PREGNANCY AND ASTHMA

Evangelos Theodoropoulos, Pulmonology

GENERAL PRINCIPLES

From the international literature that the incidence of asthma has increased over the past 20 years worldwide.

Not surprising therefore that today asthma is a disease that potentially can often complicate pregnancy.

Epidemiological speaking bronchial asthma occurs in 1% - 4% of pregnant women.

Possibly the figure is even higher if we consider that the problem does not refer either to the doctor for fear that medication can harm the fetus, either because the disease is not diagnosed when it occurs during pregnancy.

It is important to apply those strategies to combat the disease be designed to avoid damage to health of mother and fetus

POSSIBLE INTERACTIONS ASTHMA KYISIS

In principle should be to separate the potential impact on

A) Pregnancy can bring on asthma

B) Asthma in pregnancy

Regarding the first to say that in general the 1 / 3 of women with asthma has improved during pregnancy, the 1 / 3 worse and 1 / 3 stability.

THE IMPROVEMENT OF ASTHMA may be due to

- Improved bronchodilation by progesterone.

- Strengthening b adrenergic action (progesterone and estrogen).

- Increased blood levels of free cortisol.

- Other.

The deterioration of the ASTHMA may be due to

- Increased stress

- Increase or worsening gastroesophageal reflux.

- Vronchosystoli by prostaglandin F2 alpha

Statistically speaking the most likely deterioration occurring during the sixth month of pregnancy and the last 4 weeks of pregnancy often have episodes of depression.

EFFECTS ASTHMA IN PREGNANCY

Any adverse effects are usually the result of three factors:

- Insufficient control of asthma

- Drugs for asthma

- Possible other factors (clinical conditions, either alone as hypertension, hypocapnia, dehydration, or in combination with poor control of asthma causing hypoxia in the infant because of reduced blood flow between the uterus and placenta)

The harmful effects that may occur are:

To the fetus:

Delayed development of endometrial

Underweight baby

Increasing mortality during childbirth

Congenital anomalies

Ypercholerythrynaimia

For the pregnant woman:

Increasing episodes of emesis

Proeklampsia

Gestational hypertension

Complications during childbirth

Rupture membranes

Need for caesarean section

GENERAL TREATMENT LINES

The strategy to be followed in pregnancy because asthma has the following objectives.

Control of symptomatology including night events.

Maintenance of respiratory function as the strongest close to normal.

Avoid potential side effects from medicines

Prevention of asthma exacerbations.

Common objective assessment of the clinical picture of mother and fetus.

Avoid or control factors that may cause exacerbation of asthma.

Rational use of medicines.

Psychological support.

Information and Cultural Support gravid

Medication

In addition to frequent monitoring by both the lung and the gynecologist during pregnancy especially in the heavier forms of asthma have to say that it is safer for the pregnant woman with asthma medication and when needed to control the disease than to have exacerbations, or symptoms which could reduce the oxygenation of the fetus.

The type and dosage of drugs can be divided into two categories.

1) Drugs designed to control long-term.

2) Drugs immediate relief.

B2 DIEGERTES

Belonging to the class C drug safety in pregnancy.

The short-acting (Salbutamol, Terbutaline) are considered the safest category, especially the former.

The granting of per-os not recommended due to several possible effects.

The use of air space by inhalation reduces the chances of side effects and penetration in embryonic tissues.

Mainly used in mild intermittent asthma.

Generally considered drugs of choice.

The long-acting beta2 (Salmeterol Formeterol) have molecular similarity to salbutamol, toxicological and pharmacological profile with the same short-acting b2, but their use is relatively recent times.

Mainly used in

a) persistent forms of asthma

b) In conjunction with inhaled steroids (as an alternative to increasing the dose of inhaled corticosteroids).

c) If it was part of the successful treatment of asthma control before pregnancy.

d) Where it is necessary to address specific clinical conditions (eg nocturnal asthma).

CHROMONES (Nedocromil)

With little systemic absorption shall be regarded although safe but not recommended as an alternative treatment in mild persistent asthma.

THE0FYLLINI

Pretty safe to use.

Considered as an alternative but not recommended for use in mild persistent asthma. If use of the serum concentration should be between

5-12mcg/ml.

For moderate or severe asthma is an alternative but not preferred option, always in combination with steroids, it seems more effective in combination with long-acting steroid beta2 stimulant.

Finally there seems to be a useful addition to the treatment of acute crisis response.

Anticholinergics (Ipratrorium bromide).

There are insufficient data to use during pregnancy.

LEUKOTPIENI (montelukast, zafilukast).

There are insufficient data on safety of use during pregnancy.

It is an alternative but not preferred solution in the treatment of mild persistent form.

Corticoids

They are the treatment of choice for all forms of persistent asthma.

A) inhaled forms

They reduce the risk of outbreaks due to pregnancy, make better lung function (FEV) and so far no evidence linking the use of inhaled steroids with sexual abnormalities.

Their use and breastfeeding is not contraindicated.

The most strongly recommend is Budesonide and Beclomethasone.

The dosage and duration of use depends on the clinical picture and the stage of asthma.

B) systemic steroids.

Administration per os in particular during the first trimester of pregnancy or for a long time is risky complications.

(Glucose pregnancy, cleft palate, premature birth, pre-eclampsia, etc.)

In uncontrolled or severe asthma their use may be necessary.

In these cases should be using the lowest adequate dose, or used in spite of daily dosing.

Is necessary in these situations closer monitoring of the pregnant and the fetus.

Limiting factors can worsen asthma.

A) Allergens (eg Animals,, Fungi, Aeroallergiogona).

B) smoking habits.

C) Humidity

D) Other.

CONCLUSION

The treatment of asthma during pregnancy requires close cooperation among pregnant pulmonologist and gynecologist.

Deemed necessary by the frequent monitoring of pregnant by the treating specialist and the right guidance and information.

Finally, the dosage, the number and frequency of administration of drugs should be such as to obtain control of the disease by offering quality of life the mother, the fetus and the family environment.