Quality of care of asthma during pregnancy

Abstract

The goal of asthma management during pregnancy is to keep the mother symptom free and to prevent complications in the fetus. Asthma is a common chronic condition in pregnancy that, if inadequately treated, has the potential to cause adverse effects for both mother and fetus. Aggressive treatment during pregnancy can decrease costs associated with asthma now and additional costs later if the fetus has a poor outcome due to maternal asthma. A stepwise approach to the management of asthma during pregnancy has been developed and is not unlike the management of the nonpregnant patient. Although there are no double-blind, placebo-controlled studies on asthma medications in pregnant women, large cohort studies have shown the efficacy of aggressive management. With adequate control of asthma from the preconception time through delivery, studies have shown similar outcomes in asthmatic patients compared with nonasthmatics, thus obtaining the goal of a symptom-free mother and a healthy baby.

Asthma in pregnancy: a review

“… Monthly assessment including measuring pulmonary function with PEF following initial spirometry as recommended in the guidelines. Control and avoidance of triggering factors such as allergens, irritants and smoking. Ensure appropriate seasonal immunisations including influenza and pertussis. Patient education including an asthma plan for exacerbations, self-monitoring and correct use of inhalers. Asthma control is assessed at each antenatal visit, for example, using the asthma control questionnaire and current asthma medication is reviewed. When asthma is not controlled a step-wise approach to pharmacological therapies 45,61–63 involving increasing therapeutic interventions from intermittent short-acting beta 2 -agonists as needed; then the addition of daily low-dose ICS; then either a combination of low-dose ICS and long-acting beta 2 -agonist, or increasing dose of ICS to medium-dose range, increased to high-dose range; addition of systemic corticosteroid if needed. Acute exacerbations can be managed according to the asthma plan either at home, emergency department or hospital depending on the severity. Guidelines for asthma management in pregnancy indicate that when a patient has a PEF <50% of predicted for personal best, marked wheezing or shortness or breath, or is noticing decreased fetal activity (with other causes excluded), then oral steroids should be added, short acting beta agonists given repeatedly, and the patient should proceed to the emergency department for further management.…”

“…Asthma control is assessed at each antenatal visit, for example, using the asthma control questionnaire and current asthma medication is reviewed. When asthma is not controlled a step-wise approach to pharmacological therapies 45,61–63 involving increasing therapeutic interventions from intermittent short-acting beta 2 -agonists as needed; then the addition of daily low-dose ICS; then either a combination of low-dose ICS and long-acting beta 2 -agonist, or increasing dose of ICS to medium-dose range, increased to high-dose range; addition of systemic corticosteroid if needed.…”