Bronchial asthma during pregnancy: treatment and effects on the fetus. Bronchial asthma in pregnant women Is it possible to get pregnant with bronchial

Every loving mom is looking forward to the appearance of her baby and sincerely wishes that he was born healthy and without any pathologies. But in some cases, all the joys of motherhood can overshadow the illness of a pregnant woman. One of them is bronchial asthma, which a woman can suffer from during pregnancy, when all chronic or allergic diseases in her body are exacerbated.

In past centuries, doctors did not advise a woman with bronchial asthma to give birth at all, so as not to endanger herself and the fetus. But in those days, medicine was not yet as developed as it is today. Therefore, you can calm down: thanks to progress in the world now, thousands of pregnant women with bronchial asthma are giving birth to completely healthy children.

What is bronchial asthma and why can it be dangerous for your baby?

Simply put, it is an allergic reaction of the respiratory system. The mechanism of the disease is simple: the bronchi are in contact with the allergen and therefore their lumens narrow, spasms and suffocation occur. Allergens in this case can be pollen, seafood, animal hair and dander, dust, household chemicals, cigarette smoke. In rare cases, asthma occurs after a brain injury and as a result of various endocrine disorders. The disease can often be accompanied by dermatitis, eczema, rhinitis, conjunctivitis. And your baby runs the risk of getting hypoxia (insufficient amount of oxygen in the blood) while still in the womb.

But the biggest problem arises not because the disease exists, but because of its poor control. After all, if you know that you are an asthmatic, then you must constantly be under the supervision of your doctor and periodically take certain medications. To give birth to a healthy child, the expectant mother needs to be treated in order to prevent an increase in symptoms and the development of hypoxia in the baby.

Causes of Asthma During Pregnancy

As you know, a number of hormonal changes occur in the body of a pregnant woman. This leads to the fact that bronchial asthma can manifest itself differently for each mother. In about a third of asthmatic women in the position, the severity and frequency of attacks remains the same as before pregnancy. And for some, the disease ceases to bother at all and proceeds in a mild form. Doctors say this is due to the improved work of the hormone cortisol.

A severe form of asthma can often be caused by the fear of the mother herself. Fearing that the prescribed medications will negatively affect the child, she refuses to take them. And this paves the way for hypoxia in the baby. Most often, pregnant women complain of increased seizures at 28-40 weeks. It is during this period that the fetus grows and limits the movement of the mother's lungs. It becomes easier only when the baby, shortly before childbirth, descends into the small pelvis. This is why doctors insist that pregnant asthmatic women keep an inhaler near them at all times. Severe seizures can cause premature contractions.

The intensification of attacks in pregnant women depends on the forms of bronchial asthma. They are distinguished by two:

1. infectious-allergic... It develops against the background of infectious diseases of the respiratory tract. It can be pneumonia, pharyngitis, or bronchitis. Allergens in this case are harmful microbes. This form of asthma is most common in pregnant women;
2. non-infectious-allergic... Pollen of plants, dust, feathers, wool and animal dander, medicinal substances (antibiotics, penicillin, vitamin B1, aspirin, pyramidone), industrial chemicals (formalin, pesticides, cyanamides, inorganic salts of heavy metals) can provoke the development and complication of this form of bronchial asthma. ), food allergens (citrus fruits, strawberries, strawberries). An important role in the occurrence of non-infectious-allergic asthma has a hereditary predisposition.

Symptoms of asthma in a pregnant woman

First of all, bronchial asthma is a chronic inflammatory disease. The inflammatory process provokes a number of symptoms, and in no case can it be ignored. After all, asthma is precisely the case when it is not the symptoms that need to be treated, but the cause. Otherwise, the disease will only progress and cause complications.

In a pregnant woman, all three stages of the development of bronchial asthma are found: pre-asthma, asthma attacks and status asthma.

The first, pre-asthmatic phase can be recognized by the following signs:

• a pregnant woman has chronic astmoid bronchitis and chronic pneumonia with elements of bronchial spasms;
• the absence of pronounced attacks of suffocation, they develop only periodically.

The second stage of bronchial asthma in most cases it is easy to recognize. The pregnant woman begins attacks of suffocation, which last from several minutes to several hours. Most often, they torment a woman at night and are accompanied by the following symptoms:

• a scratching sensation in the throat;
• sneezing, runny nose;
• tightness in the chest;
• persistent cough without phlegm;
• breathing becomes noisy, wheezing, hoarse, it can be heard from a distance.
• the face takes on a bluish tint;
• sweaty skin
• by the end of the attack, sputum begins to separate, which becomes more and more liquid and abundant.

After this, asthmatic status occurs - a condition in which an attack of suffocation does not stop for many hours and even days. This stage is considered severe, and the use of drugs is ineffective. Status asthma can cause complications in a pregnant woman such as toxicosis, preeclampsia (a disease that increases blood pressure and can affect the placenta, kidneys, liver and brain),. The worst prognosis is possible for a baby (low birth weight, premature birth, underdevelopment, sudden death). To avoid such complications and risks for the child, mommy must carefully monitor the disease and undergo treatment in a timely manner.

Treatment and prevention of asthma during pregnancy

Most asthmatic women during pregnancy flatly refuse to take medications, believing that it will harm their baby. But it is precisely this attitude towards the disease that leads to numerous complications in the mother and the baby. You must understand that asthma treatment is imperative. If you start the disease, do not control its development, then the baby risks suffocating during an attack while still in the womb.

Asthma in pregnant women is treated with topical inhaled medications. Moreover, their concentration in the blood is minimal, and the effect in the bronchi is maximal. To avoid side effects, doctors recommend the use of CFC-free inhalers. An asthmatic woman in a position needs more careful medical supervision than before pregnancy. She is strictly prohibited from medicines and vitamins that the doctor has not prescribed.

To avoid complications later, women with bronchial asthma are advised to plan their pregnancy in advance. It is important that the expectant mother understands the causes and consequences of her illness, learns to control seizures and correctly use inhalation drugs. If you follow these simple rules, asthma may not even bother you during pregnancy.

At risk are those women in whose family there were cases of bronchial asthma.

To protect yourself from possible sudden manifestations of the disease, preventive measures should be followed:

• avoid allergens that can cause asthma attacks;
• remove from your home those things that collect dust;
• do wet cleaning every day, vacuum up upholstered furniture and carpets once a week, sleep on a synthetic pillow;
• follow a hypoallergenic diet;
• get rid of bad habits;
• do not keep cats, dogs and other animals to which you may be allergic;
• get more rest, avoid stress.

And know that bronchial asthma is not yet a sentence and not a contraindication for pregnancy. Today, medicine has stepped forward and developed new drugs and modern methods of disease control. Monitor the development of asthma, take all the necessary measures in its treatment and tune in to a positive result. Your baby will definitely be born healthy!

