Bronchial asthma is a disease surrounded by many questions and doubts that are of particular concern to women planning a pregnancy. Will the child be healthy? Do I need to abandon treatment or, on the contrary, strengthen it during pregnancy? How dangerous are the medications taken for the unborn baby? Modern ideas about this disease are capable of giving a complete answer.

Bronchial asthma is a chronic airway disorder caused by inflammation. The main manifestations: attacks of suffocation, cough, chest congestion, wheezing and wheezing. Their occurrence is provoked by contact with causally significant allergens (house dust, pet hair, pollen, etc.), irritants (tobacco smoke), infections (ARVI).

How does pregnancy affect the course of bronchial asthma?

Pregnancy is a special condition in which the organs and systems of the woman's body are transformed, aimed at creating favorable conditions for the development of the fetus. These changes can influence the course of chronic diseases. For example, the shifts in the respiratory, endocrine and immune systems are most significant in bronchial asthma.

There are 3 options for the course of bronchial asthma during pregnancy:

• Pregnancy does not affect the course of bronchial asthma;
• Improving the course of the disease during pregnancy;
• More severe bronchial asthma during pregnancy.

According to statistics, only 14% of pregnant women improve the course of bronchial asthma. It is impossible to predict exactly how the relationship will develop in each individual case. You shouldn't hope that everything will work out.

Why is poor control of bronchial asthma dangerous?

It should be understood that bronchial asthma does not directly lead to complications of pregnancy. All possible problems stem from poor disease control.

Hypoxia (lack of oxygen) is the most dangerous condition for the fetus, which occurs during an exacerbation of bronchial asthma. The difficulty in breathing that a woman experiences at the time of an attack of suffocation is also strongly felt by the child. The consequences of hypoxia are: insufficient fetal weight (malnutrition), general developmental delay, violation of organ laying (in the 1st trimester of pregnancy).

Insufficient control over bronchial asthma can lead to gestosis (a condition dangerous for both the mother and the baby), as well as contribute to the development of infectious diseases of the respiratory tract in a pregnant woman, sometimes requiring serious antibiotic therapy.

With good control of bronchial asthma during pregnancy, children are born healthy and have a positive prognosis.

Preparing for pregnancy

At the stage of pregnancy planning, the main therapy (inhaler in the minimum effective dose) should be selected that can control the course of the disease, that is, ensure the absence of exacerbations and the indicators of respiratory function that are closest to normal. The process of selecting a drug is quite lengthy. Without a doubt, it must be completed before pregnancy in order to avoid risks. An equally important role is played by the correct inhalation technique, due to which the medicinal substance fully enters the bronchi.

Exacerbations of allergic bronchial asthma are triggered by contact with allergens. By eliminating or limiting their presence, the manifestations of the disease can be reduced. In order to find out exactly your spectrum of causal allergens, it is necessary to undergo an examination in advance by an allergist-immunologist, and receive recommendations on restrictive measures. However, common to all is the observance of a hypoallergenic life - the fight against house dust and microscopic house dust mites living in the house:

• Remove "dust collectors" - items that accumulate dust: carpets, upholstered furniture, massive curtains and others;
• Store clothes in closed cabinets (put seasonal clothes in special covers);
• Perform light wet cleaning daily;
• Replace feather pillows with hypoallergenic ones made of synthetic material. Use protective covers for pillows, blankets and especially mattresses. Wash bed linen at a temperature of at least 60 С⁰ - once a week (!)
• Install an air cleaner at home.

Drug safety

The main tactic of treating bronchial asthma during pregnancy is the use of drugs that effectively control the manifestations of the disease, but do not affect the normal course of pregnancy and the development of the child, that is, they have a proven safe effect.

Each drug undergoes large-scale clinical trials, according to the results of which a pregnancy safety category is set.

Drugs to relieve symptoms

A choking fit is a sudden feeling of difficulty breathing with the inability to exhale completely. A frightening condition that you want to get rid of as soon as possible.

Pregnant women need to stop asthma attacks as quickly as possible so that hypoxia does not harm the child.

Preference is given to drugs with a rapid onset of action and selective effect on the lungs with minimal on the heart. In Russia, it is salbutamol (Ventolin). However, it must be remembered that this drug, or rather the frequency of its use, serves as an indicator of control over bronchial asthma. Ideally, with an adequately selected primary therapy, there is no need for ambulance inhalers, or it is minimal. An increase in the frequency of asthma attacks and an increasing need for this inhaler are a signal of the need for urgent consultation with a specialist.

Planned therapy

Basic therapy with drugs in inhalation form is the basis for the treatment of bronchial asthma. It is she who is aimed at normalizing the respiratory function and preventing exacerbations of the disease. To achieve the maximum long-term effect, therapy should be regular, and the drugs should be selected by a specialist - a pulmonologist or an allergist-immunologist.

With a mild degree of bronchial asthma, the doctor may prescribe inhalers Intal or Tayled, belonging to the group of cromones (non-hormonal drugs). In the case of inadequate control of the disease, a transition to hormonal inhalers (glucocorticosteroids) is necessary.

Considering that most of the basic therapy drugs are hormonal, the issue of their safety is highly relevant. The use of local (topical) glucocorticosteroids is safe, since the drug works exclusively in the area of \u200b\u200binflammation - in the bronchi. It does not enter the bloodstream, which means that it has minimal side effects on the mother's body and does not affect the fetus. Among all the drugs for the treatment of bronchial asthma, the effectiveness of such drugs is maximum.

Of the many hormonal inhalers, based on the effectiveness / safety ratio, during pregnancy, preference is given to budesonide (Pulmicort) and beclomethasone (Beklazon, Klenil).

Which medications should you avoid?

To relieve the exacerbation of bronchial asthma, hormonal preparations for intravenous administration or tablet forms are often used, which have a systemic effect on the entire body and penetrate the placenta. Such glucocorticosteroids are used only for strict indications. The safest in this case is prednisone.

Another drug used to relieve an acute condition, adrenaline (Epinephrine), can also be used only in an emergency.

Long-acting bronchodilator inhalers (formoterol, salmeterol), which are often combined with a hormonal inhaler, are used with caution, since their safety has not yet been fully understood.

Very often bronchial asthma is combined with allergic rhinitis (allergic rhinitis), and its manifestations are relieved by antiallergic (antihistamine) tablets. Unfortunately, their reception is possible only from the 2nd trimester and only if absolutely necessary. For example, loratadine (Claritin) is approved for use.

Controlling bronchial asthma at home

Bronchial asthma is a disease that requires self-control at home. The method for measuring breathing parameters is simple but effective and is called peak flowmetry, and the device itself is a peak flow meter.

