Acute asthma in pregnancy

Hanania, Nicola A.; Belfort, Michael A.

doi:10.1097/01.ccm.0000182789.14710.a1

Cited by 43 publications

(31 citation statements)

References 65 publications

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“…Management of status asthmaticus in pregnancy is no different than in nonpregnant individuals, but there are concerns about the effects of hypercapnia and acidosis on the fetus. 18 In all 4 patients who delivered, the pregnancies resulted in healthy babies. In the 1 patient who suffered a pneumomediastinum during early labor, the decision was made for cesarean delivery because of concerns about potential worsening of the barotrauma and maternal cardiopulmonary condition.…”

Section: Discussionmentioning

confidence: 96%

Increasing severity of status asthmaticus in an urban medical intensive care unit

Elsayegh

Saito

Eden

et al. 2008

Journal of Hospital Medicine

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BACKGROUND:Life‐threatening status asthmaticus (SA) requiring intensive care is a major concern given the rising prevalence of asthma. We examined episodes of SA requiring admission to the medical intensive care unit (MICU) of an urban hospital center.METHODOLOGY:The charts of patients admitted to the MICU of an urban hospital center with a diagnosis of SA during the 5‐year period 2002–2006 were reviewed retrospectively. These results were compared with those of a previously published experience at our institution from 1995 to 1999.RESULTS:The medical records of 84 MICU admissions for SA were reviewed. There were 61 women (5 pregnant). The mean age was 44 years. Use of cigarettes or illicit drugs was found in 51% and 30%, respectively. Mechanical ventilation (MV) was required in 76% of admissions. Noninvasive ventilation was used in 10 patients. Neuromuscular blockade (NMB) was needed in 9% of admissions. The highest average PaCO2 during the first 24 hours was 67 mm Hg. Median duration of MV was 4.4 days. Six patients died, 3 of whom sustained prehospital cardiac arrest. Compared with the patients in the preceding 5‐year period, the more recent patients had greater use of illicit drug and cigarettes. Patients presented with more severe asthma, as reflected by a higher PaCO2 and an increased duration of MV.CONCLUSIONS:During the recent 5‐year period, we found a trend toward increasing severity of SA, as indicated by the degree of respiratory acidosis, need for NMB, and longer duration of MV. Access to medical care and cigarette and illicit drug use remain potential targets of primary intervention. Journal of Hospital Medicine 2008;3:206–211. © 2008 Society of Hospital Medicine.

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Section: Discussionmentioning

confidence: 96%

Increasing severity of status asthmaticus in an urban medical intensive care unit

Elsayegh

Saito

Eden

et al. 2008

Journal of Hospital Medicine

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“…The implementation of asthma care maps can help in the emergency department to increase the prescription of bronchodilator therapy. 44 This can be especially useful in the labour ward where SLTA is a rare occurrence. 41, 44 and 45 • Oxygen especially high flow, start at 8 L/min.…”

Section: Managementmentioning

confidence: 99%

“…43 • A progressive increase in maternal PCO 2 or PaCO 2 > 40-45 mmHg associated with maternal exhaustion are indications for intubation and ventilation. 43 • To prevent dynamic hyperinflation with subsequent volu-and barotraumas, the following steps should be taken 44 :…”

Section: Management Of Sltamentioning

confidence: 99%

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Underlying medical conditions

Lombaard

Pattinson

2008

Best Practice & Research Clinical Obstetrics & Gynaecol

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More than half of maternal deaths in the UK are due to pre-existing medical conditions, and medical emergencies often mimic acute obstetric conditions. An acute flare of systemic lupus erythaematosus, a thyroid storm or a phaeochromocytoma have many of the signs and symptoms of imminent eclampsia. Similarly, severe postpartum haemorrhage can result in diagnostic difficulties of medical conditions such as Addison's syndrome or acute renal failure. An acute collapse can be due to a pulmonary embolus, myocardial infarction, tachyarrhythmia or myasthenia gravis. These conditions are rare; however, unless they are considered in a differential diagnosis, they will not be diagnosed, to the detriment of the woman and her infant. This chapter deals with acute medical conditions occurring uncommonly in pregnant women. An obstetrician should know the initial steps to take in the emergency management of these cases.

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“…In fact, we have found that progesterone, a maternal hormone that maintains the pregnant state, has the capacity to stimulate and activate the 33D1+ DC subset. Moreover, it has been proposed that Th2 dominancy is also required to elicit an allergic status; many allergic symptoms worsen during pregnancy [10,11]. Thus, the alteration of Th2 to Th1 dominance in vivo appears to be a promising strategy to overcome a variety of allergic diseases.…”

Section: Introductionmentioning

confidence: 99%

Effects of Dendritic Cell Subset Manipulation on Airway Allergy in a Mouse Model

Murakami¹,

Nakagawa²,

Shimizu³

et al. 2015

Int Arch Allergy Immunol

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Background: Two major distinct subsets of dendritic cells (DCs) are arranged to regulate immune responses: DEC-205+ DCs drive Th1 polarization and 33D1+ DCs establish Th2 dominancy. Th1 polarization can be achieved either by depletion of 33D1+ DCs with a 33D1-specific monoclonal antibody (mAb) or by activation of DEC-205+ DCs via intraperitoneal injection of α-galactosylceramide (α-GalCer). We studied the effect of 33D1+ DC depletion or DEC-205+ DC activation in vivo using an established mouse model of allergic rhinitis (AR). Methods: Mice were injected intraperitoneally with OVA plus alum and challenged 4 times with daily intranasal administration of OVA. Immediately after the last challenge, allergic symptoms such as sneezing and nasal rubbing as well as the number of cells in the bronchoalveolar lavage fluid (BALF) and nasal lavage fluid (NALF) were counted. The levels of serum OVA-specific IgG1, IgG2a, and IgE were also determined by ELISA. Results: The allergic symptom scores were significantly decreased in 33D1+ DC-depleted or DEC-205+ DC-activated AR mice. The levels of OVA-specific IgG1, IgG2a, and IgE, and the number of NALF cells, but not BALF cells, were reduced in 33D1+ DC-depleted but not in DEC-205+ DC-activated AR mice. Moreover, the activated DEC-205+ DCs suppressed histamine release from IgE-sensitized mast cells, probably through IL-12 secretion. Conclusions: The manipulation of innate DC subsets may provide a new therapeutic strategy for controlling various allergic diseases by reducing histamine release from IgE-sensitized mast cells by driving the immune response towards Th1 dominancy via activation of DEC-205+ DCs in vivo.

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Acute asthma in pregnancy

Abstract: Asthma can complicate the course of pregnancy, and pregnancy can worsen asthma control in some women. Optimal management of asthma during pregnancy is key in ensuring the safety of the mother and the fetus.

Cited by 43 publications

References 65 publications

Increasing severity of status asthmaticus in an urban medical intensive care unit

Increasing severity of status asthmaticus in an urban medical intensive care unit

Underlying medical conditions

Effects of Dendritic Cell Subset Manipulation on Airway Allergy in a Mouse Model

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