Is it possible to get pregnant with bronchial asthma. Danger of uncontrolled seizures. Drugs contraindicated during pregnancy
Bronchial asthma(BA) is a chronic recurrent disease with a predominant lesion of the bronchi.
The main symptom is asthma attacks and / or status asthmaticus due to spasm of bronchial smooth muscles, hypersecretion, discrinia and mucosal edema respiratory tract.
ICD-10 code
J45 Asthma.
J45.0 Asthma with a predominance of an allergic component.
J45.1 Non-allergic asthma.
J45.8 Mixed asthma.
J45.9 Asthma, unspecified
O99.5 Diseases of the respiratory system complicating pregnancy, childbirth and the postpartum period.
EPIDEMIOLOGY
The incidence of asthma has increased significantly over the past three decades. According to WHO experts, bronchial asthma is one of the most common chronic diseases: this disease is diagnosed in 8-10% of the adult population. In Russia, more than 8 million people suffer from bronchial asthma. Women suffer from bronchial asthma twice as often as men. As a rule, bronchial asthma manifests itself in childhood, which leads to an increase in the number of patients of childbearing age.
PREVENTION OF BRONCHIAL ASTHMA DURING PREGNANCY
The mainstay of prevention is limiting the exposure to disease-provoking allergens (triggers). Triggers are identified using allergy tests.
Measures to reduce exposure to household allergens:
· Use of impervious coverings for mattresses, blankets and pillows;
· Replacement of floor carpets with linoleum or wooden floors;
· replacement fabric upholstery leather furniture;
· Replacement of curtains with blinds;
· Maintaining low humidity in the room;
· Prevention of the entry of animals into living quarters;
· to give up smoking.
Currently, there are no measures for the prevention of bronchial asthma that could be recommended in the prenatal period. However, the appointment of a hypoallergenic diet during lactation to women at risk significantly reduces the likelihood of developing an atopic disease in a child. Exposure to tobacco smoke, both in the prenatal and postnatal period, provokes the development of diseases accompanied by bronchial obstruction.
Screening
Careful history taking, auscultation and study of the peak expiratory flow rate using a peak flow meter can identify patients in need of additional examination (assessment of allergic status and study of FVD).
CLASSIFICATION OF BRONCHIAL ASTHMA
Bronchial asthma is classified based on the etiology and severity of the disease, as well as the temporal characteristics of bronchial obstruction. In practical terms, the most convenient classification of the disease by severity. This classification is used in the management of patients during pregnancy. On the basis of the noted clinical signs and FVD indices, four degrees of severity of the patient's condition before the start of treatment were identified.
Bronchial asthma of intermittent (episodic) course: symptoms occur no more than once a week, nighttime symptoms no more than twice a month, exacerbations are short (from several hours to several days), indicators of lung function without exacerbation are within normal limits.
· Mild persistent bronchial asthma: asthma symptoms occur more often than once a week, but less than once a day, exacerbations can disrupt physical activity and sleep, daily fluctuations in forced expiratory volume in 1 s or peak expiratory flow rate are 20-30%.
Moderate bronchial asthma: symptoms of the disease appear daily, exacerbations interfere with physical activity and sleep, night symptoms occur more often than once a week, forced expiratory volume or peak expiratory flow rate is 60 to 80% of the proper values, daily fluctuations in forced expiratory volume or peak expiratory flow rate ³30%.
Severe bronchial asthma: symptoms of the disease appear daily, exacerbations and nocturnal symptoms are frequent, physical activity is limited, forced expiratory volume or peak expiratory flow rate £ 60% of the proper value, daily fluctuations in peak expiratory flow rate ³30%.
If the patient is already undergoing treatment, it is necessary to determine the severity of the disease based on the identified clinical signs and the amount of medications taken daily. If the symptoms of mild persistent bronchial asthma persist despite appropriate therapy, the disease is defined as persistent bronchial asthma of moderate severity. If, against the background of treatment, the patient develops symptoms of persistent bronchial asthma of moderate severity, the diagnosis is made "Bronchial asthma, severe persistent course."
ETIOLOGY (CAUSES) OF BRONCHIAL ASTHMA IN PREGNANT WOMEN
There is strong evidence that bronchial asthma is a hereditary disease. Children with BA suffer from this disease more often than children. healthy parents... The following risk factors for the development of asthma are distinguished:
Atopy;
· Hyperresponsiveness of the airways, which has a hereditary component and is closely related to the level of IgE in the blood plasma, inflammation of the airways;
· Allergens (house mites, animal hair, mold and yeast fungi, plant pollen);
· Occupational sensitizing factors (more than 300 substances are known that are related to occupational bronchial asthma);
· Smoking;
· Air pollution (sulfur dioxide, ozone, nitrogen oxides);
· ARI.
PATHOGENESIS OF GESTION COMPLICATIONS
Development of complications of pregnancy and perinatal pathology associated with the severity of the course of bronchial asthma in the mother, the presence of exacerbations this disease during pregnancy and the quality of the therapy. In women who had exacerbations of bronchial asthma during pregnancy, the likelihood of perinatal pathology is three times higher than in patients with a stable course of the disease. The immediate causes of the complicated course of pregnancy in patients with bronchial asthma include:
· Changes in FVD (hypoxia);
· Immune disorders;
· Violations of hemostatic homeostasis;
· Metabolic disorders.
FVD changes - main reason hypoxia. They are directly related to the severity of bronchial asthma and the quality of treatment during pregnancy. Immune disorders contribute to the development of autoimmune processes (APS) and a decrease in antiviral antimicrobial protection. The listed features are the main reasons for the frequent intrauterine infection in pregnant women with bronchial asthma.
During pregnancy, autoimmune processes, in particular APS, can cause damage to the vascular bed of the placenta by immune complexes. The result is placental insufficiency and fetal growth retardation. Hypoxia and damage to the vascular wall cause a disorder of hemostatic homeostasis (the development of chronic disseminated intravascular coagulation syndrome) and impaired microcirculation in the placenta. One more important reason the formation of placental insufficiency in women with bronchial asthma - metabolic disorders. Studies have shown that in patients with bronchial asthma, lipid peroxidation is increased, the antioxidant activity of the blood is reduced, and the activity of intracellular enzymes is reduced.
CLINICAL PICTURE (SYMPTOMS) OF BRONCHIAL ASTHMA IN PREGNANT WOMEN
The main clinical signs of bronchial asthma:
· Attacks of suffocation (with difficulty in exhaling);
Unproductive paroxysmal cough;
Noisy wheezing;
Shortness of breath.
