Asthma

Question 1

What are the maternal risks of pregnancy in patients with asthma?

Answer 1

Exacerbation 
Hospitalization
PPH 
GDM/GHTN
C-section

Question 2

What are the fetal risks of pregnancy in patients with asthma?

Answer 2

PPROM
Placental previa
Cleft lip and palate
Prematurity and low birth weight

Question 3

How do you define severe asthma?

Answer 3

Symptoms through out the day and 4 times nightly. Less than 60% FEV1

Question 4

How do you define moderate persistent asthma?

Answer 4

Daily symptoms and once weekly at night. 60-80% FEV1

Question 5

How do you define mild persistent asthma?

Answer 5

Symptoms > twice weekly and > twice monthly at night. >80% FEV1

Question 6

How do you define intermittent asthma?

Answer 6

Symptoms twice weekly and twice monthly at night. >80% FEV1

Question 7

What is the stepwise therapy for management of asthma?

Answer 7

Mild Persistent Asthma
Preferred-Low-dose inhaled corticosteroid

Moderate Persistent Asthma
Preferred-Low-dose inhaled corticosteroid and salmeterol or medium-dose inhaled corticosteroid or (if needed) medium-dose inhaled corticosteroid and salmeterol

Severe Persistent Asthma
Preferred—High-dose inhaled corticosteroid and salmeterol and (if needed) oral corticosteroid

Question 8

What percentage of asthma patients will have worsening disease?

Answer 8

30% became worse

***23% became better

Question 9

What are the goals of asthma therapy during pregnancy?

Answer 9

The ultimate goal of asthma therapy in pregnancy is maintaining adequate oxygenation of the fetus by preventing hypoxic episodes in the mother.

Question 10

How do you counsel a patient regarding use of short acting beta agonists such as albuterol in pregnancy?

Answer 10

Inhaled short-acting β2-agonists are the rescue therapy of choice for asthma during pregnancy. Inhaled albuterol is the first-choice, short-acting β2-agonist for pregnant women, although other agents also may be appropriate. In general, patients should use up to two treatments of inhaled albuterol (two to six puffs) or nebulized albuterol at 20-minute intervals for most mild to moderate symptoms; higher doses can be used for severe symptom exacerbation.

Question 11

What commonly used medication in pregnancy can exacerbate asthma?

Answer 11

Hemabate
Labetalol
Methergine

Question 12

Describe how you would manage an acute asthma exacerbation?

Answer 12

• History and physical
• ABG, chest x-ray
• If FEV1 less than 50% then provide oxygenation, oral steroids and anticholinergic

-If no response then add short acting beta agonist in addition to the systemic steroids and anticholinergic

• If poor response then admit to ICU
• **Anticholinergic include Ipratropium bromide

Question 13

In pregnancy with asthma exacerbation, what physiologic changes of pregnancy may make interpretation of an ABG challenging?

Answer 13

-Low PCO2 in pregnancy causes respiratory alkalosis

Normal pH 7.4 - 7.45
Normal Pco2 : 28-32
Normal Po2: 102-110