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ASTHMA IN PREGNANCY

CLARISSE B. PEDRON R.M.

ASTHMA:
ASTHMA IS A LUNG DISEASE THAT CAUSES YOUR AIRWAYS TO
TIGHTEN UP, MAKING IT HARD FOR YOU TO BREATHE.
THERES NO CURE FOR ASTHMA. EVEN IF YOU HAVE ASTHMA
AND FEEL HEALTHY, ASTHMA FLARES (WHEN SYMPTOMS
BECOME SEVERE) CAN HAPPEN AT ANY TIME.
ASTHMA IS ESTIMATED TO OCCUR IN ABOUT 4.% OF
PREGNANCIES, TYPICALLY OCCURRING AS A PREEXISTING
COMORBIDITY, ALTHOUGH SOME CASES OF ASTHMA MAY
INITIALLY PRESENT DURING A PREGNANCY .

RISKS OF UNCONTROLLED ASTHMA TO PREGNANT


WOMEN:
IF YOUR ASTHMA IS NOT CONTROLLED, RISKS TO YOUR HEALTH INCLUDE:
HIGH BLOOD PRESSUREDURING THE PREGNANCY.
PREECLAMPSIA, A CONDITION THAT CAUSESHIGH BLOOD PRESSUREAND
CAN AFFECT THEPLACENTA,KIDNEYS,LIVER, ANDBRAIN.
RISKS TO THEFETUSINCLUDE:
ABNORMALLY SLOW GROWTH OF THE FETUS (INTRAUTERINE GROWTH
RETARDATION). WHEN BORN, THE BABY APPEARS SMALL.
BIRTH BEFORE THE 37TH WEEK OF PREGNANCY (PRETERM BIRTH).
LOW BIRTHWEIGHT
DEATH IMMEDIATELY BEFORE OR AFTER BIRTH (PERINATAL MORTALITY).

WHY IS ASTHMA DURING PREGNANCY


A CONCERN?

HOWEVER, SEVERE OR POORLY CONTROLLED ASTHMA DURING PREGNANCY


MIGHT INCREASE THE RISK OF VARIOUS PROBLEMS, INCLUDING:
SEVERE MORNING SICKNESS
VAGINAL BLEEDING

A PREGNANCY COMPLICATION CHARACTERIZED BY HIGH BLOOD PRESSURE


AND SIGNS OF DAMAGE TO ANOTHER ORGAN SYSTEM, OFTEN THE KIDNEYS
(PREECLAMPSIA)
RESTRICTED FETAL GROWTH
COMPLICATED LABOR
PREMATURE BIRTH
LOW BIRTH WEIGHT

WHAT ARE THE SIGNS AND SYMPTOMS OF


ASTHMA?
TIGHTNESS IN THE CHEST
CONSTANT COUGH (ESPECIALLY AT NIGHT OR IN
THE EARLY MORNING)
SHORTNESS OF BREATH
WHEEZING (A WHISTLING SOUND WHEN YOU
BREATHE)

WHAT CAUSES ASTHMA SYMPTOMS?


ALLERGENS
ABOUT 7 OUT OF 10 PEOPLE WITH ASTHMA (70 PERCENT) HAVE
ALLERGIES. AN ALLERGY IS A REACTION TO SOMETHING YOU
TOUCH, EAT OR BREATHE IN THAT MAKES YOU SNEEZE, GET A
RASH OR HAVE TROUBLE BREATHING.
IRRITANTS
IRRITANTS ARE THINGS IN YOURENVIRONMENT THAT MAY HURT
YOUR LUNGS AND TRIGGER ASTHMA SYMPTOMS, INCLUDING AIR
POLLUTION,CIGARETTE SMOKEAND SMOKE FROM WOODBURNING STOVES OR FIREPLACES, COLD AIR AND STRONG
SMELLS, LIKE PAINT OR PERFUMES.