The measured indicator is the peak expiratory flow rate (PEF). You need to register it 2 times a day in the morning and in the evening before using the inhaler. The emerging graph reflects the state of respiratory function and may indicate a decrease in control over the disease, although there are no changes in well-being yet. A typical sign of an impending exacerbation is a "failure" of the schedule in the morning.

Correctly performed preparation at the stage of pregnancy planning and adequate full-fledged therapy in accordance with the severity of the course of the disease under the supervision of a specialist is the key to the health of the mother and baby.

Bronchial asthma is becoming an increasingly common disease that affects different segments of the population. This disease does not pose a serious danger to human life, therefore it is quite possible to live a full life with it if modern pharmaceuticals are used.

However, the period of motherhood sooner or later begins in almost every woman, but then the question arises before her - how dangerous are pregnancy and bronchial asthma? Let's see if it is possible to endure and give birth to a normal baby for an asthmatic mother, as well as consider all the other nuances.

One of the main risk factors affecting the development of the disease is the poor environment in the region of residence, as well as difficult working conditions. Statistics show that residents of megalopolises and industrial centers languish from bronchial asthma many times more often than residents of villages or villages. This risk is also very high for pregnant women.

In general, a variety of factors can provoke this ailment, therefore it is not always possible to determine the cause in any particular case. This includes household chemicals, allergens found in everyday life, insufficient nutrition, etc.

Poor heredity is a risk for the newborn. In other words, if either of the two parents had this ailment, then the probability of its occurrence in the child is extremely high. According to statistics, the hereditary factor occurs in one third of all patients. Moreover, if only one parent is sick with asthma, then the probability of this disease in a child is 30 percent. But, if both parents are sick, then this probability increases significantly - up to 75 percent. There is even a special definition for this type of asthma - atopic bronchial asthma.

Impact of bronchial asthma on pregnancy

Many doctors agree that the treatment of bronchial asthma in pregnant women is a very important task. A woman's body already tolerates various changes and increased stress during pregnancy, which are also complicated by the course of the disease. During this period, women have weakened immunity, which is a natural phenomenon when carrying a fetus, and this is a plus includes a change in hormones.

Asthma can manifest in the mother a lack of air and oxygen starvation, which already poses a danger to the normal development of the fetus. In general, bronchial asthma in pregnant women occurs only in 2% of cases, so there is no connection between these circumstances. But this does not mean that the doctor should not react to this disease, because it can really harm the future baby.

The tidal volume of a pregnant woman increases, but the expiratory volume decreases, which leads to the following changes:

• Bronchial collapse.
• Inconsistency of the amount of oxygen and blood supplied in the breathing apparatus.
• Against this background, hypoxia also begins to develop.

Fetal hypoxia is common if asthma occurs during pregnancy. A lack of carbon dioxide in a woman's blood can lead to spasms of the umbilical cord vessels.

Medical practice shows that pregnancy caused by bronchial asthma does not develop as smoothly as in healthy women. With this disease, there is a real risk of premature birth, as well as death of the fetus or mother. Naturally, these risks increase if a woman is negligent about her health without being seen by a treating specialist. At the same time, the patient becomes worse and worse for about 24-36 weeks. If we talk about the most likely complications that occur in pregnant women, then the picture is as follows:

• Gestosis, which is one of the most common causes of death in women, develops in 47 percent of cases.
• Fetal hypoxia and fetal asphyxia during childbirth - in 33 percent of cases.
• Hypotrophy - 28 percent.
• Underdeveloped baby - 21 percent.
• The threat of miscarriage - in 26 percent of cases.
• The risk of premature birth is 14 percent.

It is also worth talking about those cases when a woman takes special anti-asthma drugs to relieve attacks. Consider their main groups, as well as the impact that they have on the fetus.

The effect of drugs

Adrenomimetics

During gestation, adrenaline is strictly prohibited, which is often used to get rid of asthma attacks. The fact is that it provokes a spasm of the vessels of the uterus, which can lead to hypoxia. Therefore, the doctor makes a selection of more gentle drugs from this group, such as salbutamol or fenoterol, but their use is possible only according to the testimony of a specialist.

Theophylline

The use of theophylline preparations can lead to the development of a rapid heart rate in the unborn baby, because they are able to be absorbed through the placenta, remaining in the child's blood. Theofedrine and antastaman are also prohibited for use, because they contain belladonna extract and barbiturates. It is recommended to use ipratropinum bromide instead.

Mucolytic drugs

This group contains drugs that are contraindicated for pregnant women:

• Triamcinolone, which negatively affects the muscle tissue of the baby.
• Betamethasone with dexamethasone.
• Delomedrol, Diprospan and Kenalog-40.

Asthma treatment in pregnant women should be carried out according to a special scheme. It includes constant monitoring of the condition of the mother's lungs, as well as the choice of the method of delivery. The fact is that in most cases, he decides to conduct a cesarean section, because excess stress can provoke an attack. But such decisions are made individually, based on the specific condition of the patient.

As for exactly how asthma is treated, there are several points that can be highlighted:

• Getting rid of allergens. The bottom line is quite simple: you need to remove all kinds of household allergens from the room where the woman is staying. Fortunately, there are various types of hypoallergenic laundry, air purifying filters, etc.
• Taking special medicines. The doctor collects a thorough history, finding out about the presence of other diseases, the presence of allergies to certain drugs, i.e. conducts a full analysis to prescribe a competent treatment. In particular, a very important point is the intolerance of acetylsalicylic acid, because if it is there, then non-steroidal analgesics cannot be used.

The main point in the treatment is, first of all, the absence of risk for the unborn child, on the basis of which all drugs are selected.

Treatment of pregnancy complications

If a woman is in the first trimester, then the treatment of possible complications of pregnancy is carried out in the same way as in normal cases. But if there is a risk of termination of pregnancy in the second and third trimester, then pulmonary disease must be treated, and the mother's breathing must also be normalized.

For these purposes, the following drugs are used:

• Phospholipids, which are taken by the course, along with multivitamins.
• Actovegin.
• Vitamin E.

Childbirth and the postpartum period

At the hour of delivery, special therapy is used to improve blood circulation in the mother and her baby. Thus, drugs are introduced that improve the functioning of the circulatory systems, which is very important for the health of the unborn baby.

To avoid possible choking, inhaled glucocorticosteroids are prescribed. Also shown is the introduction of prednisone during labor.

It is very important that the woman strictly follows the doctor's recommendations, without stopping the therapy until the birth itself. For example, if a woman has been taking glucocorticosteroids on a regular basis, then she should continue taking them after the birth of the baby for the first day. Reception should be done every eight hours.

