Pregnancy and bronchial asthma

Bronchial asthma is a disease surrounded by many questions and doubts that particularly concern women planning a pregnancy. Will the baby be healthy? Do I need to refuse treatment or, on the contrary, strengthen it during pregnancy? How dangerous for the future baby taken  medication? Modern ideas about this disease can give a complete answer.

Bronchial asthma      It is a chronic disease of the respiratory tract, caused by inflammation. The main manifestations: asthma,   cough, chest tightness, wheezing and wheezing. Their occurrence is triggered by contact with cause-significant allergens (house dust, pet dander, plant pollen and others), irritants (tobacco smoke), infections (ARVI).

How does pregnancy affect asthma?

Pregnancy is a special condition in which transformations of organs and systems of the woman’s body occur, aimed at creating favorable conditions for the development of the fetus. These changes can affect the course of chronic diseases. For example, shifts occurring in the respiratory, endocrine and immune systems are most significant in bronchial asthma.

There are 3 options for the course of bronchial asthma during pregnancy:

  • Pregnancy does not affect the course of bronchial asthma;
  • Improving the course of the disease on the background of pregnancy;
  • More severe course of bronchial asthma during pregnancy.

According to statistics, only 14% of pregnant women have a better course of asthma. It is impossible to predict how the relationship will develop in each individual case. Hope that everything will cost, not worth it.

What is the danger of poor asthma control?

It should be understood that bronchial asthma does not directly lead to pregnancy complications. All possible problems are due to poor disease control.

Hypoxia (lack of oxygen)      the most dangerous condition for the fetus, which occurs during exacerbation of bronchial asthma. Difficulty breathing, which a woman experiences at the time of an attack of asphyxiation, is also strongly felt by the child. The consequence of hypoxia are: insufficient mass of the fetus (malnutrition), general developmental delay, impaired organ insertion (in the 1st trimester of pregnancy).

Inadequate control over asthma can lead to preeclampsia (a condition that is dangerous for both mother and baby), and also contribute to the development of infectious diseases of the respiratory tract in a pregnant woman, sometimes requiring serious antibiotic therapy.

With good control of asthma during pregnancy, children are born healthy and have a positive prognosis.

Preparation for pregnancy

At the planning stage of pregnancy, primary therapy should be selected (inhaler in the minimum effective dose) that can control the course of the disease, that is, ensure that there are no exacerbations and respiratory function indicators that are closest to normal. The process of selecting a drug is quite long. Without a doubt, it must be passed before the onset of pregnancy to avoid risks. No less important is the correct technique of inhalation, due to which the medicinal substance fully enters the bronchi.

Exacerbations of allergic asthma are provoked by contact with allergens. If you exclude or limit their presence, you can reduce the manifestations of the disease. In order to accurately know your spectrum of cause-significant allergens, it is necessary to be examined in advance by an allergist-immunologist’s doctor, and to receive recommendations on restrictive measures. However, it is common for all to observe hypoallergenic life – the fight against household dust and microscopic house dust mites living in a dwelling:

  • Remove “dust collectors”      objects that accumulate dust: carpets, upholstered furniture, massive curtains and others;
  • Store clothes in closed cabinets (store seasonal clothes in special covers);
  • Daily light wet cleaning;
  • Replace feather pillows on hypoallergenic, made of synthetic material. Use protective covers for pillows, blankets and especially mattresses. Wash bed linen at a temperature of at least 60 ⁰      1 time at week (!)
  • Install an air cleaner at home.

Drug safety

The main tactics of treatment of bronchial asthma during pregnancy      the use of drugs that effectively control the manifestations of the disease, but do not affect the normal course of pregnancy and   development of the child, that is, have a proven safe action.

Each drug undergoes large-scale clinical trials, the results of which put the category of safety during pregnancy.

Symptoms to relieve symptoms

A choking fit is a sudden feeling of difficulty breathing with the inability to breathe out completely. Frightening condition that I want to get rid of as soon as possible.

Pregnant women need to stop choking attacks as quickly as possible so that hypoxia does not harm the child.

Preference is given to drugs with a rapid onset of action and a selective effect on the lungs with a minimum on the heart. In Russia, it is salbutamol (Ventolin). However, we must remember that this drug, or rather the frequency of its use, is an indicator of control over bronchial asthma.Ideally, with adequately selected primary therapy, there is no need for ambulance inhalers, or it is minimal. Increased choking frequency and increasing need for this inhaler      Signal about the need for urgent expert advice.

Planned therapy

The basic therapy with drugs in inhalation form is the basis for the treatment of bronchial asthma. It is aimed at normalizing the respiratory function and preventing exacerbations of the disease. To achieve the maximum long-term effect, therapy should be regular, and drugs should be chosen by a specialist – pulmonologist or allergist-immunologist.

With mild asthma, the doctor may prescribe inhalers   Intal   or Tayled, belonging to the Cromon group (non-hormonal drugs). In case of inadequate control of the disease, a transition to hormonal inhalers (glucocorticosteroids) is necessary.

Given that most of the drugs of basic therapy      hormonal, the question of their safety is very relevant. The use of local (topical) glucocorticosteroids is safe, since the medicinal substance works exclusively in the area of ​​inflammation – in the bronchi. It does not enter the bloodstream, and therefore has minimal side effects on the mother’s body and does not affect the fetus. Among all the means of treatment of bronchial asthma, the effectiveness of such drugs is maximum.

Of the many hormonal inhalers, based on the ratio of efficacy / safety, during pregnancy, preference is given to budesonide (Pulmicort) and beclomethasone (Beclason, Klenil).

What drugs should be avoided?

To relieve asthma exacerbations, hormone preparations are often used for intravenous administration or tablet form, which have a systemic effect on the entire body and penetrate the placenta. Such glucocorticosteroids are used only according to strict indications. The safest in this case is  prednisone

Another drug used for the relief of acute condition –   adrenalin   (Epinephrine) can also be used only in an emergency.

Long-acting bronchodilator inhalers (formoterol, salmeterol), which are often combined with a hormonal inhaler, are used with caution, as their safety has not yet been fully studied.

Very often, asthma is combined with allergic rhinitis (allergic rhinitis), and its manifestations are removed antiallergic (antihistamine) tablets. Unfortunately, their reception is possible only from the 2nd trimester and only in case of emergency. To use, for example, allowed loratadin (Claritin).

Control asthma at home

Bronchial asthma is a disease that requires self-control at home. The method of measuring respiration is simple but effective and is called peak flow meter, and the device itself is peak flow meter.

The measured indicator is the peak expiratory flow rate (PSV). It is necessary to register it 2 times a day, morning and evening, before using the inhaler. The emerging graph reflects the state of respiratory function and may indicate a decrease in control over the disease, although there is still no change in well-being. A typical sign of an impending exacerbation is the “failure” of the schedule in the morning.

Properly performed training at the planning stage of pregnancy and adequate full-fledged therapy in accordance with the severity of the disease course under the supervision of a specialist is the key to the health of the mother and baby.

Expert comment

Elena Stanislavovna Kryzhenovskaya, obstetrician-gynecologist.

Pregnancy with bronchial asthma can proceed as absolutely safely, reducing the frequency and severity of asthma attacks, and, conversely, causes a worsening of the woman’s condition.

Pregnant patients with asthma require special monitoring, as a gynecologist and pulmonologist. With moderate and severe disease, pathologies such as fetal hypotrophy, placental insufficiency, preeclampsia and the threat of premature termination of pregnancy may occur.

However, in most cases, with proper control by the doctor, the condition of women with asthma does not worsen during pregnancy and they manage to bear and give birth to a healthy child.

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