Especially for Nadezhda Zaitseva

For citation: Ignatova G.L., Antonov V.N. Bronchial asthma in pregnant women // BC. Medical Review. 2015. No. 4. P. 224

The incidence of bronchial asthma (BA) in the world ranges from 4 to 10% of the population; in the Russian Federation, the prevalence among adults ranges from 2.2 to 5-7%, in the child population this figure is about 10%. In pregnant women, BA is the most common disease of the pulmonary system, the frequency of diagnostics of which in the world ranges from 1 to 4%, in Russia - from 0.4 to 1%. In recent years, standard international diagnostic criteria and methods of pharmacotherapy have been developed, which make it possible to significantly increase the effectiveness of treatment of BA patients and improve their quality of life (Global Initiative for the Prevention and Treatment of Bronchial Asthma (GINA), 2014). However, modern pharmacotherapy and monitoring of asthma in pregnant women are more difficult tasks, since they aim not only to preserve the health of the mother, but also to prevent the adverse effect of complications of the disease and side effects of treatment on the fetus.

Pregnancy has a different effect on the course of asthma. Changes in the course of the disease fluctuate within a fairly wide range: improvement - in 18–69% of women, deterioration - in 22–44%, the absence of the effect of pregnancy on the course of asthma was found in 27–43% of cases. This is explained, on the one hand, by the multidirectional dynamics in patients with varying degrees of asthma severity (with mild and moderate severity, deterioration in the course of asthma is observed in 15-22%, improvement in 12-22%), on the other hand, inadequate diagnosis and always with the right therapy. In practice, AD is often diagnosed only in the late stages of the disease. In addition, if its onset coincides with the gestational period, then the disease may remain unrecognized, since the respiratory disturbances observed in this case are often attributed to changes caused by pregnancy.

At the same time, with adequate BA therapy, the risk of an unfavorable outcome of pregnancy and childbirth is not higher than in healthy women. In this regard, most authors do not consider asthma as a contraindication to pregnancy, and it is recommended to provide control over its course using modern principles of treatment.

The combination of pregnancy and asthma requires close attention of doctors in view of the possible change in the course of asthma during pregnancy, as well as the effect of the disease on the fetus. In this regard, the management of pregnancy and childbirth in a patient suffering from BA requires careful monitoring and joint efforts of doctors of many specialties, in particular, therapists, pulmonologists, obstetricians-gynecologists and neonatologists.

Respiratory system changes in asthma during pregnancy

During pregnancy, under the influence of hormonal and mechanical factors, the respiratory system undergoes significant changes: there is a restructuring of the mechanics of respiration, ventilation-perfusion relations change. In the first trimester of pregnancy, hyperventilation may develop due to hyperprogesteronemia, changes in the blood gas composition - an increase in PaCO2. The appearance of shortness of breath in late pregnancy is largely due to the development of a mechanical factor, which is a consequence of an increase in the volume of the uterus. As a result of these changes, dysfunctions of external respiration are aggravated, the vital capacity of the lungs, the forced vital capacity of the lungs, the volume of forced expiration in 1 second (FEV1) decrease. As the gestational age increases, the resistance of the vessels of the pulmonary circulation increases, which also contributes to the development of shortness of breath. In this regard, shortness of breath causes certain difficulties in the differential diagnosis between physiological changes in the function of external respiration during pregnancy and manifestations of bronchial obstruction.

Often, pregnant women without somatic pathology develop edema of the mucous membranes of the nasopharynx, trachea and large bronchi. These manifestations in pregnant women with asthma can also aggravate the symptoms of the disease.

Low compliance aggravates the course of asthma: many patients try to stop taking inhaled glucocorticosteroids (ICS) for fear of their possible side effects. In such cases, the doctor should explain to the woman the need for basic anti-inflammatory therapy due to the negative effect of uncontrolled BA on the fetus. Asthma symptoms may first appear during pregnancy due to altered body reactivity and increased sensitivity to endogenous prostaglandin F2α (PGF2α). Asthma attacks, which first appeared during pregnancy, can disappear after childbirth, but they can also transform into true asthma. Among the factors contributing to the improvement of BA during pregnancy, a physiological increase in the concentration of progesterone, which has bronchodilatory properties, should be noted. An increase in the concentration of free cortisol, cyclic aminomonophosphate, an increase in the activity of histaminase have a beneficial effect on the course of the disease. These effects are confirmed by an improvement in the course of asthma in the second half of pregnancy, when glucocorticoids of fetoplacental origin enter the mother's bloodstream in large quantities.

The course of pregnancy and fetal development in AD

The study of the effect of asthma on the course of pregnancy and the possibility of giving birth to healthy offspring in patients with asthma is a topical issue.

Pregnant women with asthma have an increased risk of developing early toxicosis (37%), gestosis (43%), threatened abortion (26%), premature birth (19%), placental insufficiency (29%). Obstetric complications usually occur in severe cases. Adequate medical control of asthma is of great importance. The lack of adequate therapy for the disease leads to the development of respiratory failure, arterial hypoxemia of the mother's body, constriction of the placenta vessels, resulting in fetal hypoxia. A high frequency of placental insufficiency, as well as miscarriage, is observed against the background of damage to the vessels of the uterine-placental complex by circulating immune complexes, suppression of the fibrinolysis system.

Women with asthma are more likely to have children with low birth weight, neurological disorders, asphyxia, and congenital defects. In addition, the interaction of the fetus with the mother's antigens through the placenta affects the formation of the child's allergic reactivity. The risk of developing an allergic disease, including BA, in a child is 45–58%. Such children more often suffer from respiratory viral diseases, bronchitis, pneumonia. Low birth weight is observed in 35% of children born to mothers with BA. The highest percentage of low birth weight babies is observed in women with steroid-dependent asthma. The reasons for the low birth weight are insufficient BA control, which contributes to the development of chronic hypoxia, as well as prolonged intake of systemic glucocorticoids. It has been proven that the development of severe exacerbations of asthma during pregnancy significantly increases the risk of having children with low body weight.

Management and treatment of pregnant women with asthma

According to the provisions of GINA-2014, the main tasks of BA control in pregnant women are:

• clinical assessment of the condition of the mother and fetus;
• elimination and control of trigger factors;
• pharmacotherapy of asthma during pregnancy;
• educational programs;
• psychological support for pregnant women.

Taking into account the importance of achieving control over BA symptoms, compulsory examinations by a pulmonologist in the period 18–20 weeks are recommended. gestation, 28-30 weeks and before childbirth, in case of unstable BA - as needed. When managing pregnant women with asthma, one should strive to maintain lung function close to normal. Peak flowmetry is recommended to monitor respiratory function.

