Good to know 

Pregnancy with bronchial asthma. Bronchial asthma

In the modern world, more and more women suffer from bronchial asthma. However, sooner or later every woman faces the question of motherhood. Lack of control of bronchial asthma during pregnancy can threaten with various complications not only for the mother's body, but also for the fetus.

Modern medicine claims that bronchial asthma and pregnancy are quite compatible things.

Because correctly chosen therapy and regular medical supervision increase the chances of maintaining the health of the mother and giving birth to a healthy baby.

The course of the disease during pregnancy

It is very difficult to predict how pregnancy will flow with bronchial asthma. It has been noticed that women suffering from mild or moderate asthma did not notice any deterioration in their health while carrying a child. There are times when it, on the contrary, has improved. In patients with a severe course of the disease, an exacerbation of asthma was quite often observed, the number of attacks and their severity increased. To avoid such manifestations, it is necessary to be under regular supervision not only by a gynecologist, but also by a pulmonologist.

Important! If the disease begins to worsen, then hospitalization is necessary, where the drugs taken are replaced with safer ones, which will not have a negative effect not only on the fetus, but also on the mother's body.

There is also a tendency that bronchial asthma in pregnant women in the first trimester is much more severe than in the following weeks.

The following are the complications that the expectant mother may develop:

  • more frequent attacks;
  • the risk of premature birth;
  • risk of miscarriage;
  • the appearance of toxicosis.

A pregnant woman with asthma receives an insufficient amount of oxygen, as a result of which the placental blood flow is also less enriched with it. In addition, along with asthma, it can cause hypoxia in the fetus, which is fraught with the following possible complications for it:

  • low fetal weight;
  • developmental delay;
  • possible violations of the cardiovascular and muscular systems;
  • the risk of injury during childbirth increases;
  • suffocation.

All of the above consequences develop exclusively with the wrongly chosen therapy. During adequate treatment, pregnancy with asthma often ends with the birth of a healthy baby with normal weight. A single, common consequence is the baby's predisposition to allergic manifestations. Therefore, during the period of breastfeeding, the mother must strictly adhere to an anti-allergic diet.

Most often, a deterioration in a woman's well-being is observed from 28-40 weeks, when a period of active growth of the fetus occurs, which leads to a limitation of the motor function of the lungs. However, before the delivery process, when the baby descends into the pelvic area, the mother's well-being improves.

Usually, if the disease is not out of control and the woman is not in danger, then natural childbirth is recommended.

To do this, 2 weeks before the upcoming birth, the woman is hospitalized, where she and the baby are monitored around the clock. At delivery, she is injected with drugs that prevent the development of an attack, which do not have a negative effect on the fetus.

On the day of childbirth, a woman is injected with hormonal agents every 8 hours, 100 mg, and the next day, every 8 hours, 50 mg intravenously. Further, there is a gradual abolition of hormonal drugs or a transition to oral administration of the usual dosage.

If a woman notices a deterioration in well-being, her attacks become more frequent, then at 38 weeks delivery is carried out using a cesarean section. By this time, the baby is mature enough to live outside the mother's body. If surgery is not done, then both the mother and the child increase the risk of developing the above complications. During a caesarean section, epidural anesthesia is desirable, as general anesthesia can aggravate the situation. In the case of using general anesthesia, the doctor is more careful about the selection of the drug.

Treatment of the disease during pregnancy

Treatment of bronchial asthma in pregnant women is somewhat different from conventional therapy. Since some drugs are contraindicated for use, others require a significant reduction in dosage. Therapeutic actions are based on preventing the exacerbation of bronchial asthma.

The following are the main therapeutic objectives:

  1. Improving respiratory function.
  2. Prevention of asthma attacks.
  3. Stopping an attack of suffocation.
  4. Avoiding the influence of side effects of medications on the fetus.

In order for asthma and an ongoing pregnancy to be completely compatible with each other, a woman must follow these recommendations:


Medicines not recommended during pregnancy

The following are drugs that require careful use or are prohibited for use during pregnancy:


Important! During pregnancy, immunotherapy with allergens is prohibited, since this procedure gives a 100% guarantee that the baby will have it.

How to stop an asthma attack in a pregnant woman?

Unfortunately, during pregnancy, patients also have attacks of suffocation, which must be quickly stopped. First of all, you should calm down, open the window for better air flow, unfasten the collar and call an ambulance.

It is better for a woman to sit on a chair facing the back, resting her hands on her hips. So that the chest is in a deployed position. In this way, you can take a relaxing position and use the accessory pectoral muscles. as follows:


Important! It is forbidden to use Intal aerosol to stop an attack, as it can significantly aggravate the situation. This drug is used to prevent the development of asthma attacks.

Maintaining normal indicators of the function of external respiration (FVD) during gestation (bearing a child) is necessary to maintain the woman's well-being and the correct development of the fetus. Otherwise, hypoxia occurs - oxygen starvation, which entails many adverse consequences. Let's see what features bronchial asthma has during pregnancy and what are the basic principles of therapy for the disease and prevention of exacerbations.

Causes

Although the development of asthma can coincide with the period of gestation, a woman usually suffers from this disease even before conception, often from childhood. There is no single reason for the onset of an inflammatory process in the respiratory system, however, there are a fairly large number of provoking factors (triggers):

  1. Genetic predisposition.
  2. Taking medications.
  3. Infections (viral, bacterial, fungal).
  4. Smoking (active, passive).
  5. Frequent contact with allergens (household dust, mold, professional triggers - latex, chemicals).
  6. Unfavorable ecological situation.
  7. Poor nutrition.
  8. Stress.

Patients suffer from asthma throughout their lives, and the course of the disease usually worsens in the first trimester and stabilizes (with adequate therapy) in the second half of pregnancy. Between periods of remission (absence of symptoms), exacerbations occur due to a number of triggers:

  • contact with allergens;
  • unfavorable weather conditions;
  • excessive physical activity;
  • a sharp change in the temperature of the inhaled air;
  • dustiness of premises;
  • stressful situations.

