Asthma in pregnancy - Clinicals, Diagnosis, and Management

Obstetrics

Clinicals - History

Fact Explanation
Cough Dry and unproductive nocturnal cough is characteristic of bronchial asthma. Cough
Dry and unproductive nocturnal cough is characteristic of bronchial asthma.
Wheezing Wheezing is a common presentation of asthma. The quality of life and sleep should be assessed in patients because nocturnal exacerbation are common in asthma. Wheezing
Wheezing is a common presentation of asthma. The quality of life and sleep should be assessed in patients because nocturnal exacerbation are common in asthma.
Chest tightness Chest tightness is another presentation of asthma. Chest tightness
Chest tightness is another presentation of asthma.
History of bronchial asthma Most of the pregnant ladies have a history of bronchial asthma. However some females may be diagnosed at the time of the pregnancy. History of bronchial asthma
Most of the pregnant ladies have a history of bronchial asthma. However some females may be diagnosed at the time of the pregnancy.

Clinicals - Examination

Fact Explanation
Tachypnea Patients with acute exacerbations are tachypneic and may avoid speaking and lying down due to tachypnea. Tachypnea
Patients with acute exacerbations are tachypneic and may avoid speaking and lying down due to tachypnea.
Use of accessory muscles of respiration Increased airway resistance increases the work load of breathing, so accessory muscles of respiration are used as evidenced by suprasternal, substernal and intercostal recessions. Use of accessory muscles of respiration
Increased airway resistance increases the work load of breathing, so accessory muscles of respiration are used as evidenced by suprasternal, substernal and intercostal recessions.
Tracheal tug Tracheal tug is present due to hyperinflation of the lungs. Tracheal tug
Tracheal tug is present due to hyperinflation of the lungs.
Wheezing Wheezing is produced by airway hyperreactivity and bronchospasm. Silent chest is indicative of severe asthma, as there is no airflow to produce breath sounds. Wheezing
Wheezing is produced by airway hyperreactivity and bronchospasm. Silent chest is indicative of severe asthma, as there is no airflow to produce breath sounds.
Pulse Patients with acute exacerbation of asthma have tachycardia and it indicates severity of asthma. Severe exacerbation causes pulsus paradox. Pulse
Patients with acute exacerbation of asthma have tachycardia and it indicates severity of asthma. Severe exacerbation causes pulsus paradox.
Cyanosis Patients can develop peripheral cyanosis which might progress to central cyanosis if not treated. Cyanosis
Patients can develop peripheral cyanosis which might progress to central cyanosis if not treated.
Altered consciousness Patients develop altered level of consciousness with severe asthma and it is considered a premorbid sign. Altered consciousness
Patients develop altered level of consciousness with severe asthma and it is considered a premorbid sign.

Investigations - Diagnosis

Fact Explanation
Spirometry Reduced FEV1 or 12% or greater improvement in FEV1 after inhalation of a beta agonist (albuterol) can be used to diagnose bronchial asthma. Spirometry
Reduced FEV1 or 12% or greater improvement in FEV1 after inhalation of a beta agonist (albuterol) can be used to diagnose bronchial asthma.
Peak flow meter Peak flow meter measures the airflow through the bronchi so it indicates the degree of airway obstruction. During acute exacerbation peak expiratory flow rate is decreased. Peak flow meter
Peak flow meter measures the airflow through the bronchi so it indicates the degree of airway obstruction. During acute exacerbation peak expiratory flow rate is decreased.

