Asthma in pregnancy: Difference between revisions
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During pregnancy, due to high levels of progesterone, minute ventilatory rate is increased causing compensated [[respiratory alkalosis]]<ref name="pmid16443140">{{cite journal| author=Wise RA, Polito AJ, Krishnan V| title=Respiratory physiologic changes in pregnancy. | journal=Immunol Allergy Clin North Am | year= 2006 | volume= 26 | issue= 1 | pages= 1-12 | pmid=16443140 | doi=10.1016/j.iac.2005.10.004 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16443140 }} </ref>. Hence the [[arterial blood gases]] may reveal a higher PO<sub>2</sub> and lower PCO<sub>2</sub> with mild alkalotic PH. Normal PCO<sub>2</sub> during pregnancy is suggestive of impending [[respiratory failure]]. | During pregnancy, due to high levels of progesterone, minute ventilatory rate is increased causing compensated [[respiratory alkalosis]]<ref name="pmid16443140">{{cite journal| author=Wise RA, Polito AJ, Krishnan V| title=Respiratory physiologic changes in pregnancy. | journal=Immunol Allergy Clin North Am | year= 2006 | volume= 26 | issue= 1 | pages= 1-12 | pmid=16443140 | doi=10.1016/j.iac.2005.10.004 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16443140 }} </ref>. Hence the [[arterial blood gases]] may reveal a higher PO<sub>2</sub> and lower PCO<sub>2</sub> with mild alkalotic PH. Normal PCO<sub>2</sub> during pregnancy is suggestive of impending [[respiratory failure]]. | ||
Asthma is characterized by broncho-constriction or inflammation of airways with production of thick mucoid secretions. | Asthma is characterized by broncho-constriction or inflammation of airways with production of thick mucoid secretions. In a small prospective study involving 16 asthmatic pregnant women, hyper-reactivity was seen to be lower as evidenced by a reduction in minimum medication requirements<ref name="pmid2679270">{{cite journal| author=Juniper EF, Daniel EE, Roberts RS, Kline PA, Hargreave FE, Newhouse MT| title=Improvement in airway responsiveness and asthma severity during pregnancy. A prospective study. | journal=Am Rev Respir Dis | year= 1989 | volume= 140 | issue= 4 | pages= 924-31 | pmid=2679270 | doi= | pmc= | url= }} </ref>. | ||
==Treatment [http://www.nhlbi.nih.gov/guidelines/asthma/asthsumm.pdf]== | ==Treatment [http://www.nhlbi.nih.gov/guidelines/asthma/asthsumm.pdf]== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S. [2]; Lakshmi Gopalakrishnan, M.B.B.S. [3]
Overview
Asthma is one of the most common pulmonary conditions occurring during pregnancy[1] with a prevalence rate of 3.7% to 8.4% in United States during the period 1997-2001[2].
Pathophysiology
During pregnancy, due to high levels of progesterone, minute ventilatory rate is increased causing compensated respiratory alkalosis[3]. Hence the arterial blood gases may reveal a higher PO2 and lower PCO2 with mild alkalotic PH. Normal PCO2 during pregnancy is suggestive of impending respiratory failure.
Asthma is characterized by broncho-constriction or inflammation of airways with production of thick mucoid secretions. In a small prospective study involving 16 asthmatic pregnant women, hyper-reactivity was seen to be lower as evidenced by a reduction in minimum medication requirements[4].
Treatment [4]
- Monitor asthma control during all prenatal visits.
- Asthmatic symptoms worsen in about a third during pregnancy and improve in a third; hence, medications should be adjusted accordingly.
- Regular monitoring and maintenance of lung function to ensure adequate oxygen supply to the fetus.
- It is safer to treat asthma with medications than to have poorly-controlled asthma.
- Drug of choice in pregnancy:
- Albuterol is preferred to short-acting β2-agonist (SABA)
- Inhaled corticosteroid such as budesonide is preferred for long-term control of symptoms.
References
- ↑ Rey E, Boulet LP (2007). "Asthma in pregnancy". BMJ. 334 (7593): 582–5. doi:10.1136/bmj.39112.717674.BE. PMC 1828355. PMID 17363831.
- ↑ Kwon HL, Belanger K, Bracken MB (2003). "Asthma prevalence among pregnant and childbearing-aged women in the United States: estimates from national health surveys". Ann Epidemiol. 13 (5): 317–24. PMID 12821270.
- ↑ Wise RA, Polito AJ, Krishnan V (2006). "Respiratory physiologic changes in pregnancy". Immunol Allergy Clin North Am. 26 (1): 1–12. doi:10.1016/j.iac.2005.10.004. PMID 16443140.
- ↑ Juniper EF, Daniel EE, Roberts RS, Kline PA, Hargreave FE, Newhouse MT (1989). "Improvement in airway responsiveness and asthma severity during pregnancy. A prospective study". Am Rev Respir Dis. 140 (4): 924–31. PMID 2679270.