Asthma that develops in the early trimester of pregnancy may spontaneously disappear by the end of the first half of the gestation period.

This phenomenon is observed in women whose mothers suffered episodes of bronchial obstruction (narrowing of the airway as a result of spasm) during their own pregnancy. However, it is not common. Asthma attacks can not only disappear without a trace, but also transform into the so-called true, already chronic asthma.

Although the disease is not always associated with allergies, it is immune disorders that underlie the pathogenesis (mechanism of development) of most episodes. The key link in the formation of the reaction is hyperreactivity, or increased, heightened sensitivity of the bronchi to stimuli of various nature.

Why is asthma dangerous during pregnancy?

In addition to the usual risks associated with suffocation and hypoxia (oxygen deprivation), bronchial asthma during pregnancy increases the likelihood of conditions and consequences such as:

  • early toxicosis;
  • the formation of the threat of termination of pregnancy;
  • the development of violations of labor;
  • spontaneous abortion.

In addition, the mother's illness can affect the health of the fetus (during exacerbations, it suffers from hypoxia) and the newborn baby. Asthma symptoms may appear in him already in the first year of life, although most episodes of hereditary asthma are still recorded in children older than this age. There is also a tendency to diseases of the respiratory system - including infectious pathologies.

Symptoms

During the period of remission of asthma, a pregnant woman feels well, but in case of relapse, an attack of suffocation develops. An exacerbation usually begins at night and lasts from a few minutes to hours. First, the "harbingers" appear:

  • runny nose;
  • sore throat;
  • sneezing;
  • chest discomfort.

Soon, a combination of characteristic signs can be observed:

  1. Shortness of breath with difficulty in exhaling.
  2. Paroxysmal cough.
  3. Noisy breathing, audible at a distance from the patient.
  4. Dry wheezing in lungs.

The woman assumes a seated position and tenses the muscles of the chest, shoulder girdle and neck to ease shortness of breath. She has to rest her hands on a hard surface. The face becomes bluish, cold sweat appears on the skin. The separation of viscous, "glassy" sputum indicates the end of the attack.

During pregnancy, there is also a risk of status asthmaticus - a severe attack in which conventional medications do not work, and the airway patency is sharply reduced up to suffocation (asphyxia). In this case, the patient limits physical activity, assuming a forced position with support on her hands, is silent, breathes often, or vice versa, rarely, superficially. Wheezing may be absent ("dumb lung"), consciousness is depressed up to coma.

Diagnostics

The survey program is based on such methods as:

  • survey;
  • inspection;
  • laboratory tests;
  • functional tests for the assessment of high-pressure function.

When talking with a patient, you need to determine what causes an attack, to understand whether there is a hereditary predisposition to asthma. Inspection allows you to find out the characteristics of the current objective state. As for laboratory tests, they can be general or specific in nature:

  1. Blood test (erythrocytes, leukocytes, formula calculation, gas composition).
  2. Determination of the concentration of class E immunoglobulins (IgE), or antibodies - protein complexes responsible for the development of allergic reactions.
  3. Sputum analysis (search for an increased number of eosinophilic cells, Kurshman coils, Charcot-Leiden crystals).

The "gold standard" of functional tests is spirography and peak flowmetry - the measurement with the help of special devices of such indicators of high pressure as:

  • forced expiratory volume in the first second (FEV1);
  • vital capacity of the lungs (VC);
  • peak expiratory flow (PSV).

Skin tests for allergens during pregnancy are prohibited.

They are not performed regardless of the period and condition of the patient, since there is a high risk of developing anaphylactic shock.

Treatment

BA therapy during pregnancy is not much different from standard schemes. Although during gestation it is recommended to stop taking drugs of the group of H1-histamine receptor blockers (Suprastin, Tavegil, etc.), the woman should continue and, if necessary, plan or supplement the course of treatment.

Modern medications used for basic therapy do not have a negative effect on the fetus. If the course of the disease is controllable (stable), patients use topical (local) forms of drugs - this allows the drug to be concentrated in the area of ​​inflammation and to exclude or significantly reduce the systemic (on the entire body as a whole) effect.

Principles of pregnancy management

It is necessary to determine the severity of asthma, the level of risk for the mother and child. Regular examinations of a pulmonologist are recommended - with controlled asthma three times: at 18-20, 28-30 weeks and before childbirth, with an unstable form - as needed. Also required:

Drug therapy

Since uncontrolled asthma is dangerous for both the mother and the fetus, pharmacological drugs occupy an important place in the algorithms for treating asthma during pregnancy. They are appointed by choosing in accordance with the safety category:

  • no maternal / fetal side effects when taken at standard therapeutic dosages (B);
  • toxic effects have been recorded in humans and animals, but the risk of withdrawal from the drug is higher than the likelihood of side effects (C).

There are no Category A medications for asthma (meaning that research has not identified a hazard to the fetus). However, the correct application of level B and, when necessary, C products usually does not entail negative consequences. For the main, or basic therapy, are used:

Pharmacological group Sample drug Safety category
Beta2 agonists Short acting Salbutamol C
Prolonged Formoterol
Glucocorticosteroids Inhalation Budesonide B
Systemic Prednisone
Anticholinergics Ipratropium bromide
Monoclonal antibodies Omalizumab
Mast cell membrane stabilizers Nedokromil
Methylxanthines Theophylline C
Leukotriene receptor antagonists Zafirlukast B

Step therapy: for mild asthma, drugs are used on demand (this is usually Salbutamol, Ipratropium bromide), then other drugs are added (depending on the severity of the condition). If a woman has taken leukotriene receptor antagonists before pregnancy, it is advisable to continue therapy with them.

