Lung diseases are quite common among pregnant women: 5-9% suffer from chronic asthma, exacerbation of asthma together with pneumonia gives 10% of all hospitalizations for extragenital pathology, in 10% maternal mortality is due to pulmonary thromboembolism.

Bronchial asthma - chronic inflammatory disease of the respiratory tract, manifested by their overreaction to certain stimuli. The disease is characterized by a paroxysmal course associated with a sudden narrowing of the lumen of the bronchi and manifested by cough, wheezing, decreased excursion of respiratory movements and an increase in respiratory rate.

Clinic. Bronchial asthma attacks start more often at night, last from several minutes to several hours. Suffocation is preceded by a “scratching” sensation in the throat, sneezing, vasomotor rhinitis, tightness in the chest. In the onset of an attack, a persistent dry cough is characteristic. There is a sharp difficulty in inhaling. The patient sits down, strains all the muscles of the chest, neck, shoulder girdle in order to exhale air. Breathing becomes noisy, hissing, hoarse, audible from a distance. At first, breathing is quickened, then reduced to 10 per minute. The face becomes cyanotic. The skin is covered with perspiration. The chest is expanded, almost does not move during breathing. Percussion sound is boxy, cardiac dullness is not defined. Breathing is heard with an elongated exhalation (2-3 times longer than inhalation, and normally exhalation should be 3-4 times shorter than inhalation) and a lot of dry wheezing of different nature. With the cessation of the attack, wheezing quickly disappears. By the end of the attack, sputum begins to separate, becoming more liquid and abundant.

• allergens
• upper respiratory tract infection
• medications (aspirin, β-blockers)
• environmental factors
• occupational factors - cold air, emotional stress, exercise,
• genetic factor:
  • genes possibly associated with the cause of asthma are located on chromosomes 5, 6, 11, 12, 14 and 16 and encode affinity for IgE receptors, cytokine production and receptors for T-lymphocyte antigens,
  • discusses the etiological role of the ADAM-33 gene mutation located on the short arm of chromosome 20

Lung vital capacity (VC) - the maximum volume of air that can be exhaled slowly after the deepest inhalation.

Forced vital capacity (FVC) - the maximum volume of air that a person is able to exhale following the maximum inhalation. In this case, breathing is performed with the maximum possible force and speed.

Functional residual lung capacity - a portion of air that can be exhaled after a calm exhalation while relaxing all the respiratory muscles.

Forced expiratory volume in 1 s (FEV 1) - the volume of air expelled with maximum effort from the lungs during the first second of exhalation after a deep breath, that is, part of the FVC in the first second. Normally, it is 75% of FVC.

Peak Volumetric Forced Expiratory Velocity (PSV) - the maximum volumetric velocity that the patient can develop during forced expiration. The indicator reflects the patency of the airways at the level of the trachea and large bronchi, depending on the muscle effort of the patient. Normally, the value is 400 (380-550) l / min, with bronchial asthma, the indicator is 200 l / min.

Average volumetric velocity (maximum mid-expiratory flow) - the speed of the forced expiratory flow in its middle (25–75% FVC). The indicator is informative in detecting early obstructive disorders, does not depend on the patient's efforts.

Total lung capacity (TLC) Is the entire volume of air in the chest after maximum inhalation.

Residual lung volume (ROL) - the volume of air remaining in the lungs at the end of the maximum expiration.

I. During normal pregnancy, an increase in respiratory function occurs:

• Minute ventilation already in the first trimester increases by 40-50% from the level before pregnancy (from 7.5 l / min to 10.5 l / min), which is mainly associated with an increase in the volume of each inspiration, since the respiratory rate does not change ...
• The functional residual lung capacity is reduced by 20%.
• An increase in ventilation leads to a decrease in the partial tension of CO2 in arterial blood to 27 - 32 mm Hg and to an increase in the partial tension of O 2 to 95 - 105 mm Hg.
• The increase in the content of carbonic anhydrase in erythrocytes under the influence of progesterone facilitates the transition of CO 2 and reduces PaCO 2, regardless of the level of ventilation.
• The resulting respiratory alkalosis leads to an increase in renal secretion of bicarbonate and its serum level decreases to 4 mU / l.

II. Shortness of breath is one of the most common symptoms during pregnancy:

• About 70% of pregnant women report shortness of breath. Dyspnea is most commonly described as "feeling short of breath."
• This symptom appears at the end of the 1st - beginning of the 2nd trimester of pregnancy. The maximum period for the onset of shortness of breath in uncomplicated pregnancy is 28-31 weeks. Shortness of breath often develops spontaneously during rest and is not associated with physical activity.
• The etiology of the symptom is not entirely clear, although the effect of progesterone on ventilation is considered and a connection with a drop in the partial tension of CO 2 in arterial blood is traced. It was noted that dyspnea most often develops in women with a higher level of partial CO 2 tension outside of pregnancy.
• Despite the fact that the diaphragm rises by 4 cm by the end of pregnancy, this has no significant effect on respiratory function, since the excursion of the diaphragm is not disturbed, and even increases by 1.5 cm.

Thus, uncomplicated pregnancy is characterized by:

1. decrease in blood pCO 2
2. increase in blood pO 2
3. decrease in blood НСО 3 (up to 20 meq / l)
4. respiratory alkalosis (plasma pH 7.45)
5. increased inspiratory volume
6. constancy of VC.

III. Signs indicating pathological shortness of breath during pregnancy:

• An indication of a history of bronchial asthma, even if the last attack was 5 years ago.
• Oxygen saturation during exercise is less than 95%.
• An increase in the amount of hemoglobin.
• Tachycardia and tachypnea.
• The presence of cough, wheezing, obstructive pulmonary function.
• Pathological findings of lung radiography.

