Asthma is a chronic respiratory disease characterized by prolonged coughing and asthma attacks. Often the disease is hereditary, but can occur at any age, both in women and in men. A woman’s bronchial asthma and pregnancy are often at the same time, in which case increased medical control is required.
Bronchial asthma: effects on pregnancy
The uncontrolled course of bronchial asthma during pregnancy can have a negative effect on both the health of a woman and the fetus. Despite all the difficulties, asthma and pregnancy are completely compatible concepts. The main thing is adequate treatment and constant monitoring by doctors.
It is impossible to predict the course of the disease in the period of gestation in advance. It often happens that in pregnant women the condition improves or remains unchanged, but this applies to mild and moderate forms. And in severe asthma, seizures can become more frequent, and their severity increases. In this case, the woman should be under the supervision of doctors throughout her pregnancy.
Medical statistics suggest that the disease has a severe course only the first 12 weeks, and then the pregnant woman feels better. At the time of exacerbation of asthma, hospitalization is usually offered.
In some cases, pregnancy can cause a complicated course of the disease in a woman:
- increased seizures
- more severe course of the attack,
- accession of a viral or bacterial infection,
- preterm delivery
- risk of miscarriage,
- complicated toxicosis.
Bronchial asthma during pregnancy can also affect the fetus. An asthma attack causes oxygen starvation of the placenta, which leads to fetal hypoxia and serious violations in the development of the child:
- low fetal weight
- the development of the baby is delayed,
- pathologies of the cardiovascular system, neurological diseases may develop, muscle tissue development may be impaired,
- when the child passes through the birth canal, difficulties may arise and entail birth injuries,
- due to oxygen deficiency, there are cases of fetal asphyxiation (suffocation).
With a complicated pregnancy, the risk of having a baby with a heart defect and a predisposition to respiratory diseases increases, such children can significantly lag behind the norms in development.
All these problems arise if the treatment is not carried out correctly, and the condition of the woman is not controlled. If the pregnant woman is registered and she is prescribed adequate therapy, the birth will take place safely, and the baby will be born healthy. The risk for a child may be a tendency to allergic reactions and inheritance of bronchial asthma. For this reason, the newborn is shown breastfeeding, and the mother is shown a hypoallergenic diet.
Asthma Pregnancy Planning
The condition of the woman - asthma should be controlled not only during pregnancy, but also when planning it. Control over the disease should be established even before pregnancy and must be maintained throughout the first trimester.
During this time, it is necessary to choose an adequate and safe therapy, as well as eliminate irritating factors in order to minimize the number of seizures. A woman should quit smoking if this addiction has occurred and avoid inhaling tobacco smoke if family members smoke.
Before pregnancy, the expectant mother should be vaccinated against pneumococcus, influenza, hemophilic bacillus, hepatitis, measles, rubella, tetanus and diphtheria. All vaccinations are given three months before pregnancy under the supervision of a physician.
How pregnancy affects the course of the disease
With the onset of pregnancy, a woman changes not only the hormonal background, but also the work of the respiratory system. The composition of blood, progesterone and carbon dioxide is changing, breathing is becoming more frequent, ventilation of the lungs is increasing, a woman may experience shortness of breath.
At large stages of pregnancy, dyspnea is associated with a change in the position of the diaphragm, the growing uterus raises it. The pressure in the pulmonary artery also changes, it increases. This causes a decrease in lung volume and a deterioration in spirometry indications in asthmatics.
Pregnancy can cause swelling of the nasopharynx and respiratory tract, even in a healthy woman, and in a patient with bronchial asthma - an asthma attack. Every woman should remember that spontaneous withdrawal of certain drugs is as dangerous as self-medication. You can not stop taking steroids, unless there is a doctor’s order. Drug withdrawal can cause an attack, which will cause much more harm to the child than the effect of the drug.
If asthma manifested itself only during pregnancy, it is rarely possible to diagnose it in the first months, therefore, in most cases, treatment begins in the later stages, which is bad for pregnancy and labor.
How are births with asthma?
If pregnancy is controlled throughout, the woman is allowed to give birth independently. Usually she is hospitalized at least two weeks before the due date and prepared for childbirth. All indicators of the mother and child are under the strict supervision of doctors, and during childbirth, a woman must be prescribed medicine to prevent an asthmatic attack. These drugs are absolutely safe for the baby, but positively affect the state of the woman in childbirth.
If asthma during pregnancy has become more severe, and asthma attacks have become more frequent, then childbirth is carried out using a planned cesarean section at 38 weeks of pregnancy. By this time, the fetus is considered full-term, absolutely viable and formed for independent existence. Some women are biased against operative delivery and refuse to have a cesarean section, in this case complications during childbirth cannot be avoided, moreover, you can not only harm the baby, but also lose it.
Common complications during childbirth:
- premature discharge of amniotic fluid, before the onset of labor,
- rapid childbirth that adversely affects the baby,
- abnormal labor.
If childbirth began on its own, but in the process there was an attack of suffocation and cardiopulmonary insufficiency, in addition to intensive therapy, surgical intervention is indicated, the patient is urgently given a cesarean section.
With delivery, an asthmatic attack occurs extremely rarely, provided that the patient takes all the necessary drugs. As such, asthma is not considered an indication for caesarean section. If there are indications for surgery, anesthesia is better to use not an inhalation type, but a regional blockade.
In the event that the pregnant woman was treated with Prednisolone in a large dosage, Hydrocortisone is given during injections during childbirth.
Bronchial asthma during pregnancy: treatment
If a woman has already treated asthma and became pregnant, the course of treatment and drugs should be replaced. Some medications are simply contraindicated during pregnancy, while others require dosage adjustment.
Throughout the duration of pregnancy, doctors should monitor the fetus using ultrasound, with exacerbations, oxygen therapy is very important in order to avoid oxygen starvation of the fetus. The condition of the pregnant woman is also monitored, special attention is paid to the condition of the vessels of the uterus and placenta.
The goal of treating bronchial asthma during pregnancy is seizure prevention and safe therapy for both the fetus and mother. The main task of doctors is to achieve the following results:
- improve the function of external respiration,
- prevent an asthmatic attack,
- stop side effects from the effects of drugs,
- disease control and timely relief of attacks.
To improve the condition and reduce the risk of developing an asthma attack, as well as other complications, a woman should strictly follow the following recommendations:
- exclude from your diet all foods that can cause an allergic reaction,
- wear underwear and clothing made from natural fabrics,
- for personal hygiene, use hypoallergenic products (creams, shower gels, soap, shampoo),
- eliminate external allergens from everyday life, to avoid dusty places, polluted air, inhalation of various chemicals, often wet cleaning the house,
- To maintain optimal humidity in the home, use special humidifiers, ionizers and air purifiers,
- avoid contact with animals and their hair,
- more often to be in the fresh air, take walks before bedtime,
- if a pregnant woman is professionally associated with chemicals or harmful fumes, she should be immediately transferred to a safe place of work.
