PB#90: Asthma in Pregnancy Flashcards
Trademark characteristics of asthma
Chronic airway inflammation w/ increased airway responsiveness to variety of stimuli, and airway obstruction that is partially/completely reversible
Is it safer for pregnant pts to be treated w/ asthma meds, or for them to have asthma sxs/exacerbations w/o meds?
Safer to be treated w/ asthma meds in pregnancy
General maternal/perinatal outcomes in pregnant pts w/ mild/well-controlled moderate asthma
Excellent outcomes
Maternal/Fetal risks associated w/ severe/poorly-controlled asthma in pregnancy
Prematurity, C/S, pre-E, FGR, perinatal complications, maternal M&M
Ultimate goal of asthma therapy in pregnancy
Maintaining adequate oxygenation of fetus by preventing hypoxic episodes in pt
Measures to optimally manage asthma during pregnancy (4)
Objective monitoring of lung function, avoiding/controlling asthma triggers, educating pts, individualizing pharmacologic tx to maintain normal pulm function
Long-term control meds used for maintenance therapy to prevent asthma manifestations (4)
Inhaled corticosteroids, cromolyn, LABAs, theophylline
Meds used for rescue therapy to provide immediate relief of sxs
SABAs
Meds that can be used either as rescue therapy or as long-term control therapy for pts w/ severe persistent asthma
PO corticosteroids
L&D meds that can trigger bronchospasm (4)
Nonselective β-blockers, carboprost, ergonovine, indomethacin (in pts who are sensitive to ASA)
L&D med that is a bronchodilator
Mag sulfate
Cervical ripening/abortion/PPH meds that are safe to use w/ asthma (2)
Misoprostol, cervidil
Most commonly used pulm function parameters (2)
PEFR, FEV1
Sx frequency, nighttime awakenings, interference w/ normal activity, and FEV1 measurements for intermittent (well-controlled) asthma
2 or fewer days/week, 2 or fewer times/month, no interference, >80% of personal best
Sx frequency, nighttime awakenings, interference w/ normal activity, and FEV1 measurements for mild persistent (not well controlled) asthma
> 2 days/week but not daily, >2 times/month, minor limitation, >80% of personal best
Sx frequency, nighttime awakenings, interference w/ normal activity, and FEV1 measurements for moderate persistent (not well controlled) asthma
Daily, >1x/week, some limitation, 60-80% of personal best
Sx frequency, nighttime awakenings, interference w/ normal activity, and FEV1 measurements for severe persistent (very poorly controlled) asthma
Throughout the day, at least 4x/week, extreme limitations, <60% of personal best
Asthma exacerbation rates, hospitalization rates of pregnant pts w/ mild asthma
12.6%, 2.3%
Asthma exacerbations rates, hospitalization rates of pregnant pts w/ moderate asthma
25.7%, 6.8%
Asthma exacerbation rates, hospitalization rates of pregnant pts w/ severe asthma
51.9%, 26.9%
Percentage of pts having improved asthma sxs during pregnancy, percentage of pts having worsened asthma sxs during pregnancy
23%, 30%
Increased fetal risks associated w/ decreasing FEV1 during pregnancy (2)
LBW, prematurity
Characteristic sxs of asthma (4)
Wheezing, chest cough, SOB, chest tightness
Temporal relationships classically associated w/ asthma (2)
Fluctuating intensity, worse at night)