Asthma in pregnancy

Question 1

Why is it vital that asthma is well managed in pregnancy?

Answer 1

• prevent asthma attacks
• ensure sufficient maternal/fetal oxygenation
• increased risk of pregnancy complications such as intrauterine growth restriction, preterm birth, hypoxia, stillbirth
• women with well managed asthma have same outcomes as non-asthmatic women

Question 2

What usually happens to asthma in pregnancy?

Answer 2

• stays the same or improves for about 40% of women

- worsens for 60% of women - particularly between 17 and 34 weeks gestation

Question 3

What prepregnancy couselling should be offered for women with asthma?

Answer 3

• stop smoking
• assess asthma and ensure good management prior to pregnancy
• reassure that most asthma medications are safe to continue in pregnancy
• identify triggers and discuss avoidance strategies
• encourage self-monitoring for signs of deteriorating control
• consider influenza vaccine

Question 4

What is asthma?

Answer 4

a chronic inflammatory disease of the airways with periodic reversible airway narrowing characterised by breathlessness, wheezing, and coughing

Question 5

What medications are used to treat asthma in pregnancy?

Answer 5

• classified as relievers and preventers
  Relievers
• inhaled short acting B2 agonists (SABAs) such as salbutamol and terbutaline
• inhaled long acting B2 agonists (LABAs) such as salmeterol, eformoterol
  Preventers
• inhaled corticosteroids such as budesonide, less evidence for others but also beclomethasone, fluticasone and ciclesonide
  May also consider treatment for allergies/hayfever that may trigger asthma
  e.g. seretide (combined corticosteroid and LABA), Pulmicort (budesonide inhaled corticosteroid), Ventolin (salbutamol SABA)
• treatment usually includes SABA as needed for symptom relief, then add inhaled corticosteroid and/or LABA depending on severity

Question 6

What normal physiological changes in pregnancy may impact dosage of asthma medication?

Answer 6

• increased alveolar ventilation
• increased circulating volume
• increased particle absorption and diffusion of inhaled medications
• often less drug is required to achieve same effect as pre-pregnancy

Question 7

Are asthma treatments usually considered safe in pregnancy?

Answer 7

• most asthma medications are considered safe in pregnancy and should be continued - both relievers and preventers
• risk of harm to baby if uncontrolled asthma or asthma attack
• risk asthma may get worse in pregnancy
• ventolin category A
• seretide category B3 (no evidence for adverse effect on baby)

Question 8

What considerations are there for giving ergometrine to asthmatic women?

Answer 8

• ergometrine may cause bronchospasm, especially where there is general anaesthetic
• syntometrine seems to be ok as third stage prophylaxis

Question 9

What intrapartum considerations are important for women with asthma?

Answer 9

• pain relief
• prefer regional to general anaesthesia
• continue asthma management
• maintain hydration and analgesia as required
• usually vaginal birth, occasionally with very severe asthma women may be advised to have IOL or LUSCS after 37 weeks at a time when asthma is very well controlled

Question 10

What considerations are important for asthmatic women breastfeeding?

Answer 10

• breastfeeding should be encourages as it may reduce risk of asthma particularly for children with family history of atopy
• no contraindication to breastfeeding associated with any asthma medications