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Asthma in pregnancy


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Nigeria

 

Image: Dr. Samuel Adebayo

 

ASTHMA is a common chronic disease worldwide, affecting about 235 million people. The rate of asthma is rising worldwide. The pathphysiology of asthma is complex and involves airway inflammation, intermittent airflow obstruction and bronchial hyper responsiveness.

Asthma usually presents as acute exacerbation, intermittent with symptom-free periods. Most asthmatic attacks are usually short-lived, mostly between few minutes and few hours. Most recent studies of asthma in pregnancy show that two-fifths of all asthma in pregnancy will get worse during pregnancy; while two-fifths will remain unchanged and the last one-fifth will get better during pregnancy.

Other findings predict that one-third will get worse, one-third will get better, while one-third will remain unchanged during pregnancy.

Recent studies also show that women with  severe asthma seem more likely to suffer post-partum (post-delivery) relapse, close to 10 per cent of asthmatic pregnant patients may suffer acute attack in labour. Unfortunately, the precise effect that asthma has on pregnancy is not clear.

The prevalence of asthma in general population is between four and five per cent, while in pregnancy, it is a wide range between one and four per cent.

Generally, women with mild asthma may not have any problem throughout the pregnancy period, but severe asthma may pose greater risk of deterioration, which is worse in the last few weeks of pregnancy.

Severe or poorly controlled asthma has been associated with numerous adverse pregnancy outcome, which may include pre-term labour and premature birth; foetal growth restriction, pregnancy-induced hypertension, pre-eclampsia, low birth weight, uterine haemorrhage, congenital abnormalties, etc. It may also be associated with neonatal hypoglycemia, trachypnea, seizures and neonatal intensive care admission.

Good control of asthma appears to reduce the risk of small baby or pre-term birth. Low- birth-weight infants are more common in women with recurrent asthmatic attack with daily symptoms or low expiratory flow than women without asthma.

Presentation of asthma in pregnancy is similar to those without pregnancy, which include chest tightness, wheeziness, coughs, breathlesness, especially in the early hours of the morning.

Some conditions in pregnancy may present as asthma. They include airway obstruction, amniotic fluids embolism, acute congestive heart failure, etc. At times, physiologic dyspnea of pregnancy, especially in a woman carrying multiple foetuses like twins, triplets or higher, may mimmic mild asthma.

Diagnosis of asthma in pregnancy starts from the detailed history of the woman before pregnancy. Most asthmatic women in pregnancy are already aware of the diagnosis either from childhood or long before the onset of pregnancy. It is extremely rare to diagnose asthma or present for the first time in pregnancy; so, there is history of known asthma before pregnancy, which will include cough, shortness of breath, chest tightness, noisy breathing, recurrent history of asthma or similar allergic reactions, e.g. emphysema.

Clinical findings, on examination, may include tachypnea (fast breathing), difficulty in breathing, obvious respiratory distress, diffused wheezes, diffused bronchi, or bronchovesicular sounds.

With good history and thorough clinical assessment, accurate diagnosis of asthma in pregnancy can be achieved. Chest X-ray may be indicated if there is co-existing conditions like pneumonia, congestive heart failure, etc.

Looking at the underlying predisposing factors to asthma, asthma results from a complex and poorly defined interraction of genetic predisposing and environmental stimulations. The mechanisms for abnormal overraction of the lungs to stimulus is unknown. Common stimuli includes allergens like pollens, dust, cockroach antigen, etc. Irritants like  cigarette smoke, wood smoke, air pollution, dust, chemicals, etc., can also trigger the attack.

Also, asthma can be aggravated by medical conditions like upper respiratory infections, malaria, oesophageal issues. Again, drugs and chemicals, including reflux, aspirin, beta blockers, etc., as well as rigorous exercise, cold, emotional stress, menses, etc., can  aggravate or initiate acute asthmatic attack.

Almost all anti-asthma drugs are safe in pregnancy, but undertreatment is very common because the patient or, sometimes, even the doctor, may be worried about the effects of the medication on the foetus.

The basic goal of the medications are to suppress the reaction to stimulus, reduce secretions along the lungs, reduce inflammation (swelling of the bronchi) and also to dilate the bronchioles. Also, adequate foetal surveillance in form of ultrasound scan should be done.

Management of asthma in pregnancy during antenatal depends on the severity of the illness. In most cases, outpatient management on bronchodilator and corticosteroid may just be enough. In few severe cases, there may be need to admit at the emergency unit, give oxygen support, among other care, for stabilisation.

In labour, asthmatics are adequately monitored. Labour must be actively managed to avoid prolonged period of labour. Medications like ergometrin must be avoided. Close monitoring also continues after delivery.

Several simple steps can help control environmental factors that worsen or trigger asthmatic attacks. For example, the patient must avoid exposure to specific allergens like strong perfumes, insecticides, etc. She should cover mattress, pillows and upholstery with leather to reduce exposure to dust mites.

Pregnant women should avoid smoking or second-hand smoke. She should also avoid kitchen smokes, e.g. from kerosene stove, wood, etc. Pregnant asthmatics must register early in a standard health facility and have a good asthmatic control during pregnancy to avoid likely complications.

Article Credit: Punch Newspaper

Updated 6 Years ago
 

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