Asthma is a common condition affecting approximately 8% of pregnant women. Epidemiological evidence demonstrates that the course of asthma during pregnancy is variable and unpredictable, with approximately one-third of women experiencing an improvement, one-third experiencing a worsening, and one-third having no changes in asthma symptoms. It is also apparent that poor control of maternal asthma leads to increased risk of adverse maternal and fetal outcomes. Because of these risks and the unpredictable course of asthma symptoms, it is especially important to provide appropriate monitoring and management of the asthmatic patient throughout pregnancy.
Women with well-controlled asthma usually have good pregnancy outcomes. Pregnancy in women with more severe asthma can precipitate worsening control and lead to increase in maternal and neonatal morbidity.
Symptoms Breathlessness, cough, wheeze, chest tightness and nocturnal waking due to cough.
Signs Raised respiratory rate, wheeze, use of accessory muscles and tachycardia.
Triggering Factors Pollen, animal fur, dust, exercise, cold, emotion, upper respiratory infections and medications (aspirin and beta blockers).
Symptoms of asthma peak in the late second or early third trimester, but exacerbations are rare during labor and the peripartum period.
Physical examination in people with bronchial asthma may be normal, but the most frequent physical sign is wheezing on auscultation. Wheezing may be absent in cases of severe bronchial asthma exacerbations as a result of severe reduction of airflow (silent chest).
Given below are a number of changes that happen during pregnancy that have an effect on bronchial asthma.
The quantity of asthma medicines that get into breast milk is very little. According to the NAEPP, prednisone, theophylline, antihistamines, ICSs, beta agonists and cromolyn can be taken by women breastfeeding their children. Women should be made aware that the medicines should be kept to the minimum necessary for control. Taking the medicines after breastfeeding is advised.
Uncontrolled asthma in pregnancy has been linked with a higher incidence of low fetal birth weight and preterm birth. However, in general, the prognosis of asthma in pregnancy is similar to that of asthma in other populations. Patients who are pregnant and diagnosed with bronchial asthma should receive adequate asthma assessment and treatment. Bronchial asthma should be treated and managed in pregnant women the same way as in non-pregnant patients.
Pregnant women should be made to understand that having asthma under control is essential for the well-being of the fetus. It is necessary for the patients to have some basic knowledge about asthma. They should know the proper use of controller and rescue medications and should be able to identify what sets off the condition. They should be able to monitor themselves and should also have regular consults with a clinician to make sure asthma is under control.
Dr. Anantha Subramanian Consultant Pulmonologist Kauvery Hospital
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