Asthma in pregnancy: Optimizing treatment strategies and the emerging role of biologic therapies.

Asthma is the most common chronic respiratory disease during pregnancy and is a major contributor to preventable maternal morbidity and adverse fetal outcomes when poorly controlled. Although most asthma therapies are considered safe during pregnancy, asthma control frequently deteriorates, reflecting diagnostic uncertainty, suboptimal monitoring, poor treatment adherence, and clinician hesitancy to escalate therapy. This review focuses on strategies to optimize asthma control throughout pregnancy. We highlight the importance of objective assessment, showing that pregnancy does not significantly alter spirometry or fractional exhaled nitric oxide levels, thereby supporting their routine use to guide diagnosis and monitoring. Effective asthma management is underpinned by 4 core pillars: regular review, treatment optimization, lifestyle and comorbidity management, and patient education. Structured, proactive follow-up, particularly during the second and third trimesters when exacerbation risk is highest, is essential for early identification of deteriorating control. Contemporary pharmacologic approaches play a central role in improving outcomes. Anti-inflammatory reliever strategies such as anti-inflammatory reliever therapy and maintenance and reliever therapy may reduce exacerbations by linking symptom relief with anti-inflammatory treatment and improving adherence. For women with severe asthma, emerging registry and real-world data, supported by international consensus recommendations, suggest that biologic therapies can be continued or initiated during pregnancy when clinically indicated to maintain disease control and reduce reliance on systemic corticosteroids. Improving asthma control in pregnancy requires consistent, evidence-based messaging, multidisciplinary care, and shared decision-making. Future research should prioritize biomarker-guided strategies and implementation of contemporary treatment models, to further refine care and reduce preventable asthma-related complications in pregnancy.