During pregnancy, asthma is treated with bronchodilators and expectorant drugs. In addition, breathing exercises, a rest regimen and the exclusion of physical and emotional stress are recommended.
The main drugs for asthma during pregnancy are inhalers that are used to stop (salbutamol) and prevent (beclamethasone) attacks. Other means can be prescribed as prophylaxis, the doctor focuses on the degree of the disease.
In the later stages, drug therapy should be aimed not only at adjusting the condition of the lungs, but also at optimizing intracellular processes that may be impaired due to the disease. Maintenance therapy includes a complex of drugs:
- complex vitamins
- Interferon to strengthen the immune system,
- Heparin to normalize blood coagulation.
To track positive dynamics, it is necessary to monitor the level of hormones that the placenta produces and the fetal cardiovascular system.
Drugs contraindicated during pregnancy
Self-medication is not recommended for any disease, and even more so for asthma. A pregnant woman should take medicine strictly as prescribed by a doctor and be aware that there are a number of drugs that are prescribed to patients with asthma, but are canceled during gestation:
List of contraindicated products:
- Adrenaline relieves an asthma attack, but is prohibited for use during pregnancy. Taking this remedy can lead to fetal hypoxia, it causes vascular cramps of the uterus.
- Terbutaline, Salbutamol, Fenoterol - prescribed for pregnant women, but under strict medical supervision. In the later stages they are usually not used, they can complicate and delay the delivery, medicines similar to these are used when there is a threat of miscarriage.
- Theophylline is not used in the last three months of pregnancy, it penetrates the bloodstream of the fetus through the placenta and causes an increase in the heart rate of the baby.
- Some glucocorticosteroids are contraindicated - Triamcinolone, Dexamethasone, Betamethasone, these drugs adversely affect the muscular system of the fetus.
- Pregnant women do not use antihistamines of the 2nd generation, side effects badly affect the mother and the baby.
Bronchial asthma during pregnancy is not dangerous with the right treatment and following all the recommendations.
Classification of bronchial asthma in pregnant women
In the management of pregnant women suffering from asthma, use the clinical systematization of the forms of the disease, taking into account the severity. The classification criteria for this approach are the frequency of occurrence of asthma attacks, their duration, and changes in external respiration. The following options for asthma during pregnancy:
- Occasional (intermittent). Attacks of suffocation are observed no more than once a week, at night the patient is disturbed no more than 2 times a month. Periods of exacerbation last from several hours to several days. Outside of exacerbations, the functions of external respiration are not impaired.
- Light persistent. Typical symptoms occur several times during the week, but no more than once a day. With exacerbations, sleep disturbance and habitual activity are possible. The peak expiratory flow rate and its second volume during forced breathing during the day change by 20-30%.
- Persistent moderate. Daily attacks are noted. Choking at night develops more often than once a week. Changed physical activity and sleep. A 20-40% decrease in the peak expiratory flow rate and its second volume during forcing with daily variability of more than 30% is characteristic.
- Heavy persistent. Pregnant bothers with daily attacks with frequent exacerbations and the appearance at night. There are limitations to physical activity. The basic indicators for assessing the functions of external respiration are reduced by more than 40%, and their daily fluctuations exceed 30%.
Causes of bronchial asthma during pregnancy
In the body of a pregnant woman, a number of hormonal changes occur. This leads to the fact that bronchial asthma can manifest itself differently for each mom. In about a third of women asthmatics, the severity and seizure frequency remains the same as before pregnancy. And for some, the disease generally ceases to bother and proceeds in a mild form. Doctors say this happens thanks to the improved functioning of the hormone cortisol.
Severe form of asthma can often cause fear of the mother herself. Afraid that the prescribed medications will negatively affect the child, she refuses to take them. And this paves the way for crumbs in hypoxia. Most often, pregnant women complain of increased seizures at 28-40 weeks. It is during this period that the fetus grows and restricts the movement of the mother's lungs. It becomes easier only when the baby falls shortly before delivery into the small pelvis. That is why doctors insist that pregnant women asthmatics constantly keep an inhaler near them. Severe attacks can cause premature contractions.
Pregnancy Planning for Asthma
The condition of the woman - asthma should be controlled not only during pregnancy, but also when planning it. Control over bronchial asthma should be established before pregnancy and must be maintained during the first trimester.
During this time, it is necessary to choose adequate and safe therapy, as well as eliminate irritating factors in order to minimize the number of seizures. A woman should quit smoking if this addiction has occurred and avoid inhaling tobacco smoke if family members smoke.
Before pregnancy, the expectant mother should be vaccinated against pneumococcus, influenza, hemophilic bacillus, hepatitis, measles, rubella, tetanus and diphtheria. All vaccinations are given three months before pregnancy under the supervision of a physician.
Pregnancy Risk Factors
One of the main risk factors affecting the development of the disease is the poor environment in the region of residence, as well as difficult working conditions. Statistics show that residents of megacities and industrial centers suffer from bronchial asthma many times more often than residents of villages or villages. For pregnant women, this risk is also very high.
In general, a variety of factors can provoke this ailment, so it is not always possible to determine the cause in any particular case.This includes household chemicals, allergens found in everyday life, malnutrition, etc.
For a newborn, the risk is poor heredity. In other words, if either of the two parents had this ailment, then the probability of his appearance in the child is extremely high. According to statistics, a hereditary factor occurs in one third of all patients. Moreover, if only one parent is sick with bronchial asthma, then the probability of this disease in a child is 30 percent. But, if both parents are sick, then this probability increases significantly - up to 75 percent. There is even a special definition for this type of asthma - atopic bronchial asthma.
The course of bronchial asthma in pregnant women in trimesters
If bronchial asthma existed even before pregnancy, then during gestation its course can be unpredictable, although doctors reveal certain patterns.
In about 20% of pregnant women, the condition remains the same, as it was before pregnancy, about 10% of mothers noted relief of attacks and significant improvement, and in the remaining 70%, bronchial asthma was much more severe than before.
In the latter case, both moderate severity and severe seizures that occur daily, or even several times a day, predominate. Periodically, seizures can be delayed, the effect of treatment is rather weak. Often, the first signs of deterioration are noted already from the first weeks of the first trimester, but by the second half of gestation it becomes easier. If during the previous pregnancy there was a dynamics in a positive or negative direction, subsequent gestations usually repeat the scenario.
Asthmatic attacks during childbirth are a rarity, especially if women use bronchodilators or hormones during this period as a preventive measure. After giving birth, about a quarter of women and mild bronchial asthma experience an improvement. Another 50% do not note changes in the condition, and in the remaining 25%, the condition becomes worse, and they are forced to take hormonal drugs, the doses of which are constantly increasing.
Features of the course of pregnancy
Women with bronchial asthma it is not contraindicated to have children. For a favorable pregnancy, the doctor must constantly monitor the patient so that a healthy and full-fledged baby is born. An important component is the right choice of drugs to prevent attacks.