INFECTIONS
INFECTIONS LIKE A COLD, THE FLU OR VIRAL PNEUMONIA,
CAN TRIGGER ASTHMA SYMPTOMS IN SOME PEOPLE.
EXERCISE
EXERCISECAN CAUSE ASTHMA SYMPTOMS IN SOME
PEOPLE. IF YOUR ASTHMA IS UNDER CONTROL, YOU
PROBABLY CAN EXERCISE WITHOUT ANY PROBLEMS. BUT
IF EXERCISING DURING PREGNANCY SETS OFF YOUR
ASTHMA, TALK TO YOUR HEALTH CARE PROVIDER.

HOW IS ASTHMA DIAGNOSED?


ASTHMA CAN BE HARD TO DIAGNOSE. TO FIND OUT IF YOU HAVE ASTHMA,
YOUR HEALTH CARE PROVIDER TAKES YOURHEALTH HISTORY, DOES A
PHYSICAL EXAM AND LISTENS TO YOUR BREATHING.
YOU ALSO MAY GET A LUNG FUNCTION TEST CALLED SPIROMETRY. THIS IS A
TEST THAT CHECKS HOW WELL YOUR LUNGS WORK. DURING THE TEST, YOU
TAKE A DEEP BREATH AND EXHALE (BLOW) INTO A MACHINE CALLED A
SPIROMETER. THIS MACHINE MEASURES THE AMOUNT OF AIR YOU BREATHE
IN AND OUT. IT ALSO MEASURES HOW FAST YOU CAN BREATHE. WHEN
YOURE PREGNANT, NORMAL CHANGES IN YOUR BODY CAN MAKE YOU SHORT
OF BREATH. THIS TEST CAN HELP YOUR PROVIDER KNOW IF SHORTNESS OF
BREATH IS A COMMON COMPLICATION OF PREGNANCY OR IF ITS CAUSED BY
ASTHMA.

SPIROMETRY

SYMPTOMS AND TRIGGERS OF


ASTHMA:
RESPIRATORY INFECTIONS SUCH AS ACOLD,FLU,BRONCHITIS,
ANDSINUSITIS: BOTH BACTERIAL AND VIRAL INFECTIONS CAN TRIGGER AN
ASTHMA ATTACK.

CIGARETTESMOKE (FIRSTHAND OR SECONDHAND)


GASTROESOPHAGEAL REFLUX DISEASE(GERD)
SMOKE FROM COOKING OR WOOD FIRES
EMOTIONAL UPSET
FOODALLERGIES
ALLERGIC RHINITIS (HAY FEVEROR SEASONALALLERGIES)
CHANGES IN WEATHER, ESPECIALLY COLD, DRY AIR
EXERCISE

MANAGEMENT IN ASTHMA:
PREGNANT WOMENMANAGE ASTHMA THE SAME WAY NONPREGNANT WOMEN DO.
LIKE ALL PEOPLE WITH ASTHMA, PREGNANT WOMEN NEED TO HAVE
AN ASTHMA ACTION PLANTO HELP THEM
CONTROLINFLAMMATIONAND PREVENT AND CONTROLASTHMA
ATTACKS.
PART OF A PREGNANT WOMAN'S ACTION PLAN SHOULD BE TO
RECORD FETAL MOVEMENTS. YOU CAN DO THIS BY NOTING
WHETHER FETAL KICKS DECREASE OVER TIME. IF YOU NOTICE LESS
FETAL ACTIVITY DURING AN ASTHMA ATTACK, CONTACT YOUR
DOCTOR OR EMERGENCY HELP IMMEDIATELY TO GET INSTRUCTIONS.