Complications of Gestation
In bronchial asthma, in most cases, pregnancy is not contraindicated. However, with an uncontrolled course of the disease, frequent attacks of suffocation, causing hypoxia, can lead to the development of complications in the mother and the fetus. So, in pregnant women with BA, the development of premature birth is noted in 14.2%, the threat of termination of pregnancy - in 26%, IGR - in 27%, fetal malnutrition - in 28%, fetal hypoxia and asphyxia at birth - in 33%, gestosis - in 48%. Surgical delivery for this disease is performed in 28% of cases.
DIAGNOSIS OF BRONCHIAL ASTHMA DURING PREGNANCY
ANAMNESIS
When collecting anamnesis, the presence of allergic diseases in the patient and her relatives is established. In the course of the study, the features of the appearance of the first symptoms (the time of year of their appearance, the relationship with physical activity, exposure to allergens), as well as the seasonality of the disease, the presence of professional harm and living conditions (presence of pets). It is necessary to clarify the frequency and severity of symptoms, as well as the effect of anti-asthma treatment.
PHYSICAL STUDY
The results of the physical examination depend on the stage of the disease. During the period of remission, the study may not show any abnormalities. During the period of exacerbation, the following clinical manifestations: rapid breathing, increased heart rate, participation in the act of breathing of auxiliary muscles. On auscultation, note hard breathing and dry wheezing. A boxed sound may be heard when percussed.
LABORATORY RESEARCH
For timely diagnosis complications of gestation, definition is shown AFP level, b-hCG at the 17th and 20th weeks of pregnancy. The study in the blood of hormones of the fetoplacental complex (estriol, PL, progesterone, cortisol) is carried out at the 24th and 32nd weeks of pregnancy.
INSTRUMENTAL STUDIES
· Clinical analysis blood to detect eosinophilia.
· Revealing an increase in the content of IgE in blood plasma.
· Examination of sputum for the detection of Kurshmann coils, Charcot-Leiden crystals and eosinophilic cells.
· Study of FVD to detect a decrease in maximum expiratory flow rate, forced expiratory volume and a decrease in peak expiratory flow rate.
· ECG to establish sinus tachycardia and overload of the right heart.
DIFFERENTIAL DIAGNOSTICS
Differential diagnosis is carried out taking into account the data of the anamnesis of the results of allergic and clinical examination... Differential diagnosis of FVD assessment (presence of reversible bronchial obstruction) with COPD, HF, cystic fibrosis, allergic and fibrosing alveolitis, occupational diseases of the respiratory system.
INDICATIONS FOR CONSULTING OTHER SPECIALISTS
· Severe course of the disease with pronounced signs of intoxication.
· Development of complications in the form of bronchitis, sinusitis, pneumonia, otitis media, etc.
EXAMPLE FORMULATING A DIAGNOSIS
Pregnancy 33 weeks. Persistent bronchial asthma medium severity, unstable remission. The threat of premature birth.
TREATMENT OF BRONCHIAL ASTHMA DURING PREGNANCY
PREVENTION AND PREDICTION OF GESTION COMPLICATIONS
Prevention of complications of gestation in pregnant women with bronchial asthma consists in the full treatment of the disease. If necessary, carry out basic therapy using inhaled glucocorticosteroids according to
the recommendations of the group of the Global Initiative on Asthma (GINA). Treatment of chronic foci is mandatory
infections: colpitis, periodontal diseases, etc.
FEATURES OF TREATMENT OF COMPLICATIONS OF GESTATION
Treatment of complications of gestation by trimester
In the first trimester, the treatment of bronchial asthma when there is a threat of termination of pregnancy has no specific features. The therapy is carried out according to generally accepted rules. In the second and third trimester, the treatment of obstetric and perinatal complications should include correction of the underlying pulmonary disease, optimization of redox processes. To reduce the intensity of lipid peroxidation, stabilize the structural and functional properties of cell membranes, normalize and improve fetal trophism, the following are used medicines:
· Phospholipids + multivitamins, 5 ml intravenously for 5 days, then 2 tablets 3 times a day for three weeks;
Vitamin E;
· Actovegin © (400 mg intravenously for 5 days, then 1 tablet 2-3 times a day for two weeks).
To prevent the development of infectious complications, immunocorrection is performed:
Immunotherapy with interferon-a2 (500 thousand rectally twice a day for 10 days, then twice a day
every other day for 10 days);
Anticoagulant therapy:
- sodium heparin (for normalization of hemostasis parameters and binding of circulating immune complexes);
- antiplatelet agents (to increase the synthesis of prostacyclin by the vascular wall, which makes it possible to reduce intravascular platelet aggregation): dipyridamole 50 mg 3 times a day, aminophylline 250 mg 2 times a day for two weeks.
When an increased level of IgE in blood plasma, markers of autoimmune processes (lupus
anticoagulant, antibodies to hCG) with signs of intrauterine fetal suffering and the lack of a sufficient effect from
conservative therapy is indicated for therapeutic plasmapheresis. Carry out 4-5 procedures 1-2 times a week with
elimination of up to 30% of the circulating plasma volume. Indications for inpatient treatment - the presence of gestosis,
threats of termination of pregnancy, signs of PN, RRP 2-3 degrees, fetal hypoxia, severe exacerbation of asthma.
Treatment of complications during childbirth and the puerperium
During childbirth, therapy continues, aimed at improving the functions of the fetoplacental complex. Therapy includes the introduction of drugs that improve placental blood flow- xanthinol nicotinate (10 ml with 400 ml of isotonic sodium chloride solution), as well as taking piracetam for the prevention and treatment of intrauterine fetal hypoxia (2 g in 200 ml of 5% glucose solution intravenously). To prevent asthma attacks that provoke the development of fetal hypoxia, bronchial asthma therapy using inhaled glucocorticoids is continued during childbirth. Patients taking systemic glucocorticosteroids, as well as with an unstable course of bronchial asthma, need parenteral administration of prednisolone at a dose of 30-60 mg (or dexamethasone in an adequate dose) at the beginning of the first stage of labor, and if the duration of labor is more than 6 hours, the glucocorticosteroid injection is repeated at the end of the second period childbirth.
ASSESSMENT OF TREATMENT EFFICIENCY
The effectiveness of the therapy is assessed by the results of determining the hormones of the fetoplacental complex in the blood, ultrasound of fetal hemodynamics and CTG data.