Due to the high risk of developing fetoplacental insufficiency, it is necessary to regularly assess the condition of the fetus and the uteroplacental complex using ultrasound fetometry, ultrasound dopplerometry of the vessels of the uterus, placenta and umbilical cord. In order to increase the effectiveness of therapy, patients are advised to take measures to limit contact with allergens, to quit smoking, including passive smoking, to strive to prevent ARVI, to exclude excessive physical exertion. An important part of BA treatment in pregnant women is the creation of educational programs that allow the patient to establish close contact with the doctor, increase the level of knowledge about their disease and minimize its impact on the course of pregnancy, and teach the patient self-control skills. The patient should be trained in peak flowmetry in order to monitor the effectiveness of treatment and recognize early symptoms of an exacerbation of the disease. Patients with moderate and severe asthma are advised to carry out peak flowmetry in the morning and evening hours every day, calculate the daily fluctuations in the peak expiratory flow rate and record the obtained values ​​in the patient's diary. According to the 2013 Federal Clinical Recommendations for the Diagnosis and Treatment of Bronchial Asthma, it is necessary to adhere to certain provisions (Table 1).

The basic approaches to the pharmacotherapy of asthma in pregnant women are the same as in non-pregnant women (Table 2). For basic therapy of mild asthma, it is possible to use montelukast; for moderate and severe asthma, it is preferable to use inhaled corticosteroids. Among the currently available inhaled GCS drugs, only budesonide at the end of 2000 was assigned to category B. If it is necessary to use systemic GCS (in extreme cases) in pregnant women, it is not recommended to prescribe triamcinolone drugs, as well as long-acting GCS drugs (dexamethasone). Prednisolone is preferred.

Of the inhaled forms of bronchodilators, the use of fenoterol (group B) is preferable. It should be borne in mind that β2-agonists in obstetrics are used to prevent preterm labor, their uncontrolled use can cause prolongation of labor. The appointment of depot forms of GCS preparations is categorically excluded.

Exacerbation of asthma in pregnant women

The main activities (tab. 3):

Assessment of the condition: examination, measurement of peak expiratory flow rate (PEF), oxygen saturation, assessment of the state of the fetus.

Starting therapy:

• β2-agonists, preferably fenoterol, salbutamol - 2.5 mg via a nebulizer every 60–90 minutes;
• oxygen to maintain saturation at 95%. If saturation<90%, ОФВ1 <1 л или ПСВ <100 л/мин, то:
• continue the administration of selective β2-agonists (fenoterol, salbutamol) through a nebulizer every hour.

With no effect:

• budesonide suspension - 1000 mcg via a nebulizer;
• add ipratropium bromide through a nebulizer - 10-15 drops, since it has a category B.

If there is no further effect:

• prednisolone - 60–90 mg IV (this drug has the lowest rate of passage through the placenta).

With the ineffectiveness of the therapy and the absence of prolonged theophyllines in the treatment before the exacerbation of the disease:

• enter theophylline IV in usual therapeutic dosages;
• inject β2-agonists and budesonide suspension every 1-2 hours.

When choosing a therapy, it is necessary to consider the risk categories for prescribing medicines for pregnant women, as established by the Physicians Desk Reference:

• bronchodilators - all categories C, except for ipratropium bromide, fenoterol, which belong to category B;
• IHKS - all categories C, except for budesonide;
• antileukotriene drugs - category B;
• cromones - category B.

AD treatment during childbirth

Delivery of pregnant women with a controlled course of asthma and the absence of obstetric complications is carried out at full-term pregnancy. Vaginal delivery should be preferred. Caesarean section is performed with appropriate obstetric indications. During labor, the woman should continue to take standard basic therapy (Table 4). If it is necessary to stimulate labor, oxytocin should be preferred and the use of PGF2α, which is able to stimulate bronchoconstriction, should be avoided.

Vaccine prophylaxis in the management of pregnancy

When planning a pregnancy, it is necessary to vaccinate against:

• rubella, measles, mumps;
• hepatitis B;
• diphtheria, tetanus;
• poliomyelitis;
• respiratory pathogens;
• influenza virus;
• pneumococcus;
• Haemophilus influenzae type b.

Timing of vaccine administration before pregnancy:

Viral vaccines:

• rubella, measles, mumps - in 3 months. and more;
• poliomyelitis, hepatitis B - in 1 month. and more;
• influenza (subunit and split vaccines) - 2-4 weeks.

Toxoids and bacterial vaccines:

• diphtheria, tetanus - for 1 month. and more;
• pneumococcal and hemophilic infections - for 1 month. and more.

Vaccination schedule before pregnancy:

The beginning of vaccination is at least 3 months. before conception.

Stage I - administration of vaccines against rubella, measles (within 3 months), mumps, hepatitis B (1st dose), Haemophilus influenzae type b.

Stage II - the introduction of vaccines against poliomyelitis (2 months, once), hepatitis B (2nd dose), pneumococcus.

Stage III - administration of vaccines against diphtheria, tetanus (for 1 month), hepatitis B (3rd dose), influenza (Table 5).

The combination of vaccines may vary depending on the woman's condition and the season.

The most important in preparation for pregnancy is vaccination against pneumococcal, hemophilus influenza type b, influenza for women with children, since they are the main source of the spread of respiratory infections.

BA and pregnancy are mutually aggravating conditions, therefore, the management of pregnancy complicated by BA requires careful monitoring of the condition of the woman and the fetus. Achieving asthma control is an important factor contributing to the birth of a healthy child.

Literature

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2. Bratchik A.M., Zorin V.N. Obstructive pulmonary disease and pregnancy // Medical business. 1991. No. 12. S. 10-13.
3. Babylonian S.A. Optimization of bronchial asthma management in pregnant women: Author's abstract. dis. ... Cand. honey. sciences. M., 2005.
4. Vaccination of adults with bronchopulmonary pathology: a guide for doctors / ed. M.P. Kostinova. M., 2013.
5. Makhmutkhodzhaev A.Sh., Ogorodova L.M., Tarasenko V.I., Evtushenko I.D. Obstetric care for pregnant women with bronchial asthma // Actual problems of obstetrics and gynecology. 2001. No. 1. S. 14-16.
6. Ovcharenko S.I. Bronchial asthma: diagnosis and treatment // BC. 2002. T. 10.No. 17.
7. T.A. Pertseva, T.V. Chursinova Pregnancy and bronchial asthma: the state of the problem // Health of Ukraine. 2008. No. 3/1. S. 24-25.
8. Fassakhov R.S. Treatment of bronchial asthma in pregnant women // Allergology. 1998. No. 1. S. 32-36.
9. Chernyak B.A., Vorzheva I.I. Agonists of beta2-adrenergic receptors in the treatment of bronchial asthma: issues of efficacy and safety // Consilium medicum. 2006. T. 8.No. 10.
10. Federal clinical guidelines for the diagnosis and treatment of bronchial asthma // http://pulmonology.ru/publications/guide.php (reference 20.01.2015).
11. Abou-Gamrah A., Refaat M. Bronchial Asthma and Pregnancy // Ain Shams Journal of Obstetrics and Gynecology. 2005. Vol. 2.P. 171-193.
12. Alexander S., Dodds L., Armson B.A. Perinatal outcomes in women with asthma during pregnancy // Obstet. Gynecol. 1998. Vol. 92. P. 435-440.
13. European Respiratory Monograph: Respiratory Diseases in women / Ed. by S. Bust, C.E. Mapp. 2003. Vol. 8 (Monograph 25). R. 90-103.
14. Global Initiative for Asthma3. 2014. (GINA). http://www.ginasthma.org.
15. Masoli M., Fabian D., Holt S., Beasley R. Global Burden of Asthma. 2003.20 p.
16. Rey E., Boulet L.P. Asthma and pregnancy // BMJ. 2007. Vol. 334. P. 582-585.

