18.01.2021

Treatment of asthma in a pregnant woman

Management of asthma in pregnant women occurs in the same way as in non-pregnant. Like any other asthmatic, a pregnant woman should follow the prescribed treatment and adhere to a treatment program to control the inflammatory processes and prevent asthma attacks.

Part of the treatment program for a pregnant woman should be set aside to observe the movements of the fetus. This can be done independently by recording every movement of the fetus. If you notice that the fetus began to move less during an asthma attack, contact your doctor immediately or call an ambulance.

Overview of Asthma Treatment in a Pregnant Woman:

  • If more than one specialist is involved in treating a pregnant woman with asthma, they should work together and coordinate their actions. An obstetrician should also be involved in the treatment of asthma.
  • It is necessary to carefully monitor the performance of the lungs during the entire pregnancy – the child must receive a sufficient amount of oxygen. Since the severity of asthma can change during the second half of a woman’s pregnancy, regular examinations of symptoms and pulmonary function are necessary. The doctor uses spirometry or pneumotachometer to check for pulmonary function.
  • After 28 weeks it is necessary to observe the movements of the fetus.
  • In the case of poorly controlled or severe asthma after 32 weeks, an ultrasound examination of the fetus is necessary. An ultrasound examination also helps the doctor examine the condition of the fetus after an asthma attack.
  • Try to do everything possible to avoid and control the causative agents of asthma (for example, tobacco smoke or dust mites), and you can take smaller doses of the medicine. Most women have nasal symptoms, and there is a close relationship between nasal symptoms and asthma attacks. Gastroesophageal reflux disease (GERD), especially common during pregnancy, can also cause exacerbation of symptoms.
  • It is very important to protect yourself from the flu. You need to be vaccinated against the flu before the season begins – sometimes from the beginning of October to mid-November in the first, second or third trimester of pregnancy. The flu vaccine is only valid for one season. It is absolutely safe during pregnancy and is recommended for all pregnant women.

Asthma is very common in people, including pregnant women. Some women suffer from asthma during pregnancy, although there has never been the slightest sign of illness before. But during pregnancy, asthma not only affects the body of a woman, but also limits the access of oxygen to the child. But this does not mean that asthma complicates or increases the danger for a woman and for a child during pregnancy. In women with asthma, with proper control of the disease, pregnancy is carried out with minimal risk or no risk for the woman herself and her fetus.

Most pregnant women have allergies other than asthma, such as allergic rhinitis.

Therefore, allergy treatment is a very important part of treating and managing asthma.

  • Inhaled corticosteroids at recommended doses are effective and safe for pregnant women.
  • An antihistamine, loratadine or cetirizine is also recommended.
  • If immunotherapy is started before the pregnancy begins, it can be continued, but it is not recommended to begin during pregnancy.
  • Talk to your doctor about taking a decongestant (oral). Perhaps there are other better treatment options.
Asthma drugs and pregnancy

The results of studies on animals and people taking medication for asthma during pregnancy did not reveal so many side effects to which a woman and her child are exposed. It is much safer to take medications for asthma during pregnancy than to leave things as they are. Poor control of the disease does more harm to the fetus than medication. Budesonide, approved by the Food and Drug Administration, is the safest inhaled corticosteroid for use during pregnancy. One study showed that small doses of inhaled corticosteroid are safe for the woman and her fetus.

Recommendations for taking medication during pregnancy

Severity

Daily intake medications necessary to maintain long-term disease control

Heavy permanent form Preferred:

  • A large dose of inhaled corticosteroid, preferably budesonide,  and
  • Inhaled long-acting beta-2 agonist (eg, salmeterol or formoterol)  OR
  • Combination medications that contain a large dose of corticosteroid and beta-2 long-acting agonist (for example, Advair Diskus)  AND IF NECESSARY
  • Long-acting corticosteroid tablets or syrup (2 mg / kg / day, usually not more than 60 mg / day). (Try to reduce the number of pills taken and maintain control of the disease with large doses of an inhaled corticosteroid.) If you are taking oral corticosteroids for a long time, you should consult a specialist.