If a woman uses inhalation during pregnancy, there is a risk of developing respiratory failure due to a decrease in oxygen in the blood and an increase in the level of carbon dioxide.
The danger of this condition is that the developing fetus will experience oxygen starvation.
Also during pregnancy there is a high probability of the following complications:
- the appearance of early toxicosis,
- premature birth
- forced abortion,
- capillary congestion due to changes in the vessels of the respiratory system,
- pathological indications of changes in the pulmonary system after x-ray examination:
- the presence of cough and wheezing,
- arrhythmia and tachypnea,
- an increase in hemoglobin in the blood,
- preeclampsia (late toxicosis),
- fetoplacental insufficiency.
Complications of the course of pregnancy in women are observed in the early stages .
These complications arise if the patient was wrong treatment regimen or there was a need to take drugs that had a negative effect on the development of the fetus.
There is also a high probability that children will have a congenital allergy, low body weight, defects in mental or physical development, asphyxia or functional disorders in the functioning of the nervous system.
As the fetus develops, improvements in well-being are observed in 70% of women. This is due to the fact that by the beginning of the third trimester in the body of a pregnant woman progesterone begins to be produced intensively, which contributes to the expansion of the bronchi.
Also, as the fetus develops, the placenta itself produces glucocorticoids, which reduce inflammation in the body.
The problem of therapy for bronchial asthma during gestation
For a long time, experts believed that the basis of bronchial asthma is a spasm of smooth muscle elements in the bronchi, which leads to asthma attacks. Therefore, the basis of treatment was drugs with a bronchodilating effect. Only in the 90s of the last century it was determined that the basis of bronchial asthma is chronic inflammation of an immune nature, and the bronchi remain inflamed in any course and severity of the pathology, even when there are no exacerbations. The discovery of this fact led to a change in the fundamental approaches to the treatment of asthma and its prevention. Today, asthmatics use anti-inflammatory drugs in inhalers as their basic medicines.
If we talk about pregnancy and its combination with bronchial asthma, then the problems are associated with the fact that during gestation it can be poorly controlled by medications. Against the background of seizures, the greatest risk to the fetus is the presence of hypoxia - an oxygen deficiency in maternal blood. Due to bronchial asthma, a similar problem becomes several times more acute. When an asthma attack is formed, it is felt not only by the mother herself, but also by the fetus, which is completely dependent on her and suffers sharply from a lack of oxygen. It is frequent attacks of hypoxia that lead to violations in the development of the fetus, and in critical periods of development can even lead to violations in the laying of tissues and organs.
For the birth of a relatively healthy baby, a full and adequate treatment is necessary, which fully corresponds to the severity of bronchial asthma. This will prevent frequent attacks and increased hypoxia.
During pregnancy, treatment should be mandatory, and the prognosis for those women in whom bronchial asthma is completely under control regarding the health of children is very favorable.
Prevention of Complications
The basis of all preventive measures is the complete restriction of the contact of a pregnant woman with allergens that cause her an asthma attack.
A pregnant woman who has been diagnosed with bronchial asthma should also follow these recommendations:
- adjust the diet and completely exclude from the diet all foods that can trigger allergies,
- clothes and bedding should be made of natural fibers,
- refuse detergents and creams,
- take a shower daily
- exclude contact with dust and animals,
- spend the maximum amount of time in the fresh air,
- Wet daily
- exclude any work with harmful substances,
- exclude smoking and drinking alcohol,
- Avoid crowded places
- monitor the temperature and humidity in the living room. Humidity should not be higher than 60%, air temperature - 20-23 degrees.
During pregnancy, all medications prescribed by the doctor must be used.
Drugs that contraindicated:
- Adrenalin. It can cause vasospasm and cause miscarriage or hypoxia.
- Theophylline. The drug is able to penetrate the placenta, causing arrhythmia in the fetus.
- Triamcinolone. It has a negative effect on the formation of muscle mass in the fetus.
During gestation, adrenaline, which is often used to get rid of attacks of bronchial asthma, is strictly prohibited. The fact is that it provokes a spasm of the vessels of the uterus, which can lead to hypoxia. Therefore, the doctor makes the selection of more gentle drugs from this group, such as salbutamol or phenoterol, but their use is possible only according to the indications of a specialist.
The use of theophylline preparations during pregnancy can lead to the development of a rapid heartbeat in the unborn baby, because they are able to be absorbed through the placenta, remaining in the baby’s blood. Theofedrine and antastaman are also prohibited, because they contain belladonna extract and barbiturates. Instead, it is recommended to use ipratropinum bromide.
In this group are drugs that are contraindicated in pregnant women:
- Triamcinolone, which negatively affects the muscle tissue of the baby.
- Betamethasone with dexamethasone.
- Delomedrol, Diprospan and Kenalog-40.
Treatment of bronchial asthma in pregnant women should be carried out according to a special scheme. It includes constant monitoring of the condition of the mother’s lungs, as well as the choice of the method of childbirth. The fact is that in most cases it makes a decision to have a cesarean section, because unnecessary stress can provoke an attack. But such decisions are made individually, based on the specific condition of the patient.
As for how exactly the treatment of bronchial asthma occurs, there are several points that can be highlighted:
- Getting rid of allergens. The bottom line is quite simple: you need to remove from the room where the woman is, all kinds of household allergens. Fortunately, there are various hypoallergenic underwear, air purifying filters, etc.
- Taking special medicines. The doctor collects a thorough medical history, finding out about the presence of other diseases, the presence of allergies to certain drugs, i.e. conducts a full analysis to prescribe competent treatment. In particular, an intolerance to acetylsalicylic acid is a very important point, because if it is, then non-steroidal analgesics can not be used.
The main point in the treatment is primarily the lack of risk for the unborn child, on the basis of which all drugs are selected.
Birth and postpartum
Under the hour of childbirth, special therapy is used to improve blood circulation in the mother and her baby. Thus, drugs are introduced that improve the functioning of the circulatory systems, which is very important for the health of the future baby.
To prevent possible suffocation, glucocorticosteroids are prescribed by inhalation. The administration of prednisone during labor is also indicated.
It is very important that the pregnant woman strictly follows the recommendations of the doctor, without stopping therapy until the birth itself. For example, if a woman has been taking glucocorticosteroids on an ongoing basis, then she should continue to take them after the birth of the baby during the first day. Reception should be every eight hours.
If caesarean section is used, epidural anesthesia is preferred. If general anesthesia is appropriate, then the doctor should carefully select the drugs for administration, because carelessness in this matter can lead to asthma attacks in the child.
Many after childbirth suffer from various bronchitis and bronchospasm, which is a completely natural reaction of the body to labor. To avoid this, it is necessary to take ergometrine or any other similar drugs. Also, special care should be taken when taking antipyretic drugs, which include aspirin.
