Asthma and pregnancy

Abstract

•Asthma is the most common lung disease during pregnancy and its diagnosis is determined in the same way in pregnant and non-pregnant women. •Spirometry is a simple test used to confirm and monitor the disease, and has no contraindications for use during pregnancy both in the pre- and post-bronchodilator phase. •The control of asthma before pregnancy is the main predictor of disease severity during pregnancy. Other predictors of asthma attacks include smoking, overweight and obesity. •Inadvertent interruption of maintenance medication is one of the factors most associated with exacerbation and complications related to asthma during pregnancy. •In general, treatment of pregnant women with asthma should be similar to that of non-pregnant women. Inhaled corticosteroids (ICS) are the main medication to achieve and maintain control of the disease during pregnancy. •Corticosteroids prescribed for maintenance treatment of chronic asthma have no effect on accelerating fetal maturity. The usual protocol should be used when this acceleration is necessary. •Moderate asthma exacerbation includes at least one of the following criteria: 1) worsening of respiratory symptoms; 2) worsening of lung function; 3) increased use of inhaled pump medication (e.g., salbutamol; at least two-day duration). •Severe asthma exacerbation includes at least one of the following criteria: 1) use of systemic corticosteroids or increased dose of maintenance oral corticosteroids for at least three days; 2) hospitalization or visit to the emergency room (ER) due to asthma requiring the use of systemic corticosteroids. •Asthma does not normally affect labor or the choice of delivery route.

Figure 1. Proposed treatment flowcharts. The solid arrow shows the progression of medication use and the hatched arrow shows the de-escalation of medications

Figure 2. Flowchart of care (diagnosis and management) for pregnant women with asthma