Asthma during pregnancy

Asthma occurs in people very often, including pregnant women. Some women suffer from asthma during pregnancy, although before that there was never the slightest sign of the disease. But during pregnancy, asthma not only affects the body of a woman, but also limits the access of oxygen to a child. But this does not mean that asthma complicates or increases the danger to a woman and to a child during pregnancy. In women with asthma, with the proper control of the disease, pregnancy passes with minimal risk or at all risk for the woman herself and her fetus.

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

Risks of refusing treatment during pregnancy

If previously you did not have the slightest signs of asthma, then you do not need to be so sure that dyspnea or wheezing during pregnancy is a sign of asthma. Very few women, who know for sure that they have asthma, draw attention to minor symptoms. But we must not forget that asthma affects not only your body, but the fetus, so you need to take preventive measures in time.

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

  • High blood pressure during pregnancy.
  • Pre-eclampsia, a disease that increases blood pressure and can affect the placenta, kidneys, liver and brain.
  • Greater than usual toxicosis in the early stages of pregnancy (hyperemesis of pregnant women).
  • Births that occur unnaturally (the attending physician causes the onset of labor) or go through with complications.

Risks to the fetus:

  • Sudden death before or after birth (perinatal mortality).
  • Poor development of the fetus (retardation of intrauterine development). Small child weight at birth.
  • The onset of labor until 37 weeks of pregnancy (premature birth).
  • Low birth weight.

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

Asthma and pregnancy

Management of asthma in pregnant women occurs in the same way as in non-pregnant women. Like any other asthmatic, a pregnant woman should follow prescribed treatment and adhere to a treatment program to control inflammation and prevent asthma attacks. Part of the treatment program for a pregnant woman should be reserved for monitoring the movements of the fetus. This can be done independently, recording each movement of the fetus. If you notice that during an attack of asthma the fetus became less moving, immediately contact your doctor or call an ambulance.

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Overview of asthma treatment in a pregnant woman:

  • If more than one specialist participates in the treatment of a pregnant woman suffering from asthma, they
    Asthma during pregnancy
    Asthma during pregnancy

    must work together and coordinate their actions. In the treatment of asthma, an obstetrician should also participate.
  • It is necessary to carefully monitor the lung function during the entire pregnancy – the child should receive a sufficient amount of oxygen. Since the severity of asthma may change in the second half of a woman’s pregnancy, regular examination of symptoms and pulmonary function is necessary. For the examination of pulmonary function, the attending physician uses spirometry or a pneumotachometer.
  • 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. Ultrasound examination also helps the doctor to examine the condition of the fetus after an asthma attack.
  • Try to do everything possible to avoid and control asthma triggers (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 connection between nasal symptoms and asthma attacks. Gastroesophageal reflux disease (GERD), especially common during pregnancy, can also exacerbate symptoms.
  • It is very important to protect yourself from the flu. It is necessary to get vaccinated against the flu before the season starts – sometimes from the beginning of October to the middle of November in the first, second or third trimester of pregnancy. The vaccine against influenza only lasts one season. It is absolutely safe during pregnancy and is recommended for all pregnant women.

Most pregnant women except for asthma have allergies, for example, allergic rhinitis. Therefore, the treatment of allergies is a very important part of the management and management of asthma.

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

Preparations for asthma and pregnancy

The results of studies in animals and on people taking asthma medications during pregnancy found not many side effects to which a woman and her child are exposed. It is much safer to take asthma medications during pregnancy than to leave it as it is. Poor control of the disease brings more harm to the fetus than the drugs. Budesonide, approved by the Food and Drug Administration, is the safest inhaled corticosteroid for taking during pregnancy. One study showed that small doses of an inhaled corticosteroid are safe for the woman herself and for her fetus.

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That’s what is recommended for admission during pregnancy.

Recommendations for taking medication during pregnancy

Degree of severity

Medications for daily intake, necessary to maintain long-term control of the disease

Heavy permanent shape

Preferably:

  • A large dose of an inhaled corticosteroid, preferably budesonide, AND
  • An inhaled beta-2 long-acting agonist (eg, salmeterol or formoterol) OR
  • Combination of drugs that contain a large dose of a corticosteroid and a long-acting beta-2 agonist (eg, Advair Diskus) AND IF NECESSARY
  • Tablets or corticosteroid long-acting 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 take oral corticosteroids for a long time, a specialist consultation is necessary.

Alternative:

  • A large dose of inhaled corticosteroids AND
  • Theophylline with prolonged action, serum concentration from 5 to 12 mg / ml

Medium constant form

Preferably:

  • OR a small dose of inhaled corticosteroids, preferably budesonide, and an inhaled beta-2 long-acting agonist OR
  • The average dose of an inhaled corticosteroid
  • IF NECESSARY for women with recurrent asthma attacks, the average dose of an inhaled corticosteroid and an inhaled beta-2 long-acting agonist

Alternative:

  • A small dose of an inhaled corticosteroid, preferably budesonide, or a modifier of leukotriene or theophylline (methylxanthine)
  • The average dose of an inhaled corticosteroid and / or a leukotriene modifier, or theophylline, if necessary

Minor permanent form

Preferably:

  • A small dose of inhaled corticosteroids, preferably budesonide

Alternative:

  • Mast cell stabilizer or leukotriene modifier OR
  • Theophylline with prolonged action, serum concentration from 5 to 12 mg / ml

Periodic

  • The daily taking of medication is not necessary
  • A fast-acting bronchodilator to relieve the symptoms that appear and pass: 2-4 strokes of an inhaled beta-2 fast acting agonist depending on the symptoms. For this, it is better to choose albuterol. If you take albuterol more than two days a week, the attending physician should prescribe treatment, as for a permanent form with minimal symptoms.
  • More serious seizures may occur with greater interruptions without a single symptom or impairment of pulmonary function. For serious attacks it is recommended to take a course of taking tablets, syrup or injections of a corticosteroid.

Fast rescue:for all patients

  • A fast-acting bronchodilator: 2 to 4 strokes for an inhalation beta-2 fast acting agonist, depending on the symptoms. It is preferable to take albuterol.
  • The intensity of treatment depends on the severity of the attack. It may be necessary to take a one-time treatment with aerosol or up to three approaches with interruptions of 20 minutes. In addition, it may be necessary to undergo a course of treatment with tablets, syrup or corticosteroid injections.
  • Receiving a beta-2 fast-acting agonist more than two per week (except for stress asthma cases) suggests that treatment should be reviewed.
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Never stop taking or lowering the dose of medication without the doctor’s permission. Make any changes to the treatment you need only after the pregnancy.

The drugs that can cause potential harm to the fetus include epinephrine, alpha-adrenergic components (other than pseudoepinephrine), decongestants (other than pseudoepinephrine), antibiotics (tetracycline, sulfanilamide preparations, ciprofloxasin), immunotherapy (stimulation or dose increase), and iodides. Before you start taking the medicine, being pregnant or intending to become pregnant, you need to consult a specialist.

Asthma during pregnancy
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