It is no secret that many drugs pass into the mother’s breast milk. This also applies to funds for bronchial asthma, but they get into milk in an insignificant amount, so this can not be a contraindication for breastfeeding. In any case, the doctor himself prescribes drugs for the patient, bearing in mind the fact that she has to breastfeed her baby, so he does not prescribe those medicines that could harm the baby.
How is the birth in patients with asthma? Labor activity in bronchial asthma can proceed quite normal, without visible complications. But there are times when childbirth is not so simple:
- Water can drain before labor occurs.
- Childbirth can pass too quickly.
- An abnormal labor can be observed.
If the doctor decides on spontaneous delivery, then he must make a puncture of the epidural space. Then, bupivacaine is introduced there, which helps to expand the bronchi. In a similar way, labor is anesthetized in bronchial asthma by administering drugs through a catheter.
If, during childbirth, the patient has an attack of bronchial asthma, then the doctor may decide to have a cesarean section to reduce the risks for the mother and the baby.
Prognosis and prevention during pregnancy
Adequate therapy for bronchial asthma during pregnancy can completely eliminate the danger to the fetus and minimize threats to the mother. Perinatal prognoses for controlled treatment do not differ from forecasts for children born by healthy women. For prophylactic purposes, patients at risk who are prone to allergic reactions or suffering from atopic diseases are recommended to quit smoking, restrict contact with household, industrial, food, vegetable, animal exoallergens. Pregnant women with asthma to reduce the frequency of exacerbations are shown exercise therapy, therapeutic massage, special complexes of breathing exercises, speleo and halotherapy.
Compliance with the recommended preventive measures, the strict implementation of all medical recommendations and timely treatment allow a woman to safely endure and give birth to a baby. It should be noted that bronchial asthma and pregnancy may well coexist together and the presence of this disease in the history of a woman is not an obstacle to motherhood.
Candidate of Medical Sciences. Head of the Department of Pulmonology.
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Asthma in pregnant women: how dangerous is it
Pregnancy is possible with exogenous, endogenous and mixed bronchial asthma. The disease is not a contraindication. However, when a woman uses inhalation to relieve asphyxiation, the amount of oxygen in the blood decreases and the amount of carbon dioxide increases. The vessels of the placenta become narrower, respiratory failure is formed. As a result, oxygen is not enough for the fetus. For this reason, complications such as:
- premature toxicosis,
- the threat of medical abortion,
- fetoplacental insufficiency,
- early delivery.
Exacerbations are usually encountered by patients with a severe degree of AD. Children who are born in such conditions are often allergic. Also, there is a high risk of having a baby with insufficient weight, central nervous system problems, mental and physical retardation. In the future, such babies systematically suffer from colds, pneumonia, bronchitis.
Attention! The patient may experience swelling of the bronchi, trachea, and nasal mucosa. This leads to asphyxiation.
The effect of the disease and drugs on the fetus
With the bearing of the fetus, serious changes occur in the female body. They relate to the respiratory system. Initially, the amount of progesterone and the amount of carbon dioxide in the blood increase. This leads to increased breathing.
Later shortness of breath takes on a mechanical nature. The diaphragm rises, and pressure increases in the pulmonary artery system. All this has a direct effect on the forced expiratory flow rate per second. Due to the deterioration of respiratory functions, difficulties arise with the control of AD.
Any type of bronchial asthma in pregnant women causes severe toxicosis. Such patients have a high risk of interruption and the onset of pathologies in labor. Against the backdrop of complex attacks, the percentage of miscarriages and cesarean section increases.
Attention! If the disease arose during pregnancy, it is usually diagnosed in the third trimester. At first, shortness of breath simply appears.
It is impossible to refuse adequate treatment. It is important not to allow severe attacks, because it is they that pose a serious danger to the fetus. Refusal of medicines threatens with the acquisition of asthmatic status. As a result, both the mother and the child may die.
If inhaled glucocorticoids were used before pregnancy, then you can not refuse them, otherwise the fetus may be harmed. In the second trimester, a woman's well-being usually improves. The reason lies in the change in progesterone levels.
Future mothers are recommended inhalers without freon. On the packaging of such a medicine indicate such a designation as "H" or "IVF".
Basic treatment is indispensable. It allows you to suppress inflammation in the bronchi. Without such therapy, the struggle solely with the symptoms of the pathology will lead to its development. The treatment plan is a doctor. The current state of the patient and the severity of asthma are taken into account.
The prescribed drugs should be taken daily, strictly in the prescribed dose. Basic therapy reduces the need for additional medications. This has a positive effect on the development of the fetus.
Basic treatment is carried out for three trimesters after the birth of the baby. When the disease passes in a mild form, “Intal” or “Tiled” is prescribed. Beclomethasone or Budesonide may be prescribed.
To monitor the condition at home, you must use a portable device - a peak flow meter. It helps to know the characteristics of breathing. This information is important for the attending physician. Measurements should be made in the morning and evening. The information received must certainly be recorded on paper, and then shown to the doctor. Such data help analyze the dynamics of well-being.
What drugs should not be taken by pregnant women for treatment?
There are many medications for asthma during pregnancy. In no case should you choose them yourself. They are taken only as prescribed by the doctor, strictly observing the dosage. There are medicines that absolutely can not be taken during gestation and when diagnosing AD, otherwise irreparable harm will be done to the health of the future mother and baby.
So, during pregnancy, you need to abandon the following drugs:
- Fenoterol, Salbutamol, Terbutaline. They can lead to a miscarriage. Such drugs are prescribed only in rare cases and only under the supervision of a medical specialist. They are strictly contraindicated in the later stages.
- Adrenalin. It helps to stop an attack of asphyxia, but fetal hypoxia can occur due to it. The drug provokes spasms of the uterus.
- Theophylline. Through the placenta, it enters the bloodstream of the fetus and leads to an increase in its heart rate.
- Antihistamines. Negatively affect the female body and the baby.
- Individual glucocorticosteroids. They have a negative effect on the muscles of the fetus.
If the treatment is selected correctly, then health will not be harmed. It is important to follow all the recommendations of doctors.
Attention! In the period after childbirth, it is already possible, if necessary, to take the above medicines. But be sure to consult a doctor and follow his recommendations.
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Pregnancy and bronchial asthma
This disease is considered the most common among pathologies of the respiratory system. In most cases, asthma during pregnancy begins to progress, and symptoms are more pronounced (short-term attacks of suffocation, cough without sputum, shortness of breath, etc.).
An exacerbation is observed in the second trimester of pregnancy, when a change in the hormonal background occurs in the body. In the last month, a woman feels much better, this is due to an increase in the amount of cortisol (a hormone produced by the adrenal glands).
Many women are wondering if a woman with such a diagnosis can become pregnant. Experts do not consider asthma a contraindication to bearing a child. In a pregnant woman with bronchial asthma, the control of the state of health should be more stringent than in women without pathologies.
