Misoprostol not linked to peripartum asthma exacerbations

1. No patients receiving misoprostol (prostaglandin E₁) reported worsening of respiratory symptoms.

2. No patients required systemic corticosteroids or increased bronchodilator use after receiving prostaglandin E₁.

Evidence Rating Level: 2 (Good)

Study Rundown: Misoprostol, or prostaglandin E1 (PGE₁), is commonly used to treat obstetric patients for cervical ripening, labor induction, therapeutic abortions, uterine atony and postpartum hemorrhage. It is currently unknown whether misoprostol, a commonly used synthetic PGE₁, causes dyspnea and bronchospasm, which have been documented as rare adverse effects of the drug in the general population. While the American Congress of Obstetricians and Gynecologists endorses the use of misoprostol as an appropriate treatment for labor induction and postpartum hemorrhage, the organization does not provide specific information on its use in patients who are at risk for bronchoconstriction. PGE₁ is typically considered a bronchodilator, but prior work has suggested that certain conditions, including pregnancy and hyperdynamic bronchial sensitivity an in asthma, can predispose an individual to bronchoconstriction following administration of PGE₁. As such, the present work evaluated whether misoprostol use in peripartum women was associated with asthma exacerbations. The authors observed no evidence of increased incidence of asthma exacerbations, suggesting that PGE₁ is relatively safe to use in asthmatic patients and has a low likelihood of inducing respiratory symptoms in this population.

Strengths of the study included prospective data collection following administration of PGE₁. Limitations included retrospective design, dependence on proper documentation of respiratory symptoms and therapy, and a relatively small asthmatic sub-population. Additional prospective study in a larger population of asthmatic patients is needed to better characterize whether asthma exacerbations or other respiratory difficulties are a side effect of PGE₁.

Click to read the study in AJOG

Relevant Reading: Asthma exacerbations during pregnancy- incidence and association with adverse pregnancy outcomes

In-Depth [retrospective cohort]: This study evaluated respiratory complications associated with the use of PGE₁ in 2629 peripartum women, particularly among women with a previous diagnosis of asthma (n=234). Outcomes of interest were moderate asthma exacerbations, defined as events necessitating a change in treatment, and severe asthma exacerbations, defined as events requiring urgent action and treatment with systemic corticosteroids.

No clinical evidence of asthma exacerbation was observed, and no patients required systemic corticosteroids or increased rescue inhaler use. Cumulative PGE₁ dosages ranged from 25mcg to 4200mg and routes of administration included buccal/sublingual, rectal and vaginal.

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