CHOICE OF TIME AND METHOD OF DELIVERY
Delivery of pregnant women with a mild course of the disease with adequate anesthesia and corrective drug therapy is not difficult and does not worsen the patient's condition. In most patients, labor ends spontaneously. Among the complications of childbirth, the following are most often observed:
· Rapid course of labor;
· Prenatal outpouring of OS;
Anomalies generic activity.
In connection with the possible bronchospastic effect of methylergometrine in the prevention of bleeding in the second stage of labor, intravenous administration of oxytocin should be preferred. In pregnant women with severe asthma, uncontrolled course of moderate asthma, status asthmaticus during this pregnancy, or exacerbation of the disease at the end of the third trimester, delivery is associated with the risk of severe exacerbation of the disease, acute respiratory failure, and intrauterine fetal hypoxia. Given the high risk of infection and the occurrence of complications associated with surgical trauma, elective vaginal delivery is considered the method of choice for severe illness with signs of respiratory failure. When delivering through the vaginal birth canal, before labor induction, puncture and catheterization of the epidural space are performed in thoracic region at the ThVIII – ThIX level with the introduction of 0.125% bupivacaine solution, which gives a pronounced bronchodilator effect. Then, labor is induced by the amniotomy method. The behavior of the woman in labor during this period is active. After the start of regular labor, labor is anesthetized by epidural anesthesia at the LI – LII level. The introduction of an anesthetic with a prolonged action in a low concentration does not limit the mobility of the woman in labor, does not weaken the attempts in the second stage of labor, has a pronounced bronchodilator effect (an increase in the forced vital capacity of the lungs, the volume of forced expiration, the peak expiratory flow rate) and allows you to create a kind of hemodynamic protection. As a result, spontaneous delivery is possible, without the exception of attempts, in patients with obstructive breathing disorders. To shorten the second stage of labor, an episiotomy is performed.
In the absence of sufficient experience or technical capabilities for performing epidural anesthesia at the thoracic level, delivery by the CS should be performed. The method of choice for anesthesia during a caesarean section is epidural anesthesia. Indications for operative delivery in pregnant women with bronchial asthma are signs of cardiopulmonary insufficiency in patients after relief of severe prolonged exacerbation or status asthmaticus and a history of spontaneous pneumothorax. C-section can be performed according to obstetric indications (for example, the presence of an inconsistent scar on the uterus after a previous CS, narrow pelvis etc.).
PATIENT INFORMATION
Therapy of bronchial asthma during pregnancy is required. There are drugs for the treatment of bronchial asthma that are approved for use during pregnancy. With a stable condition of the patient and the absence of exacerbations of the disease, pregnancy and childbirth proceed without complications. It is necessary to take classes at the Asthma School or independently familiarize yourself with the materials of the educational program for patients.
Asthma is very common in humans, including pregnant women. Some women suffer from asthma during pregnancy, although they never had the slightest sign of the disease before. But during pregnancy, asthma not only affects the woman's body, but also limits the access of oxygen to the baby. But this does not mean that asthma complicates or increases the danger to the woman and to the baby during pregnancy. In women with asthma, with proper control illness, pregnancy passes with minimal risk or even without risk to the woman herself and to her fetus.
Most of the medicines used to treat asthma are safe for pregnant women. After years of research, experts can now say for sure that it is much safer to continue treating asthma than to stop treatment during pregnancy. Talk to your doctor about the safest treatment for you.
Risks of refusing treatment during pregnancy
If you have not had the slightest signs of asthma before, then you do not need to be so sure that shortness of breath or wheezing during pregnancy is a sign of asthma. Very few women who know for sure they have asthma pay attention to minor symptoms. But we must not forget that asthma affects not only your body, but also the body of the fetus, so you need to take preventive measures in time.
If the disease is out of control, then it threatens the following:
High blood pressure during pregnancy.
Preeclampsia, a disease that raises blood pressure and can affect the placenta, kidneys, liver, and brain.
Greater than usual toxicosis in early pregnancy (hyperemesis of pregnant women).
Childbirth that does not occur naturally(the attending physician causes the onset of labor) or passes with complications.
Risks to the fetus:
Sudden death before or after birth (perinatal mortality).
Poor fetal development (delayed intrauterine development). Little weight baby at birth.
Onset of labor before 37 weeks of gestation (preterm labor).
Low birth weight.
The higher the control over the disease, the lower the risks.
Asthma treatment and pregnancy
Asthma in pregnant women is managed in the same way as in non-pregnant women. Like any other asthmatic woman, a pregnant woman should follow the prescribed treatment and adhere to a treatment program to control inflammation and prevent asthma attacks. Part of a pregnant woman's treatment program should be devoted to monitoring fetal movements. You can do this yourself by recording every movement of the fetus. If you notice that the fetus has begun to move less during an asthma attack, immediately contact your doctor or call an ambulance.
Overview of asthma treatment in a pregnant woman:
If more than one specialist is involved in treating a pregnant woman with asthma, they must work together and coordinate their actions. An obstetrician should also be involved in the treatment of asthma.
It is necessary to carefully monitor the performance of the lungs during the entire pregnancy - the child should receive enough oxygen. Since the severity of asthma can change during the second half of a woman's pregnancy, regular examinations of symptoms and pulmonary function are necessary. Your doctor uses a spirometry or pneumotachometer to check your lung function.
After 28 weeks, it is necessary to observe the movements of the fetus.
In the case of poorly controlled or severe asthma after 32 weeks, an ultrasound examination of the fetus is necessary. Ultrasound examination also helps the doctor evaluate the fetus after an asthma attack.
Try to do your best to avoid and control asthma pathogens (such as tobacco smoke or dust mites) so you can take smaller doses of your medicine. Most women develop nasal symptoms, and between nasal symptoms and asthma attacks close connection... Gastroesophageal reflux disease (GERD), especially common during pregnancy, can also exacerbate symptoms.
It is very important to protect yourself from the flu. It is necessary to get a flu shot before the season starts - sometimes from early October to mid-November in the first, second or third trimester of pregnancy. The flu vaccine is only valid for one season. It is completely safe during pregnancy and is recommended for all pregnant women.
Most pregnant women have allergies in addition to asthma, such as allergic rhinitis. Therefore, allergy treatment is a very important part of asthma treatment and management.
If immunotherapy is started before pregnancy, it can be continued, but it is not recommended to start during pregnancy.
Talk to your healthcare provider about taking a decongestant (oral). Perhaps there are others best options treatment.