Help with exacerbation

If a pregnant woman has an asthma attack, it is necessary:

  • stop the trigger (if it can be detected - food, cosmetics, etc.);
  • open a window, a window, if the situation occurs indoors;
  • unbutton or take off clothing that interferes with breathing (shirt buttons, heavy coat);
  • Helping you use a medication inhaler - such as Salbutamol
  • call an ambulance.

If possible, they resort to the administration of drugs through a nebulizer - this is a device that creates a medicinal aerosol from small particles that penetrate even into areas of the respiratory tract that are difficult to access by a conventional means. However, you can only stop a mild attack on your own, a severe exacerbation requires urgent hospitalization of the pregnant woman in the hospital - and sometimes immediately to the intensive care unit.

Labor management

It is carried out against the background of basic BA therapy, which the patient received during gestation. In the absence of seizures, FVD indicators are assessed every 12 hours, with exacerbation - as needed. If a woman was prescribed systemic glucocorticosteroids during pregnancy, she is transferred from Prednisolone to Hydrocortisone - for the period of childbirth and for 24 hours after the birth of the child.

The presence of bronchial asthma in a pregnant woman does not mean the impossibility of natural delivery.

On the contrary, surgery is seen as an extreme option because it entails additional risks. It is used when there is a direct threat to the life of the mother / child, and the need for an operation is determined by obstetric indications (placenta previa, abnormal position of the fetus, etc.).

To prevent exacerbation of bronchial asthma, you must:

  1. Avoid contact with allergens and other attack provocateurs.
  2. Follow the doctor's recommendations for basic therapy.
  3. Do not refuse treatment and do not reduce the dosage of drugs on your own.
  4. Keep a diary of indicators of the function of external respiration and, if there are significant fluctuations, visit a doctor.
  5. Remember about the planned consultations of specialists (therapist, pulmonologist, obstetrician-gynecologist) and do not miss visits.
  6. Avoid excessive physical exertion, stress.

A woman suffering from bronchial asthma is recommended to be vaccinated against influenza at the stage of pregnancy planning, since this variant of an acute respiratory infection can significantly worsen the course of the underlying disease. It is allowed to get vaccinated during the gestation period, taking into account the patient's state of health.

Many fears and misconceptions are still associated with bronchial asthma, and this leads to an erroneous approach: some women are afraid of pregnancy and doubt their right to have children, others rely too much on nature and stop treatment during pregnancy, considering any drugs to be definitely harmful this period of life. Perhaps the whole point is that modern methods of treating asthma are still very young: they are a little over 12 years old. People still remember the times when asthma was a frightening and often disabling disease. Now the state of affairs has changed, new data on the nature of the disease led to the creation of new drugs and the development of methods for controlling the disease.

A disease called asthma

Bronchial asthma is a widespread disease, known since ancient times and described by Hippocrates, Avicenna and other great doctors of the past. However, in the 20th century, the number of patients with asthma increased dramatically. Ecology, dietary changes, smoking and much more play an important role in this. At the moment, it has been possible to establish a number of external and internal risk factors for the development of the disease. The most important internal factor is atopy. This is the hereditary ability of the body to respond to the effects of allergens by producing an excess amount of immunoglobulin E - a "provocateur" of allergic reactions that manifest themselves immediately and violently after contact with an allergen. External risk factors include contact with environmental allergens, as well as air pollutants, primarily with tobacco smoke. Active and passive smoking significantly increases the risk of developing asthma. The disease can begin in early childhood, but it can be at any age, and its onset can be triggered by a viral infection, the appearance of an animal in the house, a change of residence, emotional stress, etc.

Until recently, it was believed that the basis of the disease is a spasm of the bronchi with the development of asthma attacks, so treatment was limited to the appointment of bronchodilator drugs. And only in the early 90s the idea of ​​bronchial asthma as a chronic inflammatory disease was formed, the root cause of all the symptoms of which is a special chronic immune inflammation in the bronchi, which persists at any severity of the disease and even without exacerbations. Understanding the nature of the disease has changed the principles of treatment and prevention: inhaled anti-inflammatory drugs have become the basis of asthma treatment.

As a matter of fact, all the main problems of pregnant women with asthma are associated not with the fact of the presence of bronchial asthma, but with its poor control. The greatest risk to the fetus is hypoxia (insufficient amount of oxygen in the blood), which occurs due to the uncontrolled course of bronchial asthma. If suffocation develops, not only does the pregnant woman feel difficulty breathing, but the unborn child also suffers from a lack of oxygen (hypoxia). It is hypoxia that can interfere with the normal development of the fetus, and in vulnerable periods even disrupt the normal laying of organs. To give birth to a healthy baby, it is necessary to receive treatment appropriate to the severity of the disease in order to prevent an increase in the onset of symptoms and the development of hypoxia. Therefore, it is necessary to treat asthma during pregnancy. The prognosis for children born to mothers with well-controlled asthma is comparable to that for children whose mothers do not have asthma.

During pregnancy, the severity of bronchial asthma often changes. It is believed that asthma improves in about a third of pregnant women, worsens in a third, and remains unchanged in a third. But rigorous scientific research is less optimistic: asthma improves in only 14% of cases. Therefore, you should not rely on this chance in the hope that all problems will be resolved by themselves. The fate of a pregnant woman and her unborn child is in her own hands - and in the hands of her doctor.

Preparing for pregnancy

Pregnancy with bronchial asthma should be planned. Even before it begins, it is necessary to visit a pulmonologist for the selection of planned therapy, training in inhalation technique and self-control methods, as well as an allergist to determine causally significant allergens. Patient education plays an important role: understanding the nature of the disease, awareness, the ability to use drugs correctly and the presence of self-control skills are necessary conditions for successful treatment. Asthma schools and allergy schools operate at many clinics, hospitals and centers.

A pregnant woman with asthma needs more careful medical supervision than before pregnancy. You should not use any medications, even vitamins, without consulting your doctor. In the presence of concomitant diseases requiring treatment (for example, hypertension), the consultation of an appropriate specialist is needed to correct therapy taking into account pregnancy.

