Asthma in Pregnancy Flashcards
Asthma Symptoms =2 days/week
Intermittent Asthma (well controlled)
Asthma Symptoms > 2 days/week
Mild Persistent Asthma (not well controlled)
Asthma Symptoms Daily
Moderate Persistent (not well controlled)
Multiple symptoms though out the day
Severe Persistent Asthma (poorly controlled)
Describe Predicted Peak Flow for all ashtma categorites (intermittent, mild presistent, moderate persistent, and severe persistent)
Treatment for mild intermittent Asthma
Symptoms < 2 days per week
Nighttime awakening 2x per month of less
No interference with normal activity
NO DAILY MEDICATIONS - Albuterol Inhaler PRN
Treatment for mild persistent asthma
Symtpoms > 2 days/week (but not daily)
Nighttime awakening 2 x month
Minor limitations to activity
Prefered treatment - low dose inhaled corticosteroid
Treatment for moderate persistant asthma
DAILY symptoms
Nightime awakening > once per week
Some limitation in activity
Treatment = low dose inhaled corticosteroid + salmeterol *prefered*
OR
medium dose inhaled corticosteroid +/- salmeterol
Treatment for severe persistent asthma
Symptoms multiple times during day
Nighttime awakening 4x/week or more
Extreme interference w/ normal acitivty
Treatment = high dose coritcosteroid, salmeterol, +/- PO corticosteroid
What is the preferred inhaled corticosteroid in pergnancy?
Budesonide
What fetal/maternal morbidity/moratlity is assocaited with severe and poorly controlled asthma?
Increased prematurity
Need for C/S
Pre E
Growth Restriction
How do you diagnose asthma?
Demonstrating airway obstruction on spirometry that is aleast partially reversible (greather than 12% increase in FEV1 after bronchdilator)
What is the rescue therapy of choice for asthma during pregnancy?
Inhaled short acting B2 agonists = inhaled albuterol
Name two long acting inhaled B2 agonists that should be the preferred “add on” therapy during pregnancy
Salmeterol
Formoterol
*Has been shown to be more effective add-on therpay in non-pregnant patients than leukotriene receptor anatgonists or theophylline
Describe step-wise treatment if asthma is poorly controlled
Step 1: Albuterol inhaler PRN, no daily medications
Step 2: Daily low dose inhaled corticosteroid (budesinide)
Step 3: Add salmeterol (long acting B2 agonist)
*could considering going from low dose steroid to medium dose also*
Step 4: Daily high dose corticosteroid + salmeterol +/- PO Steroid