Asthma in Pregnancy Flashcards
What is asthma?
Chronic inflammatory airway disease characterized by variable reversible airway obstruction, a hyper-sensitive airway and bronchial inflammation (existing within pregnancy – i.e. there was a diagnosis of asthma before pregnancy)
How common is asthma in pregnancy?
Most common chronic disease in pregnancy (3-12%
Most occur between 24 and 36 weeks
What is the aetiology of asthma in pregnancy?
must exist before pregnancy (N.B. allergic predisposition)
What are the signs and symptoms of asthma in pregnancy?
o Wheeze, breathlessness, cough – worse in morning and at night
§ Precipitating factors – e.g. cold, drugs (beta blocker, NSAIDs), exercise
§ Atopic history
o Tachypnoea, use of accessory muscles, prolonged expiratory phase, polyphonic wheeze, hyperinflated chest
o Severe attack -> PEFR 33-50%, pulse >110, RR > 25, inability to complete sentences
o Life-threatening à PEFR <33%, silent chest, cyanosis, bradycardia, hypotension, confusion, coma
What investigations would yo do for asthma in pregnancy?
o Peak flow, pulse oximetry, ABG, FBC (WCC infection?), CRP, U&Es, blood/sputum cultures
o PEFR monitoring (diary)
What should be avoided in pregnancy?
Bronchoconstrictors
Smoking
How does monitoring change with asthma?
Flu vaccine and monitor foetal movements daily after 28 weeks
What is the acute management of asthma in pregnancy?
§ High flow oxygen, neb salbutamol, ipratropium 0.5mg QDS
§ Steroid therapy (IV hydrocortisone, PO prednisolone 5-7 days)
§ IV magnesium sulphate and summon senior help (PCO2 up)
§ Discharge when:
· PEFR >75% of pts best
· Diurnal variation <25%
· Stable on discharge meds for 24h
What is the long term management for asthma in pregnancy?
SABA SABA + ICS SABA +ICS+LTRA LABA + ICS + LTRA LABA + inc dose ICS + LTRA Trials (tehophylline/ LMRA)
Oral CS
What are the complications of asthma in pregnancy?
o Prolonged hypoxia -> foetal growth restriction (FGR) and ultimately, foetal brain injury
o Oral corticosteroids use in first trimester increases cleft lip risk
o Preterm birth, perinatal mortality
o Prognosis → severity of asthma remains stable in 1/3, worsens in another 1/3 and improves in the 1/3