If a caesarean section is used, an epidural is preferred. If general anesthesia is advisable, then the doctor should carefully select the drugs for administration, because carelessness in this matter can lead to asthma attacks in the child.

Many after childbirth suffer from various bronchitis and bronchospasm, which is a completely natural reaction of the body to labor. To avoid this, you must take ergometrine or any other similar medications. Also, you need to be very careful about taking antipyretics, which include aspirin.

Breast-feeding

It is no secret that many drugs pass into mother's breast milk. This also applies to drugs for asthma, but they pass into milk in small quantities, so this cannot be a contraindication for breastfeeding. In any case, the doctor himself prescribes medications for the patient, bearing in mind the fact that she will have to breastfeed the baby, so he does not prescribe those medications that could harm the baby.

How is childbirth going in patients with bronchial asthma? Labor activity with bronchial asthma can proceed quite normally, without visible complications. But there are times when childbirth is not so easy:

• Water can leave before labor begins.
• Labor may be too fast.
• Abnormal labor may be observed.

If the doctor decides on spontaneous childbirth, then he must make a puncture of the epidural space. Then bupivacaine is injected there, which promotes the expansion of the bronchi. In a similar way, labor pain relief in bronchial asthma is carried out by administering drugs through a catheter.

If the patient has an asthma attack during childbirth, the doctor may decide to have a caesarean section in order to reduce the risks to the mother and baby.

Conclusion

In the end, I would like to say that pregnancy at different periods and bronchial asthma can coexist quite well if a woman receives proper treatment. Of course, this slightly complicates the process of childbirth and the postpartum period, but if you follow the basic recommendations of your doctor, asthma is not as dangerous during pregnancy as it might seem at first glance.

Bronchial asthma has recently become very widespread - many people know firsthand about this disease. And all would be fine - it is quite possible to live with her, and medicine allows you to keep the disease under control. But sooner or later a woman faces the question of motherhood. And here panic begins - will I be able to endure and give birth to a child: Will the baby be healthy?

Doctors answer unequivocally “yes”! Bronchial asthma is not a sentence to your motherhood, because modern medicine allows women suffering from this ailment to become mothers. But the topic is very difficult, so let's understand everything in order so that you do not finally get lost.

The World Health Organization defines bronchial asthma as a chronic disease in which a chronic inflammatory process develops in the respiratory tract under the influence of T-lymphocytes, eosinophils and other cellular elements. Asthma increases bronchial obstruction to external stimuli and to various internal factors - in other words, this is the response of the airways to inflammation.

And although bronchial obstruction is of varying severity and is subject to - spontaneously or under the influence of treatment - complete or partial reversibility, you need to know that in people who have a predisposition, the process of inflammation leads to the generalization of the disease.

At the beginning of the eighteenth century, it was believed that asthma attacks were not such a serious disease to pay special attention to - doctors treated the phenomenon as a side effect of other diseases. For the first time, a systematic approach to the study of asthma was applied by scientists from Germany - Kurshman and Leiden. They identified a number of cases of suffocation, and, as a result, described and systematized clinical manifestations, asthma began to be perceived as a separate disease. But still, the level of technical equipment of medical institutions of that time was not sufficient to establish the cause and fight the disease.

Bronchial asthma affects 4 to 10% of the world's population. Age for the disease does not matter: half of the patients encountered the disease before 10 years, another third - before 40 years. The ratio of the incidence of the disease among children by gender: 1 (girls): 2 (boys).

Risk factors

The most important factor is genetic. Cases when the disease is transmitted from generation to generation in the same family or from mother to child are quite common in clinical practice. Clinical and genealogical analysis data indicate that in one third of patients the disease is hereditary. If one of the parents is sick with asthma, then the probability that the child will encounter this disease is up to 30%; when diagnosing the disease in both parents, the probability reaches 75%. Hereditary, allergic (exogenous) asthma, in medical terminology, is called atopic bronchial asthma.

Harmful working conditions and unfavorable environmental conditions are considered other important risk factors. It is not for nothing that residents of large cities suffer from bronchial asthma many times more often than those who live in rural areas. But nutritional characteristics, household allergens, detergents and others are also of great importance - in a word, it is very difficult to say what exactly can provoke the development of bronchial asthma in a particular case.

Varieties of bronchial asthma

The classification of bronchial asthma is based on the etiology of the disease and its severity, and also depends on the features of bronchial obstruction. The classification by severity is especially popular - it is used in the management of such patients. There are four degrees of severity of the course of the disease at initial diagnosis - they are based on clinical signs and indicators of respiratory function

• First degree: episodic

This stage is considered the easiest, since the symptoms make themselves felt no more than once a week, night attacks - no more than twice a month, and the exacerbations themselves are short-term (from an hour to several days), outside periods of exacerbations - indicators of lung function in the norm.

• Second degree: mild form

Mild persistent asthma: Symptoms occur more often than once a week, but not every day, exacerbations can interfere with normal sleep and daily physical activity. This form of the disease is most common.

• Third degree: medium

The average severity of bronchial asthma is characterized by daily symptoms of the disease, exacerbations interfere with sleep and physical activity, weekly multiple manifestations of nocturnal attacks. The vital volume of the lungs is also significantly reduced.

• Fourth degree: severe course

Daily symptoms of the disease, frequent exacerbations and nocturnal manifestations of the disease, limited physical activity - all this indicates that the disease has taken the most severe form of the course and the person should be under constant medical supervision.

Impact of bronchial asthma on pregnancy

Doctors rightly believe that the treatment of bronchial asthma in expectant mothers is a particularly important problem that requires a careful approach. The course of the disease is influenced by cardinal changes in the state of the hormonal background, the specificity of the external respiration function of a pregnant woman and a weakened immune system. By the way, the weakening of immunity during pregnancy is a prerequisite for carrying a baby. Oxygen starvation caused by bronchial asthma is a serious risk factor for fetal development and requires active intervention by the attending physician.

There is no direct connection between pregnancy and bronchial asthma, since the disease occurs in only 1-2% of pregnant women. But, taking into account all the factors mentioned, asthma requires special intensive treatment - otherwise there is a danger that the baby will have health problems.

The body of a pregnant woman and the fetus have an increasing need for oxygen. This causes some changes in the basic functions of the respiratory system. During pregnancy, due to the enlargement of the uterus, the abdominal organs change their position, and the vertical size of the chest decreases. These changes are compensated by an increase in the circumference of the chest and increased diaphragmatic breathing. In the early stages of pregnancy, the tidal volume increases due to an increase in lung ventilation by 40-50% and a decrease in the reserve expiratory volume, and at a later date, alveolar ventilation increases to 70%.

