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Q1: My husband and I are trying for a baby and I have suffered with asthma for as long as I can remember and having had numerous attacks which put me in hospital I was wondering if there is anything I can do to try to limit the impact of my asthma on a foetus if we are lucky enough to conceive and also if I can reduce the likelihood of passing asthma to the child? Name and address withheld

A1: Nobody can predict the effect of asthma on pregnancy in an individual patient. However the chances of your asthma improving during pregnancy, becoming worse or remaining the same have been worked out. The usual odds are that 20 per cent of women find that pregnancy improves their asthmatic state, 40 per cent have more trouble with asthma when pregnant and in the other 40 per cent of cases the patient is unable to notice any difference.

The good news is that the standard treatments, or rather the treatments I usually provided for asthmatic patients, including inhalers containing steroids such as Symbicort, Pulmicort or the beta 2 agonists whether short or long acting, are safe in pregnancy. If problems do occur as the result of asthma in pregnancy it is usually because of acute attacks of wheezing and breathlessness. These occasionally could lead to the baby being temporarily deprived of oxygen, hence the need to maintain good control of the asthma and to have your anti wheeze inhaler with you at all times.

Research has shown that very little, if any, of the steroid inhaled crosses the placenta barrier. It is important that your standard medication, if it is inhaled, should be continued when you are pregnant as the object of treatment is to keep your blood oxygen at normal levels. If you can achieve this, and most patients do so without difficulty, your baby will be of normal weight and not be upset by oxygen lack at any time.

This may mean that you may have to increase the number of your regular preventive puffs you take daily when pregnant. I am a believer in asthmatic patients having their own heat flow meter so that they are able to track the effect of the pregnancy on their asthma. Any drugs taken for asthma when pregnant should be by inhaler rather than by mouth. No asthmatic drugs should be taken by mouth by a pregnant woman unless they have been discussed with their own doctor. This is especially important during the first three months of pregnancy when your baby is still being laid down, rather than merely growing bigger as happens after the 12th or 13th week.

The most important factor in the prevention of asthma later in an unborn child is the avoidance of exposure to tobacco smoke by the mother while she is pregnant and in the baby's early life. Whatever someone's views are about the nanny state and smoking there is no doubt that smoking when pregnant increases the likelihood of a child developing allergies and asthma. Similarly after birth there is an association between fathers, as well as mothers, smoking in the presence of new born children and the development of asthma and other allergic conditions. A child's home should be a tobacco smoke free zone.

There have been studies that have shown children are more likely to develop asthma if they are born in the months when there is a high pollen count - say from March to June. However it is difficult for many couples to plan their pregnancies so carefully and there are disadvantages, such an increased incidence of schizophrenia, that are associated with having babies during the winter months. I shouldn't let the calendar interfere with your planned parenthood. After delivery there is evidence that breast fed babies are slightly less likely to develop asthma and other allergies.

Q2: I was diagnosed with asthma when I was fourteen years old. I have used over the counter inhalers three to four times a week since my late teens. I am a fifty-five-year-old male. I started smoking seven years ago and since then I have found no need to use the inhalers. Has smoking cured my asthma? Dennis

A2: Nobody knows why asthma suddenly improves in some patients. I hate to be depressing but doctors never say that a patient who has had asthma for several years as an adult and then it suddenly disappears is spontaneously cured of it. Rather we suggest that the asthma has gone into remission. We don't know why this happened, but we do know that asthma may equally suddenly return.

It is interesting about the effect of smoking. In my youth smoking was said to help some people and they were provided with special cigarettes. All tobacco smoking is now thought to make wheezing and other symptoms of asthma worse and to have serious long term effects on lungs and heart. Smoking, even with products that are tobacco free, is not now recommended. Your spontaneous remission may by chance have been associated with smoking, or you might be one of the occasional exceptions to the rule that smoking makes asthma worse.