To reduce the risk of complications during pregnancy planning, you must pass all the necessary tests, undergo comprehensive treatment. During the period of carrying the baby, maintenance medication is prescribed.
What is the danger of asthma during pregnancy?
A woman suffering from pregnancy with bronchial asthma is more likely to experience toxicosis. The lack of treatment entails the development of serious consequences for both the mother and her unborn child. A complicated pregnancy is accompanied by such pathologies:
- respiratory failure
- arterial hypoxemia,
- early toxicosis
- premature birth.
Pregnant women with severe asthma have a higher risk of dying from gestosis. In addition to a direct threat to the life of a pregnant woman, bronchial asthma has a negative effect on the fetus.
Frequent exacerbations of the disease lead to the following consequences:
- low birth weight,
- intrauterine developmental disorders,
- birth injuries that occur when the baby is difficult to pass through the birth canal,
- acute lack of oxygen (fetal hypoxia),
- intrauterine death due to lack of oxygen.
In severe forms of asthma in the mother, children are born with pathologies of the cardiovascular system and respiratory system. They fall into the group of potential allergy sufferers, over time, many of them are diagnosed with bronchial asthma.
That is why the expectant mother must be especially careful about her health when planning pregnancy, as well as throughout the entire period of gestation. Failure to comply with medical recommendations and improper treatment increases the risk of complications.
It is worth noting that pregnancy itself also affects the development of the disease. With hormonal changes, the level of progesterone rises, due to changes in the respiratory system, the carbon dioxide content in the blood increases, breathing quickens, shortness of breath is more often observed.
As the baby grows, the uterus rises in the diaphragm, thereby exerting pressure on the respiratory system. Very often during pregnancy, a woman has swelling of the mucous membrane in the nasopharynx, which leads to exacerbations of asthma attacks.
If the disease manifested itself in the initial stages of pregnancy, then diagnosing it is quite difficult. According to statistics, the progression of asthma when carrying a baby is more common in severe cases. But this does not mean that in other cases a woman can refuse drug therapy.
Statistics indicate that with frequent exacerbations of asthma attacks in the first months of pregnancy, children born into the world suffer from heart defects, pathologies of the gastrointestinal tract, spine and nervous system. They have a low resistance to the body, so more often than other children suffer from influenza, acute respiratory viral infections, bronchitis and other diseases of the respiratory system.
Treating Asthma During Pregnancy
Treatment of chronic bronchial asthma in pregnant women is carried out under the strict supervision of a physician. First of all, it is necessary to carefully monitor the condition of the woman and the development of the fetus.
With previously diagnosed bronchial asthma, it is recommended to replace the drugs that were taken. The basis of therapy is the prevention of exacerbations of symptoms and the normalization of respiratory function in the fetus and the expectant mother.
Doctors carry out mandatory control of the function of external respiration using peak flowmetry. For early diagnosis of placental insufficiency, a woman is prescribed fetometry and Doppler blood flow in the placenta.
Drug therapy is selected taking into account the severity of the pathology. It should be borne in mind that many drugs are prohibited for pregnant women. A group of drugs and dosage are selected by a specialist. Most commonly used:
- bronchodilators and expectorants,
- asthma inhalers with drugs that stop the attack and prevent unpleasant symptoms,
- bronchodilators, help relieve coughing attacks,
- antihistamines help reduce allergy symptoms,
- systemic glucocorticosteroids (in severe forms of the disease),
- leukotriene antagonists.
The most effective methods
The most effective is inhalation therapy. To do this, apply:
- portable handheld devices into which, with the help of a special dispenser, the necessary volume of medicine is introduced,
- spacers, which are a special nozzle for an inhaler,
- nebulizers (with their help, the drug is sprayed, thus maximizing the therapeutic effect).
Successful treatment of asthma in pregnant women is facilitated by the following recommendations:
- Exclusion from the diet of potential allergens.
- The use of clothing made from natural materials.
- The use of hygienic products with a neutral pH and hypoallergenic composition.
- Elimination of potential allergens from the environment (animal hair, dust, smell of perfume, etc.).
- Conducting daily wet cleaning in the living room.
- Frequent outdoor activities.
- Exclusion of physical and emotional stress.
An important stage of therapeutic therapy is breathing exercises, it helps to establish proper breathing and provide the body of a woman and the fetus with sufficient oxygen. Here are some effective exercises:
- bend the legs at the knees and pull their chin, while exhaling through the mouth. Perform 10-15 sets,
- close one nostril with your index finger, take a breath through the second. Then close it and exhale through the second. The number of approaches is 10-15.
They can be performed independently at home, before starting classes, you must always consult a doctor.
Childbirth in asthma
Most often, delivery in patients with asthma occurs naturally, but sometimes a cesarean section is prescribed. Exacerbation of symptoms during labor is a rare occurrence. As a rule, a woman with such a diagnosis is placed in a hospital in advance and her condition is monitored before the onset of labor.
During childbirth, she is necessarily given anti-asthma drugs that help relieve a possible asthma attack. These drugs are absolutely safe for the mother and the fetus and do not adversely affect the birth process.
With frequent exacerbations and the transition of the disease to a severe form, the patient is prescribed a planned cesarean section, starting from the 38th week of pregnancy. Failure increases the risk of complications during natural childbirth, increases the risk of death of the child.
Among the main complications that arise in women in childbirth with bronchial asthma are:
- Earlier discharge of amniotic fluid.
- Rapid birth.
- Complications of childbirth.
In rare cases, an asthma attack is possible during labor, the patient develops heart and pulmonary insufficiency. Doctors decide on an emergency caesarean section.
It is strictly forbidden to use drugs from the group of prostaglandins after the onset of labor, they provoke the development of bronchospasm. To stimulate the contraction of the muscular muscles of the uterus, oxytocin is allowed. With severe attacks, the use of epidural anesthesia is allowed.
Postpartum and Asthma
Very often, asthma after childbirth can be accompanied by frequent bronchitis and bronchospasm. This is a natural process, which is the body's response to the load. To avoid this, a woman is prescribed special medications; it is not recommended to use medicines containing aspirin.
The postpartum period for asthma includes the mandatory intake of medications that are selected by a specialist. It is worth noting that most of them tend to penetrate into breast milk in small amounts, but this is not a direct contraindication for use during breastfeeding.
As a rule, after delivery, the number of seizures decreases, the hormonal background comes into shape, the woman feels much better. Be sure to exclude any contact with potential allergens that can trigger an exacerbation. When all medical recommendations are followed and the necessary medications are taken, there is no risk of developing postpartum complications.
In cases of severe course of the disease after childbirth, a woman is prescribed glucocorticosteroids. Then the question may arise about the abolition of breastfeeding, since these medicines, penetrating into milk, can harm the health of the child.
According to statistics, severe exacerbation of asthma is observed in women 6-9 months after birth. At this time, the level of hormones in the body returns to normal, the cycle of menstruation can resume, the disease worsens.