The increase in alveolar ventilation leads to an increase in the volume of oxygen in the blood and, accordingly, is directly related to the increased level of progesterone, which sometimes acts as a direct stimulant and leads to an increased sensitivity of the respiratory apparatus to CO2. The consequence of hyperventilation is respiratory alkalosis - it is easy to guess what problems this can result in.

A decrease in expiratory volume, due to an increase in tidal volume, provokes the possibility of a number of changes:

• Collapse of small bronchi in the lower lungs.
• Violation of the ratio of oxygen and blood supply in the respiratory apparatus and peri-pulmonary organs.
• The development of hypoxia and others.

This is due to the fact that the residual volume of the lungs approaches the functional residual capacity.

This factor can also provoke fetal hypoxia if a pregnant woman has bronchial asthma. Lack of CO2 in the blood, which develops during hyperventilation of the lungs, leads to the development of spasms of the vessels of the umbilical cord and thus creates a critical situation. Be sure to keep this in mind during attacks of bronchial asthma, as hyperventilation aggravates the embryo's hypoxia.

The physiological changes described above in a woman's body during pregnancy are a consequence of the activity of hormones. Thus, the effect of estrogen is marked by an increase in the number of β-adrenergic receptors, a decrease in the clearance of cortisol, an enhanced bronchodilatory effect of β-adrenergic agonists, and the effect of progesterone is an increase in the amount of cortisol-binding globulin, relaxation of bronchial smooth muscles, and a decrease in the tone of all smooth muscles in the body. Progesterone competes with cortisol for receptors in the respiratory system, increases lung sensitivity to CO2, and leads to hyperventilation.

The following factors contribute to an improvement in the course of asthma: a high level of estrogen, estrogen potentiation of the bronchodilatory effect of β-adrenergic agonists, a low level of histamine in plasma, an increase in the level of free cortisol and, as a consequence, an increase in the number and affinity of β-adrenergic receptors, an increase in the half-life of bronchodilators, especially methylxanthines ...

The following factors potentially worsen the course of bronchial asthma: an increase in the sensitivity of β-adrenergic receptors, a decrease in the reserve expiratory volume, a decrease in the sensitivity of the expectant mother's body to cortisol due to competition with other hormones, stressful situations, respiratory infections, and various diseases of the gastrointestinal tract.

Long-term monitoring of pregnancy in women suffering from bronchial asthma, unfortunately, showed an increase in the risk of premature birth, as well as neonatal mortality. Inadequate control of the course of the disease, as already mentioned, can cause the development of the most severe complications - from premature birth to the death of the mother and / or child. Therefore, be sure to visit your doctor regularly!

During pregnancy, one third of patients experience an improvement in their condition, another third - a deterioration, and the rest - a stable condition. As a rule, the deterioration of the condition is observed in patients suffering from severe forms of the disease, and patients with a mild form either have an improvement or their condition is stable.

The deterioration of the condition of pregnant women with bronchial asthma occurs at a later date and usually after an acute respiratory illness or other adverse factors. The 24-36th weeks are especially critical, and the improvement of the condition is observed in the last month.

The picture of possible complications in patients with bronchial asthma in percentage terms looks like this: gestosis - in 47% of cases, hypoxia, as well as baby asphyxia at birth - in 33%, fetal malnutrition - in 28%, delayed child development - in 21%, the threat of termination of pregnancy - in 26%, the development of premature birth - in 14.2%.

Treatment of bronchial asthma during pregnancy

For pregnant women, there is a special treatment regimen for bronchial asthma. It includes: assessment and constant monitoring of the mother's lungs, preparation and selection of the optimal method of labor management. Speaking of childbirth: in such a situation, doctors often choose childbirth through a cesarean section - excessive physical stress can lead to another severe attack of bronchial asthma. However, of course, everything is decided individually, in each specific situation. But let's get back to the ways to treat the disease:

• Elimination of allergens

Successful therapy of atopic bronchial asthma assumes, as a prerequisite, the removal of allergens from the environment in which the sick woman is. Fortunately, technological progress today makes it possible to expand the possibilities for this condition: washing vacuum cleaners, air filters, hypoallergenic bedding, after all! And it goes without saying that the cleaning in this case should not be done by the expectant mother!

• Medications

For successful treatment, it is very important to collect the correct anamnesis, the presence of concomitant diseases, the tolerance of drugs - non-steroidal anti-inflammatory drugs, as well as drugs containing them (theofedrine and others), and, especially, acetylsalicylic acid. When diagnosing aspirin bronchial asthma in a pregnant woman, the use of non-steroidal analgesics is excluded - the doctor must remember this when choosing medications for the expectant mother.

Since most pharmaceutical drugs affect the unborn baby in one way or another, the main task in the treatment of asthma is to use effective drugs that do not harm the development of the unborn baby.

The effect of anti-asthma drugs on a child

• Adrenomimetics

During pregnancy, adrenaline is strictly contraindicated, which is usually used to relieve acute asthma attacks, since vasospasm associated with the uterus can lead to fetal hypoxia. Therefore, for expectant mothers, doctors select more gentle drugs that will not harm the baby.

Aerosol forms of β2-adrenergic agonists (fenoterol, salbutamol and terbutaline) are safer and more effective, but they can also be used only as directed by a doctor and under his supervision. In late pregnancy, the use of β2-adrenergic agonists can lead to an increase in the duration of the labor period, since drugs similar in action (partusisten, ritodrin) are also used to prevent preterm labor.

• Theophylline preparations

The clearance of theophylline in pregnant women in the third trimester is significantly reduced, therefore, when prescribing intravenous theophylline preparations, the doctor should take into account the fact that the half-life of the drug increases to 13 hours compared to 8.5 hours in the postpartum period and the binding of theophylline to plasma proteins decreases. In addition, the use of methylxanthine preparations can cause postpartum tachycardia in a child, since these drugs have a high concentration in the fetal blood (they penetrate the placenta).

To avoid adverse effects on the fetus, it is highly discouraged to use powders according to Kogan - antastaman, theofedrine, They are contraindicated because of the belladonna extracts and barbiturates they contain. In comparison with them, ipratropinum bromide (inhaled anticholinergic) does not have a negative effect on the development of the fetus.

• Mucolytic agents

The most effective anti-inflammatory drugs for asthma are glucocorticosteroids. If indicated, they can be safely prescribed to pregnant women. Contraindicated for short-term and long-term use are triamcinolone preparations (a negative effect on the development of the child's muscles), GCS preparations (dexamethasone and betamethasone), as well as depot preparations (Depomedrol, Kenalog-40, Diprospan).

If there is a need for use, then it is preferable to use effective drugs, such as prednisolone, prednisone, inhaled corticosteroids (beclomethasone dipropionate).

