asthma in pregnancy

Question 1

define intermittent asthma

Answer 1

daytime sx less than 2x/week, nighttime awakening 2x/month, no interference with activity, FEV 1 or peak flow > 80%

Question 2

define mild persistent asthma

Answer 2

daytime sx > 2x/week but not daily, nighttime awakening > 2x/month, minor limitation in activity, FEV1 or peak flow >80%

Question 3

define moderate persistent asthma

Answer 3

daytime sx daily, night time awakening > 1 x/week, some limitation, FEV1 or Peak flow 60-80%

Question 4

define severe persistent asthma

Answer 4

daytime sx throughout day, nighttime sx > 4x/week, significant activity limitation, peak flow or FEV 1 < 60%

Question 5

what is treatment for intermittent asthma?

Answer 5

rescue inhaler (short acting beta 2 agonist - albuterol)

Question 6

what is treatment for mild persistent asthma?

Answer 6

low dose inhaled corticosteroid (preferred) or (alternative) leukotriene receptor modulator (montelukast - singulair) or cromolyn or theophylline (serum level 5-12mcg/ml)

Question 7

what is treatment for moderate persistent asthma?

Answer 7

(preferred):
-low dose inhaled corticosteroid + long acting beta agonist (salmeterol or formeterol)
- medium dose corticosteroid +/- LABA
(alternative)
- low dose or medium dose inhaled steroid + montelukast or cromolyn or theophylline (serum level 5-12 mcg/ml)

Question 8

what is diagnosis of severe persistent asthma?

Answer 8

(preferred) :
- high dose inhaled corticosteroid + salmeterol +/- PO steroid
(alternative) :
- high dose inhaled corticosteroid + montelukast +/- PO steroid

Question 9

what is the steroid of choice is pregnancy for asthma? what are low/medium/high dose ranges

Answer 9

budesinide

• low: TDD < 80-540
• medium: 540-1080
• high: > 1080

Question 10

how to dispo acute asthma episode?

Answer 10

clinical impression

• FEV > 70% after 1 hr of treatment (i.e. combivent) -> home
• FEV 50-70% after 1 hr tx -> shared decision/individualize
• FEV < 50% -> admit
• ICU if AMS, severe persistent sx, PaCO2 > 42 mm Hg

Question 11

example of acute asthma treatment with admission

Answer 11

• continuous O2 monitoring
• continuous EFM
• albuterol 10-15 mg/hr continuous or frequent dosing (5 mg q20 m x 3 doses
• then (if not better) ipratropium inhaler 500 mcg q20 m x 3 does
• then PO steroid or IV steroids

Question 12

regimen for patients after discharge from admission

Answer 12

• Albuterol q3-4 hr
• PO steroid 40-60 mg/day divided in 2-3 doses
• Inhaled corticosteroids
• f/u within 5 days

Question 13

considerations on L&D

Answer 13

• adequate hydration
• adequate analgesia
• stress dose steroids if recently on systemic steroids (hydrocortisone 100 mg q8hr then continue for 24 hrs after delivery)