THINGS TO THINK ABOUT FOR ASTHMA IN PREGNANT


WOMEN INCLUDE THE FOLLOWING:
MONITORLUNGFUNCTION CAREFULLY THROUGHOUT YOUR PREGNANCY TO
ENSURE THAT YOUR GROWING FETUS GETS ENOUGH OXYGEN. BECAUSE
ASTHMA SEVERITY CHANGES FOR ABOUT TWO-THIRDS OF WOMEN DURING
PREGNANCY, YOU SHOULD HAVE MONTHLY CHECKUPS WITH YOUR DOCTOR TO
MONITOR YOUR SYMPTOMS AND LUNG FUNCTION.YOUR DOCTOR WILL USE
EITHERSPIROMETRYOR APEAK FLOW METERTO MEASURE YOUR LUNG
FUNCTION.
MONITOR FETAL MOVEMENTS DAILY AFTER 28 WEEKS.
IF YOUR ASTHMA IS NOT WELL CONTROLLED OR IF YOU HAVE MODERATE OR
SEVERE ASTHMA, THINK ABOUT HAVINGULTRASOUNDSAFTER 32 WEEKS TO
MONITOR FETAL GROWTH. ULTRASOUND EXAMS CAN ALSO HELP YOUR
DOCTOR CHECK ON THE FETUS AFTER AN ASTHMA ATTACK.

TRY TO DO MORE TO AVOID AND CONTROLASTHMA


TRIGGERS(SUCH AS TOBACCO SMOKE ORDUST MITES), SO THAT
YOU CAN TAKE LESS MEDICINE IF POSSIBLE. MANY WOMEN HAVE
NASAL SYMPTOMS, AND THERE MAY BE A LINK BETWEEN
INCREASED NASAL SYMPTOMS ANDASTHMA ATTACKS
.GASTROESOPHAGEAL REFLUX DISEASE (GERD), WHICH IS
COMMON IN PREGNANCY, MAY ALSO CAUSE SYMPTOMS.
IT IS IMPORTANT THAT YOU HAVE EXTRA PROTECTION AGAINST
THEFLU (INFLUENZA). GET THEFLU VACCINEAS SOON AS IT'S
AVAILABLE, WHETHER YOU ARE IN YOUR FIRST, SECOND, ORTHIRD
TRIMESTERAT THE TIME. THEFLU VACCINEIS EFFECTIVE FOR ONE
SEASON. THEFLU SHOTIS SAFE IN PREGNANCY AND IS
RECOMMENDED FOR ALL PREGNANT WOMEN.

ASTHMA MEDICATIONS:
BRONCHODILATORSSHORT-ACTING
BRONCHODILATORS RAPIDLY RELIEVE ASTHMA
SYMPTOMS BY RELAXING THE AIRWAYS.
THEY INCLUDE ALBUTEROL (PROVENTIL,
VENTOLIN), METAPROTERENOL (ALUPENT),
TERBUTALINE, AND OTHER DRUGS. SHORT-ACTING
BRONCHODILATORS APPEAR TO BE SAFE DURING
PREGNANCY. SEVERAL STUDIES HAVE SHOWN THAT
THE BABIES OF WOMEN WHO USED THESE DRUGS
DURING PREGNANCY HAD NO INCREASE IN HEALTH
PROBLEMS WHEN COMPARED TO THE BABIES OF

GLUCOCORTICOIDSGLUCOCORTICOIDS ARE USED TO TREAT MANY


CONDITIONS IN ADDITION TO ASTHMA. EXPERIENCE FROM THEIR USE IN
PREGNANT WOMEN SUGGESTS THAT THESE DRUGS ARE GENERALLY
SAFE FOR BOTH THE MOTHER AND THE BABY.
THE GLUCOCORTICOIDS INCLUDE PILLS SUCH AS PREDNISONE AND
INHALED DRUGS SUCH AS BECLOMETHASONE (QVAR),
BUDESONIDE (PULMICORT), AND FLUTICASONE (FLOVENT).
ORAL GLUCOCORTICOIDSSOME STUDIES HAVE SUGGESTED THAT
THERE MAY BE A VERY SMALL INCREASED RISK OF CLEFT LIP OR CLEFT
PALATE IN THE BABIES OF MOTHERS WHO TOOK ORAL GLUCOCORTICOID
MEDICATIONS DURING THE FIRST 13 WEEKS OF PREGNANCY. TWO
STUDIES FOUND A SLIGHTLY INCREASED RISK OF PREMATURE DELIVERY,
AND ONE STUDY FOUND A SLIGHTLY INCREASED RISK OF HAVING A LOW
BIRTH WEIGHT BABY. HOWEVER, THE RESEARCHERS COULD NOT RULE
OUT THE POSSIBILITY THAT THESE EFFECTS WERE RELATED TO THE
SEVERITY OF ASTHMA AND NOT TO THE USE OF THE DRUG.

