Rachel Meislin, MD, on when to co-manage asthma with pulmonology

Newer anti-inflammatory reliever and maintenance strategies for asthma are standard in pulmonology, but how familiar are most ob-gyns with those approaches, and where does pulmonology or allergy co-management become essential?

Rachel Meislin, MD, board-certified OB-GYN and maternal-fetal medicine specialist at the Icahn School of Medicine at Mount Sinai, joined Contemporary OB/GYN to discuss. The discussion continues Meislin's earlier conversations on asthma in pregnancy, drawn from a review she co-authored in the American Journal of Obstetrics and Gynecology.^1,2

Meislin noted that many obstetricians were trained on an older treatment model.

“Most of us were trained on the sort of traditional model of having a daily controller inhaler with using albuterol separately as a rescue medication,” she said, contrasting that with more recent approaches. “The newer strategies and many trials have shown that there's benefit really to using an anti-inflammatory both as reliever and as maintenance, so every day and as needed for symptoms.”

She emphasized that ob-gyns need not manage these regimens independently but should avoid interrupting them.

“It's not that ob-gyns necessarily need to manage this independently. It's more that they should be aware of what the pulmonology team is doing and not necessarily dissuade or even stop that medication regimen because it's not standard practice for us yet,” Meislin said.

She outlined the circumstances in which co-management with pulmonology or allergy specialists becomes important.

“Pulmonology-allergy co-management becomes really important when the diagnosis is uncertain, if they have persistent lack of control of symptoms despite stepping up or giving the appropriate treatment, if we're needing recurrent steroid courses, if there's hospitalization and ER visits,” she said.

Baseline disease severity should also guide the decision to involve specialists, Meislin added.

“Assessing their baseline severity is important, so if there's someone who's already on a biologic medication because their asthma's so severe, they should probably be involved in the management as well,” she said.

Per the review, contemporary asthma management strategies include anti-inflammatory reliever therapy and maintenance and reliever therapy, alongside nonpharmacologic interventions, with an emphasis on maintaining control to optimize maternal-fetal outcomes.¹

Reference:

1. Meislin R, Bose S, et al. Asthma in pregnancy: contemporary management. Am J Obstet Gynecol. 2026. Accessed August 21, 2026. https://www.ajog.org/article/S0002-9378(26)00153-5/abstract
2. Fitch J. Asthma control as fetal protection in pregnancy, with Rachel Meislin, MD. Contemporary OB/GYN. Published August 19, 2026. Accessed August 21, 2026. https://www.contemporaryobgyn.net/view/asthma-control-as-fetal-protection-in-pregnancy-with-rachel-meislin-md