How is a diagnosis made?
Usually, a doctor can diagnose bronchial asthma with a thorough questioning of a woman, auscultation (listening to respiratory sounds through the chest wall) and several additional studies, the decision on which is made in connection with the data collected during the survey. For example, if a patient claims that she is allergic and against the background of contact with allergens she has seizures, a test will be performed that will assess the status of the body in contact with various substances that can cause allergies. Sputum is also examined for the presence of Kurshman spirals (viscous, long scraps of sputum) and Charcot-Leiden crystals (fragments of destroyed blood cells of eosinophils that enter the sputum due to the inflammatory and allergic process in the bronchi). Another laboratory study is a general and immunological blood test for an increase in the blood of the same eosinophils and immunoglobulin E, which takes part in allergic reactions.
In addition to assessing the allergic status and laboratory tests of sputum and blood, a study of respiratory function with the help of spirometry and peak flowmetry is mandatory. These methods allow you to evaluate the main respiratory volumes and capacities of the patient and compare the latter with normal indicators characteristic of a person of a given age, height, gender, race and physique. At the same time, the subject breathes into a special apparatus, which registers all the data and demonstrates the results in the form of numerical data and graphing, even the shape of which can already tell a lot to the specialist.
One of the additional instrumental studies may be electrocardiography. It can indicate the formation of heart failure on the background of respiratory failure, which is gradually formed in each patient with bronchial asthma.
The most important stage during the diagnosis is to determine whether the treatment is effective in this patient. This is important for determining the so-called stage of the disease and adjusting therapeutic measures in connection with the new physiological state of the woman and its features. The treatment must be effective.
How bronchial asthma complicates pregnancy
Complications that can occur due to bronchial asthma during pregnancy are associated primarily with the severity of the disease in the mother and how often its exacerbations occur, as well as how effective and volumetric treatment was chosen before pregnancy.
The main reasons for the complicated course of pregnancy in this case include the following:
- Immune system disorders
- Disorders of homeostasis (equilibrium of the internal environment of the body), having a hemostatic nature (associated with adverse changes in blood coagulation),
- Changes in the function of the external respiration of the mother, which leads to hypoxia (lack of oxygen in the blood) of both the fetus and herself,
- Disorders of metabolism (metabolism).
Of all of the above, maternal and fetal hypoxia has a direct connection with the disease, since asthmatics have almost always impaired respiratory function, the only question is the extent of these disorders. In this case, the chosen treatment is of the greatest importance for the prevention of complications.
Failures associated with the functioning of the immune system contribute to a decrease in the patient’s resistance (resistance) to viral, bacterial and fungal infections. In this regard, intrauterine infection often occurs. In addition, damage to the vessels of the placenta can occur ("a child's place", the placenta maintains the viability of the fetus) by immune complexes, and therefore, fetal development is often delayed.
Hemostatic disorders can be expressed in a chronic thrombohemorrhagic syndrome (coagulation system disorder, when coagulation is alternately sharply increased, and multiple blood clots occur in microvessels, then significantly reduced, which leads to hemorrhages in them) of the placenta vessels, which will also slow down the development of the fetus.
It should be noted that the clinical manifestations of bronchial asthma itself do not differ from those outside pregnancy. They are expressed in wheezing, shortness of breath, dry cough and asthma attacks, usually occurring with difficulty exhaling.
As a rule, the disease is not a contraindication to pregnancy, but you need to remember that an uncontrolled, severe course of the disease with frequent, difficult to stop (stopping) seizures can lead to complications in the mother and fetus, up to premature birth, the threat of termination of pregnancy, hypoxia and fetal asphyxiation during childbirth. Often in such cases it is necessary to carry out an operative delivery.
How to choose the right treatment
In addition to the fact that the patient will receive medical treatment, a woman needs to give up smoking and permanent (permanent) exposure to harmful volatile substances on her body. Of course, smoking cessation must be final, because the latter adversely affects not only the course of bronchial asthma, but also the fetus during pregnancy.
It is advisable to treat bronchial asthma in a pregnant woman without losing sight of the trimester (three months span, part of the pregnancy, three of them stand out: the first, second and third).
In the first trimester, treatment usually does not have characteristic features. Therapy is carried out in accordance with the stage of the disease. The main drugs are various inhalants used during an attack (salbutamol) and daily to prevent attacks (beclamethasone). To prevent attacks, different medications can be used in tablet form, it depends on the severity of the disease.
In the next two trimesters, treatment should consist not only in the correction of pulmonary complications, but also in maintaining and optimizing the state of the energy processes inside the cells, since during pregnancy, accompanied by bronchial asthma, these processes can suffer. To maintain the latter at the proper level, the following treatment is applied:
- Vitamin E (tocopherol),
- Phospholipids and multivitamins (to prevent damage to cells by active oxygen radicals - its special variants that can cause serious tissue damage),
- Interferon - alpha 2 (immunotherapy for the prevention of complications in the form of various infections),
- Heparin sodium (a drug that normalizes the function of the blood coagulation system and binds immune complexes that can damage the blood vessels of the placenta).
Whether the selected treatment is effective can be determined using ultrasound diagnostics of the fetus and its hemodynamics (the adequacy of the vascular system), as well as the level of hormones produced (produced) by the placenta.
How is the birth in patients with asthma
Often, childbirth in patients with mild bronchial asthma occurs naturally and without complications. The worsening of the disease does not occur. However, childbirth can be complicated. The most common complications include:
- amniotic fluid before birth
- giving birth too fast
- childbirth complicated by abnormal (irregular, non-physiological) labor.
It should be remembered that childbirth with frequent exacerbations of the disease in the last trimester can be quite difficult.
If it is decided that the birth should take place spontaneously, then before the delivery, the epidural space is punctured (a puncture of the spinal canal to enter the space near the hard shell of the spinal cord), after which the drug bupivacaine is injected there, which causes additional expansion of the bronchi. In addition, during childbirth continue the usual, previously selected treatment of bronchial asthma.
If after the childbirth has begun, the patient has signs of cardiopulmonary failure or asthmatic status (prolonged, non-discontinuing during therapy, an attack of bronchial asthma), then this is an indication for surgical delivery.
Bronchial asthma (BA) - the most common pathology of the respiratory system during pregnancy, occurs in 2-9% of patients. According to the observations of obstetrician-gynecologists and pulmonologists, disease progression is noted in 33-69% of pregnant women. At the same time, in some women the condition remains stable and even improves. Light forms of AD are diagnosed in 62% of women, moderate in 30%, severe in 8%. Although an exacerbation of the disease is possible at any stage of pregnancy, it most often occurs in the second trimester, and during the last 4 weeks spontaneous improvement usually occurs due to an increase in the content of free cortisol. The relevance of timely diagnosis of asthma is associated with an almost complete absence of complications with proper medical control.