• Antihistamines

The appointment of antihistamines in the treatment of asthma is not always advisable, but since such a need may arise during pregnancy, it should be remembered that the drug of the alkylamine group - brompheniramine is absolutely contraindicated. Alkylamines are also included in other medicines recommended for the treatment of colds (Fervex, etc.) and rhinitis (Coldakt). Also, the use of ketotifen is strongly discouraged (due to the lack of safety information) and other antihistamines of the previous, second generation.

During pregnancy, immunotherapy using allergens should not be carried out under any pretext - this is an almost 100% guarantee that the baby will be born with a strong predisposition to bronchial asthma.

The use of antibacterial drugs is also limited. In atopic asthma, drugs based on penicillin are strictly contraindicated. For other forms of asthma, it is preferable to use ampicillin or amoxicillin, or drugs in which they are found together with clavulanic acid (Augmentin, Amoxiclav).

Treatment of pregnancy complications

With the threat of termination of pregnancy in the first trimester, asthma therapy is carried out according to generally accepted rules, without characteristic features. Further, during the second and third trimesters, the treatment of complications typical of pregnancy should include the optimization of respiratory processes and correction of the underlying pulmonary disease.

To prevent hypoxia, improve and normalize the processes of cellular nutrition of the unborn baby, the following drugs are used: phospholipids + multivitamins, vitamin E; actovegin. The doctor selects the dosage of all drugs individually, after making a preliminary assessment of the severity of the disease and the general condition of the woman's body.

In order to prevent the development of infectious diseases that people with bronchial asthma are exposed to, complex immunocorrection is carried out. But again, I would like to draw your attention - any treatment should be carried out only under the strict supervision of a doctor. After all, what is ideal for one expectant mother can harm another.

Childbirth and the postpartum period

Therapy during childbirth, first of all, should be aimed at improving the circulatory systems of the mother and the fetus - that is why the introduction of drugs that improve placental blood flow is recommended. And the expectant mother in no case should refuse the therapy suggested by the doctor - you don't want your baby's health to suffer, do you?

You can not do without the use of inhaled glucocorticosteroids, which prevent attacks of suffocation, and hence the subsequent development of fetal hypoxia. At the beginning of the first stage of labor, women who are constantly taking glucocorticosteroids, as well as those expectant mothers whose asthma is unstable, must be given prednisone.

The therapy is assessed from the point of view of effectiveness according to the results of ultrasound, fetal hemodynamics, according to CTG, by definition in the blood of the hormones of the fetoplacental complex - in a word, the mother and baby should be under the vigilant supervision of a doctor.

In order to prevent possible complications during childbirth, women with bronchial asthma must adhere to certain rules. They should continue their mainstream anti-inflammatory therapy - do not interrupt treatment on the eve of a momentous event in your life. Patients who have previously received systemic glucocorticosteroids are advised to take hydrocortisone every 8 hours and for 24 hours after the birth of the baby.

Since thiopental, morphine, tubocurarine have a histamine-releasing effect and can provoke an attack of suffocation, they are excluded if a cesarean section is necessary. When giving birth by caesarean section, epidural anesthesia is preferred. And in the event that there is a need for general anesthesia, the doctor will choose the drug especially carefully

In the postpartum period, a newly-made mother suffering from bronchial asthma is very likely to develop bronchospasm - it is the body's response to stress, which is the birth process. To prevent it, it is necessary to exclude the use of prostaglandin and ergometrine. Also, with aspirin bronchial asthma, special care should be taken when using pain relievers and antipyretics.

Breast-feeding

You have received comprehensive information about pregnancy and bronchial asthma. But don't forget about breastfeeding, which is an important part of the bond between mother and baby. Very often, women refuse to breastfeed for fear that the medication will harm the baby. Of course they are right, but only partly.

As you know, the overwhelming majority of drugs inevitably end up in milk - this also applies to drugs for bronchial asthma. The components of methylxanthine derivatives, adrenergic agonists, antihistamines and other drugs are also excreted together with milk, but in a much lower concentration than they are present in the mother's blood. And the concentration of steroids in milk is also low, but the drugs should be taken at least 4 hours before feeding.

(hereinafter BA or asthma) is a chronic inflammatory disease of the respiratory tract. It is accompanied by shortness of breath, bouts of coughing and suffocation - this is how the respiratory system reacts to external stimuli. The protective system works, they narrow, mucus is abundantly produced, which disrupts the flow of air into the lungs. The disease is characterized by periodic exacerbations and remissions. Strong occurs during the acute phase. Various irritants can be provocateurs - strong laughter, crying, physical activity, allergens, and even the weather. Internal factors - disorders of the immune and endocrine systems. The disease is often hereditary. Unfortunately, pregnant women also suffer from it, which greatly worries parents who are worried about the health of their baby.

How does the disease affect the child

Stages and term

There are 3 stages of asthma:

1. Predastma. It is recognized by the occurrence of chronic asthmatic bronchitis, pneumonia and bronchospasm.
2. Choking attacks. Their duration is from 2-3 minutes to several hours (chest tightness, dry cough, breathing with noise and whistling, the skin becomes sweaty, the face becomes bluish, the end of the attack is accompanied by a cough with profuse sputum production).
3. Asthmatic status. It is characterized by suffocation, which lasts several days. Medicines generally do not bring the expected relief, which also affects the condition of the fetus in a woman.

Any stage and shape can be present during pregnancy.

Asthma is not a contraindication to childbirth, but requires increased medical supervision.

If asthma is mild, then the expectant mother may practically not bother. The same cannot be said for those with a severe illness.

BA in severe form in pregnant women brings dramatic shifts in the woman's immune system and has a negative effect on both the mother and the fetus.

If there were no attacks of suffocation before pregnancy, this does not mean that they will not appear when carrying a child. Some have asthma at the beginning of the term, others in the second half. In this case, the first option can be confused with toxicosis.

In the video, a pulmonologist talks about why asthma can develop for the first time precisely during the period of a child's development in the womb.

In the first trimester, pre-asthma attacks may begin. In this case, an ultrasound examination of the fetus is regularly performed to prevent intrauterine oxygen starvation. How seizures will affect the unborn baby is difficult to predict. It happens that a woman's condition improves if a more serious form does not occur.

The first 12 weeks are very difficult, it is better not to refuse hospitalization to reduce the risks to the fetus. Asthma can lead to hypoxia, which affects the mental development of the child. Properly selected treatment will not cause discomfort or aggravate the disease. The main thing is to prevent the development of a difficult third stage.

