Asthma in Pregnancy

Question 1

Severe and poorly controlled asthma may be associated with:

Answer 1

1- increased prematurity, 
2- cesarean delivery, 
3- preeclampsia, 
4- growth restriction, 
5- other perinatal complications, and maternal morbidity and mortality

Question 2

The ultimate goal of asthma therapy in pregnancy is?

Answer 2

maintaining adequate oxygenation of the fetus by preventing hypoxic episodes in the mother

Question 3

What is the preferred inhaled corticosteroid for use during pregnancy?

Answer 3

Budesonide (200mcg per inhalation)

Question 4

4 Classifications of asthma?

Answer 4

Mild intermittent (FEV>80%)
Mild Persistent (FEV>80%)
Moderate Persistent (FEV 60-80%)
Severe Persistent (FEV<60%)

Question 5

Does Asthma get worse in pregnancy?

Answer 5

Rule of thirds

Question 6

The four components of effective asthma therapy during pregnancy are:

Answer 6

• Monitoring of maternal lung function and fetal well-being as a guide to therapy
• Control of environmental and other triggers for asthma (eg, smoking, allergen exposure)
• Patient education
• Pharmacologic therapy

Question 7

Intravenous magnesium sulfate in Asthma?

Answer 7

may be beneficial in acute severe asthma as an adjunct to inhaled beta agonists and intravenous glucocorticoids

Question 8

Inhaled long-acting beta agonist of choice?

Answer 8

Salmeterol (Serevent)

Question 9

Inhaled glucocorticoid of choice? 2nd Choice?

Answer 9

Budesonide, Fluticasone

Question 10

Why would you use Monte- or Zafirlukast?

Answer 10

Could be considered as alternative but NOT preferred therapy for mild persistent asthma or as add-on therapy to inhaled glucocorticoids, especially for patients who have shown a uniquely favorable response prior to pregnancy

Question 11

What’s in Advair?

Answer 11

Fluticasone/Salmeterol

Question 12

How should fetus be monitored in pooorly controlled asthma?

Answer 12

Serial US for activity and growth starting at 32 weeks

Question 13

Criteria for Mild Intermittent?

Answer 13

Symptom Frequency: < or equal to 2days/week
Nighttime awakening: < or equal to 2x/month
Interference with Normal Activity: None
FEV: >80%

Question 14

Criteria for Mild Persistent?

Answer 14

Symptom Freq: > or equal to 2days/week (but not daily)
Nighttime awakening: > 2x/month
Interference with Normal Activity: Minor
FEV: >80%

Question 15

Criteria for Moderate Persistent?

Answer 15

Symptom Freq: daily
Nighttime awakening: > 1x/week
Interference with Normal Activity: Some
FEV: 60-80%

Question 16

Criteria for Severe Persistent?

Answer 16

Symptom Freq: throughout the day
Nighttime awakening: > or equal to 4x/week
Interference with Normal Activity: Severely limited
FEV: <60%

Question 17

Symbicort contains?

Answer 17

Formoterol/Budesonide