Asthma medications and pregnancy
Animal and human studies of asthma medication during pregnancy have found fewer side effects that a woman and her baby are exposed to. It is much safer to take asthma medications during pregnancy than to leave it alone. Poor disease control does more harm to the fetus than medications. FDA-approved budesonide is the safest inhaled corticosteroid to take during pregnancy. One study has shown that small doses of an inhaled corticosteroid are safe for the woman herself and her fetus.
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Severity |
Daily Medicines Needed to Maintain Long-term Disease Control |
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Severe permanent form |
Preferred:
Alternative:
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Average permanent form |
Preferred:
Alternative:
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Minor permanent form |
Preferred:
Alternative:
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Periodic |
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Quick Rescue: for all patients |
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Never stop taking or reduce the dose of your medication without your doctor's approval. It is only necessary to make any changes to the treatment after pregnancy.
To medicines that can cause potential harm fetus include epinephrine, alpha-adrenergic components (except pseudoepinephrine), decongestants (except pseudoepinephrine), antibiotics (tetracycline, sulfa drugs, ciprofloxasin), immunotherapy (stimulation or dose escalation), and iodides. Before you start taking the medicine, being pregnant or about to become pregnant, you should consult a specialist.
Bronchial asthma (BA) is a chronic inflammatory disease of the airways associated with increased bronchial reactivity. The development of this pathology during pregnancy complicates life significantly. future mother... Pregnant women with asthma are at high risk of gestosis, placental insufficiency and other complications during this period.
Causes and risk factors
According to statistics, the prevalence of bronchial asthma in the globe is up to 5%. Among pregnant women, asthma is considered the most frequently diagnosed respiratory disease. From 1 to 4% of all expectant mothers suffer from this pathology in one form or another. The combination of asthma and pregnancy requires special attention doctors due to the high risk of developing various complications.
There is a certain genetic predisposition to the occurrence of bronchial asthma. The disease develops mainly in women with a burdened allergic history. Many of these patients suffer from other allergic diseases (atopic dermatitis, hay fever, food allergies). The likelihood of developing bronchial asthma increases if one or both parents of a woman had this disease.
When faced with an allergen, all the main symptoms of bronchial asthma develop. Usually the first encounter with a dangerous agent occurs during childhood or adolescence... In rare cases, the first episode of bronchial asthma occurs in mature age, including during pregnancy.
Triggers are factors that provoke an exacerbation of bronchial asthma:
- stress;
- hypothermia;
- a sharp change in temperature (cold air);
- respiratory infections;
- contact with sharp-smelling household chemicals (powders, dishwashing detergents, etc.);
- smoking (including passive).
In women, an exacerbation of bronchial asthma often occurs during menstruation, as well as with the onset of pregnancy due to pronounced changes in hormonal levels.
Bronchial asthma is one of the stages in the development of the atopic march. This condition occurs in children with allergies. In early childhood, babies suffer from food allergies, manifested in the form of a rash and stool breakdown. V school age hay fever occurs - a seasonal runny nose as a reaction to pollen. And finally, hay fever is replaced by bronchial asthma - one of the most severe manifestations of the atopic march.
Symptoms
TO typical manifestations bronchial asthma include:
- dyspnea;
- labored breathing;
- persistent or intermittent dry cough.
During an attack, the patient takes a forced position: the shoulders are raised, the body is tilted forward. It is difficult for a pregnant woman in this state to talk due to an almost incessant cough. The appearance of such symptoms is triggered by contact with an allergen or one of the triggers. The exit from the attack occurs independently or after the use of drugs that dilate the bronchi. At the end of the attack, a dry cough is replaced by a wet cough small amount viscous sputum.
Bronchial asthma usually develops long before pregnancy. The expectant mother knows what a classic attack is and how to cope with this condition. A woman with asthma should always have fast-acting bronchodilators in her medicine cabinet.
Bronchial asthma is not always typical. In rare cases, the disease manifests itself only as a painful dry cough. A cough occurs after contact with an allergen or against a background of prolonged SARS. It is rather difficult to recognize the disease in this case. Often, the initial symptoms of bronchial asthma are taken for natural changes in the respiratory system associated with the onset of pregnancy.
Diagnostics
Spirography is performed to detect bronchial asthma. After a deep breath, the patient is asked to exhale forcefully into a special tube. The device records the readings, evaluates the strength and expiratory flow rate. Based on the data obtained, the doctor makes a diagnosis and prescribes the necessary therapy.
The course of pregnancy
Women suffering from bronchial asthma are at risk of developing such complications:
- toxicosis in early pregnancy;
- preeclampsia;
- placental insufficiency and concomitant chronic hypoxia fetus;
- miscarriage up to 22 weeks;
- premature birth.
Adequate therapy of bronchial asthma is also of great importance. The lack of competent drug control of seizures leads to respiratory failure, which inevitably affects the condition of the fetus. Arises oxygen starvation, brain cells die, fetal development slows down. Women with asthma have an increased risk of having a baby with low birth weight, asphyxia and various neurological disorders.
Probability severe complications pregnancy occurs in the following situations:
- severe course of bronchial asthma (the higher the frequency of attacks during pregnancy, the more often complications develop);
- refusal of treatment and drug control of asthma during pregnancy;
- incorrectly selected dosage of drugs for the treatment of bronchial asthma;
- combination with other chronic diseases of the respiratory system.
Serious complications against the background of mild to moderate asthma, as well as with properly selected drug therapy, are quite rare.
Consequences for the fetus
The tendency to develop bronchial asthma is inherited. The likelihood of an illness in a child is:
- 50% if only one parent has asthma;
- 80% if both parents have asthma.
An important point: not the disease itself is inherited, but only the tendency to develop allergies and bronchial asthma in the future. In a child, pathology can manifest itself in the form of hay fever, food allergies, or atopic dermatitis... It is impossible to predict in advance what form of an allergic reaction will occur.
The course of bronchial asthma during pregnancy
Pregnancy affects the course of the disease in different ways. In 30% of women, there is a noticeable improvement in their condition. This is largely due to the action of cortisol, which begins to be intensively produced during pregnancy. Under the influence of cortisol, the frequency of attacks decreases and the functioning of the respiratory system improves. In 20% of women, the condition worsens. Half of expectant mothers do not notice any special changes in the course of the disease.
The deterioration of the condition during pregnancy is facilitated by the refusal of drug therapy. Often, women do not dare to take the usual medications, fearing for the condition of their baby. Meanwhile, a competent doctor can choose safe enough remedies for the expectant mother that do not affect the course of pregnancy and the development of the fetus. Frequent uncontrolled seizures are much more severe in the child than modern drugs used to treat bronchial asthma.
