2. LEARNINIG OBJECTIVES
• Define asthma
• Describe risk factors for asthma in pregnancy
• Explain clinical features and complications of asthma
in pregnancy
• Establish diagnoses of asthma in pregnancy
• Treat conduct follow up services and refer as
appropriate in a patient with asthma in pregnancy
according to guidline.
3. Introduction
• Definition;
-is a result of chronic inflammation of airways that result in airway
obstruction and can be triggered by various stimuli.
OR
It is a chronic reseversible obstractive inflammatory disease in which
many cells and cellular elements play a role by constriction of bronchial
smooth muscles causing bronchospasm,oedema of bronchial mucous
membrane and blockage of the smaller bronchi with plug of mucus.
• >50% of asthmatics are prone to exacerbations during pregnancy
• Women with severe asthma tend to have worsening of their asthma.
• Asthma exacerbations can occur at anytime during pregnancy but tend
to occur more between 17th and 34th weeks of GA.
4. CHANGES …
Respiratory physiological changes during pregnancy;
• Tidal volume increases due to increased ventilatory
drive(from the effect of progesterone which is a direct
respiratory stimulant)
• Increased minute ventilation which causes
hyperventilation picture.
• No change in RR and vital capacity
• In general, airway conductance is increased and
pulmonary resistance is reduced hence more effective
gaseous exchange
5. Risk/triggering factors
• Allergens; pollen, house-dust mites, cockroach, molds
• Irritants; cigarette smoke, air pollution, odors, chemicals,
drugs such as NSAIDs
• Medical conditions; Respiratory viral infections, allergic
rhinitis, sinusitis, GERD, ascariasis
• Cessation of medications
• Psychological stress
• exercise
6. Pathophysiology
• Inflammation of the airways in response to trigger
• Abnormal accumulation of eosinophils, lymphocytes,
mast cells, macrophages, dendritic cells and
myofibroblasts
• Reduction in airway diameter resulted from smooth
muscle contraction.
• Vascular congestion, bronchial wall edema and thick
secretions.
7. CLINICAL PRESENTATION.
• Shortness of breath
• Wheezing(on expiration)
• Rhonchi(inspiration and or expiration)
• Cough
• Chest tightness
• Nocturnal awakenings
• Tachypnea
• Agitation(due to hypoxia)
8. Investigaions
• CBC or FBC{looking for eosinophilia}
• CXR(concurrent illnesses eg pneumonia)
• Spirometry[lung function test]
• Peak respiratory flow rate
• Serum IgE
9. Management
Goal
• Control symptoms
• Prevent acute exacerbations
• Maintain normal pulmonary function
• Minimize use of drugs/medications
• Protect mother and fetus
10. III. Pharmacologic therapy
treatment same as in non-pregnant women
beta adrenergic agonists are the mainstay treatment option
includes SABA(salbutamol) & LABA(salmeterol)
Other meds; leukotriene antagonists such as montelukast, theophylline
Cortcosteroids such as beclomethasone
Tranquilizers and sedatives should be avoided due to their respiratory
depressant effect.
Anti histamines not useful
Mucolytic agents increase bronchospasm
11. Management of acute asthma in pregnant women
• Oxygen supplementation
• Iv fluid hydration
• Salbutamol inhalation; every 20 minutes up to 3 doses in
the 1st hour
• Systemic corticosteroid IV/oral
NB; aminophylline generally not recommended
12. Maternal monitoring
• Symptoms
• Spirometry
• Peak flows
Fetal monitoring
• Uss; early in pregnancy, regularly after 32 weeks and after every
exacerbation
• NST
13. Delivery in case of caesarean section;
• Lumbar epidural anesthesia preferred
• Ketamine as general anesthesia
14. Asthma control
• No/minimal daytime symptoms
• No limitations to activity
• Nonocturnal symptoms
• No/minimal need for rescue medications
• Normal lung fucntion
• No exacerbations
15. • No effect of lactation on asthma
• Medications used for asthma are not contraindicated
during lactation.
19. DIFFERENCE BETWEEN
WHEEZING AND STRIDOR.
• Wheezing is a sound produced primarily during
expiration by air ways of any size .
WHILE
• Stridor is a single pitch , inspiratory sound that is
produced by large airways with severe narrowing .
• It may be caused by severe obstruction of any
proximal airway .
20. TREATMENT : CONTROLLER
MEDICINES IN ASTHMA.
• Inhaled corticosteroids (ICS) e.g.
Blecomethasone,fluticasone.
• Leukotriene modifiers e.g. Montelukast.
• Long acting muscarinic antagonist (LAMA)
e.g.tiotropium
• Long acting beta 2 e.g. formoterol, salmeterol.
21. RELLEVER MEDICINES IN
ASTHMA.
• Short acting beta 2 agonist( SABA) e.g. salbutamol
• Short acting muscarinic antagonist e.g. salmetorl