The second half of the term is easier to transfer. The amount of progesterone in the blood increases, the bronchi become wider. The placenta itself is shaped so that steroids are produced in it to protect the baby from inflammation.

Risks to baby and mom

The effect on the fetus during pregnancy and bronchial asthma is most severe in the third trimester. If complications are observed during the first pregnancy, then they cannot be avoided during subsequent ones.

Asthma during pregnancy can trigger:

• miscarriage;
• bleeding;
• birth trauma;
• premature birth;
• violations of labor;
• postpartum exacerbation of the disease;
• complications in the lungs and heart of the mother.

For a child, the main thing is oxygen, which he receives through the mother, because she breathes for her baby in the womb. Lack of oxygen leads to developmental problems, underweight and premature birth. It is not excluded that the baby gets asthma from the mother by inheritance. In this case, the newborn often develops upper respiratory tract diseases.

The possibility of unpleasant consequences increases if a woman takes medications uncontrollably or heals herself. Any deterioration in health requires immediate medical advice.

Let's talk about childbirth

How to make it easier

An asthmatic woman should be under the supervision of a doctor already at the planning stage of pregnancy. At the initial stage, it is important to minimize all external stimuli that provoke seizures. You can learn to control them or make them less debilitating and dangerous.

Parents-to-be are sometimes so worried that they ask if it is possible to give birth with asthma, and are afraid to even plan for a long-awaited child.

Asthma is not a contraindication for pregnancy and childbirth.

BA responds well to therapy. In order for the gestation process to be as successful as possible, preventive measures must be taken:

• maintain cleanliness in everyday life;
• do not have pets;
• refuse to use chemistry;
• remove all things on which dust accumulates;
• take balanced vitamin complexes (must be prescribed by a doctor);
• replace bedding with synthetic ones (allergies may appear to down and feathers);
• more often be in the fresh air, compose and observe a set of physical exercises suitable for pregnant women.

It is also obligatory to be registered with your therapist. The task of a woman is to strengthen her health, then the birth will take place without complications and risks.

Process features

BA must be under control for all 9 months. If all medical prescriptions are followed, the delivery is successful, without a cesarean section.

Since the baby can be born prematurely, it is recommended to be hospitalized a few weeks before the onset of labor.

Frequent complications in asthmatic women in labor:

• early discharge of amniotic fluid;
• sudden and rapid labor.

During normal childbirth, if an attack of suffocation suddenly occurs, surgery is prescribed. It is noted that asthmatic manifestations rarely occur, provided that the woman in labor has taken the prescribed drugs.

A severe form is likely to lead to a cesarean section at 38 weeks, but it is prescribed when the attacks recede and the disease passes into a favorable stage. At this time, the baby is considered full-term, healthy and capable of independent life.

During normal childbirth, oxygen inhalation is performed. It is recommended that you notify your doctor about the medications you are taking and take a regular inhaler with you. Humidified oxygen may be supplied during childbirth for asthma. Even at birth, treatment will continue. If a woman has a severe asthmatic status, she may be left in the intensive care unit or intensive care before discharge.

Treatment of a woman

Treatment of asthma during pregnancy requires special treatment, because all medications taken pass through the placenta. They should be used minimally. If asthma is of little concern, and there are no risks for the child and woman, it is recommended to abandon therapy altogether.

Since it is completely impossible to cure the disease, medications are prescribed to alleviate the symptoms that do not cause the uterus to contract. In case of minor manifestations, it is better to limit yourself to inhalation of a safe saline solution.

If a woman's condition is controlled by several specialists, their therapy actions must be coordinated.

It is important to get the flu vaccine. It is harmless and lasts for one season. The following groups of drugs provide effective assistance:

• medicines for edema;
• drugs that relax the bronchi: Berotek (from the 2nd and 3rd trimesters);
• :, in the second and third trimester;
• means that strengthen the immune system (provided that they were taken before conception);
• anti-inflammatory drugs for inhalation, for example in small doses (for example, Budesonide is indicated for severe forms).

Many medications for asthma in pregnant women are prohibited. The following inhalers should not be used:

• Teofedrin, Antastman, all powders according to Kogan: they have a high content of belladonna components, barbiturates, which can be dangerous to the fetus;
• Betamethasone and: negatively affect the muscular system of the child;
• long-acting drugs: use of any form is prohibited;
• Adrenaline: in the usual state it is indispensable for stopping suffocating attacks, but in a woman in position it can cause uterine spasms;
• Salbutamol, Terbutaline: not prescribed in the last months, as they can delay labor;
• Theophylline: prohibited in the last trimester, as it tends to penetrate the bloodstream and increase the baby's heart rate.

The use of certain antibiotics (Tetracycline, Tsiprolet, etc.) is prohibited. 2nd generation antihistamines have side effects that adversely affect the condition of the mother and fetus.

It is necessary to take the prescribed medications, the lack of medication is unsafe for the unborn child. Many pregnant women refuse to take medications, but this is dangerous because the child will suffocate while in the womb with a severe attack.

Asthma of pregnant women is treated with conventional inhalation if possible. Their concentration in the blood is low, and the effect is maximal. Doctors recommend opting for freon-free inhalers.

The expectation state of the child can change the effects of certain drugs, making them no longer work as expected. This happens when the attacks occur more often than twice a week, suffocation occurs at night several times a month, and you have to use medicines every day to relax the bronchi. In such a situation, the doctor suggests other treatment regimens.

Preventive treatment also includes appropriate exercise, which makes coughing easier. Swimming relaxes the bronchi.

It is important for pregnant women to follow a few tips:

1. The disease is often associated with the common cold. It needs to be treated in a timely manner, sometimes it is required to take antibiotics approved for pregnant women.
2. If a cesarean section was performed, as after any operation, pain relievers are used. If it is a patient with "aspirin" asthma, non-narcotic analgesics are prohibited.
3. A pregnant woman should make it a rule to keep a diary of medication and to monitor her condition, since in most cases the pregnancy outcome worsens due to uncontrolled treatment.
4. Reduce surrounding allergens. Eliminate disease-provoking food additives, strong odors. If it is impossible to get rid of the animal, then minimize contact with it, do not let it into the rooms where the woman is. Smoking is prohibited, including passive smoking.
5. Choose personal hygiene items with a soft composition. The air in the room should not be dry; ionizers and humidifiers will solve the problem.
6. If shortness of breath appears while waiting for the baby, this is not always a symptom of the disease. Perhaps these are just temporary changes in the body, but you need to undergo an examination.

During pregnancy, the essence of asthma treatment is its prevention, improving lung function. Not only the woman herself, but also the close people around her should show attention, help, care and control over her condition.