INHALED GLUCOCORTICOIDS A VARIETY


OF INHALED GLUCOCORTICOIDS HAVE BEEN
USED DURING PREGNANCY. BUDESONIDE IS
THOUGHT TO BE ONE OF THE SAFEST INHALED
GLUCOCORTICOIDS. BECLOMETHASONE HAS
ALSO BEEN USED EXTENSIVELY DURING
PREGNANCY.

LEUKOTRIENE MODIFIERSSOME DRUGS HELP CONTROL ASTHMA BY


BLOCKING THE LEUKOTRIENE PATHWAY, WHICH PLAYS AN IMPORTANT ROLE IN
ASTHMA.
THESE DRUGS INCLUDE MONTELUKAST (SINGULAIR), ZAFIRLUKAST
(ACCOLATE), AND ZILEUTON (ZYFLO). THREE STUDIES HAVE SHOWN THAT
INFANTS OF PREGNANT WOMEN WHO TOOK MONTELUKAST OR ZAFIRLUKAST
HAD NO INCREASE IN MAJOR BIRTH DEFECTS OR ADVERSE OUTCOMES.
LITTLE IS KNOWN ABOUT THE SAFETY OF ZILEUTON IN PREGNANT WOMEN.
IF YOU ARE TAKING ZILEUTON AND PLANNING TO BECOME PREGNANT,
DISCUSS WHETHER TO STOP ZILEUTON WITH YOUR DOCTOR.
ANTIHISTAMINESALTHOUGH ANTIHISTAMINES ARE NOT USED TO
DIRECTLY TREAT ASTHMA, THEY MAY BE USED TO TREAT THE ALLERGIES THAT
OFTEN ACCOMPANY ASTHMA. THESE DRUGS INCLUDE DIPHENHYDRAMINE
(BENADRYL), CHLORPHENIRAMINE (CHLOR-TRIMETON AND OTHERS),
LORATADINE (CLARITIN), FEXOFENADINE (ALLEGRA), AND CETIRIZINE
(ZYRTEC).

STUDIES IN BOTH ANIMALS AND HUMANS SUGGEST THAT


ANTIHISTAMINES CAUSE NO INCREASE OR ONLY A VERY SMALL
INCREASE IN THE RISK FOR BIRTH DEFECTS WHEN TAKEN
DURING PREGNANCY. OF THE CURRENTLY AVAILABLE
PREPARATIONS, CHLORPHENIRAMINE (WHICH CAN BE
SEDATING), LORATADINE, OR CETIRIZINE ARE CONSIDERED THE
ANTIHISTAMINES OF CHOICE FOR USE DURING PREGNANCY.
DECONGESTANTSDECONGESTANTS ARE NOT USED FOR
THE TREATMENT OF ASTHMA, BUT MAY BE USED TO TREAT THE
SYMPTOMS OF UPPER AIRWAY ALLERGIES. PSEUDOEPHEDRINE
(SUDAFED) IS A DECONGESTANT THAT IS COMMONLY
AVAILABLE.

IMMUNOTHERAPYIMMUNOTHERAPY
REFERS TO REGULAR INJECTIONS (ALLERGY
SHOTS) THAT ARE GIVEN TO REDUCE A
PERSON'S SENSITIVITY TO ALLERGENS. THIS
THERAPY APPEARS TO BE SAFE DURING
PREGNANCY, ALTHOUGH IT CARRIES A VERY
SMALL RISK OF A SEVERE ALLERGIC REACTION
(ANAPHYLAXIS) IN ANY PERSON, INCLUDING
PREGNANT WOMEN.