Asthma In Pregnancy

Question 1

RR in pregnancy

What’s abnormal?

Answer 1

12-20 RR

Persistent rate >24 at rest is abnormal

Question 2

Asthma symptoms

Answer 2

Intermittent Wheeze
SOB
Chest Tightness
Cough

Worse at night

Question 3

Severity of asthma in pregnancy

Answer 3

1/3 unchanged
1/3 worsens
1/3 improves in quality

Question 4

Is severe or mild asthma more likely to deteriorate?

Answer 4

Severe 60% more likely than mild (10%)

Question 5

When are exacerbations more common ?

Answer 5

24-36 weeks of pregnancy

Question 6

What is the most frequent trigger of exacerbations?

Answer 6

Respiratory viral infections (34%)

Question 7

Second most common trigger of exacerbations

Answer 7

Poor adherence to inhaled corticosteroid therapy (29%)

Question 8

What is the first step in the management of Asthma in pregnancy ?

Answer 8

Mild intermittent asthma

Inhaled SABA PRN

Salbutamol / terbutaline

Question 9

What is the second step in the management of asthma in pregnancy?

What are the drugs?

Answer 9

Regular preventer therapy

Beclomethasone / Budesonide

Add inhaled steroid 200-800mcg/day

400mcg is an appropriate starting dose

Start at dose of inhaled steroid appropriate to disease

Question 10

What constitutes step 3, initial add on therapy?

Answer 10

1) add inhaled b2 agonist (LABA)
2) Assess control of asthma, if good response to LABA, continue LABA. If benefit from LABA, but control still inadequate, continue LABA and increase inhaled steroid dose to 800mcg/ day if not already on that dose

If no response to LABA, stop.

Increase steroids to 800mcg/day

In control inadequate - institute trial of other therapies , leukotriene receptor antagonist or SR theophylline

Salmeterol, formerol

Question 11

What is Step 4 of asthma control?

Persistent poor control

Answer 11

Consider

Trials of inhaled steroids up to 2000mcg/day

Addition of fourth drug eg. Leukotriene receptor antagonist, SR theophylline, B, agonist tablet

Seek respiratory physician and obstetrician

Question 12

What is step 5 in asthma control?

Answer 12

Continuous or frequent use of oral steroids

Use daily steroid tablet at lowest dose providing adequate control

Maintain high dose inhaled steroid at 2000mcg/day

Consider other treatments to minimise the use of steroid tablets

Refer patent for specialist care

Question 13

Which medications commonly used at delivery should be used with caution in asthmatic women?

Answer 13

Ergometrine
Syntometrine
Prostaglandin

Cause bronchoconstriction

Question 14

Should aspirin be used in Asthmatics?

Answer 14

No