Asthma is a chronic respiratory disease characterized by prolonged coughing and asthma attacks. Often the disease is hereditary, but it can manifest itself at any age, both in women and in men. Bronchial asthma and pregnancy of a woman often occur at the same time, in this case, increased medical supervision is required.

The uncontrolled course of bronchial asthma during pregnancy can have a negative effect on both the health of the woman and the fetus. Despite all the difficulties, asthma and pregnancy are quite compatible concepts. The main thing is adequate treatment and constant supervision of doctors.

It is impossible to predict in advance the course of the disease during the period of bearing a baby. It often happens that in pregnant women the condition improves or remains unchanged, but this applies to mild and moderate forms. And in severe asthma, attacks can become more frequent, and their severity increase. In this case, the woman should be under medical supervision throughout the pregnancy.

Medical statistics suggest that the disease has a severe course only for the first 12 weeks, and then the pregnant woman feels better. At the time of an exacerbation of asthma, hospitalization is usually offered.

In some cases, pregnancy can cause a complicated course of the disease in a woman:

• an increase in the number of attacks;
• more severe course of the attack;
• the addition of a viral or bacterial infection;
• delivery before the due date;
• risk of miscarriage;
• toxicosis of a complicated form.

Bronchial asthma during pregnancy can also affect the fetus. An asthma attack causes oxygen starvation of the placenta, which leads to fetal hypoxia and serious disorders in the development of the child:

• small fetal weight;
• the development of the baby is delayed;
• pathologies of the cardiovascular system, neurological diseases may develop, the development of muscle tissue may be disrupted;
• when the child passes through the birth canal, difficulties may arise and entail birth trauma;
• due to oxygen deficiency, there are cases of fetal asphyxiation (suffocation).

With a complicated pregnancy, the risk of having a child with a heart defect and a predisposition to respiratory diseases increases, such children can significantly lag behind the norms in development.

All these problems arise if the treatment is not carried out correctly, and the woman's condition is not controlled. If the pregnant woman is registered and she is prescribed adequate therapy, the birth will go well, and the baby will be born healthy. The risk for the child may be a tendency to allergic reactions and the inheritance of bronchial asthma. For this reason, breastfeeding is indicated for the newborn, and a hypoallergenic diet for the mother.

Planning a pregnancy for asthma

The condition of a woman - asthmatics should be controlled not only during pregnancy, but also during her planning. Control over the disease should be established even before pregnancy and must be maintained throughout the first trimester.

During this time, it is necessary to select an adequate and safe therapy, as well as eliminate irritating factors in order to minimize the number of attacks. A woman should stop smoking if this addiction has taken place and avoid inhaling tobacco smoke if family members smoke.

Before pregnancy, the expectant mother should be vaccinated against pneumococcus, influenza, Haemophilus influenzae, hepatitis, measles, rubella, tetanus and diphtheria. All vaccinations are given three months before pregnancy under the supervision of a doctor.

How pregnancy affects the course of the disease

With the onset of pregnancy, a woman changes not only the hormonal background, but also the work of the respiratory system. The composition of the blood changes, progesterone and carbon dioxide become more, breathing becomes more frequent, ventilation of the lungs increases, a woman may experience shortness of breath.

In long periods of pregnancy, shortness of breath is associated with a change in the position of the diaphragm, the growing uterus raises it. The pressure in the pulmonary artery also changes, it increases. This causes a decrease in lung volume and deterioration of spirometry readings in asthmatics.

Pregnancy can cause swelling of the nasopharynx and respiratory tract even in a healthy woman, and in a patient with bronchial asthma - an attack of suffocation. Every woman should remember that spontaneous withdrawal of certain drugs is just as dangerous as self-medication. Do not stop taking steroids unless directed by your doctor. Cancellation of medications can cause an attack, which will cause much more harm to the child than the effect of the drug.

There are cases that the first symptoms of asthma develop during pregnancy. After childbirth, they may disappear, or they may turn into a chronic form of the disease.

Usually, the second half of the pregnancy is easier for the patient, the reason lies in an increase in the content of progesterone in the blood and expansion of the bronchi. In addition, the placenta is designed so that it produces its own steroids to protect the fetus from inflammation. According to statistics, the condition of a pregnant woman improves more often than it worsens.

If asthma manifests itself only during pregnancy, it is rarely possible to diagnose it in the first months, therefore, in most cases, treatment begins at a later date, which has a bad effect on the course of pregnancy and labor.

How is childbirth with asthma

If pregnancy is controlled throughout, then the woman is allowed to give birth on her own. She is usually hospitalized at least two weeks before the due date and prepared for childbirth. All indicators of the mother and child are under the strict control of doctors, and during labor, a woman must be injected with a medicine to prevent an asthmatic attack. These drugs are absolutely safe for the baby, but they have a positive effect on the condition of the woman in labor.

If asthma becomes more severe during pregnancy, and asthmatic attacks have become more frequent, then childbirth is performed using a planned caesarean section at 38 weeks of gestation. By this time, the fetus is considered full-term, absolutely viable and formed for independent existence. Some women are biased towards operative childbirth and refuse to have a cesarean section, in this case complications during childbirth cannot be avoided, moreover, you can not only harm the child, but also lose it.

Common complications during childbirth:

• premature discharge of amniotic fluid, before the onset of childbirth;
• rapid childbirth, which negatively affects the child;
• abnormal labor.

If childbirth began on its own, but in the process there was an attack of suffocation and cardiopulmonary insufficiency, in addition to intensive therapy, surgery is indicated, the patient is urgently given a cesarean section.

During delivery, an asthmatic attack occurs extremely rarely, provided that the patient takes all the necessary medications. As such, asthma is not considered an indication for a caesarean section. If there are indications for surgery, it is better to use anesthesia not of an inhalation type, but a regional blockade.

In the event that a pregnant woman was treated with Prednisolone in a large dosage, during childbirth, she is prescribed Hydrocortisone in injections.

Bronchial asthma during pregnancy: treatment

If the woman has already been treated for asthma and becomes pregnant, the course of treatment and medications must be changed. Some medications are simply contraindicated in pregnancy, while others require dosage adjustments.

Throughout the entire period of pregnancy, doctors should monitor the fetus using ultrasound; in case of exacerbations, oxygen therapy is very important in order to avoid oxygen starvation of the fetus. The condition of the pregnant woman is also monitored, special attention is paid to the state of the vessels of the uterus and placenta.