Symptoms of bronchial asthma may first appear during pregnancy. Signs of the disease persist until the very birth. After the birth of a child, bronchial asthma disappears in some women, while in others it is transformed into a chronic disease.
First aid
To stop an asthma attack, you must:
- Help the patient to take a comfortable sitting or standing position with support on hands.
- Unbutton the collar. Remove anything that interferes with free breathing.
- Open the window, let fresh air into the room.
- Use an inhaler.
- Call a doctor.
Salbutamol is used to relieve an attack in pregnant women. The drug is administered through an inhaler or nebulizer in the first minutes after the onset of an attack. If necessary, the introduction of salbutamol can be repeated after 5 and 30 minutes.
If there is no effect of therapy within 30 minutes, it is necessary:
- Call a doctor.
- Give inhaled corticosteroids (via an inhaler or nebulizer).
If inhaled corticosteroids do not help, intravenous prednisone is given. Treatment is carried out under the supervision of a specialist (an ambulance doctor or a pulmonologist in a hospital).
Treatment principles
The selection of medicines for the treatment of bronchial asthma in pregnant women is not an easy task. The selected medicines must meet the following criteria:
- Safety for the fetus (no teratogenic effect).
- No negative impact on the course of pregnancy and childbirth.
- Possibility of using in the lowest possible dosages.
- The possibility of using a long course (throughout pregnancy).
- Lack of addiction to the components of the drug.
- Convenient shape and good portability.
All pregnant women with bronchial asthma should visit a pulmonologist or allergist twice during pregnancy (at the first visit and at 28-30 weeks). In case of an unstable course of the disease, a doctor should be consulted as needed. After the examination, the doctor selects the optimal drugs and develops a monitoring scheme for the patient.
Therapy for bronchial asthma depends on the severity of the process. Currently, specialists are practicing a stepwise approach to treatment:
Stage 1. BA mild intermittent... Rare (less than 1 time per week) asthma attacks. Between attacks, the woman's condition is not disturbed.
Treatment regimen: salbutamol during an attack. There is no therapy between attacks.
Stage 2. BA mild persistent... Asthma attacks several times a week. Rare nocturnal attacks (3-4 times a month)
Treatment regimen: inhaled glucocorticosteroids (ICS) daily 1-2 times a day + salbutamol on demand.
Stage 3. persistent asthma of moderate severity.
Asthma attacks several times a week. Frequent night attacks (more than 1 time per week). The woman's condition between attacks is impaired.
Treatment regimen: ICS daily 2-3 times a day + salbutamol on demand.
Stage 4. BA severe persistent... Frequent attacks throughout the day. Night attacks. Pronounced violation of the general condition.
Treatment regimen: ICS daily 4 times a day + salbutamol on demand.
An individual therapy regimen is developed by a doctor after examining the patient. During pregnancy, the regimen may be revised towards decreasing or increasing the dosage of drugs.
Childbirth with bronchial asthma
Bronchial asthma is not a reason for operative delivery... In the absence of other indications, childbirth with this pathology is carried out through the natural birth canal. Asthma attacks during childbirth are stopped with salbutamol. During childbirth, constant monitoring of the condition of the fetus is carried out. In the early postpartum period, many women experience an exacerbation of bronchial asthma, therefore, special monitoring is established for the postpartum woman.
Prophylaxis
The following recommendations will help reduce the frequency of asthma attacks during pregnancy.
Not so long ago, 20-30 years ago, a pregnant woman with bronchial asthma often faced a negative attitude even among doctors: "What were you thinking about? What kind of children ?! You have asthma!" Thank God these times are long gone. Today, doctors all over the world are unanimous in their opinion: bronchial asthma is not a contraindication for pregnancy and in no case is it a reason for refusing to have children.
Nevertheless, a certain mystical halo around this disease persists, 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 undoubtedly harmful in this period of life. Asthma treatment is surrounded by an incredible amount of myths and legends, rejection and misconceptions. For example, when increasing blood pressure a woman will not doubt that she can give birth to a child if she is properly treated. When planning a pregnancy, she will consult with a doctor in advance which medications can be taken during pregnancy and which cannot be taken, and she will acquire a tonometer to monitor her condition. And if the disease gets out of control, he will immediately apply for medical help... Of course, you say, this is so natural. But as soon as it comes to asthma, doubts and hesitation appear.
Perhaps the whole point is that modern methods asthma treatments are still very young: they are just over 12 years old. People still remember the times when asthma was a frightening and often disabling disease. More recently, treatment was reduced to endless droppers, theofedrine and hormones in pills, and the inept and uncontrolled use of the first inhalers often ended very badly. 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. There are still no methods that can once and for all rid a person of bronchial asthma, but you can learn how to control the disease well.
As a matter of fact, all the problems are connected not with the fact of the presence of bronchial asthma, but with its poor control. Greatest risk for the fetus is hypoxia ( an insufficient amount oxygen in the blood), which occurs due to the uncontrolled course of bronchial asthma. If choking occurs, not only does the pregnant woman feel shortness of breath, but also future child suffers from a lack of oxygen (hypoxia). It is the lack of oxygen 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 in about a third of women, asthma gets better, in a third it gets worse, and in a third it remains unchanged. But rigorous scientific analysis is less optimistic: asthma improves in only 14% of cases. Therefore, you should not rely on this chance indefinitely 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.
A woman with bronchial asthma should prepare for pregnancy
Pregnancy 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. Important role the patient's education plays: understanding the nature of the disease, awareness, the ability to use drugs correctly and the presence of self-control skills - the necessary conditions successful treatment.
A pregnant woman with asthma needs more careful medical supervision than before pregnancy. You should not use any medications, even vitamins, without the consent of your doctor.
Measures to limit contact with allergens
In young people, in most cases, bronchial asthma is atopic, and the main provoking factors are allergens - household, pollen, mold, epidermal. 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 is composed of textile fibers, particles of dead skin (exfoliated epidermis) of humans and pets, mold fungi, 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 decor should be spartan: the amount of upholstered furniture should be minimized, the carpets should be removed, instead of curtains, hung vertical blinds, books and knickknacks put away on the glazed shelves.
During the heating season, air humidity is reduced, which causes dryness of the mucous membrane and contributes to an increase in the amount of dust in the air. In this case, consider a humidifier. But humidification should not be excessive: excess moisture creates conditions for the multiplication of molds and house dust mites - the main source of household allergens. Optimum humidity air is 40-50%.