Smoking is a fight!

Pregnant women should never smoke, and any contact with tobacco smoke should be carefully avoided. Staying in a smoky atmosphere inflicts tremendous harm on both the woman and her unborn child. Even if only the father smokes in the family, the likelihood of developing asthma in a child predisposed to it increases 3-4 times.

Limiting contact with allergens

In young people, in most cases, one of the main factors provoking the disease is allergens. Reducing or, if possible, completely eliminating contact with them allows you to improve the course of the disease and reduce the risk of exacerbations with the same or even less drug therapy, which is especially important during pregnancy.

Modern dwellings tend to be overloaded with dust-collecting objects. House dust is a complex of allergens. It includes textile fibers, particles of dead skin (deflated epidermis) of humans and pets, molds, allergens of cockroaches and tiny arachnids living in dust - house dust mites. A pile of upholstered furniture, carpets, curtains, stacks of books, old newspapers, scattered clothes serve as an endless reservoir of allergens. The conclusion is simple: you should reduce the number of objects that collect dust. The amount of upholstered furniture should be minimized, carpets should be removed, instead of curtains, vertical blinds should be hung, books and knickknacks should be stored on glazed shelves.

Excessively dry air in the house will lead to dry mucous membranes and an increase in the amount of dust in the air, too humid creates conditions for the multiplication of molds and house dust mites - the main source of household allergens. The optimum humidity level is 40-50%.

To clean the air from dust and allergens, special devices have been created - air purifiers. It is recommended to use purifiers with HEPA filters (an English abbreviation which means “high-efficiency filter for particle retention”) and their various modifications: ProHERA, ULPA, etc. High-efficiency photocatalytic filters are used in some models. Devices that do not have filters and purify the air only due to ionization should not be used: during their operation, ozone is formed - chemically active and toxic in high doses, a compound that irritates and damages the respiratory system and is dangerous for pulmonary diseases in general, and for pregnant women and young children in particular.

If a woman does the cleaning herself, she should wear a respirator that protects against dust and allergens. Daily wet cleaning has not lost its relevance, but you cannot do without a vacuum cleaner in a modern home. In this case, you should prefer vacuum cleaners with HEPA filters, specially designed for the needs of allergy sufferers: a conventional vacuum cleaner retains only coarse dust, and the smallest particles and allergens "slip" through it and again enter the air.

The bed, which serves as a resting place for a healthy person, turns into the main source of allergens for an allergic person. Dust accumulates in ordinary pillows, mattresses and blankets, woolen and downy fillers serve as an excellent breeding ground for the development and reproduction of molds and house dust mites - the main sources of household allergens. Bedding must be replaced with special hypoallergenic - made of light and airy modern materials (polyester, hypoallergenic cellulose, etc.). Fillers in which glue or latex was used to hold the fibers together (for example, synthetic winterizer) should not be used.

Proper care is also necessary for bedding: regular whipping and airing, frequent washing at 60 ° C and above (ideally once a week). Modern fillers are easy to wash and restore their shape after multiple washes. To reduce the frequency of washing, as well as to wash things that cannot withstand high temperatures, special additives have been developed to kill house dust mites (acaricides) and eliminate major allergens. Similar products in the form of sprays are intended for the treatment of upholstered furniture and textiles.

Developed acaricides of chemical (Akarosan, Akaryl), plant (Milbiol) origin and complex action (Allcrgoff, combining plant, chemical and biological agents to combat ticks), as well as plant-based agents for neutralizing allergens of mites, domestic animals and molds (Mite -NIX). Anti-allergenic protective covers for pillow, mattress and duvet provide even greater protection against allergens. They are made of a special dense weave fabric that allows air and water vapor to pass freely, but impervious even to small dust particles. In addition, in the summer it is useful to dry the bedding in direct sunlight, in the winter - to freeze it at a low temperature.

Types of asthma

There are many classifications of bronchial asthma, taking into account the characteristics of its course, but the main and most modern of them depends on the severity. Allocate mild intermittent (episodic), mild persistent (with mild, but regular symptoms), moderate and severe bronchial asthma. This classification reflects the degree of activity of chronic inflammation and allows you to select the required amount of anti-inflammatory therapy. In the arsenal of medicine today there are quite effective means to achieve control over the disease. Thanks to modern approaches to treatment, it has even become inappropriate to say that people suffer from asthma. Rather, we can talk about the problems that arise in a person diagnosed with bronchial asthma.

Treatment of bronchial asthma during pregnancy

Many pregnant women try to avoid taking medications. But it is necessary to treat asthma: the harm caused by a severe uncontrolled disease and the resulting hypoxia (lack of oxygen) of the fetus is immeasurably higher than the possible side effects of drugs. Not to mention the fact that allowing asthma to worsen is a huge risk to the life of the woman herself.

In the treatment of asthma, preference is given to topical (topical) inhalation drugs that are most effective in the bronchi with a minimum concentration of the drug in the blood. It is recommended to use inhalers that do not contain freon (in this case, the inhaler has an inscription “does not contain freon”, “ECO” or “N” may be added to the name of the medicine), Dosed aerosol inhalers should be used with a spacer (an auxiliary device for inhalation - a camera into which the aerosol is supplied from the can before the patient inhales it). The spacer increases the efficiency of inhalation by eliminating problems with the correct execution of the inhalation maneuver, and reduces the risk of side effects associated with the deposition of aerosol in the mouth and throat.