The goal of bronchial asthma treatment during pregnancy is to prevent an attack and safe therapy for both the fetus and the mother. The main task of doctors is to achieve the following results:

• improve the function of external respiration;
• prevent an asthmatic attack;
• stop side effects from exposure to drugs;
• disease control and timely relief of seizures.

To improve the condition and reduce the risk of developing an attack of suffocation, as well as other complications, a woman should strictly follow the following recommendations:

1. exclude from your diet all foods that can cause an allergic reaction;
2. wear underwear and clothing made from fabrics of natural origin;
3. for personal hygiene, use hypoallergenic products (creams, shower gels, soap, shampoo);
4. eliminate external allergens from everyday life, to do this, avoid dusty places, polluted air, inhalation of various chemicals, often wet cleaning the house;
5. to maintain optimal humidity in the home, you should use special humidifiers, ionizers and air purifiers;
6. avoid contact with animals and their hair;
7. be in the fresh air more often, take walks before bedtime;
8. if a pregnant woman is professionally exposed to chemicals or harmful vapors, she should be immediately transferred to a safe place of work.

During pregnancy, asthma is treated with bronchodilators and expectorant drugs. In addition, breathing exercises, a rest regimen and exclusion of physical and emotional stress are recommended.

The main drugs for asthma during pregnancy remain inhalers, which are used to stop (Salbutamol) and prevent (Beklamethasone) attacks. As a prophylaxis, other means can be prescribed, the doctor is guided by the degree of the disease.

In the later stages, drug therapy should be aimed not only at correcting the condition of the lungs, but also at optimizing intracellular processes that can be disrupted due to the disease. Supportive therapy includes a set of drugs:

• Tocopherol;
• complex vitamins;
• Interferon to strengthen immunity;
• Heparin for the normalization of blood clotting.

To track the positive dynamics, it is necessary to monitor the level of hormones produced by the placenta and the cardiovascular system of the fetus.

Drugs contraindicated during pregnancy

Self-medication is not recommended for any diseases, and even more so for asthma. A pregnant woman should take medications strictly as prescribed by a doctor and know that there are a number of drugs that are prescribed for patients with asthma, but are canceled during gestation:

List of contraindicated drugs:

• Adrenaline relieves asthma attacks well, but is prohibited during pregnancy. Taking this remedy can lead to fetal hypoxia, it causes vascular spasms of the uterus.
• Terbutaline, Salbutamol, Fenoterol - are prescribed for pregnant women, but under strict medical supervision. In the later stages, they are usually not used, they can complicate and delay childbirth, drugs similar to these are used when there is a threat of miscarriage.
• Theophylline is not used in the last three months of pregnancy, it enters the fetal bloodstream through the placenta and causes an increase in the baby's heart rate.
• Some glucocorticosteroids are contraindicated - Triamcinolone, Dexamethasone, Betamethasone, these drugs negatively affect the muscular system of the fetus.
• Antihistamines of the 2nd generation are not used for pregnant women; side effects have a bad effect on the mother and child.

Bronchial asthma during pregnancy does not pose a danger with the right treatment and adherence to all recommendations.

Maintaining normal indicators of the function of external respiration (FVD) during gestation (bearing a child) is necessary to maintain the woman's well-being and the correct development of the fetus. Otherwise, hypoxia occurs - oxygen starvation, which entails many adverse consequences. Let's see what features bronchial asthma has during pregnancy and what are the basic principles of therapy for the disease and prevention of exacerbations.

Causes

Although the development of asthma can coincide with the period of gestation, a woman usually suffers from this disease even before conception, often from childhood. There is no single reason for the onset of an inflammatory process in the respiratory system, however, there are a fairly large number of provoking factors (triggers):

1. Genetic predisposition.
2. Taking medications.
3. Infections (viral, bacterial, fungal).
4. Smoking (active, passive).
5. Frequent contact with allergens (household dust, mold, professional triggers - latex, chemicals).
6. Unfavorable ecological situation.
7. Poor nutrition.
8. Stress.

Patients suffer from asthma throughout their lives, and the course of the disease usually worsens in the first trimester and stabilizes (with adequate therapy) in the second half of pregnancy. Between periods of remission (absence of symptoms), exacerbations occur due to a number of triggers:

• contact with allergens;
• unfavorable weather conditions;
• excessive physical activity;
• a sharp change in the temperature of the inhaled air;
• dustiness of premises;
• stressful situations.

Asthma that develops in the early trimester of pregnancy may spontaneously disappear by the end of the first half of the gestation period.

This phenomenon is observed in women whose mothers suffered episodes of bronchial obstruction (narrowing of the airway as a result of spasm) during their own pregnancy. However, it is not common. Asthma attacks can not only disappear without a trace, but also transform into the so-called true, already chronic asthma.

Although the disease is not always associated with allergies, it is immune disorders that underlie the pathogenesis (mechanism of development) of most episodes. The key link in the formation of the reaction is hyperreactivity, or increased, heightened sensitivity of the bronchi to stimuli of various nature.

Why is asthma dangerous during pregnancy?

In addition to the usual risks associated with suffocation and hypoxia (oxygen deprivation), bronchial asthma during pregnancy increases the likelihood of conditions and consequences such as:

• early toxicosis;
• the formation of the threat of termination of pregnancy;
• the development of violations of labor;
• spontaneous abortion.

In addition, the mother's illness can affect the health of the fetus (during exacerbations, it suffers from hypoxia) and the newborn baby. Asthma symptoms may appear in him already in the first year of life, although most episodes of hereditary asthma are still recorded in children older than this age. There is also a tendency to diseases of the respiratory system - including infectious pathologies.

Symptoms

During the period of remission of asthma, a pregnant woman feels well, but in case of relapse, an attack of suffocation develops. An exacerbation usually begins at night and lasts from a few minutes to hours. First, the "harbingers" appear:

• runny nose;
• sore throat;
• sneezing;
• chest discomfort.

Soon, a combination of characteristic signs can be observed:

1. Shortness of breath with difficulty in exhaling.
2. Paroxysmal cough.
3. Noisy breathing, audible at a distance from the patient.
4. Dry wheezing in lungs.

The woman assumes a seated position and tenses the muscles of the chest, shoulder girdle and neck to ease shortness of breath. She has to rest her hands on a hard surface. The face becomes bluish, cold sweat appears on the skin. The separation of viscous, "glassy" sputum indicates the end of the attack.

During pregnancy, there is also a risk of status asthmaticus - a severe attack in which conventional medications do not work, and the airway patency is sharply reduced, up to suffocation (asphyxia). In this case, the patient limits physical activity, assuming a forced position with support on her hands, is silent, breathes often, or vice versa, rarely, superficially. Wheezing may be absent ("dumb lung"), consciousness is depressed up to coma.

Diagnostics

The survey program is based on such methods as:

• survey;
• inspection;
• laboratory tests;
• functional tests for the assessment of high-pressure function.

