TABLE I.

Steps in asthma therapy during pregnancy

Step	Preferred controller medication	Alternative controller medication
1	None	—
2	Low-dose ICS	LTRA, theophylline, or cromolyn
3	Medium-dose ICS or low-dose ICS plus LABA	Low-dose ICS plus LTRA or theophylline
4	Medium-dose ICS plus LABA	Medium-dose ICS plus either LTRA or theophylline
5	High-dose ICS plus LABA	Medium-dose ICS plus LABA plus tiotropium; consider adding omalizumab for patients with allergy or adding other asthma biologics (anti–IL-5, anti–IL-5Rα, anti–IL-4Rα) for appropriate candidates
6	High-dose ICS plus LABA plus oral prednisone	Consider adding omalizumab for patients with allergy or adding other asthma biologics (anti–IL-5, anti–IL-5Rα, anti–IL-4Rα) for appropriate candidates

ICS, Inhaled corticosteroid; LABA, long-acting β-agonist; LTRA, leukotriene receptor antagonist.

There are no randomized clinical trials of asthma biologics that intentionally included pregnant women.

Data modified from Schatz and Dombrowski.¹³