#90 Asthma In Pregnancy

Question 1

Is asthma an obstructive or restrictive airway disease?

Answer 1

Obstructive

Question 2

What are obstetric outcomes associated with severe/poorly controlled asthma?

Answer 2

Increased prematurity, need for cesarean section, preeclampsia, growth restriction, other perinatal complications as well as maternal morbidity and mortality

Question 3

What are the long term management medications used for asthma?

Answer 3

Inhaled corticosteroids, cromolyn, long acting beta agonist, theophylline

Question 4

What can be used for rescue medications for asthma exacerbation

Answer 4

Beta agonist, inhaled corticosteroids

Question 5

What commonly used medications in obstetrics should be avoided in an asthmatic patient?

Answer 5

Non selective beta blockers, carboprost (prostaglandin F2), And ergonovine. Indomethacin May induce bronchospasm in patients with ASA sensitivity

Question 6

How is intermittent asthma (well controlled) defined?

Answer 6

Symptoms 2 days per week or less.
Nighttime awakening 2 times per month or less.
No interference with normal activity
FEV1 or peak flow >80%

Question 7

How is mild persistent (not well controlled) asthma defined?

Answer 7

Symptoms >2x/wk, not daily.
Nighttime awakening >2x/month
Minor limitation with normal activity
FEV1 or peak flow > 80%

Question 8

How is moderate persistent (not well controlled) asthma defined?

Answer 8

Daily symptoms
Nighttime awakening more than once per week
Some limitation with normal activity
FEV1 or Peak flow 60-80%

Question 9

How is severe persistent (very poorly controlled) asthma defined?

Answer 9

Symptoms throughout the day
Nighttime awakening 4x/wk or more
Extreme limitation with normal activity
FEV1 or peak flow <60%

Question 10

How does pregnancy affect asthma?

Answer 10

Variably. 23% with improved symptoms. 30% with worsened symptoms.

Question 11

What pregnancy outcomes are associated with low FEV1/poorly controlled asthma?

Answer 11

Low birth weight and prematurity.

Question 12

How do you diagnose asthma in pregnancy?

Answer 12

Same as without pregnancy. Evidence of reversible obstructive disease (>12% improvement with bronchodilator). This may not be demonstrable in some patients, if clinically sounds like asthma, reasonable to treat as such and improvement with asthma therapies = asthma

Question 13

What is the most common cause of respiratory symptoms in pregnancy?

Answer 13

Dyspnea of pregnancy

Question 14

How should women with asthma be assessed during pregnancy?

Answer 14

Pulmonary function and asthma severity may change during pregnancy, routine evaluation of pulmonary function in pregnant women with persistent asthma is recommended. During outpatient visits, spirometry is preferable, but peak expiratory flow measurement with a peak flow meter also is sufficient.

Question 15

Can allergy shots be started or continued during pregnancy?

Answer 15

• Do not want patients to go into anaphylaxis.
• Maintenance or near-maintenance dose immunotherapy w/ clinical benefit should be continued. Consider dose-reduction to further decrease the chance of anaphylaxis. -Do not begin allergen immunotherapy.

Question 16

What rescue therapy is first line for asthma in pregnancy

Answer 16

albuterol

Question 17

What is the preferred inhaled corticosteroid in pregnancy?

Answer 17

Budesonide. No evidence that others are not safe in pregnancy

Question 18

What is the preferred add-on controller medication in pregnancy?

Answer 18

Long acting beta2 agonist (preferred initial controller is ICS)

Question 19

What are the names of the Long acting beta2 agonists?

Answer 19

1) salmeterol and 2) formoterol.

Question 20

What are criteria for discharge after initial treatment in pregnant patient with asthma exacerbation?

Answer 20

FEV1 or PEFR >=70% sustained for 60 minutes after treatment
No distress
Reassuring fetal status

Question 21

What are criteria for ICU admission after initial treatment in pregnant patient with asthma exacerbation?

Answer 21

Poor response and severe symptoms, drowsiness, confusion, or Pco2 level greater than 42 mm Hg. Intubation should be considered

Question 22

What are criteria for hospital (not ICU) admission after initial treatment in pregnant patient with asthma exacerbation?

Answer 22

Poor response with FEV1 or PEFR <50%

Question 23

What are considerations for fetal surveillance in pregnancies complicated by asthma?

Answer 23

Serial ultrasound examinations to monitor fetal activity and growth should be considered (starting at 32 weeks of gestation) for women who have poorly controlled asthma or moderate-to-severe asthma and for women recovering from a severe asthma exacerbation.

Question 24

What should you use during labor/postpartum in asthmatics who have been taking or recently took systemic corticosteroids?

Answer 24

IV corticosteroids during labor and 24 hours after delivery to prevent adrenal crisis

Question 25

What is the risk of bronchospasm in asthmatics receiving regional anesthesia?

Answer 25

2%

Question 26

Any contraindications to breast feeding with asthma/asthma medications?

Answer 26

No