When talking with a patient, you need to determine what causes an attack, to understand whether there is a hereditary predisposition to asthma. Inspection allows you to find out the characteristics of the current objective state. As for laboratory tests, they can be general or specific in nature:

1. Blood test (erythrocytes, leukocytes, formula calculation, gas composition).
2. Determination of the concentration of class E immunoglobulins (IgE), or antibodies - protein complexes responsible for the development of allergic reactions.
3. Sputum analysis (search for an increased number of eosinophilic cells, Kurshman coils, Charcot-Leiden crystals).

The "gold standard" of functional tests is spirography and peak flowmetry - the measurement with the help of special devices of such indicators of high pressure as:

• forced expiratory volume in the first second (FEV1);
• vital capacity of the lungs (VC);
• peak expiratory flow (PSV).

Skin tests for allergens during pregnancy are prohibited.

They are not performed regardless of the period and condition of the patient, since there is a high risk of developing anaphylactic shock.

Treatment

BA therapy during pregnancy is not much different from standard schemes. Although during gestation it is recommended to stop taking drugs of the group of H1-histamine receptor blockers (Suprastin, Tavegil, etc.), the woman should continue and, if necessary, plan or supplement the course of treatment.

Modern medications used for basic therapy do not have a negative effect on the fetus. If the course of the disease is controllable (stable), the patients use topical (local) forms of drugs - this allows the drug to be concentrated in the area of ​​inflammation and to exclude or significantly reduce the systemic (on the entire body as a whole) effect.

Principles of pregnancy management

It is necessary to determine the severity of asthma, the level of risk for the mother and child. Regular examinations of a pulmonologist are recommended - with controlled asthma three times: at 18-20, 28-30 weeks and before childbirth, with an unstable form - as needed. Also required:

Drug therapy

Since uncontrolled asthma is dangerous for both the mother and the fetus, pharmacological drugs occupy an important place in the algorithms for treating asthma during pregnancy. They are appointed by choosing in accordance with the safety category:

• no maternal / fetal side effects when taken at standard therapeutic dosages (B);
• toxic effects have been recorded in humans and animals, but the risk of withdrawal from the drug is higher than the likelihood of side effects (C).

There are no Category A medications for asthma (meaning that research has not identified a hazard to the fetus). However, the correct application of level B and, when necessary, C products usually does not entail negative consequences. For the main, or basic therapy, are used:

Pharmacological group		Sample drug	Safety category
Beta2 agonists	Short acting	Salbutamol	C
	Prolonged	Formoterol
Glucocorticosteroids	Inhalation	Budesonide	B
	Systemic	Prednisone
Anticholinergics		Ipratropium bromide
Monoclonal antibodies		Omalizumab
Mast cell membrane stabilizers		Nedokromil
Methylxanthines		Theophylline	C
Leukotriene receptor antagonists		Zafirlukast	B

Step therapy: for mild asthma, drugs are used on demand (this is usually Salbutamol, Ipratropium bromide), then other drugs are added (depending on the severity of the condition). If a woman has taken leukotriene receptor antagonists before pregnancy, it is advisable to continue therapy with them.

Help with exacerbation

If a pregnant woman has an asthma attack, it is necessary:

• stop the trigger (if it can be detected - food, cosmetics, etc.);
• open a window, a window, if the situation occurs indoors;
• unbutton or take off clothing that interferes with breathing (shirt buttons, heavy coat);
• Helping you use a medication inhaler - such as Salbutamol
• call an ambulance.

If possible, they resort to the administration of drugs through a nebulizer - this is a device that creates a medicinal aerosol from small particles that penetrate even into areas of the respiratory tract that are difficult to access by a conventional means. However, only a mild attack can be stopped on your own, a severe exacerbation requires urgent hospitalization of the pregnant woman in the hospital - sometimes immediately to the intensive care unit.

Labor management

It is carried out against the background of basic BA therapy, which the patient received during gestation. In the absence of seizures, the FVD indicators are assessed every 12 hours, with an exacerbation - as needed. If a woman was prescribed systemic glucocorticosteroids during pregnancy, she is transferred from Prednisolone to Hydrocortisone - for the period of childbirth and for 24 hours after the birth of the child.

The presence of bronchial asthma in a pregnant woman does not mean the impossibility of natural delivery.

On the contrary, surgery is seen as an extreme option because it entails additional risks. It is used when there is a direct threat to the life of the mother / child, and the need for an operation is determined by obstetric indications (placenta previa, abnormal position of the fetus, etc.).

To prevent exacerbation of bronchial asthma, you must:

1. Avoid contact with allergens and other attack provocateurs.
2. Follow the doctor's recommendations for basic therapy.
3. Do not refuse treatment and do not reduce the dosage of drugs on your own.
4. Keep a diary of indicators of the function of external respiration and, if there are significant fluctuations, visit a doctor.
5. Remember about the planned consultations of specialists (therapist, pulmonologist, obstetrician-gynecologist) and do not miss visits.
6. Avoid excessive physical exertion, stress.

A woman suffering from bronchial asthma is recommended to be vaccinated against influenza at the planning stage of pregnancy, since this variant of an acute respiratory infection can significantly worsen the course of the underlying disease. It is allowed to get vaccinated during the gestation period, taking into account the patient's state of health.

Bronchial asthma is a chronic inflammatory disease of the airways in which many cells and cellular elements play a role. Chronic inflammation causes a concomitant increase in airway hyperresponsiveness, resulting in repeated episodes of wheezing, shortness of breath, chest tightness, and coughing, especially at night or in the early morning. These episodes are usually associated with widespread but variable bronchial obstruction that is often reversible either spontaneously or with treatment. AD is a treatable disease that can be effectively prevented.

ICD-10 code. 0.99 Other maternal diseases classified elsewhere but complicating pregnancy, childbirth and the puerperium. 0.99.5. Respiratory diseases complicating pregnancy, childbirth and the postpartum period. J.45. Asthma. J.45.0. Asthma with a predominance of an allergic component. J.45.1. Non-allergic asthma. J.45.8. Mixed asthma. J.45.9. Asthma, unspecified

Classification of asthma severity by clinical signs before starting treatment.

