ASHMA TB INFLUENZA

1. BY
DR.HAFSA

2.  Pulmonary diseases are one of the major indirect
causes of maternal death.
 Significant physiological changes occur in
pregnancy to meet metabolic needs of both
mother and fetus.

3.  Hormonal changes in pregnancy affect the URT &
upper airway mucosa, producing hyperemia,
mucosal edema, hypersecretion & increased
mucosal friability.
 Estrogen is responsible for producing tissue
edema, capillary congestion & hyperplasia of
mucous glands.
 The enlarging uterus & the hormonal effects
produce anatomical changes to the thoracic cage.
 The AP/PA & transverse diameter of the thorax
increases.
 Diaphragm function remains normal.

4.  Anatomical changes to the thorax produce a
decrease in FRC, which is reduced 10-20% by
term.
 The RV can decrease slightly during pregnancy.
 The increased circumference of the thoracic cage
allows VC to remain unchanged & TLC decreases
only minimally by term.
 Hormonal changes do not significantly affect
airway function
 Pregnancy does not change lung compliance.

5.  The MV increases significantly, beginning in the
first trimester & reaching 20-40% above baseline
at term.
 Alveolar ventilation increases by 50-70%.
 The increase in ventilation occurs because of
increased metabolic CO2 production.
 The VT increases by 30-35%.
 The respiratory rate remains relatively constant.

6.  Physiological hyperventilation results in
respiratory alkalosis with compensatory renal
excretion of bicarbonate.
 The arterial CO2 pressure reaches a plasma level
of 28-32 mmHg & bicarbonate is ↓ to 18-21
mmol/L, maintaining arterial pH in the range of
7.40-7.47.
 Mild hypoxemia might occur when the patient is
in supine position.
 Oxygen consumption ↑ at the beginning of the
trimester & ↑ by 20-33% by term because of
fetal demands & maternal metabolic processes.

7. Physiologic dyspnea.
 The increase in minute ventilation that accompanies
pregnancy is often perceived as shortness of breath.
 Shortness of breath at rest or with mild exertion is so
common that it is often referred to as physiologic
dyspnea.
Pathologic dyspnea
 Increased respiratory rate greater than 20 breaths
per minute, arterial PCO2 less than 30 or greater than
35, hypoxemia or abnormal measures on forced
expiratory spirometry, or cardiac echocardiography
 Abrupt or paroxysmal episodes of dyspnea suggest
an abnormal condition

8.  Dyspnea of pregnancy
 Allergic rhinitis
 Bronchial asthma
 Tuberculosis
 Pneumonia
 Influenza
 Anemia
 Interstitial lung disease
 Pleural diseases
 Pulmonary thromboembolism
 Amniotic fluid embolism
 Pneumothorax
 Gestational trophoblastic disease
 Peripartum cardiomyopathy
 Drugs e.g., tocolytics

9.  It is one of the most common conditions
complicating the pregnancy.
 Pregnancy is a heterogeneous immune state
affecting the course of the asthma, during which
the latter may worsen or improve or remain
stable with equal distribution.
 Prevalence of bronchial asthma in pregnancy is
about 8%-12%
 Bronchial asthma is safe during pregnancy if
controlled.

10.  PIH
 Pre eclampia
 Intrauterine growth retardation (IUGR)
 low birth weight
 premature birth
 increased elective caesarian delivery
 Exacerbations during first trimester are
associated with increased risk of congenital
malformations

11.  Diagnosis of bronchial asthma during pregnancy
is similar to that done in non pregnant state,
which includes
 History
 Clinical examination
 pulmonary function tests(PFT).

12.  Management of bronchial asthma during
pregnancy is almost similar to non
pregnant.
 Patient education
 avoidance of triggers
 Goals of bronchial asthma management
include decreasing the use of short acting
beta-2 agonists (SABA), preventing the
exacerbations and maintaining near normal
lung function
 Long acting beta-2 agonists(LABA) are used
in step up therapy only if asthma is not
controlled by medium or low dose inhaled
corticosteroids (ICS).

13.  Systemic corticosteroids are associated with
more adverse effects than inhaled and should be
used only in moderate and severe bronchial
asthma.
 Use of systemic corticosteroids in early
pregnancy is associated with cleft lip, cleft
palate, preeclampsia and gestational diabetes.

14.  Treatment of acute severe asthma in pregnancy
is almost similar to non pregnant counterparts.
 Initially the patients should be treated with
inhaled albuterol or salbutamol 2.5mg for every
20 min followed by systemic corticosteroids.
 Inhaled ipratropium bromide can be added to
this regimen.
 They are monitored for every 30-60 minutes.
Treating maternal hypoxia and continuous fetal
monitoring are more important

15.  Risk factors for tuberculosis (TB) in
pregnancy include positive family
history or past history of TB,
residence in area of high prevalence
of TB.
 Treatment of TB in pregnancy is
similar to that administered to non
pregnant women.
 Streptomycin is contraindicated
because of
and vestibular defects in fetus.
 Breast feeding is not
contraindicated in women taking
anti-TB treatment

16.  Pneumonia is one of the important causes of
indirect maternal mortality
 Most common organisms being
Streptococcus pneumoniae, Haemophilus
influenza, Mycoplasma pneumonia.
 Clinical presentation is similar to that of non-
pregnant woman but risk of respiratory
failure and empyema is increased
 Patient presents with dyspnea. Respiratory
rate is not increased
 Patients with suspected pneumonia should
get a chest radiograph with abdominal
shield.
 Other investigations are sputum microscopy,
sputum culture and serologic tests.
 Quinolones and tetracyclines should be
avoided in pregnancy

17.  It is most common viral infection in pregnancy
 resulting in increased morbidity and mortality.
 Risk of hospitalization for an acute
cardiopulmonary illness is three to four times
more likely in third trimester
 Influenza(H1N1) should be suspected in patients
not responding to routine antibiotics and in
pneumonia or respiratory failure.
 Increased risk of preterm delivery or a low-birth
weight infant, severe pneumonia, maternal
deaths have been observed

18.  It includes prevention and supportive care.
 Antipyretics should be used for the treatment of
fever as these not only reduces fetal tachycardia,
but are also been associated to be a protective
agent against congenital abnormalities.
 Dehydration should be avoided.
 The use of antiviral medications in pregnancy is
controversial.
 Neuraminidase inhibitors(zanamivir, oseltamivir)
are also used in the treatment.