Bronchial asthma is one of the most common lung diseases in pregnant women. Due to the increase in the number of people prone to allergies, cases of bronchial asthma have become more frequent in recent years (from 3 to 8% in different countries; moreover, every decade the number of such patients increases by 1-2%).
This disease is characterized by inflammation and temporary obstruction of the airways and occurs against the background of increased irritability of the airways in response to various influences. Bronchial asthma can be of non-allergic origin - for example, after brain injury or as a result of endocrine disorders. However, in the overwhelming majority of cases, bronchial asthma is an allergic disease, when in response to exposure to an allergen, bronchial spasm occurs, manifested by suffocation.

VARIETIES

Distinguish between infectious-allergic and non-infectious-allergic forms of bronchial asthma.
Infectious-allergic bronchial asthma develops against the background of previous infectious diseases of the respiratory tract (pneumonia, pharyngitis, bronchitis, tonsillitis); in this case microorganisms are the allergen. Infectious-allergic bronchial asthma is the most common form, accounting for more than 2/3 of all cases of the disease.
In the case of a non-infectious-allergic form of bronchial asthma, the allergen can be various substances of both organic and inorganic origin: plant pollen, street or house dust, feathers, wool and dander of animals and humans, food allergens (citrus fruits, strawberries, strawberries, etc.), medicinal substances (antibiotics, especially penicillin, vitamin B1, aspirin, pyramidon, etc.), industrial chemicals (most often formalin, pesticides, cyanamides, inorganic salts of heavy metals, etc.). In the event of non-infectious-allergic bronchial asthma, hereditary predisposition matters.

SYMPTOMS

Regardless of the form of bronchial asthma, there are three stages of its development: pre-asthma, asthma attacks and asthmatic status.
All forms and stages of the disease occur during pregnancy.
ness.
Chronic asthmoid bronchitis and chronic pneumonia with bronchospasm elements belong to predastma. There are no pronounced attacks of suffocation at this stage yet.
In the initial stage of asthma, asthma attacks develop periodically. With an infectious-allergic form of asthma, they appear against the background of any chronic disease of the bronchi or lungs.
Choking attacks are usually easy to recognize. They start more often at night, lasting from several minutes to several hours. Choking is preceded by a scratching sensation in the throat, sneezing, runny nose, tightness in the chest. The attack begins with a persistent paroxysmal cough, no sputum. There is a sharp difficulty in exhaling, tightness in the chest, nasal congestion. The woman sits down, strains all the muscles of the chest, neck, shoulder girdle to exhale air. Breathing becomes noisy, hissing, hoarse, audible from a distance. At first, breathing is quickened, then it becomes less frequent - up to 10 respiratory movements per minute. The face becomes bluish. The skin is covered with perspiration. By the end of the attack, sputum begins to separate, which becomes more liquid and abundant.
Status asthma is a condition in which a severe attack of suffocation persists for hours or days. In this case, those medications that the patient usually takes are ineffective.

FEATURES OF THE COURSE OF BRONCHIAL ASTHMA DURING PREGNANCY AND LABOR

With the development of pregnancy in women with bronchial asthma, pathological shifts in the immune system occur, which have a negative impact on both the course of the disease and the course of pregnancy.
Bronchial asthma usually begins before pregnancy, but may first appear during pregnancy. In some of these women, the mothers also suffered from bronchial asthma. In some patients, asthma attacks develop at the beginning of pregnancy, in others - in the second half. Asthma that occurs at the beginning of pregnancy, like early toxicosis, can disappear by the end of the first half of it. In these cases, the prognosis for the mother and fetus is usually quite favorable.
Bronchial asthma, which began before pregnancy, during it can proceed in different ways. According to some reports, during pregnancy, 20% of patients retain the same condition as before pregnancy, 10% experience improvement, and most women (70%) have a more severe disease, with moderate and severe forms of exacerbation prevailing with daily repeated attacks. suffocation, recurrent asthmatic conditions, unstable treatment effect.
Asthma usually worsens in the first trimester of pregnancy. In the second half, the disease is easier. If the deterioration or improvement of the condition occurred during a previous pregnancy, then it can be expected during subsequent pregnancies.
Attacks of bronchial asthma during childbirth are rare, especially with the prophylactic use of glucocorticoid drugs (prednisolone, hydrocortisone) or bronchodilators (aminophylline, ephedrine) during this period.
After childbirth, the course of bronchial asthma improves in 25% of women (these are patients with a mild form of the disease). In 50% of women, the condition does not change, in 25% it worsens, they are forced to constantly take prednisone, and the dose has to be increased.
Patients with bronchial asthma more often than healthy women develop early toxicosis (in 37%), the threat of termination of pregnancy (in 26%), labor disorders (in 19%), rapid and rapid labor, which results in high birth traumatism ( in 23%), premature and low birth weight babies can be born. Pregnant women with severe bronchial asthma have a high percentage of spontaneous miscarriages, premature births and caesarean section operations. Cases of fetal death before and during childbirth are noted only in severe disease and inadequate treatment of asthmatic conditions.
The mother's illness can affect the baby's health. In 5% of children, asthma develops in the first year of life, in 58% in subsequent years. In newborns of the first year of life, diseases of the upper respiratory tract often occur.
The postpartum period in 15% of puerperas with bronchial asthma is accompanied by an exacerbation of the underlying disease.
Patients with bronchial asthma during full-term pregnancy usually give birth through the vaginal birth canal, since asthma attacks during childbirth are easy to prevent. Frequent attacks of suffocation and asthmatic conditions observed during pregnancy, the ineffectiveness of the treatment carried out serve as an indication for early delivery at 37-38 weeks of pregnancy.