Stage 1: intermittent BA
Symptoms less than 1 time per week
Short flare-ups
Night attacks no more than 2 times a week
Variability in PSV or FEV 1< 20%

Stage 2: mild persistent asthma
Symptoms more often than 1 time per week, but less than 1 time per day
Night attacks more often than 2 times a month
FEV 1 or PSV ≥ 80% of the expected values
Variability of PSV or FEV indicators 1 = 20-30%

Stage 3: persistent asthma of moderate severity:
Daily symptoms
Flare-ups can affect physical activity and sleep
Nighttime symptoms more often than 1 time per week
FEV 1 or PSV from 60 to 80% of the due values
Variability in PSV or FEV 1> 30%

Stage 4: severe persistent asthma
Daily symptoms
Frequent exacerbations
Frequent night attacks
FEV 1 or PSV<60% от должных значений
Variability of PSV or FEV 1> 30%

Diagnostics.
Mandatory studies of a pregnant woman with asthma include:

Study of a clinical blood test, in which eosinophilia is diagnostically significant over 0.40x10 9 / l.
Sputum examination, where microscopic examination reveals eosinophils, Charcot-Leiden crystals, metachromatic cells.
- A functional study of the lungs is carried out to assess the degree of airway obstruction, to quantify the effect of treatment, as well as for differential diagnosis of asthma. The most important indicators of these studies in AD are the forced expiratory volume in the first minute (FEV 1) and the associated forced vital capacity (FVC), as well as the peak expiratory flow rate (PSV). The diagnosis of asthma can be confirmed by spirometry, when after inhalation of a bronchodilator or in response to trial glucocorticosteroid therapy, an increase in FEB1 of at least 12% is noted. Regular measurement of indicators at regular intervals, depending on the severity of the disease, helps to monitor the progression of the disease and the long-term effects of treatment. So, it is advisable to measure PSV in the morning and evening before bedtime. The daily spread of PSV by more than 20% is considered as a diagnostic sign of the disease, and the magnitude of the deviations is directly proportional to the severity of the disease.
- Measurement of specific IgE in serum for the diagnosis of asthma in pregnant women is not very informative.
- Radiography of the lungs in pregnant women with BA to clarify the diagnosis and carry out differential diagnostics is performed according to strict indications.
- Skin tests with allergens are contraindicated during pregnancy.

Epidemiology.
According to epidemiological studies, the prevalence of asthma reaches 5% of the general population and there is a general tendency for a further increase in the number of patients, there is a steady trend towards an increase in the number of patients who are often hospitalized due to a severe course of the disease. Most often, BA is found among the pathology of the bronchopulmonary system in pregnant women, accounting for 5%. Starting from the transitional age, the female part of the population suffers from asthma more often than the male. At reproductive age, the ratio of women to men reaches 10: 1. Aspirin-induced asthma is also more common in women.

Etiology.
In the etiology of AD, both internal factors (or innate characteristics of the organism) play a role, which determine a person's predisposition to the development of AD or protect against it, and external factors that cause the onset or development of AD in people predisposed to this, leading to an exacerbation of AD and / or long-term persistence of symptoms of the disease.

Internal factors include genetic predisposition to the development of either AD or atopy, airway hyperresponsiveness, gender, race.

External factors include:

Factors (triggers) that cause asthma exacerbation and / or contribute to the persistence of symptoms include: allergens, air pollutants, respiratory infections, exercise and hyperventilation, weather changes, sulfur dioxide, food, food additives and medications, emotional stress. Exacerbation of asthma can be caused by pregnancy, menstruation, rhinitis, sinusitis, gastroesophageal reflux, polliposis, etc.

Pathogenesis.
The pathogenesis of AD is based on a specific inflammatory process in the bronchial wall, leading to airway obstruction in response to various triggers. The main cause of obstruction is a decrease in the tone of smooth muscles of the bronchi, caused by the action of agonists released from mast cells, local centripetal nerves and from posganglionic centrifugal nerves. Subsequently, contractions of the smooth muscles of the airways increase due to thickening of the bronchial wall due to acute edema, cellular infiltration and remodeling of the airways - chronic hyperplasia of smooth muscles, vessels and secretory cells and matrix deposition in the bronchial wall. The obstruction is aggravated by a dense viscous secretion produced by goblet cells and submucous glands. In fact, all functional disorders in AD are caused by obstruction involving all parts of the bronchial tree, but expressed as much as possible in small bronchi with a diameter of 2 to 5 mm.

AD is usually associated with a condition of the airways when they narrow too easily and / or strongly "hyperreactive" in response to provoking factors.

Patients with asthma have more than just chronic hypersecretion of mucus. The secretion produced also differs in viscosity, elasticity and rheological properties. A pathological increase in viscosity and "rigidity" of such a secretion occurs due to increased production of mucin and the accumulation of epithelial cells, albumin, basic proteins and DNA from decomposed inflammatory cells. In the sputum of BA patients, these changes appear in the form of mucous clots (Kurshman's spiral).

Signs of bronchial inflammation persist even in the asymptomatic period of the disease, and their severity correlates with the symptoms that determine the severity of the disease.

Clinic.
With an exacerbation of asthma, the patient has asthma symptoms: shortness of breath, swelling of the wings of the nose on inspiration, raised shoulders, tilt of the trunk forward, participation of the auxiliary respiratory muscles in breathing, orthopnea position, difficulty speaking due to interrupted speech, persistent or intermittent cough that interferes with sleep , tachycardia, cyanosis. Dry rales are heard auscultation, intensifying on exhalation. However, in some patients in the period of BA exacerbation, wheezing may not be heard due to obstruction of small bronchi. It is important to indicate that the onset of symptoms is provoked by allergens or nonspecific irritants, and the disappearance of symptoms occurs spontaneously or after the use of bronchodilators.

Assessment of lung function, especially the reversibility of impairment, provides the most accurate degree of airway obstruction.

Differential diagnosis
Despite the clear diagnostic signs of asthma, a number of difficulties arise when analyzing the course of the disease in pregnant women suffering from other pulmonary pathology accompanied by bronchial obstruction: chronic obstructive pulmonary disease, cystic fibrosis, tumors of the respiratory system, lesions of the upper respiratory tract, tracheobronchial dyskinesia, pulmonary vasculitis, constrictive bronchiolitis, hyperventilation syndrome, acute and chronic left ventricular failure, sleep apnea-hypopnea syndrome, fungal infections of the lungs, etc. BA can occur in patients suffering from the above diseases, which also aggravates the course of the disease.

Treatment.
Before planning a pregnancy, BA patients should undergo training at the “School for Patients with Bronchial Asthma” for the most complete awareness of BA and the creation of sustainable motivation for self-control and treatment. Pregnancy should be planned after an allergic examination, under the supervision of a pulmonologist, to achieve maximum control over the course of asthma. The onset of pregnancy and childbirth should not be planned during the flowering period of plants to which the mother is sensitized.

A pregnant woman should adhere to a hypoallergenic diet, minimize contact with an allergen as much as possible, stop active and exclude passive smoking, and sanitize foci of infection in a timely manner.

In severe and moderately severe asthma, efferent methods of treatment (plasmapheresis) should be used to reduce the amount and dosage of drugs.

During pregnancy, the severity of asthma often changes, and patients may need more careful medical supervision and a change in the treatment regimen. Retrospective studies have shown that during pregnancy in about a third of women, the course of asthma worsens, in a third it becomes less severe, and in the remaining third it does not change. The general perinatal prognosis for children born to mothers in whom BA was well controlled is comparable to the prognosis for children born to mothers without BA. Poorly controlled asthma leads to an increase in perinatal mortality, an increase in the number of preterm births and the birth of premature babies. For this reason, the use of drugs to achieve optimal BA control is justified even when their safety during pregnancy is controversial. Treatment with inhaled p 2 -agonists, theophylline, sodium cromoglycate, inhaled glucocorticosteroids is not accompanied by an increase in the incidence of congenital malformations of the fetus.