Routine therapy (basic therapy to control the disease). As mentioned above, all asthma symptoms are based on chronic inflammation in the bronchi, and if you fight only with the symptoms, and not with their cause, the disease will progress. Therefore, in the treatment of asthma, planned (basic) therapy is prescribed, the volume of which is determined by the doctor, depending on the severity of the course of asthma. It includes drugs that need to be used systematically, daily, regardless of how the patient is feeling and whether there are symptoms. Adequate basic therapy significantly reduces the risk of exacerbations, minimizes the need for drugs to relieve symptoms and prevent the occurrence of fetal hypoxia, i.e. contributes to the normal course of pregnancy and the normal development of the child. Basic therapy is not stopped even during childbirth to avoid exacerbation of asthma.

Cromones (INTAL, TILED) are used only for mild asthma. If the drug is prescribed for the first time during pregnancy, sodium cromolyn is used (INTAL). If cromones do not provide adequate disease control, they should be replaced with inhaled hormonal drugs. The appointment of the latter during pregnancy has its own characteristics. If the drug is to be prescribed for the first time, BUDESONID or BEKJ1O-METAZONE is preferred. If asthma has been successfully controlled with another inhaled hormonal drug prior to pregnancy, this therapy may be continued. The drugs are prescribed by the doctor individually, taking into account not only the clinic of the disease, but also the data of peak flowmetry.

Peak Flowmetry and Asthma Action Plan. A device called a peak flow meter has been developed for self-monitoring in asthma. The indicator recorded by him - the peak expiratory flow rate, abbreviated as PSV - allows you to monitor the state of the disease at home. The PSV data are also guided when drawing up an Action Plan for Asthma - detailed doctor's recommendations, which describe the basic therapy and the necessary actions for changes in the state.

PSV should be measured 2 times a day, in the morning and in the evening, before using the drugs. The data is recorded as a graph. An alarming symptom is "morning dips" - periodically recorded low rates in the morning hours. This is an early sign of deterioration in asthma control, ahead of the onset of symptoms, and if measures are taken in time, the development of an exacerbation can be avoided.

Drugs to relieve symptoms. A pregnant woman should not endure or wait out attacks of suffocation, so that the lack of oxygen in the blood does not harm the development of the unborn child. This means that a drug is needed to relieve asthma symptoms. For this purpose, selective inhalation 32-agonists with a rapid onset of action are used. In Russia, salbutamol is more commonly used (SALBUTAMOL, VENTOLIN, etc.). Frequency of bronchodilator (bronchodilator) use is an important indicator of asthma control. With an increase in the need for them, you should contact a pulmonologist to enhance the planned (basic) therapy to control the disease.

During pregnancy, the use of any ephedrine preparations (TEOFEDRIN, Kogan powders, etc.) is absolutely contraindicated, since ephedrine causes a narrowing of the vessels of the uterus and aggravates fetal hypoxia.

Treatment of exacerbations. The most important thing is to try to prevent exacerbations. But exacerbations do occur, and the most common cause is ARVI. Along with the danger to the mother, the exacerbation poses a serious threat to the fetus, therefore, a delay in treatment is unacceptable. In the treatment of exacerbations, inhalation therapy is used with the help of a nebulizer - a special device that converts a liquid medicine into a fine aerosol. The initial stage of treatment consists in the use of bronchodilator drugs; in our country, the drug of choice is salbutamol. Oxygen is prescribed to combat fetal hypoxia. In case of an exacerbation, the appointment of systemic hormonal drugs may be required, while they prefer PREDISOLONE or METHYLPRED-NISOLONE and avoid using trimcinolone (POLCORTOLON) because of the risk of affecting the muscular system of the mother and fetus, as well as dexamethasone and betamethasone. Both in connection with asthma and with allergies during pregnancy, the use of deposited forms of long-acting systemic hormones - KENALOG, DIPROSPAN is categorically excluded.

Will the baby be healthy?

Any woman is worried about the health of her unborn child, and inherited factors are certainly involved in the development of bronchial asthma. It should be noted right away that we are not talking about the indispensable inheritance of bronchial asthma, but about the general risk of developing an allergic disease. But other factors also play a role in the realization of this risk: the ecology of the home, contact with tobacco smoke, feeding, etc. Breastfeeding is especially important: you need to breastfeed your baby for at least 6 months. But at the same time, the woman herself must follow a hypoallergenic diet and receive recommendations from a specialist on the use of drugs during breastfeeding.

Bronchial asthma is one of the most common lung diseases in pregnant women. Due to the increase in the number of people prone to allergies, cases of bronchial asthma have become more frequent in recent years (from 3 to 8% in different countries; moreover, every decade the number of such patients increases by 1-2%).
This disease is characterized by inflammation and temporary obstruction of the airways and occurs against the background of increased irritability of the airways in response to various influences. Bronchial asthma can be of non-allergic origin - for example, after brain injury or as a result of endocrine disorders. However, in the overwhelming majority of cases, bronchial asthma is an allergic disease, when in response to exposure to an allergen, bronchial spasm occurs, manifested by suffocation.

VARIETIES

There are infectious-allergic and non-infectious-allergic forms of bronchial asthma.
Infectious-allergic bronchial asthma develops against the background of previous infectious diseases of the respiratory tract (pneumonia, pharyngitis, bronchitis, tonsillitis); in this case microorganisms are the allergen. Infectious-allergic bronchial asthma is the most common form, accounting for more than 2/3 of all cases of the disease.
In the case of a non-infectious-allergic form of bronchial asthma, the allergen can be various substances of both organic and inorganic origin: plant pollen, street or house dust, feathers, wool and dander of animals and humans, food allergens (citrus fruits, strawberries, strawberries, etc.), medicinal substances (antibiotics, especially penicillin, vitamin B1, aspirin, pyramidon, etc.), industrial chemicals (most often formalin, pesticides, cyanamides, inorganic salts of heavy metals, etc.). In the event of non-infectious-allergic bronchial asthma, hereditary predisposition matters.

