Asthma & pregnancy
A case presentation:
Status asthmatic complicated by emphysema and pneumomediastinum during pregnancy
A 25 y old 30 week pregnant,p3+2, known asthmatic on steroids, she stopped her medication during pregnancy thinking that its harmful to the baby,developed sever attack due to acute exacerbation after exposure to allergen , intubated .Then, she developed emphysema &pneumomediastinum ,she had emergency caserean section ,the baby Apgar scor was very poor and unfortunately died after few days due to fetal hypoxia.
Sever & poorly controlled asthma has been associated with numerous adverse perinatal outcome including preeclampsia , pregnancy induce hypertension ,uterine haemorrhage, pretermlabour, congenital abnormalities, fetal growth restriction & low birth weight.
Review of pathophysiology of asthma & the effect of the physiological changes of pregnancy on asthma.
The clinical assessment of asthma include both subjective evaluation & pulmonary function test & how to do that properly?
Goals of management:
Is to reduce hospitalization , emergency room admission, prevent work loss& chronic disability.
The key of treatment is by frequent assessment of the patients, the severity of the attack and the patient response to treatment. Both number & dosage of medications can be increased as asthma severity increased.
Hypoxia, acidosis, hypercapniea & pneumothorax is a warning sign of sever exacerbations
B2 agonist is the mainstay of treatment; budesonide is the preferred inhaled steroid.
Early systemic steroid,,theophylline, antihistamin oxygen supply, Intravenous fluid, avoids tranquilizer& sedative.
Discussing the criteria for hospital admission & ICU admission &ventilation setting.
The prognosis; great risk in the last portion of pregnancy.
It is important because of most complication were due to under medication,
Prevention & avoidance of triggers, allergens & irritant
Home use of metered dose inhalers& pulmonary function test, using written diary to record PEFR
Use a written guideline for management of exacerbation.