Asthma in Pregnancy

1. 2020 Advances in Women’s Health  A Virtual Conference  October 15-16, 2020  www.acoog.org
A Virtual Conference  October 15-16, 2020
Asthma in
Pregnancy
Nathan Lott, DO
Clinical Assistant Professor (Affiliated)
Texas A&M University College of Medicine
Division of Pulmonary/Critical Care/ Sleep Medicine
Baylor Scott and White Hillcrest

2. 2020 Advances in Women’s Health  A Virtual Conference  October 15-16, 2020  www.acoog.org
Learning Objectives
• Introduction
• Review physiologic changes that occur in pregnancy
• Review how pregnancy impacts asthma
• Discuss asthma management in pregnancy

3. 2020 Advances in Women’s Health  A Virtual Conference  October 15-16, 2020  www.acoog.org
Introduction
• Common Complication of Pregnancy
• ~8% of pregnancies in US
• Maternal and Fetal morbidity and mortality are
impacted

4. 2020 Advances in Women’s Health  A Virtual Conference  October 15-16, 2020  www.acoog.org
What is asthma
• Chronic Inflammatory disease of
the lung:
• Airway Hyper Responsiveness
• Reversible Airway Obstruction
• Airway inflammation
From: National Heart, Lung, and Blood Institute. What is
asthma?

5. 2020 Advances in Women’s Health  A Virtual Conference  October 15-16, 2020  www.acoog.org
Pulmonary
Adaptation to
Pregnancy
• Tidal Volume: Increase
• Total Lung Capacity: Decrease
• ERV, FRC and RV: Decrease
• Inspiratory Capacity: Increases
• Minute Ventilation: Increases
• Oxygenation: Increased PaO2

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7. 2020 Advances in Women’s Health  A Virtual Conference  October 15-16, 2020  www.acoog.org
How does Pregnancy Impact Asthma
• Rule of thirds:
• 1/3 improve
• 1/3 aggravated
• 1/3 stay the same
• Baseline control ~ 3 months Post-partum
• Severity at baseline greatest predictor of severity during
pregnancy
• Tends to recur in subsequent pregnancies

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Asthma Management

9. 2020 Advances in Women’s Health  A Virtual Conference  October 15-16, 2020  www.acoog.org
Primary goals of management
• Preventing Acute exacerbations
• Prevents acute hypoxia
• Reduce alkalosis and hypocapnia
• Optimizing Maternal Pulmonary Function
• Reduce Chronic hypoxia
• Control Maternal Symptoms

10. 2020 Advances in Women’s Health  A Virtual Conference  October 15-16, 2020  www.acoog.org
Non-pharmacologic Management
• Patient Education
• Environmental Controls
• Avoid Triggers
• Smoking Cessation
Education
Goldie MH, Brightling CE. Asthma in pregnancy. The Obstetrician & Gynaecologist 2013;15:241–5

11. 2020 Advances in Women’s Health  A Virtual Conference  October 15-16, 2020  www.acoog.org
Smoking
• Critical that smoking cessation be addressed:
• Increased need for medication
• Increased perinatal morbidity
• Smoking cessation education is also billable
• 99406: 3-10 min
• 99407: >10 min

12. 2020 Advances in Women’s Health  A Virtual Conference  October 15-16, 2020  www.acoog.org
Pharmacologic Management
• Guideline based management
• Changes ~ every 5 years (Most recent update 2020)
• GINA (Global Initiative for Asthma)
• http://www.ginasthma.org
• Step Based
• More severe, more medications

13. © Global Initiative for Asthma, www.ginasthma.org
GINA 2020, Box 3-5A

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Monitoring
• Close follow up recommended
• Monthly if necessary
• Peak Flow Meters can be helpful
• Requires diligence
• Asthma Action Plan

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Drug Safety in Pregnancy
• Pregnancy Risk Categories
• This has been phased out and new labeling is “PLLR”
• “Pregnancy and Lactation Labeling Rules”
• Changed in 2015
• Phased in over the next 5 years
• Most drugs used in Asthma are classically “B or C”

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