A key link in the development of asthma during pregnancy is an increase in the responsiveness of the bronchial tree caused by specific changes in the autonomic nervous system, inhibition of cyclic nucleotides (cAMP), mast cell degranulation, the effects of histamine, leukotrienes, cytokines, chemokines, and other inflammatory mediators. The action of trigger allergens triggers reversible obstruction of the bronchi with increased airway resistance, overstretching of the alveolar tissue, and a mismatch between lung ventilation and perfusion. The final stage of respiratory failure is hypoxemia, hypoxia, metabolic disorders.
Symptoms of asthma during pregnancy
The clinical picture of the disease is represented by asthma attacks with a short breath and a long difficult exhalation. Some pregnant women are preceded by a classic symptom of an aura - nasal congestion, sneezing, coughing, the appearance on the skin of a very itchy urticaria rash. To facilitate breathing, a woman takes the characteristic posture of orthopnea: sits down or becomes, leaning forward and raising her shoulders. During the attack, intermittent speech is noted, an unproductive cough occurs with a small amount of vitreous sputum passing away, wheezing rattles are heard remotely, palpitations increase, cyanosis of the skin and visible mucous membranes is observed.
In breathing, auxiliary muscles are usually involved - the shoulder girdle, the abdominal press. Intercostal spaces expand and retract, and the chest becomes cylindrical. On inhalation, the wings of the nose swell. Choking is provoked by the action of a certain air allergen, nonspecific irritant (tobacco smoke, gases, sharp perfumes), physical exertion. Periodically, symptoms develop at night, disturbing sleep. With a prolonged course, pain in the lower chest is possible due to overstrain of the diaphragm. The attack ends spontaneously or after using bronchodilators. In the interictal period, clinical manifestations are usually absent.
In the absence of proper medical control, a pregnant woman with signs of bronchial asthma develops respiratory failure, arterial hypoxemia, and peripheral microcirculation is impaired. As a result, 37% of patients have early toxicosis, 43% have gestosis, 26% have a threat of abortion, and 14.2% have a premature birth. The occurrence of hypoxia at the time when the laying of the main organs and systems of the child occurs, leads to the formation of congenital malformations. According to the results of research, heart defects, gastrointestinal tract, spine, nervous system development disorders are observed in almost 13% of children born by women with exacerbations and asthma attacks in the 1st trimester.
The circulating immune complexes damage the endothelium of the uteroplacental vessels, which leads to fetoplacental insufficiency in 29% of cases of pregnancy with AD. Fetal growth retardation is detected in 27% of patients, malnutrition in 28%, hypoxia and asphyxia of newborns in 33%. Every third child born to a woman with a clinic of asthma has insufficient body weight. This indicator is even higher with a steroid-dependent form of the disease. Constant interaction with maternal antigens sensitizes the baby to allergens. In the future, 45-58% of children have an increased risk of developing allergic diseases, more often they suffer from SARS, bronchitis, pneumonia.
The appearance in a pregnant woman of repeated attacks of suffocation and a sudden unproductive cough is a sufficient basis for a comprehensive examination, which allows confirming or refuting the diagnosis of bronchial asthma. In the gestational period, there are certain restrictions on the conduct of diagnostic tests. Due to the possible generalization of the allergic reaction, pregnant women are not prescribed provocative and scarification tests with probable allergens, provocative inhalations of histamine, methacholine, acetylcholine and other mediators. The most informative for the diagnosis of asthma during pregnancy are:
Additional diagnostic criteria are an increase in the content of eosinophils in the general blood test, identification of eosinophilic cells, Charcot-Leiden crystals and Kursman spirals in the analysis of sputum, the presence of sinus tachycardia and signs of overload of the right atrium and ventricle on an ECG. Differential diagnosis is carried out with chronic obstructive pulmonary diseases, cystic fibrosis, tracheobronchial dyskinesia, constrictive bronchiolitis, fibrosing and allergic alveolitis, tumors of the bronchi and lungs, occupational diseases of the respiratory organs, pathology of the cardiovascular system with heart failure. According to the indications, the patient is consulted by a pulmonologist, an allergist.
Pregnancy Asthma Treatment
When managing patients with AD, it is important to ensure high-quality monitoring of the state of the pregnant woman, the fetus, and to maintain normal respiratory function. With a stable course of the disease, a woman is examined three times during pregnancy by a pulmonologist - at 18-20, 28-30 weeks of gestation and before childbirth. The function of external respiration is controlled by peak flowmetry. Given the high risk of placental insufficiency, fetometry and dopplerography of placental blood flow are regularly performed. When choosing a pharmacotherapy regimen, the severity of bronchial asthma is taken into account:
- With intermittent form of asthma the basic drug is not prescribed. Before the likely contact with the allergen, when the first signs of bronchospasm appear and at the time of the attack, inhaled short-acting bronchodilators from the β2-agonist group are used.
- With persistent forms of AD: basic therapy with category B inhaled glucocorticoids is recommended, which, depending on the severity of asthma, is combined with antileukotrienes, short or long-acting β-agonists. The attack is stopped using inhaled bronchodilators.
The use of systemic glucocorticosteroids that increase the risk of developing hyperglycemia, gestational diabetes, eclampsia, preeclampsia, and the birth of a child with low weight is justified only with the insufficient effectiveness of basic pharmacotherapy. Not shown triamcinolone, dexamethasone, depot form. Prednisone analogs are preferred. With exacerbation, it is important to prevent or reduce possible fetal hypoxia. For this, inhalations with quaternary derivatives of atropine, oxygen are additionally used to maintain saturation, in extreme cases, provide artificial ventilation of the lungs.
Although with a quiet course of bronchial asthma, delivery by natural birth is recommended, in 28% of cases with obstetric indications a cesarean section is performed. After the onset of labor, the patient continues to take basic drugs in the same dosages as during gestation. If necessary, oxytocin is prescribed to stimulate uterine contractions. The use of prostaglandins in such cases can provoke bronchospasm. During breastfeeding, it is necessary to take basic anti-asthma drugs in doses that correspond to the clinical form of the disease.
Changes in the respiratory system in AD during pregnancy
During pregnancy, under the influence of hormonal and mechanical factors, the respiratory system undergoes significant changes: there is a restructuring of the mechanics of respiration, and ventilation-perfusion relationships change. In the first trimester of pregnancy, hyperventilation may occur due to hyperprogesteronemia, changes in the gas composition of the blood - an increase in the content of PaCO2. The appearance of shortness of breath in late pregnancy is largely due to the development of a mechanical factor, which is a consequence of an increase in the volume of the uterus. As a result of these changes, disturbances in the function of external respiration are aggravated, the vital capacity of the lungs, the forced vital capacity of the lungs, and the volume of forced expiration in 1 second (FEV1) are reduced. As the gestation period increases, the resistance of the vessels of the pulmonary circulation increases, which also contributes to the development of shortness of breath. In this regard, shortness of breath causes certain difficulties in the differential diagnosis between physiological changes in the function of external respiration during pregnancy and manifestations of bronchial obstruction.
