.

Turning to patient counseling, Meislin stressed the importance of validating concerns before reframing the decision.

“Pregnant patients are always very cautious about eating or drinking anything that might be dangerous for their baby, and many have also had this sort of message that more medications may be more dangerous,” she said. “We reframe the decision for the patient. It's really not about medication exposure or no exposure, it's really about the asthma being treated appropriately versus the risk of uncontrolled inflammation.”

She pointed to the safety data supporting inhaled corticosteroids in pregnancy.

“We know that extensive research has been done that has not shown a harm to inhaled corticosteroids in pregnancy. It's really acting mostly on the lungs. So we have a lot of data from many years of treating pregnant patients with asthma,” Meislin said.

She also reframed treatment escalation as appropriate rather than a shortcoming.

“Stepping up treatment is not a failure. So, really, anything we need to do to maintain control,” she said, while emphasizing the importance of confirming proper usage and adherence before escalating therapy.

Per the review, uncontrolled asthma is associated with worse pregnancy outcomes, and guidance aligned with international asthma guidelines emphasizes continuation or escalation of controller therapy to maintain control.¹

Reference:

1. Meislin R, Bose S, et al. Asthma in pregnancy: contemporary management. Am J Obstet Gynecol. 2026. Accessed August 19, 2026. https://www.ajog.org/article/S0002-9378(26)00153-5/abstract