Alternative:

  • Large dose inhaled corticosteroids  and
  • Theophylline with a prolonged action, serum concentration from 5 to 12 mg / ml
Average permanent form Preferred:

  • OR a  small dose of inhaled corticosteroids, preferably budesonide, and a long-acting inhaled beta-2 agonist  OR
  • Medium Inhalation Corticosteroid Dose
  • IF NECESSARY  for women with recurring asthma attacks, average dose of inhaled corticosteroid and inhaled beta-2 long-acting agonist

Alternative:

  • A small dose of inhaled corticosteroid, preferably budesonide, or leukotriene modifier or theophylline (methylxanthine)
  • Medium dose of inhaled corticosteroid and / or leukotriene modifier, or theophylline, if necessary
Minor permanent form Preferred:

  • A small dose of inhaled corticosteroids, preferably budesonide

Alternative:

  • Mast cell stabilizer or leukotriene modifier  OR
  • Theophylline with a prolonged action, serum concentration from 5 to 12 mg / ml
Periodic
  • No need to take medication daily
  • A fast-acting bronchodilator to relieve symptoms that appear and go away: 2-4 presses of an inhaled beta-2 agonist of quick action, depending on the symptoms. For this it is better to choose albuterol. If you take albuterol more than two days a week, your doctor must prescribe a treatment, as for a permanent form with minimal symptoms.
  • More serious seizures can occur with large interruptions without a single symptom or deterioration of pulmonary function. For serious attacks, it is recommended to take a course of taking pills, syrup or injections of corticosteroid.
Fast rescue:  for all patients
  • Rapid-acting bronchodilator: 2 to 4 presses for a fast-acting inhaled beta-2 agonist, depending on the symptoms. Albuterol is preferred.
  • The intensity of treatment depends on the severity of the attack. You may need a one-time treatment with an aerosol or up to three approaches at intervals of 20 minutes. In addition, it may be necessary to undergo a course of treatment with pills, syrup or injections of a corticosteroid.
  • A fast-acting beta-2 agonist more than two per week (except in cases of stress asthma) suggests that treatment should be reviewed.

Never stop taking or reduce the dose of medication without a doctor’s permission. Make any changes to the treatment is necessary only after the expiration of pregnancy.

Drugs that can potentially harm a fetus include epinephrine, alpha adrenergic components (except pseudoepinephrine), decongestants (except pseudoepinephrine), antibiotics (tetracycline, sulfanilamide drugs, ciprofloxasin), immunotherapy (stimulation or dose increase), and iodine drugs (iodine stimulants, sulfanilamide drugs, ciprofloxasin), immunotherapy (stimulating or increasing the dose), and iodine drugs (iodine stimulants). Before you start taking the medication, being pregnant or about to become pregnant, you should consult a specialist.

Most medicines used to treat asthma are safe for pregnant women. After many years of research, experts can now say for sure that it is much safer to continue to treat asthma than to stop treatment during pregnancy. Check with your doctor about which treatment will be the safest for you.

Risks of non-treatment during pregnancy

If you previously had no signs of asthma, then you do not need to be so sure that shortness of breath or wheezing during pregnancy is a sign of asthma. Very few women who know that they have asthma, pay attention to minor symptoms. But we must not forget that asthma affects not only your body, but also the body of the fetus, so you need to take preventive measures in time.

If the disease is out of control, then it threatens the following:

  • High blood pressure during pregnancy.
  • Preeclampsia, a disease that increases blood pressure and can affect the placenta, kidneys, liver and brain.
  • Greater than usual toxicosis in early pregnancy (pregnant women with hyperemesis).
  • Births that occur in an unnatural way (the attending physician causes the onset of labor) or passes with complications.
Risks to the fetus:
  • Sudden death before or after birth (perinatal mortality).
  • Poor fetal development (intrauterine growth retardation). Small weight of a child at birth.
  • The onset of labor before the 37th week of pregnancy (preterm labor).
  • Low birth weight.

The higher the control over the disease, the lower the risks.

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