SYMPTOMS

Regardless of the form of bronchial asthma, there are three stages of its development: pre-asthma, asthma attacks and asthmatic status.
All forms and stages of the disease occur during pregnancy.
ness.
Chronic astmoid bronchitis and chronic pneumonia with elements of bronchospasm belong to pre-asthma. There are no pronounced attacks of suffocation at this stage yet.
In the initial stage of asthma, asthma attacks develop periodically. With an infectious-allergic form of asthma, they appear against the background of any chronic disease of the bronchi or lungs.
Choking attacks are usually easy to recognize. They start more often at night, lasting from several minutes to several hours. Choking is preceded by a scratching sensation in the throat, sneezing, runny nose, tightness in the chest. The attack begins with a persistent paroxysmal cough, no sputum. There is a sharp difficulty in exhaling, tightness in the chest, nasal congestion. The woman sits down, strains all the muscles of the chest, neck, shoulder girdle to exhale air. Breathing becomes noisy, wheezing, hoarse, audible from a distance. At first, breathing is quickened, then it becomes less frequent - up to 10 respiratory movements per minute. The face becomes bluish. The skin is covered with perspiration. By the end of the attack, sputum begins to separate, which becomes more liquid and abundant.
Status asthma is a condition in which a severe attack of suffocation persists for hours or days. In this case, the medications that the patient usually takes are ineffective.

FEATURES OF THE COURSE OF BRONCHIAL ASTHMA DURING PREGNANCY AND CHILDBIRTH

With the development of pregnancy in women with bronchial asthma, pathological shifts in the immune system occur, which have a negative effect on both the course of the disease and the course of pregnancy.
Bronchial asthma usually begins before pregnancy, but may first appear during pregnancy. In some of these women, the mothers also suffered from bronchial asthma. In some patients, asthma attacks develop at the beginning of pregnancy, in others - in the second half. Asthma that occurs at the beginning of pregnancy, like early toxicosis, can disappear by the end of the first half of it. In these cases, the prognosis for the mother and fetus is usually quite favorable.
Bronchial asthma, which began before pregnancy, during it can proceed in different ways. According to some reports, during pregnancy, 20% of patients retain the same condition as before pregnancy, 10% experience improvement, and most women (70%) have a more severe disease, with moderate and severe forms of exacerbation prevailing with daily repeated attacks suffocation, recurrent asthmatic conditions, unstable treatment effect.
Asthma usually worsens in the first trimester of pregnancy. In the second half, the disease is easier. If the deterioration or improvement of the condition occurred during a previous pregnancy, then it can be expected during subsequent pregnancies.
Attacks of bronchial asthma during childbirth are rare, especially with the prophylactic use of glucocorticoid drugs (prednisolone, hydrocortisone) or bronchodilators (aminophylline, ephedrine) during this period.
After childbirth, the course of bronchial asthma improves in 25% of women (these are patients with a mild form of the disease). In 50% of women, the condition does not change, in 25% it worsens, they are forced to constantly take prednisolone, and the dose has to be increased.
Patients with bronchial asthma more often than healthy women develop early toxicosis (37%), the threat of termination of pregnancy (26%), labor disorders (19%), rapid and rapid labor, which results in high birth traumatism ( in 23%), premature and low birth weight babies can be born. Pregnant women with severe bronchial asthma have a high percentage of spontaneous miscarriages, premature births and cesarean section operations. Cases of fetal death before and during childbirth are noted only in severe cases of the disease and inadequate treatment of asthmatic conditions.
The mother's illness can affect the baby's health. In 5% of children, asthma develops in the first year of life, in 58% in subsequent years. In newborns of the first year of life, diseases of the upper respiratory tract often occur.
The postpartum period in 15% of puerperas with bronchial asthma is accompanied by an exacerbation of the underlying disease.
Patients with bronchial asthma during full-term pregnancy usually give birth through the vaginal birth canal, since asthma attacks during childbirth are easy to prevent. Frequent attacks of suffocation and asthmatic conditions observed during pregnancy, ineffectiveness of the treatment is an indication for early delivery at 37-38 weeks of pregnancy.