For air purification from dust and allergens, harmful gases and unpleasant odors special devices - air purifiers - have been created. It is recommended to use cleaners with HEPA filters (English abbreviation for "high efficiency particle filter") and carbon filters. Various modifications of HEPA filters are also used: ProHEPA, ULPA, etc. Some models use highly efficient photocatalytic filters. Devices that do not have filters and purify the air exclusively due to ionization should not be used: during their operation, ozone is formed, a chemically active and toxic compound in high doses, which is dangerous when lung diseases in general, but especially for pregnant women and young children.
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 can't do without a vacuum cleaner in a modern apartment. In this case, one should prefer vacuum cleaners with HEPA filters, specially designed for the needs of allergy sufferers: an ordinary 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 air modern materials(polyester, hypoallergenic cellulose, etc.). Fillers in which glue or latex was used to hold the fibers together (for example, synthetic winterizer) are not recommended.
But just changing your pillow isn't enough. New bedding needs proper care: regular beating and airing, regular frequent wash at a temperature of 60C and above. Modern fillers are easy to wash and restore their shape after multiple washes. There is also a way to wash less often while increasing your allergen resistance by placing your pillow, mattress and blanket in anti-allergen protective covers made of special fabric dense weave, freely permeable to air and water vapor, but impervious even to small particles. It is good to dry in summer bed dress in direct sunlight, in winter - freeze at low temperatures.
In connection with the huge role of house dust mites in the development of allergic diseases, means for their destruction have been developed - acaricides of chemical (Akarosan) or plant (Milbiol) origin, as well as complex action (Allergoff), combining plant, chemical and biological means of fighting the mite. Means have also been developed to neutralize mite, pet and mold allergens (Mite-NIX). All these they possess high rates safety, but despite this, the processing process should not be carried out by the pregnant woman herself.
Smoking is a fight!
Pregnant women are absolutely not allowed to smoke! Any contact with tobacco smoke should also 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 predisposed child increases 3-4 times.
Infections
Respiratory infections, which are dangerous for any pregnant woman, are many times more dangerous in bronchial asthma, since they carry the risk of exacerbation. Contact with infections must be avoided. At high risk influenza, the issue of vaccination with influenza vaccine is being considered.
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 (insufficient supply of oxygen to 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 (topically acting) inhalation drugs, since the concentration of the drug in the blood is minimal, and the local effect in the target zone, in the bronchi, is maximum. It is recommended to use freon-free inhalers. Metered-dose aerosol inhalers should be used with a spacer to reduce the risk of side effects and to eliminate problems with inhalation technique.
Routine therapy (basic, therapy for disease control)
Bronchial asthma, regardless of severity, is chronic inflammatory disease... It is this inflammation that causes the symptoms, and if you only deal with the symptoms, and not 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. 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.
Cromones (Intal, Tiled) are used only for mild persistent asthma. If the drug is prescribed for the first time during pregnancy, sodium cromolyn is used (Intal). If cromones do not provide adequate control of the disease, inhaled hormonal drugs should be prescribed. Their appointment during pregnancy has its own characteristics. If the drug is to be prescribed for the first time, budesonide or beclomethasone is preferred. If, before pregnancy, asthma was successfully controlled by another inhaled hormonal drug continuation of this therapy is possible. The drugs are prescribed by the doctor individually, taking into account not only the clinic of the disease, but also the peak flowmetry data.
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. They are guided by the PSV data when drawing up an Action Plan for Asthma: detailed doctor's recommendations, in which basic therapy and necessary actions when the state changes.
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: if you take action in time, you can avoid the development of an exacerbation.
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. Therefore, a drug is needed to relieve symptoms. For this purpose, selective inhalation beta2-agonists are used with quick start actions. The drugs of choice are terbutaline and salbutamol. In Russia, salbutamol is more commonly used (Salbutamol, Ventolin, etc.). The frequency of use of bronchodilators is important indicator control asthma. 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 (theofedrine, 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, exacerbation is serious threat for the fetus, therefore, a delay in treatment is unacceptable. In the treatment of exacerbations, nebulizer therapy is used. The drug of choice in our country is salbutamol. To combat fetal hypoxia, oxygen therapy is prescribed early. It may be necessary to prescribe systemic hormonal drugs, while prednisolone or methylprednisolone is preferred and trimcinolone (Polcortolone) is avoided due to the risk of affecting the muscular system of the mother and fetus, as well as dexamethasone and betamethasone. Deposited forms of long-acting systemic hormones - Kenalog, Diprospan - are categorically not used either for asthma or for allergies during pregnancy.
Other drug therapy issues
Any drugs during pregnancy can only be used as directed by a doctor. In the presence of concomitant diseases requiring planned therapy (for example, hypertension), it is necessary to consult a specialist to correct therapy taking into account pregnancy.
Intolerance to any medications is not uncommon in bronchial asthma. You should always have with you a passport of an allergic patient filled out by an allergist with an indication of medications that have previously caused an allergic reaction or are contraindicated in asthma. Before using any medication, you must familiarize yourself with its composition and instructions for use, and discuss all questions with your doctor.
Pregnancy and allergen-specific immunotherapy (ASIT, or SIT)
Although pregnancy is not a contraindication for ASIT, it is not recommended to start treatment during pregnancy. But if pregnancy occurs during ASIT, the treatment can be continued. One study showed that children born to mothers who received ASIT had a reduced risk of developing allergies.
Childbirth
A pregnant woman should know and take into account in her plans that with bronchial asthma, compared with healthy women the risk of both premature birth and prolonged pregnancy is slightly increased, which requires careful observation by a gynecologist. To avoid exacerbation of asthma during labor, basic therapy and PSV assessment are not stopped during labor. It is known that adequate pain relief during childbirth reduces the risk of exacerbation of bronchial asthma.
Risk of having a baby with asthma and allergies
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 (namely the risk!) Of development allergic disease... But other factors play an equally important role in the realization of this risk: the ecology of the home, contact with tobacco smoke, feeding, etc.
Breastfeeding is recommended for at least 6 months, while the woman herself must observe hypoallergenic diet and get advice from a specialist on the use of drugs during the period breastfeeding... If it is necessary to take medications, they should be used no later than 4 hours before feeding: in this case, their concentration in milk is minimal. It is not established whether they stand out with breast milk inhalation hormones, although it can be assumed that inhaled topical drugs with a minimal systemic effect, when used in recommended doses, can enter milk in only a small amount.
