Information

Bronchial asthma

Bronchial asthma


Bronchial asthma is a chronic respiratory disease characterized by seizures with dyspnoea (difficult breathing), wheezing (specific noisy breathing) and cough; between seizures lung function is normal. Asthma is a common condition in pregnant women, even if they have not had this disease before pregnancy. During pregnancy asthma affects the mother, but at the same time reduces the amount of oxygen that reaches the fetus. However, the mother's asthma does not make the pregnancy more difficult for the baby or the mother. Proper treatment of asthma in pregnant women ensures a low or no risk pregnancy.
Most medications given in asthma have no adverse effects on pregnancy. After many years of research, specialists have come to the conclusion that it is much safer to continue taking drugs that control the disease than to stop treatment during pregnancy.
complications
If the pregnant woman has not had asthma before becoming pregnant, symptoms such as dyspnea (difficult breathing) or wheezing (noisy breathing specific to asthma attacks) may be overlooked, delaying the diagnosis. If the disease was present before pregnancy, the presence of mild symptoms usually does not worry the pregnant woman. However, asthma can affect both the mother and the baby and should therefore be treated as such.
If bronchial asthma is not controlled there is a risk of development:

  • hypertension of pregnancy
  • preeclampsia, a condition that causes an increase in blood pressure and which affects the kidneys, liver and brain
  • vomiting, early and larger than normal (hyperemesis gravidarum)
  • labor does not start naturally (it is caused by a gynecologist) and can be complicated.
    The risks of the fetus include:
  • death at birth (perinatal mortality)
  • abnormally slow development of the fetus (intrauterine growth retardation); at birth the baby looks small
  • the birth before the 37th week of gestation (premature birth)
  • light weight at birth.
    The better the disease is controlled, the lower the risks.
    Treatment
    The management of asthma in the pregnant woman is identical to that of the non-pregnant woman. Like all asthmatic patients, the pregnant woman should receive treatment and follow-up to control inflammation, to prevent and control acute asthma episodes.
    Follow-up of pregnancy with asthma should also include recording of fetal movements. This can be done by tracking if fetal movements decrease over time. If, during an acute episode, the fetal activity decreases, the specialist doctor should be contacted urgently or rescue should be requested.
    In the treatment of asthma in pregnant women, the following must be taken into account:
  • if more specialist doctors are involved in pregnancy care and asthma treatment, they should consult on the treatment; The obstetrician must be involved in the treatment of asthma
  • lung function should be carefully monitored throughout pregnancy to ensure that the fetus receives sufficient oxygen; because the severity of the disease changes during pregnancy in about two thirds of the pregnant women, it is advisable to consult a specialist doctor to monitor the symptoms and lung function; the specialist doctor will use either spirometry (a process by which lung volumes are measured) or peak-flow-meters (a device that measures the respiratory rates in and out of breath) to evaluate the functioning of the lungs.
  • fetal movements should be monitored daily after the 28th week of pregnancy
  • after week 32 of pregnancy, ultrasound will be used to monitor fetal growth if asthma is not well controlled or moderate or severe asthma symptoms are present; ultrasound examinations can help the specialist doctor examine the fetus after a cry
  • it is advisable to avoid the triggering factors of the seizures (cigarette smoke or dust) so that the pregnant woman will be given as few drugs as possible; many pregnant women have symptoms in the nose and there may be a connection between their intensity and asthmatic episodes; gastro-oesophageal reflux disease, which is a common condition in pregnancy, can trigger a bout of asthma
  • it is important to protect the pregnancy against the flu; for this purpose, flu vaccination is indicated before the cold season (October - mid-November) regardless of the age of pregnancy; the flu vaccine is only effective for one year; it has no risks for pregnancy and is recommended for all pregnant women.
    Asthma and allergies
    Many pregnant women also have allergic diseases, such as allergic rhinitis. Allergy treatment is an important part of asthma management.
    It includes:
  • Inhaled corticosteroids given in optimal doses are effective and can be used by the pregnant woman
  • antihistamines such as loratadine or cetirizine
  • Allergic vaccination: If the pregnant woman received the allergy vaccines before becoming pregnant, they may be continued, but their administration cannot be started during pregnancy
  • the specialist doctor should be consulted regarding the use of decongestants taken orally; there may be better treatment options.
    Drug options
    A review of human and animal studies on the effects of anti-asthmatic drugs given during pregnancy has led to the conclusion that there are few risks for both mother and baby. It is safer for asthma pregnant to be treated with drugs than to have uncontrolled asthma symptoms and seizures. Reduced disease control is more harmful to the fetus than anti-asthma medication. The medical specialists involved in the American National Program for the Prevention and Education of Bronchial Asthma have formulated protocols for the administration of drugs in each type of bronchial asthma (severe persistent asthma, persistent moderate asthma, mild persistent asthma, mild intermittent asthma). These will be exposed below.
    Medicines are divided into preferred medicines and medicines administered as an alternative to the preferred ones.
    More information on: Sfatulmedicului.ro