TREATMENT OF BRONCHIAL ASTHMA DURING PREGNANCY

When treating bronchial asthma in pregnant women, it should be borne in mind that all drugs used for this purpose pass through the placenta and can harm the fetus, and since the fetus is often in a state of hypoxia (oxygen starvation), a minimum amount of drugs should be administered. If asthma does not worsen during pregnancy, there is no need for drug therapy. With a slight exacerbation of the disease, you can limit yourself to mustard plasters, banks, inhalations of saline. However, it should be borne in mind that severe and poorly treated asthma poses a much greater risk to the fetus than the drug therapy used to treat it. But in all cases, a pregnant woman suffering from bronchial asthma should use medications only as directed by a doctor.
The main treatment for bronchial asthma includes bronchodilators (sympathomimetics, xanthine derivatives) and anti-inflammatory (intal and glucocorticoids) agents.
The most widely used drugs are from the group of sympathomimetics. These include izadrin, euspiran, novodrin. Their side effect is an increased heart rate. Better to use the so-called selective sympathomimetics; they cause bronchial relaxation, but this is not accompanied by palpitations. These are drugs such as salbutamol, bricanil, salmeterol, berotek, alupent (asthmopent). When inhaled, sympathomimetics act faster and stronger, therefore, with an attack of suffocation, 1-2 breaths are taken from the inhaler. But these medicines can also be used as prophylactic agents.
Adrenaline also belongs to sympathomimetics. Its injection can quickly eliminate an attack of suffocation, but it can cause spasm of peripheral vessels in a woman and a fetus, and worsen uteroplacental blood flow. Ephedrine is not contraindicated during pregnancy, but it is ineffective.
It is interesting that sympathomimetics are widely used in obstetrics for the treatment of miscarriage. An additional beneficial effect of these drugs is the prevention of distress syndrome - breathing disorders in newborns.
Methylxanthines are the preferred treatment for asthma during pregnancy. Euphyllin is administered intravenously for severe attacks of suffocation. As a prophylactic agent, aminophylline is used in tablets. Recently, extended-release xanthines, theophylline derivatives, such as theopec, have become more widespread. Theophylline preparations have a beneficial effect on the body of a pregnant woman. They improve uteroplacental circulation and can be used to prevent distress in newborns. These drugs increase renal and coronary blood flow and decrease pulmonary artery pressure.
Intal is used after 3 months of pregnancy with a non-infectious-allergic form of the disease. In severe cases of the disease and asthmatic condition, this drug is not prescribed. Intal is used only for the prevention of bronchospasm, but not for the treatment of already developed asthma attacks: this can lead to increased suffocation. Intal is taken by inhalation.
Among pregnant women, there are more and more patients with severe bronchial asthma who are forced to receive hormone therapy. They usually have a negative attitude towards taking glucocorticoid hormones. However, during pregnancy, the danger associated with the introduction of glucocorticoids is less than the risk of developing hypoxemia - a lack of oxygen in the blood, from which the fetus is very seriously affected.
Treatment with prednisolone must be carried out under the supervision of a physician, who sets an initial dose sufficient to eliminate the exacerbation of asthma in a short time (1-2 days), and then prescribes a lower maintenance dose. In the last two days of treatment, inhalation of becotide (beclamide), a glucocorticoid that has a local effect on the respiratory tract, is added to the prednisolone tablets. This drug is harmless. It does not stop the developing attack of suffocation, but serves as a prophylactic agent. Inhaled glucocorticoids are currently the most effective anti-inflammatory drugs for the treatment and prevention of bronchial asthma. With exacerbations of asthma, without waiting for the development of severe attacks, the dose of glucocorticoids should be increased. For the fetus, the doses used are not dangerous.
Anticholinergics are agents that reduce the narrowing of the bronchi. Atropine is administered subcutaneously for an attack of suffocation. Platyphyllin is prescribed in powders prophylactically or to stop an attack of bronchial asthma - subcutaneously. Atrovent is an atropine derivative, but with a less pronounced effect on other organs (heart, eyes, intestines, salivary glands), which is associated with its better tolerance. Berodual contains atrovent and berotec, which was mentioned above. It is used to suppress acute attacks of asthma and to treat chronic bronchial asthma.
The well-known antispasmodics papaverine and no-shpa have a moderate bronchodilatory effect and can be used to suppress mild asthma attacks.
In case of infectious-allergic bronchial asthma, it is necessary to stimulate the excretion of sputum from the bronchi. Regular breathing exercises, the toilet of the nasal cavity and oral mucosa are important. Expectorants serve as thinning phlegm and promoting the removal of bronchial contents; they moisturize the mucous membrane, stimulate coughing. For this purpose, the following can serve:
1) inhalation of water (tap or sea), saline, soda solution, heated to 37 ° C;
2) bromhexine (bisolvon), mucosolvin (in the form of inhalation),
3) ambroxol.
3% solution of potassium iodide and solutane (containing iodine) are contraindicated for pregnant women. An expectorant mixture with marshmallow root, terpine hydrate in tablets can be used.
It is useful to drink medicinal preparations (if you do not have intolerance to the components of the collection), for example, from wild rosemary herb (200 g), oregano herb (100 g), nettle leaves (50 g), birch buds (50 g). They need to be crushed, mixed. 2 tablespoons of the collection pour 500 ml of boiling water, boil for 10 minutes, then leave for 30 minutes. Drink 1/2 cup 3 times a day.
Recipe for another collection: plantain leaves (200 g), St. John's wort leaves (200 g), linden flowers (200 g), chop and mix. 2 tablespoons of the collection pour 500 ml of boiling water, leave for 5-6 hours. Drink 1/2 cup 3 times a day warm before meals.
Antihistamines (diphenhydramine, pipolfen, suprastin, etc.) are indicated only for milder forms of non-infectious-allergic asthma; in the case of an infectious-allergic form of asthma, they are harmful, since they contribute to the thickening of the secretion of the bronchial glands.
In the treatment of bronchial asthma in pregnant women, it is possible to use physical methods: physiotherapy exercises, a complex of gymnastic exercises that facilitate coughing, swimming, inductothermy (warming up) of the adrenal glands, acupuncture.
During childbirth, the treatment of bronchial asthma does not stop. The woman is given humidified oxygen, and drug therapy continues.
Treatment of status asthmaticus must be carried out in a hospital in the intensive care unit.

PREVENTION OF PREGNANCY COMPLICATIONS

It is necessary for the patient to eliminate the risk factors for exacerbation of the disease. In this case, removal of the allergen is very important. This is achieved by damp cleaning of the room, excluding food from food that cause allergies (oranges, grapefruits, eggs, nuts, etc.), and nonspecific food irritants (pepper, mustard, spicy and salty foods).
In some cases, the patient needs to change jobs if it is associated with chemicals that play the role of allergens (chemicals, antibiotics, etc.).
Pregnant women with bronchial asthma should be registered with a therapist of the antenatal clinic. Each "cold" disease is an indication for antibiotic treatment, physiotherapy procedures, expectorants, for the prophylactic administration of drugs that dilate the bronchi, or to increase their dose. With an exacerbation of asthma at any stage of pregnancy, hospitalization is carried out, preferably in a therapeutic hospital, and in case of symptoms of the threat of termination of pregnancy and two weeks before the due date, in a maternity hospital to prepare for childbirth.
Bronchial asthma, even its hormone-dependent form, is not a contraindication for pregnancy, since it is amenable to drug-hormonal therapy. Only with recurring asthmatic conditions can the question of abortion in early pregnancy or early delivery of the patient arise.

Pregnant women with bronchial asthma should be regularly monitored by an obstetrician and a therapist of the antenatal clinic. Asthma treatment is complex and must be directed by a doctor.