It was considered a serious obstacle to carrying a pregnancy. Often with such a diagnosis, if the attacks were frequent, women were forbidden to become pregnant and give birth. But today, the attitude towards this diagnosis has been significantly revised, and doctors around the world no longer consider the presence of bronchial asthma to be a reason for the prohibition of bearing and even the natural birth of a baby. But it is quite obvious that during such a gestation there are peculiarities, nuances, and on the part of doctors, a specific attitude towards a woman and the fetus she is carrying is necessary, which you need to know about in advance.
What is bronchial asthma?
Today, bronchial asthma is considered one of the most common pathologies of the bronchopulmonary system during pregnancy. This is especially true for atopic (allergic) type of asthma, which is associated with an increase in the total number of women with allergies.
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According to allergists and pulmonologists, the number of cases of asthma ranges from 3-4 to 8-9% of all allergy sufferers, and their number is constantly increasing by about 2-3% per decade.
If we talk about the nature of pathology, this is a chronically current inflammatory process in the area of the mucous membranes of the bronchi with the simultaneous formation of their narrowing, temporary spasm of smooth muscle elements, which reduces the lumen of the airways and makes breathing difficult.
Attacks are associated with an increase in the reactivity (excitability) of the walls of the bronchi, their abnormal reactions in response to various types of influences. Do not think that bronchial asthma is always an allergic pathology, such a state of the respiratory tract is possible after suffering brain injuries, severe infectious diseases, due to pronounced endocrine disorders and other influences . In most cases, the development of asthma is provoked by the influence of allergens, and in some cases, a milder form of pathology (c) is initially formed, and then the transition to damage to the bronchopulmonary system and asthmatic attacks with the formation of shortness of breath, wheezing and choking.
Asthma options: allergies and more
By their nature, two types of bronchial asthma are distinguished - an infectious-allergic course and an allergic one, without the participation of an infectious factor. If we talk about the first option, such bronchial asthma can form after suffering serious infectious lesions of the respiratory system - these are, severe, or. Various pathogens, often of microbial or fungal origin, act as provocateurs and allergenic components.
The infectious-allergic form is one of the most common among all variants of the course; episodes of its development account for up to 2/3 of all variants of asthmatic attacks in women.
If we talk about atopic (purely allergic, without microbes) bronchial asthma, then for it, allergens can act various substances, having both organic (plant, animal, artificial synthesis) origin, and inorganic (substances environment). The most common are such provocateurs as wind-pollinated pollen, household or professional dust, outdoor dust, components of wool, feathers, down of animals, birds. Food components can also become provocateurs of attacks - these are citruses, bright berries with a high allergenic potential, as well as some types of medicines (salicylates, synthetic vitamins).
A separate place is assigned to professional, chemical allergens, which in the form of suspension, dust, aerosol get into the air and into the respiratory system. These can be various compounds of perfumery, household chemicals, varnishes and paints, aerosols, etc.
For atopic asthma and its development, a woman's hereditary predisposition to any allergy is extremely important.
How do seizures appear?
Regardless of the form in which the patient has bronchial asthma, there are three stages in its development, which can successively replace each other. This is pre-asthma, then typical asthmatic attacks (with, whistling or choking), gradually turning into the formation of asthmatic status. All three of these options are quite likely to occur during pregnancy:
- If speak about pre-asthmatic condition , attacks of obstructive, asthmatic bronchitis or frequent pneumonia with bronchospasm are typical for him. However, episodes of severe suffocation, typical for bronchial asthma, have not yet been observed.
- On the initial stage asthma
typical attacks with suffocation occur from time to time, and against the background of an infectious-allergic form of the condition, it can manifest itself with an exacerbation of any chronic bronchopulmonary diseases (bronchitis, pneumonia). Asthmatic attacks are usually easily recognized, their onset usually occurs at night, they can last within a few minutes, although a protracted course is possible - from an hour or more.
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Choking attacks may be preceded by certain precursors - a burning sensation with severe sore throat, a runny nose or sneezing, a feeling of pressure, a sharp tightness in the chest.
The attack itself usually starts as a persistent cough without phlegm, after which there is a sharply difficult exhalation, almost complete nasal congestion and a feeling of compression in the chest. To breathe easier, the woman sits down and strains the auxiliary muscles in the chest and neck, shoulder girdle, which helps to exhale with effort. Typically noisy and hoarse breathing with whistles that can be heard from a distance. Initially, breathing becomes more frequent, but then due to the hypoxia of the respiratory center, it decreases to 10-15 breaths per minute. The patient's skin becomes covered with perspiration, the face may become red or cyanotic, at the end of the attack, when coughing, a lump of viscous, like shards of glass, sputum may come off.
- occurrence status asthmaticus - extremely dangerous condition threatening the lives of both. With him, the arising attack of suffocation does not stop for a long time for several hours, or even days in a row, and respiratory disorders are expressed to the maximum extent. Moreover, all the medications that are usually taken by the patient do not give any effect.
Bronchial asthma: the effect of attacks on the fetus
Against the background of pregnancy, naturally occur hormonal changes in the body of the expectant mother, as well as specific deviations in the functioning of the immune system, so that the fetus, which half consists of the father's genes, is not rejected. Therefore, at this time, the course of bronchial asthma can both worsen and improve. Naturally, the presence of seizures will negatively affect the condition of the pregnant woman herself, as well as the course of pregnancy.
Often, bronchial asthma is present even before pregnancy, although it is quite possible that it develops already during gestation, especially against the background of previously existing allergic manifestations, including hay fever. There is also a hereditary predisposition, a tendency to asthma in the relatives of a pregnant woman, including the presence of asthmatics.
Asthma attacks can begin in the first weeks, or join in the second half of the gestational period. The presence of asthma in the early stages, similar to the manifestations of the early, can spontaneously disappear in the second half. Making preliminary forecasts in such cases for a woman and her child will be most favorable.
The course of seizures by trimester
If asthma was present even before pregnancy, then during gestation its course can be unpredictable, although doctors reveal certain patterns.
In about 20% of pregnant women, the condition remains at the same level, as it was before pregnancy, about 10% of mothers note relief of attacks and significant improvement, and the remaining 70% have a much more severe illness than before.
In the latter case, both moderate and severe seizures prevail, which occur daily, or even several times a day. From time to time, attacks can be delayed, the effect of treatment is rather weak. Often, the first signs of deterioration are noted already from the first weeks of the first trimester, but by the second half of gestation it becomes easier. If during the previous pregnancy there was a trend in a positive or negative direction, subsequent gestations usually repeat the scenario.
Asthma attacks during childbirth are rare, especially if the preventive purpose women use bronchodilator or hormonal agents during this period. After giving birth to a child, about a quarter of women and mild asthma, there is an improvement in the condition. Another 50% do not notice any changes in their condition, and the remaining 25% have a worsening condition, and they are forced to constantly take hormonal drugs, the doses of which are constantly increasing.