Often, pregnant women without somatic pathology develop edema of the mucous membranes of the nasopharynx, trachea and large bronchi. These manifestations in pregnant women with AD can also aggravate the symptoms of the disease.
Low compliance contributes to the deterioration of the course of asthma: many patients try to refuse to take inhaled glucocorticosteroids (IHC) because of fear of their possible side effects. In such cases, the doctor should explain to the woman the need for basic anti-inflammatory therapy in connection with the negative effect of uncontrolled AD on the fetus. Symptoms of asthma may first appear during pregnancy due to altered body reactivity and hypersensitivity to endogenous prostaglandin F2α (PGF2α). Attacks of suffocation, which first occurred during pregnancy, can disappear after childbirth, but can also be transformed into true AD.Among the factors contributing to the improvement of AD during pregnancy, a physiological increase in the concentration of progesterone with bronchodilation properties should be noted. Favorably affect the course of the disease, an increase in the concentration of free cortisol, cyclic aminomonophosphate, and an increase in the activity of histaminase. These effects are confirmed by an improvement in the course of AD in the second half of pregnancy, when glucocorticoids of fetoplacental origin enter the bloodstream of a mother in large numbers.
Pregnancy and fetal development in AD
Topical issues are the study of the effect of AD on pregnancy and the possibility of giving birth to healthy offspring in patients with AD.
Pregnant women with asthma have an increased risk of developing early toxicosis (37%), gestosis (43%), the threat of termination of pregnancy (26%), premature birth (19%), and placental insufficiency (29%). Obstetric complications, as a rule, occur in severe cases of the disease. Of great importance is the conduct of adequate medical control of asthma. The lack of adequate therapy for the disease leads to the development of respiratory failure, arterial hypoxemia of the mother’s body, and constriction of the vessels of the placenta, resulting in fetal hypoxia. A high frequency of fetoplacental insufficiency, as well as miscarriage, is observed against the background of damage to the vessels of the uteroplacental complex by circulating immune complexes, inhibition of the fibrinolysis system 1, 7.
Women with AD are more likely to have children with low birth weight, neurological disorders, asphyxia, and congenital malformations. In addition, the interaction of the fetus with maternal antigens through the placenta affects the formation of allergic reactivity of the child. The risk of developing an allergic disease, including AD, in a child is 45–58%. Such children are more likely to suffer from respiratory viral diseases, bronchitis, pneumonia. Low birth weight is observed in 35% of children born to mothers with AD. The highest percentage of births of small children is observed in women suffering from steroid-dependent asthma. The reasons for the low birth weight are insufficient BA control, which contributes to the development of chronic hypoxia, as well as prolonged use of systemic glucocorticoids. It is proved that the development of severe asthma exacerbations during pregnancy significantly increases the risk of having children with low body weight 7, 12.
Management and treatment of pregnant women with asthma
According to the provisions of GINA-2014, the main tasks of controlling AD in pregnant women are:
- clinical assessment of the condition of the mother and fetus,
- elimination and control of trigger factors,
- pharmacotherapy of asthma during pregnancy,
- educational programs,
- psychological support for pregnant women.
Given the importance of controlling asthma symptoms, mandatory pulmonologist examinations of 18–20 weeks are recommended. gestation, 28-30 weeks. and before childbirth, in case of an unstable course of asthma - as necessary. In the management of pregnant women with asthma, one should strive to maintain lung function close to normal. As a monitoring of respiratory function, peak flow measurements are recommended.
Due to the high risk of developing placental insufficiency, it is necessary to regularly assess the condition of the fetus and the uteroplacental complex using ultrasound fetometry, ultrasound dopplerometry of the vessels of the uterus, placenta and umbilical cord. In order to increase the effectiveness of therapy, patients are advised to take measures to limit contact with allergens, quit smoking, including passive smoking, strive to prevent ARVI, and eliminate excessive physical exertion. An important part of the treatment of AD in pregnant women is the creation of training programs that allow the patient to establish close contact with the doctor, increase the level of knowledge about her illness and minimize its effect on the course of pregnancy, and teach the patient self-control skills. The patient needs to be trained in peak flowmetry in order to monitor the effectiveness of treatment and to recognize the early symptoms of an exacerbation of the disease. It is recommended that BA patients with moderate severity and severe course perform peak flowmetry in the morning and evening hours, calculate daily fluctuations in peak volume expiratory flow rate and record the obtained values in the patient's diary. According to the 2013 Federal Clinical Recommendations for the Diagnosis and Treatment of Bronchial Asthma, certain provisions must be adhered to (Table 1).
The principal approaches to the pharmacotherapy of AD in pregnant women are the same as in non-pregnant women (Table 2). For basic therapy of mild asthma, it is possible to use montelukast, for moderate to severe, it is preferable to use inhaled corticosteroids. Among the currently available preparations of inhaled GCS, only budesonide was assigned to category B at the end of 2000. If it is necessary to use systemic GCS (in extreme cases) in pregnant women, it is not recommended to prescribe triamcinolone preparations, as well as long-acting GC drugs (dexamethasone). The use of prednisone is preferred.
Of the inhaled forms of bronchodilators, phenoterol (group B) is preferred. It should be borne in mind that β2-agonists in obstetrics are used to prevent premature birth, their uncontrolled use can cause an extension of the duration of labor. The appointment of depot forms of GCS preparations is categorically excluded.
Exacerbation of AD in pregnant women
The main activities (table. 3):
Assessment of the condition: examination, measurement of peak expiratory flow rate (PSV), oxygen saturation, assessment of the fetus.
- β2-agonists, preferably phenoterol, salbutamol - 2.5 mg through a nebulizer every 60–90 minutes,
- oxygen to maintain saturation at 95%. If Saturation Literature
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For registered users only
What it is
Bronchial asthma, or AD, is considered a disease that manifests itself as a chronic form of inflammation in the respiratory tract.
Symptoms are respiratory, wheezing with shortness of breath in the chest and coughing.
Inflammations vary in time and intensity, appear together with other diseases.
Risks for the newborn
The risk of developing a disease in a newborn is quite high if at least one of the parents is sick. Heredity makes an almost fifty percent contribution to an individual's overall predisposition to the development of bronchial asthma. However, a child’s illness may not occur. Much in this case depends on preventive measures taken by parents, including constant monitoring by a specialist in a therapeutic profile.
If the baby was born through Caesarean section, the risk of developing the disease increases.
What should be remembered by a woman
Treatment of the disease during pregnancy is a must. You can choose drugs that will not harm the fetus and mother. If the patient's condition is stable and there are no exacerbations, then the pregnancy itself and childbirth will proceed without complications.
To understand how bronchial asthma and pregnancy should coexist at the same time, you can attend Asthma schools or independently obtain and read materials from the educational program for patients.