Bronchial asthma is a chronic pathology that often affects women of childbearing age. An uncontrolled course of the disease leads to the development of complications from both the mother and the fetus. However, concepts such as bronchial asthma and pregnancy are quite compatible. With the right treatment and constant medical supervision, there is a high probability of giving birth to a healthy baby and not harming your body.

The course of the disease during pregnancy

It is difficult to predict how the disease will behave during pregnancy. It is noted that in persons with mild and moderate bronchial asthma, the state either does not change, or, on the contrary, improves. But in women with a severe course of pathology, the number of seizures and their severity often increase during pregnancy. However, there are exceptions. Therefore, the entire period of gestation, a woman should be under the supervision of specialists.

It was also noted that during the first trimester, the disease progresses more severely, and after 13 weeks the condition improves. In case of an exacerbation of the disease, a woman should be hospitalized in a clinic, where drugs will be replaced with drugs that are safe for the mother and fetus.

Possible complications from the mother

  • Increased seizure frequency.
  • The development of infectious diseases of the respiratory tract.
  • Premature birth.
  • The threat of termination of pregnancy.
  • Development of gestosis (toxicosis).

Possible fetal complications

Asthma during pregnancy results in insufficient oxygen supply to the placental bloodstream. Due to frequent attacks of suffocation, fetal hypoxia occurs, which is fraught with serious violations:

  • Insufficient fetal body weight.
  • Delayed child development.
  • Violation of the development of individual systems (nervous, muscular, cardiovascular).
  • Birth injury.
  • Asphyxia (suffocation).

The above complications are found only with the wrong treatment of the disease. If the correct therapy is selected for a woman, then the child is born healthy and with sufficient body weight. The only complication that occurs quite often is a tendency to allergic diseases. Therefore, after giving birth, a woman should breastfeed her baby for at least 6 months and follow a hypoallergenic diet.

Bronchial asthma and childbirth

With a controlled course of bronchial asthma, childbirth is carried out in a natural way. Two weeks before giving birth, the pregnant woman is admitted to the clinic for preparation. More often, the vital signs of the mother and fetus are monitored, and childbirth is carried out in the department of pathology of pregnant women. During delivery, drugs are administered against bronchial asthma, which prevent the development of an attack and do not harm the baby.

If the pregnant woman has frequent asthma attacks, that is, asthma is not controlled, delivery by cesarean section is performed at 38 weeks. During this period, the body of the fetus is sufficiently formed to exist on its own. And refusal from a cesarean section threatens with the above complications.

How to treat bronchial asthma in pregnant women?

During pregnancy, you cannot take the same course of treatment as out of position. Some drugs are contraindicated for expectant mothers, and some require a dose reduction. Treatment for asthma during pregnancy is based on preventing attacks and taking medications that are safe for the baby.

The main objectives in therapy are:

  • Improving the function of external respiration.
  • Prevention of asthmatic attacks.
  • Prevention of the development of side effects of drugs.
  • Rapid relief of seizures.

In order to reduce the risk of exacerbation of the disease and prevent complications, a pregnant woman should take the following measures:

  • Follow a hypoallergenic diet.
  • If possible, use clothes and linen made from natural fabrics.
  • In everyday hygiene, use hypoallergenic shower gels, creams and detergents.
  • Reduce contact with dust.
  • Use filters and humidifiers.
  • Do not contact with animal hair.
  • Walk more on the street away from places of atmospheric air pollution.
  • When working with hazardous substances, switch to safer work.

Asthma treatment during pregnancy is carried out with bronchodilators and expectorants. It is also important to regularly perform breathing exercises and eliminate emotional and physical overstrain.

What drugs are contraindicated in pregnancy?

  • Adrenalin. If outside of pregnancy this drug is often used to relieve seizures, then women in a position should not use it. Adrenaline leads to a spasm of the vessels of the uterus, resulting in fetal hypoxia.
  • Salbutamol, fenoterol and terbutaline. The drugs can be taken during pregnancy, but only under medical supervision. At a later date, these drugs help to lengthen the birth period, since their analogues are used in gynecology to prevent premature birth.
  • Theophylline. The drug crosses the placenta and, when taken in the third trimester, can lead to increased cardiac activity of the fetus.
  • Triamcinolone. It has a negative effect on the development of the muscular system of the fetus. Also, betamethasone and dexamethasone are contraindicated from glucocorticosteroids.
  • Brompheniramine, ketotifen and other 2nd generation antihistamines.

Traditional medicine in the treatment of bronchial asthma

Traditional recipes for the treatment of bronchial asthma should be used in addition to drug treatment. However, you should not use any prescription without consulting a doctor, as well as if you have an individual intolerance to the components of the product.

  • Peel and rinse a half liter jar of oats. Boil 2 liters of milk and 0.5 liters of water, add oats there and boil for 2 hours. The result is 2 liters of broth. For reception, you need to add 1 tsp in 150 ml. honey and 1 tsp. butter. Drink the resulting product hot on an empty stomach.
  • Add 2 cups of oats to 2 liters of boiling water and simmer for an hour. Then add half a liter of goat's milk and simmer for another 30 minutes. After cooking, add honey to the broth and drink 0.5 cups 30 minutes before meals.
  • Place 20 g of propolis and 100 g of beeswax in a water bath. After the mixture has warmed up, cover your head with a towel and inhale the vapors through your mouth for 15 minutes. You can carry out the procedure 2 times a day.
  • To prepare propolis oil, you need to mix 10 g of propolis and 200 g of vegetable oil. Heat the mixture in a water bath for 30 minutes, then strain. Take 1 teaspoon 2 times a day.
  • Squeeze the juice out of the fresh ginger root and add salt. Take about 30 g at the onset of an attack. For the prevention of seizures, it is recommended to drink 1 tbsp. with honey before bed. You can drink the resulting medicine with water or tea.

Bronchial asthma is a serious illness. However, with adequate therapy, the disease does not threaten even during pregnancy. The main thing is regular medical supervision and taking prescribed medications.