Investigations - Management

Fact Explanation
Pulse oximetry Continuous monitoring of oxygen saturation is indicated and oxygen saturation should be maintained at 95% or more. Pulse oximetry
Continuous monitoring of oxygen saturation is indicated and oxygen saturation should be maintained at 95% or more.
Monitoring of fetal well being Fetal ultrasound scan is necessary for evaluation of fetal well being. Fetal movements, liquor volume and growth parameters are being assessed. Cardiotocogram is helpful in detecting fetal cardiac activity. Monitoring of fetal well being
Fetal ultrasound scan is necessary for evaluation of fetal well being. Fetal movements, liquor volume and growth parameters are being assessed. Cardiotocogram is helpful in detecting fetal cardiac activity.
Methacholine testing Females who are diagnosed to have bronchial asthma during pregnancy should undergo methacholine testing during the postpartum period. This test demonstrates airway hyperreactivity and it is not indicated during the period of pregnancy. Methacholine testing
Females who are diagnosed to have bronchial asthma during pregnancy should undergo methacholine testing during the postpartum period. This test demonstrates airway hyperreactivity and it is not indicated during the period of pregnancy.

Management - Supportive

Fact Explanation
Health education Females with asthma are at increased risk of preeclampsia, preterm birth, low birth weight, intrauterine growth retardation, and congenital malformations of the infant and perinatal death. However better symptom control is associated with good outcome. Hence patients should be advised to be compliant with treatment.
Patients should be educated about the inhaler technique.
avoidance of triggers should be done always if possible.
Smoking both active and passive should be quit.
Health education
Females with asthma are at increased risk of preeclampsia, preterm birth, low birth weight, intrauterine growth retardation, and congenital malformations of the infant and perinatal death. However better symptom control is associated with good outcome. Hence patients should be advised to be compliant with treatment.
Patients should be educated about the inhaler technique.
avoidance of triggers should be done always if possible.
Smoking both active and passive should be quit.

Management - Specific

Fact Explanation
Inhaled oxygen Oxygen should be administered in almost all the patients with acute exacerbation of asthma. Inhaled oxygen
Oxygen should be administered in almost all the patients with acute exacerbation of asthma.
Corticosteroids Inhaled corticosteroids is the most effective controller medication used. If the disease is not controlled with inhaled corticosteroids alone, add-on therapy with long-acting β-agonists, leukotriene-receptor antagonists or theophylline is indicated.
Oral corticosteroids can be used in severe cases.
Systemic corticosteroids is administered via an intravenous line during an acute exacerbation of asthma.
Patients who require high doses of inhaled corticosteroids can be treated with fluticasone.
Corticosteroids
Inhaled corticosteroids is the most effective controller medication used. If the disease is not controlled with inhaled corticosteroids alone, add-on therapy with long-acting β-agonists, leukotriene-receptor antagonists or theophylline is indicated.
Oral corticosteroids can be used in severe cases.
Systemic corticosteroids is administered via an intravenous line during an acute exacerbation of asthma.
Patients who require high doses of inhaled corticosteroids can be treated with fluticasone.
β-agonists Inhaled short acting β-agonists are used as relievers, as this provides a symptomatic relief during an acute exacerbation.
Long acting β-agonists are used as preventers.
Intravenous β2 agonists are indicated in the management of acute exacerbation refractory to inhalation therapy.
β-agonists
Inhaled short acting β-agonists are used as relievers, as this provides a symptomatic relief during an acute exacerbation.
Long acting β-agonists are used as preventers.
Intravenous β2 agonists are indicated in the management of acute exacerbation refractory to inhalation therapy.
Inhaled anticholinergic drugs Combination of inhaled β-agonists and anticholinergic drugs(ipratropium) are used in the treatment of acute exacerbation of asthma. Inhaled anticholinergic drugs
Combination of inhaled β-agonists and anticholinergic drugs(ipratropium) are used in the treatment of acute exacerbation of asthma.
Leukotrine modifiers Although its safety during pregnancy is doubtful, leukotrine modifiers are recommended to be continued in patients with resistant asthma who showed significant response to leukotrine modifiers. Leukotrine modifiers
Although its safety during pregnancy is doubtful, leukotrine modifiers are recommended to be continued in patients with resistant asthma who showed significant response to leukotrine modifiers.
Intravenous aminophylline Intravenous aminophylline is used in emergency situations where inhalation therapy fails. Intravenous aminophylline
Intravenous aminophylline is used in emergency situations where inhalation therapy fails.

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