TREATMENT OF BRONCHIAL ASTHMA DURING PREGNANCY

When treating bronchial asthma in pregnant women, it should be borne in mind that all drugs used for this purpose pass through the placenta and can harm the fetus, and since the fetus is often in a state of hypoxia (oxygen starvation), a minimum amount of drugs should be administered. If asthma does not worsen during pregnancy, there is no need for drug therapy. With a slight exacerbation of the disease, you can confine yourself to mustard plasters, cans, inhalations of saline. However, it should be borne in mind that severe and poorly treated asthma poses a much greater danger to the fetus than the drug therapy used to treat it. But in all cases, a pregnant woman suffering from bronchial asthma should use medications only as directed by a doctor.
The main treatment for bronchial asthma includes bronchodilators (sympathomimetics, xanthine derivatives) and anti-inflammatory (intal and glucocorticoids) agents.
The most widely used drugs are from the group of sympathomimetics. These include izadrin, euspiran, novodrin. Their side effect is an increased heart rate. It is better to use the so-called selective sympathomimetics; they cause bronchial relaxation, but this is not accompanied by palpitations. These are drugs such as salbutamol, bricanil, salmeterol, berotek, alupent (asthmopent). When inhaled, sympathomimetics act faster and stronger, therefore, with an attack of suffocation, 1-2 breaths are taken from the inhaler. But these drugs can also be used as preventive measures.
Adrenaline also belongs to sympathomimetics. Its injection can quickly eliminate an attack of suffocation, but it can cause spasm of peripheral vessels in a woman and a fetus, and worsen uteroplacental blood flow. Ephedrine is not contraindicated during pregnancy, but it is ineffective.
Interestingly, sympathomimetics are widely used in obstetrics for the treatment of miscarriage. An additional beneficial effect of these drugs is the prevention of distress syndrome - breathing disorders in newborns.
Methylxanthines are the preferred treatment for asthma during pregnancy. Euphyllin is administered intravenously for severe attacks of suffocation. As a prophylactic agent, aminophylline is used in tablets. Recently, extended-release xanthines, theophylline derivatives, such as theopec, have become increasingly widespread. Theophylline preparations have a beneficial effect on the body of a pregnant woman. They improve uteroplacental blood circulation and can be used to prevent distress syndrome in newborns. These drugs increase renal and coronary blood flow and decrease pulmonary artery pressure.
Intal is used after 3 months of pregnancy with a non-infectious-allergic form of the disease. In severe disease and asthmatic conditions, this drug is not prescribed. Intal is used only for the prevention of bronchospasm, but not for the treatment of already developed asthma attacks: this can lead to increased suffocation. Intal is taken by inhalation.
Among pregnant women, there are more and more patients with severe bronchial asthma who are forced to receive hormone therapy. They usually have a negative attitude towards taking glucocorticoid hormones. However, during pregnancy, the danger associated with the introduction of glucocorticoids is less than the danger of developing hypoxemia - a lack of oxygen in the blood, from which the fetus is very seriously affected.
Treatment with prednisolone must be carried out under the supervision of a physician, who sets an initial dose sufficient to eliminate the exacerbation of asthma in a short time (1-2 days), and then prescribes a lower maintenance dose. In the last two days of treatment, inhalation of becotide (beclamide), a glucocorticoid that has a local effect on the respiratory tract, is added to the prednisolone tablets. This drug is harmless. It does not stop the developed asthma attack, but serves as a prophylactic agent. Inhaled glucocorticoids are currently the most effective anti-inflammatory drugs for the treatment and prevention of bronchial asthma. With exacerbations of asthma, without waiting for the development of severe attacks, the dose of glucocorticoids should be increased. For the fetus, the doses used are not dangerous.
Anticholinergics are agents that reduce the narrowing of the bronchi. Atropine is administered subcutaneously for an attack of suffocation. Platyphyllin is prescribed in powders prophylactically or to stop an attack of bronchial asthma - subcutaneously. Atrovent is an atropine derivative, but with a less pronounced effect on other organs (heart, eyes, intestines, salivary glands), which is associated with its better tolerance. Berodual contains atrovent and berotec, which was mentioned above. It is used to suppress acute attacks of asthma and to treat chronic bronchial asthma.
The well-known antispasmodics papaverine and no-shpa have a moderate bronchodilatory effect and can be used to suppress mild asthma attacks.
In case of infectious-allergic bronchial asthma, it is necessary to stimulate the excretion of sputum from the bronchi. Regular breathing exercises, toilet of the nasal cavity and oral mucosa are important. Expectorants serve as thinning phlegm and promoting the removal of bronchial contents; they moisturize the mucous membrane, stimulate coughing. For this purpose can serve:
1) inhalation of water (tap or sea), saline, soda solution, heated to 37 ° C;
2) bromhexine (bisolvon), mucosolvin (in the form of inhalation),
3) ambroxol.
3% solution of potassium iodide and solutane (containing iodine) are contraindicated in pregnant women. An expectorant mixture with marshmallow root, terpinhydrate tablets can be used.
It is useful to drink medicinal preparations (if you have no intolerance to the components of the collection), for example, from wild rosemary herb (200 g), oregano herb (100 g), nettle leaves (50 g), birch buds (50 g). They need to be crushed, mixed. 2 tablespoons of the collection pour 500 ml of boiling water, boil for 10 minutes, then leave for 30 minutes. Drink 1/2 cup 3 times a day.
Recipe for another collection: plantain leaves (200 g), St. John's wort leaves (200 g), linden flowers (200 g) chop and mix. 2 tablespoons of the collection pour 500 ml of boiling water, leave for 5-6 hours. Drink 1/2 cup 3 times a day before meals in a warm state.
Antihistamines (diphenhydramine, pipolfen, suprastin, etc.) are indicated only for milder forms of non-infectious-allergic asthma; in the case of an infectious-allergic form of asthma, they are harmful, since they contribute to the thickening of the secretion of the bronchial glands.
In the treatment of bronchial asthma in pregnant women, it is possible to use physical methods: physiotherapy exercises, a complex of gymnastic exercises that facilitate coughing, swimming, inductothermy (warming up) of the adrenal glands, acupuncture.
During childbirth, the treatment of bronchial asthma does not stop. The woman is given humidified oxygen, and drug therapy continues.
Treatment of status asthmaticus must be carried out necessarily in the hospital in the intensive care unit.

PREVENTION OF PREGNANCY COMPLICATIONS

It is necessary for the patient to eliminate risk factors for exacerbation of the disease. The removal of the allergen is very important. This is achieved by wet cleaning the room, excluding allergic foods (oranges, grapefruits, eggs, nuts, etc.) and nonspecific food irritants (peppers, mustard, spicy and salty foods) from food.
In some cases, the patient needs to change jobs if it is associated with chemicals that play the role of allergens (chemicals, antibiotics, etc.).
Pregnant women with bronchial asthma should be registered with a therapist of the antenatal clinic. Each "cold" disease is an indication for antibiotic treatment, physiotherapy procedures, expectorants, for the prophylactic administration of drugs that dilate the bronchi, or to increase their dose. With an exacerbation of asthma at any stage of pregnancy, hospitalization is carried out, preferably in a therapeutic hospital, and in case of symptoms of the threat of termination of pregnancy and two weeks before the due date, in a maternity hospital to prepare for childbirth.
Bronchial asthma, even its hormone-dependent form, is not a contraindication for pregnancy, since it is amenable to drug-hormonal therapy. Only with recurring asthmatic conditions can the question arise about abortion in early pregnancy or about early delivery of the patient.

Pregnant women with bronchial asthma should be regularly monitored by an obstetrician and a therapist of the antenatal clinic. Asthma treatment is complex and must be directed by a doctor.