The effect of bronchial asthma on a woman and a fetus
Against the background of existing bronchial asthma, women are more likely than healthy ones to suffer from early toxicosis pregnancy, they have a higher threat and disorders in labor... Often there can be rapid or rapid childbirth, which is why the percentage of birth injuries is high for both the mother and the baby. They also often have small or premature babies.
Against the background of severe attacks, the percentage of and is high, as well. Serious complications for the fetus and its death are possible only with extremely grave condition and inadequate treatment. But the presence of a mother's illness can negatively affect the child in the future. About 5% of babies may suffer from asthma, which develops in the first three years of life, in subsequent years the chances of it reaching 60%. Newborns are prone to frequent pathologies from the respiratory tract.
If a woman suffers from bronchial asthma and the pregnancy is full-term, childbirth is carried out naturally, since possible attacks of suffocation can be easily stopped. If attacks are frequent or status asthmaticus threatens, the effectiveness of treatment is low, and there may be indications for early delivery after 36-37 weeks.
The problem of asthma therapy during gestation
For a long time, experts believed that the basis of the disease is a spasm of smooth muscle elements in the bronchi, which leads to asthma attacks. Therefore, the treatment was based on drugs with a bronchodilatory effect. Only in the 90s of the last century it was determined that the basis of asthma is a chronic inflammation of an immune nature, and the bronchi remain inflamed in any course and severity of the pathology, even when there are no exacerbations. The discovery of this fact led to a change in the fundamental approaches to the therapy of asthma and its prevention. ... Today, the basic drugs for asthmatics are anti-inflammatory drugs in inhalers.
If we talk about pregnancy and its combination with bronchial asthma, then the problems are associated with the fact that during gestation it can be poorly controlled by medications. Against the background of seizures, the greatest risk to the fetus is the presence of hypoxia - a lack of oxygen in the maternal blood. Due to asthma, this problem becomes several times more acute. When an attack of suffocation is formed, it is felt not only by the mother herself, but also by the fetus, which is completely dependent on her and suffers sharply from a lack of oxygen. It is the frequent bouts of hypoxia that lead to disturbances in the development of the fetus, and in critical periods development can even lead to disturbances in the laying of tissues and organs.
For the birth of a relatively healthy baby, you need a full and adequate treatment, which fully corresponds to the severity of bronchial asthma. This will not allow more frequent attacks and increased hypoxia.
During pregnancy, treatment should be mandatory, and the prognosis for those women whose asthma is completely under control regarding the health of children is very favorable.
Pregnancy planning, preparation for it
It is important to approach pregnancy with bronchial asthma with all responsibility, in advance of it against the background of all the necessary measures for treatment and prevention. It is important to visit a pulmonologist or allergist in advance with the selection of basic treatment, as well as training in self-monitoring of the condition and inhalation administration of drugs. It is necessary for the allergic nature of the attacks to conduct tests and tests in order to fully determine the range of dangerous allergens and exclude contact with them. Immediately after conception, a woman needs close observation doctor, it is prohibited to take any medications without his permission. If there are concomitant pathologies, treatment is also carried out taking into account the condition and the presence of asthma.
Measures to prevent attacks and exacerbations
It is strictly forbidden to smoke during pregnancy and even come into contact with tobacco smoke... Its components lead to irritation of the bronchi and the formation of their inflammation, an increase in the reactivity of the immune system. It is important to convey this information to the future father, if he smokes, the risk of having an asthmatic child increases by 4 times.
It is equally important to exclude possible contact with allergens, which most often provoke asthma attacks, especially in the warm season. There are also options for year-round allergic asthma, for which you need to create a special hypoallergenic lifestyle that reduces the load on the woman's body and leads to an improvement in the course of the disease, and a decrease in the risk of complications. This allows you to reduce (but not completely eliminate) medications during gestation.
How is bronchial asthma treated in pregnant women?
Often, women during pregnancy try to refuse to take medications, but this is not the case with asthma, its treatment is simply necessary. The harm that can be caused to the fetus by severe attacks that are not controlled, as well as episodes of hypoxia, are much more dangerous for the fetus than the possible side effects that are likely to occur when taking medications. If you refuse to treat asthma, this can threaten a woman with status asthmaticus, then both can die.
Today, in the treatment, the use of topical inhalation drugs is preferred, which act locally, have the maximum activity in the bronchi area while creating the lowest possible concentration of drugs in the blood plasma. In treatment, it is recommended to use freon-free inhalers, they usually have the markings "ECO" or "N", there is a phrase "without freon" on the packages. If it is a metered-dose aerosol inhaler, it should be used in combination with a spacer - this is an additional chamber into which the aerosol is supplied from the balloon before the patient inhales. Due to the spacer, the effect of inhalation increases, problems with the use of the inhaler are eliminated and the risk of side effects that are possible due to aerosol getting on the mucous membranes of the pharynx and mouth decreases.
Basic therapy: what and why?
In order to control the condition of a woman during pregnancy, it is necessary to use basic therapy that suppresses the process of inflammation in the bronchi. Without it, the fight only with the symptoms of the disease will lead to the progression of the pathology. The volume of basic treatment is selected by the doctor, taking into account the severity of asthma and the condition of the expectant mother. These medications must be taken constantly, every day, regardless of how you feel and whether there are seizures. Such treatment can significantly reduce the number of attacks and their severity, as well as reduce the need for taking complementary medications which helps in normal development child. Basic therapy is carried out throughout pregnancy and throughout childbirth. Then it is carried out already after the birth of the baby.
With a mild course of pathology, hormones are used (Tayled or Intal drugs), and if asthma occurs for the first time during pregnancy, they start with Intal, but if adequate control over it is not achieved, then they are replaced with hormonal inhalation drugs. During pregnancy, Budesonide or Beclomethasone are used from this group, if asthma was even before gestation, it was controlled by some other hormonal drug, you can continue therapy with it. The drugs are selected only by the doctor, based on the state data and peak flowmetry indicators (measurement of the peak expiratory flow rate).
To monitor the state of the house, today they use portable devices - peak flow meters, which measure respiration indicators. Doctors are guided by their data when they draw up a therapy plan. Readings are measured twice a day, in the morning and in the evening, before taking the drugs. The data is recorded in a graph, and then shown to the doctor so that he can assess the dynamics of the condition. In the presence of "morning failures", low rates, it is important to correct therapy, this is a sign possible exacerbation asthma.