Asthma

Question 1

Classification of severity based on
Symptom frequency and FEV1

Intermittent

Mild persistent

Moderate persistent

Severe persistent

Answer 1

Two days per week or less , more than 80%

Greater than two days per week but not daily, more than 80%

Daily symptoms, 60 to 80%

Throughout the day, less than 60%

Question 2

Effects of asthma on patient and fetus

Answer 2

Increased risk of low birth weight in prematurity

Severity of asthma may improve or worsen

Question 3

Step therapy for medical management and pregnancy

Mild intermittent

Mild persistent

Moderate persistent

Severe persistent

Answer 3

No medication. Albuterol as needed

Low-dose inhaled corticosteroid (budesonide)*
Cromolyn, leukotriene receptor antagonist or theophylline are alternatives

Low or medium dose inhaled corticosteroid and salmeterol (LABA)
Alternative add-Ins: theophylline, leukotriene receptor antagonists

High-dose inhaled corticosteroid, salmeterol and oral corticosteroids (if needed)

Question 4

When is intubation needed?

Answer 4

Poor response, FEV1 less than 50, drowsiness, confusion, pCO2 >42 mmHg

Question 5

Antenatal testing

Answer 5

US and weekly antenatal testing beginning at 32w for moderate to severe asthma