Currently, a stepwise approach to BA therapy has been adopted due to the fact that there is a significant variety of BA severity not only in different people, but also in the same person at different times. The goal of this approach is to achieve BA control using the least amount of the drug. The number and frequency of drug administration increases (step up) if the course of BA worsens, and decreases (step down) if the course of BA is well controlled.

Medicines for asthma are prescribed to eliminate and prevent symptoms and airway obstruction and include basic drugs that control the course of the disease and symptomatic agents.

Drugs for disease control - JIC, taken daily, for a long time, helping to achieve and maintain control over persistent asthma: anti-inflammatory drugs and long-acting bronchodilators. These include inhaled glucocorticosteroids, systemic glucocorticosteroids, sodium cromoclikate, nedocromil sodium, sustained-release theophyllines, long-acting inhaled P2 agonists, and systemic non-steroidal therapy. Currently, the most effective drugs for BA control are inhaled glucocorticosteroids.

Symptomatic medications (ambulance or emergency medications, rapid relief medications) that eliminate bronchospasm and relieve concomitant symptoms (wheezing, tightness in the chest, cough) include rapid-acting inhaled P2-agonists, systemic glucocorticosteroids, inhaled anticholinergic drugs, theophilic drugs , and short-acting oral P2 agonists.

AD medications are administered by a variety of routes, including inhalation, oral, and parenteral. The main advantage of JIC entering directly into the airways during inhalation is the more efficient creation of high concentrations of the drug in the airways and minimization of systemic adverse effects. When prescribing to pregnant women, preference should be given to inhalation forms of drug administration. Aerosol preparations for treatment are presented in the form of metered-dose aerosol inhalers, breath-activated metered-dose aerosol inhalers, dry metered-dose inhalers with dry powder, and “wet” aerosols delivered through a nebulizer. The use of a spacer (reservoir chamber) improves drug delivery from a pressurized aerosol dose inhaler.

Stage 1. Intermittent BA

Drugs of choice (treatment regimens):
Basic drugs are not indicated.

To control asthma symptoms, but not more often than 1 time per week inhalation:
Terbutaline, 100 mcg (1-2 doses);
Fenoterol 100 mcg (1-2 doses) (use with caution in the first trimester of pregnancy).

Before anticipated physical activity or contact with an allergen:
Salbutamol 100-200 mcg (1-2 doses);
Sodium cromoglicate 5 mg (1-2 doses) (contraindicated in the first trimester of pregnancy)

Stage 2. Mild persistent asthma

Drugs of choice (treatment regimens):

Beclomethasone dipropionate 250 mcg 1 dose 2 r. / day;
Budesonide 200 mcg 1 dose 2 r. / day;
Flunisolide 250 mcg 1 dose 2 r. / day;
Fluticasone propionate 50-125 mcg 1 dose 2 r. / day
+ Ipratromium bromide 20 mcg 2 doses 4 r. / day

Alternative drugs (treatment regimens):
Sodium cromoglycate 5 mg 1-2 doses 4 r. / day;
Nedocromil 2 mg for 1-2 doses 2-4 r. / day;
Theophylline 200-350 mg 1 capsule retard 2 r. / day

Stage 3. Persistent asthma of moderate severity

Drugs of choice (treatment regimens):
Salbutamol as needed (but not more often 3-4 times a day).

Daily long-term prophylactic intake:
Budesonide 200 mcg 1 dose 2-4 r. / day;
Flunisolide 250 mcg, 2 doses 2 - 4r. / day;
Fluticasone 125 mcg 1 dose 2-4 r. / day (25,50,100,125,250,500);
Salmeterol 25 mcg 1 - 2 doses 2 r. / day;
Beclomethasone dipropionate 250 mcg 1 dose 2 - 4 r. / day;
+ Theophylline 200-350 1 capsule retard 2 r. / day;
Beclomethasone dipropionate 250 mcg 2 doses 4 r. / day

Stage 4. Severe persistent asthma

Drugs of choice (treatment regimens):
Salbutamol as needed (but not more often 3-4 times a day).

Daily long-term prophylactic intake
Beclomethasone dipropionate 250 mcg 2 doses 4 r. / day;
Budesonide 200 mcg, 1 dose -4 r. / day;
Flunisolide 250 mcg, 2 doses of 4p. / day;
Fluticasone 250 mcg 1 dose 2-3 r. / day (25,50,100,125,250,500);
+ Formoterol 12 mcg 1-2 doses 2 r. / day;
Salmeterol 25mkg 1 - 2 doses 2 r. / day
+ Theophylline 200-300 mg 1 capsule retard 2 r. / day
+ prednisolone 5 mg 1-6 1 p. / day;
+ methylprednisolone 4 mg 5-10 1p. / day

Errors and unreasonable assignments
With exacerbation of asthma, parenteral administration of theophylline is unjustified if the pregnant woman is already taking it orally. In aspirin-induced asthma, the use of any systemic glucocorticosteroids other than dexamethasone is unreasonable.

Drugs, the appointment of which during pregnancy is contraindicated due to embryotoxicity and teratogenicity: adrenaline, ephedrine, brompheniramine, triamcinolone, betamethalone.

Evaluation of the effectiveness of treatment
If within 1 month during therapy, asthma symptoms do not occur, and pulmonary function (MSV and spirometry indicators) are within the expected values, then the therapy can be reduced (take a "step back"), reaching the minimum therapy required to control asthma. reducing side effects and unwanted effects from drugs for the mother and creating optimal conditions for the development of the fetus.

Severe attacks of asthma, the development of respiratory failure serve as an indication for early termination of pregnancy or early delivery. It is not recommended to use prostaglandin F2-alpha to terminate pregnancy and induce labor. it increases bronchospasm.

Delivery
Childbirth is preferable to lead through the natural birth canal. Asthma attacks during childbirth are rare and are stopped by inhalation of bronchodilators or intravenous administration of aminophylline. If a patient with asthma previously took corticosteroids orally, then on the day of delivery it is necessary to inject an additional 60-120 mg of IV prednisolone with a 2-fold reduction in dosage for the next two days.

During childbirth, the fetus is constantly monitored. Severe respiratory and pulmonary heart failure are indications for operative delivery by caesarean section under epidural anesthesia or fluorothane anesthesia. Promedol during childbirth and sedatives during surgery are used only in exceptional cases, since they depress the respiratory center and suppress the cough reflex.

With early delivery, in order to stimulate the maturation of the surfactant system of the lungs in the fetus, pregnant women are prescribed dexamethasone 16 tablets per day for 2 days.

In the early postpartum period, bleeding is possible in puerperas, as well as the development of purulent-septic complications, exacerbation of asthma.

In puerperas with moderate to severe asthma, it is recommended to suppress lactation.

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