Postpartum airway responsiveness and exacerbation of asthma during pregnancy &amp;ndash; a pilot study

Ali, Zarqa; Nilas, Lisbeth; Ulrik, Charlotte Suppli

doi:10.2147/jaa.s137847

Cited by 10 publications

(5 citation statements)

References 40 publications

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“…Older age, decreased allergen sensitization, and absence of allergic rhinitis are also associated with more severe asthma 118 . Nonallergic asthmatics have increased asthma exacerbations during pregnancy 119,120 . Airway reactivity associated with sputum neutrophilia is increased in asthmatic women during pregnancy 119 .…”

Section: Discussionmentioning

confidence: 99%

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Asthma and/or hay fever as predictors of fertility/impaired fecundity in U.S. women: National Survey of Family Growth

Turkeltaub¹,

Lockey

Holmes

et al. 2019

Sci Rep

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This study addresses whether asthma and/or hay fever predict fertility and impaired fecundity. The lifetime number of pregnancies (fertility) and spontaneous pregnancy losses (impaired fecundity) in 10,847 women representative of the U.S. population 15 to 44 years of age with histories of diagnosed asthma and/or hay fever are analyzed in the 1995 National Survey of Family Growth using multivariable Poisson regression with multiple covariates and adjustments for complex sampling. Smokers have significantly increased fertility compared to nonsmokers. Smokers with asthma only have significantly increased fertility compared to other smokers. Higher fertility is associated with impaired fecundity (ectopic pregnancy, miscarriage, stillbirth). Women with asthma (with and without hay fever) have significantly higher pregnancy losses than women without asthma. With increasing number of pregnancies, smokers have increased pregnancy losses compared to nonsmokers. Smokers, especially those with asthma only, have increased fertility and require special attention as to their family planning needs, reproductive health, and smoking cessation. Women with asthma, regardless of number of pregnancies, and smokers with higher numbers of pregnancies have high risk pregnancies that require optimal asthma/medical management prenatally and throughout pregnancy. Whether a proinflammatory asthma endotype underlies both the increased fertility and impaired fecundity associated with age and smoking is discussed.

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Section: Discussionmentioning

confidence: 99%

“…Nonallergic asthmatics have increased asthma exacerbations during pregnancy 119,120 . Airway reactivity associated with sputum neutrophilia is increased in asthmatic women during pregnancy 119 .…”

Section: Discussionmentioning

confidence: 99%

Asthma and/or hay fever as predictors of fertility/impaired fecundity in U.S. women: National Survey of Family Growth

Turkeltaub¹,

Lockey

Holmes

et al. 2019

Sci Rep

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show abstract

“…Furthermore, a higher frequency of near-fatal asthma episodes on the first day of menstruation has been reported [30]. Women in the postpartum period have been reported to develop increased airway hyperresponsiveness and worsening of asthma control [8]. Changes during pregnancy appear to be more variable with reports of decreased, increased or no change in asthma symptoms [29].…”

Section: Discussionmentioning

confidence: 99%

“…However, it is unclear how airway remodeling could cause a rapidly developing status asthmaticus. Interestingly, hormonal-related changes secondary to pregnancy can lead to an increase in airway hyperresponsiveness during the postpartum period, but the underlying histopathologic changes are yet to be described [8]. We report a case of a young woman who developed fatal status asthmaticus complicated with barotrauma at two months postpartum.…”

Section: Introductionmentioning

confidence: 99%

The anatomic substrate of irreversible airway obstruction and barotrauma in a case of hurricane-triggered fatal status asthmaticus during puerperium: Lessons from an autopsy

Febres‐Aldana

Oneto

Csete

et al. 2019

Respiratory Medicine Case Reports

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Non-fully reversible airway obstruction in fatal asthma is often seen in association with profound structural changes of the bronchial wall, termed airway remodeling. Evidence suggests that heavy precipitation events can trigger epidemics of severe asthma. We present a case of fatal asthma in a young woman with no prior near-fatal exacerbations and postulate that the patient's extensive airway remodeling and puerperal state (susceptibility factors), in combination with a massive allergen challenge during a hurricane landfall (triggering factor), played a central role in her death. The autopsy revealed diffuse obstruction of proximal and distal bronchi by mucous plugs together with transmural chronic inflammation, tissue eosinophilia, extensive goblet cell hyperplasia with MUC-5 expression and airway smooth muscle (ASM) thickening. The observed distribution of airway remodeling was heterogeneous with sparing of the lingula, which exhibited hyperinflation and expansion of perivascular spaces indicative of dissecting air. The massive stagnation of mucus and significant inter-airway structural heterogeneity created an anatomical substrate for unequal airflow distribution facilitating the development of barotrauma. Although not considered conventional risk factors for fatal asthma, we believe that in this case, the patient's puerperal state in conjunction with an extreme environmental event dispersing aeroallergens were major contributors to the development of a fatal asthma attack. Our autopsy findings suggest that effective strategies to evacuate stagnated mucus and induce relaxation of thickened ASM are crucial in the management of life-threatening asthma exacerbations.

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“…At each visit spirometry, fractional exhaled nitric oxide (F E NO) and maternal body weight were assessed. The MAP program has been described in details elsewhere 8–12 …”

Section: Methodsmentioning

confidence: 99%

Associations between maternal and environmental exposures on atopic disease in the offspring of mothers with asthma

Ali

Jemec

Ulrik

2021

Immunity Inflam & Disease

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Background and Objective Available data on the impact of perinatal and environmental factors on atopic diseases in the offspring are sparse and conflicting. We, therefore, investigated the impact of these factors on the risk of atopic diseases in the offspring of women with asthma. Methods Pregnant women referred to give birth at Copenhagen University Hospital‐Hvidovre, Denmark, have since 2007 been invited to participate in the Management of Asthma during Pregnancy program. Women with diagnosed asthma, currently prescribed asthma medication, first visit to the respiratory out‐patient clinic within the first 18 weeks of pregnancy that completed an online questionnaire about atopic diseases in their child were included in the current study. Results Five hundred and seventy‐one pregnancies were included. Among the off‐spring, 113 children (21%) had doctor‐diagnosed asthma, 178 (31%) atopic dermatitis (AD), and 55 (32%) both AD and doctor‐diagnosed asthma. AD in the offspring was associated with having a dog at home (odds ratio [OR], 2.56; 95% confidence interval [CI], [1.40–4.67], p = .002), whereas having a cat at home was associated with a higher risk of asthma in the offspring (OR, 2.16; 95% CI, [1.14–4.11], p = .02). The associations remained significant after adjusting for maternal age, smoking status, allergy, treatment with inhaled corticosteroids, forced expiratory volume in 1 s less than 80% predicted, uncontrolled asthma, and history of pre‐pregnancy asthma exacerbations. No association was found between gestational weight gain (GWG) in first trimester and total GWG and atopic disease in the offspring. Conclusion Having pets at home is associated with AD and asthma in the offspring of mothers with asthma.

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Postpartum airway responsiveness and exacerbation of asthma during pregnancy – a pilot study

Cited by 10 publications

References 40 publications

Asthma and/or hay fever as predictors of fertility/impaired fecundity in U.S. women: National Survey of Family Growth

Asthma and/or hay fever as predictors of fertility/impaired fecundity in U.S. women: National Survey of Family Growth

The anatomic substrate of irreversible airway obstruction and barotrauma in a case of hurricane-triggered fatal status asthmaticus during puerperium: Lessons from an autopsy

Associations between maternal and environmental exposures on atopic disease in the offspring of mothers with asthma

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