Fig 1. Spirogram with forced expiration

Figure 1 shows a spirogram of the forced expiratory volume in normal conditions and with various types of pulmonary dysfunction.

a. - forced vital capacity of the lungs is normal.
b. - forced vital capacity of the lungs in bronchial asthma (obstructive type).
c. - forced vital capacity of the lungs with pulmonary fibrosis, chest deformities (restrictive type).

Normally, the RVF 1 indicator is 75% of the FVC.

With the obstructive type of spirogram, this value decreases.

The total value of FVC in bronchial asthma is also less than normal.

In the restrictive type, FE 1 is equal to 75% of FVC, however, the FVC value is less than normal.

IV. Asthma attacks during pregnancy are not the result of ongoing gestational changes... Pregnancy does not affect the forced expiratory volume at 1 second (FEV 1), forced vital capacity (FVC), PSV, and mean volumetric velocity.

1. • frequency of attacks two or less times a week,
   • attacks occur two or less nights a month,
   • lack of symptoms between attacks;
2. Light persistent
   • frequency of attacks more than twice a week, but less than 1 time a day,
   • seizures more than two nights a month,
   • exacerbations cause disruption of physical activity,
   • PSV more than 80% of the maximum for a given patient, variability over several days 20-30%,
   • FEV 1 more than 80% of the indicator outside the attack;
3. Moderate persistent
   • attacks daily
   • symptoms occur more than one night a week
   • PSV, FEV 1 - 60-80%, variability over 30%,
   • the need for regular drug therapy;
4. Severe persistent
   • attacks are constantly
   • often attacks at night,
   • physical activity is limited; PSV, FEV 1 - less than 60%, variability more than 30%,
   • the need for regular use of corticosteroids.

Bronchial asthma complicates from 5 to 9% of all pregnancies. The disease is most common among women of low social status, among African-Americans. In recent years, the incidence of the disease among women of childbearing age has doubled. It is one of the most common life-threatening conditions during pregnancy. A number of factors affect bronchial asthma during pregnancy, which can both worsen and improve the course of the disease. In general, the course of asthma during pregnancy cannot be predicted: in 1/3 of all cases, bronchial asthma improves its course during pregnancy, in 1/3 it does not change it, in 1/3 of cases, bronchial asthma worsens its course: with a mild course of the disease - in 13%, with moderate - 26%, with severe - in 50% of cases.

Typically, milder asthma tends to improve with pregnancy. A pregnant woman has a risk of exacerbation of bronchial asthma, even if not a single attack of the disease has been noted during the previous 5 years. The most common exacerbations of asthma occur between 24 and 36 weeks of gestation; very rarely, the disease worsens later in life or during childbirth.

The manifestation of the disease in late pregnancy is easier. In 75% of patients, 3 months after delivery, the status that was before pregnancy returns.

Important to remember! In pregnant women with a severe degree of the disease, infections of the respiratory tract and urinary tract are more common (69%) compared with mild bronchial asthma (31%) and with the general population of pregnant women (5%).

• Increasing the level of free cortisol in the blood counteracts inflammatory triggers;
• Increasing the concentration of bronchodilating agents (such as progesterone) may improve airway conductance;
• An increase in the concentration of bronchoconstrictors (such as prostaglandin F 2α) can, on the contrary, contribute to the narrowing of the bronchi;
• A change in the cellular link of immunity disrupts the maternal response to infection.

1. The risk of developing asthma in a newborn varies from 6 to 30%, depending on the presence of bronchial asthma in the father or the presence or absence of atopy in the mother or father.
2. The risk of developing bronchial asthma in a child born by a large cesarean section is higher than in a vaginal delivery (RR 1.3 versus 1.0, respectively). This is due to the greater likelihood of developing atopy with abdominal delivery:
   • The formation of the immune system occurs with the participation of the intestinal microflora. With a caesarean section, there is a delayed colonization of the intestine by microorganisms.
   • A newborn is deprived of immunostimulating impulses during a critical period of life, he has a delay in the formation of the immune intestinal barrier.
   • A Th 2 immune response (pro-inflammatory) is formed with a change in the production of interleukin 10 (IL-10) and transforming growth factor β (TGF-β). This type of immune response predisposes to the development of atopic diseases, including bronchial asthma.

   It is important to remember: bronchial asthma is not a contraindication to pregnancy.

1. Despite the fact that as a result of an asthma attack, the partial tension of oxygen in the mother's blood decreases, leading to a significant drop in the oxygen concentration in the fetal blood, which can cause fetal suffering, most women with bronchial asthma carry their pregnancies to term and give birth to children of normal body weight.
2. There are no convincing data on the relationship between bronchial asthma and pathological pregnancy outcomes:
   • When using full anti-asthma therapy, there was no increase in the number of cases of miscarriage.
   • The overall incidence of preterm birth in women with bronchial asthma is on average 6.3%, the frequency of births of children weighing less than 2500 g is 4.9%, which does not exceed similar indicators in the general population.
   • The relationship between bronchial asthma and gestational diabetes, preeclampsia, chorionamnionitis, oligohydramnios, low birth weight and children with congenital malformations has not been established. However, women with asthma have an increased incidence of chronic arterial hypertension.
3. It has been proven that the use of anti-asthma drugs - β-agonists, inhaled corticosteroids, theophylline, cromolynedocromil does not worsen perinatal outcomes. Moreover, against the background of the use of inhaled corticosteroids, the frequency of low birth weight babies in pregnant women with bronchial asthma becomes comparable to that in the general population (7.1% versus 10%, respectively).
4. Only with poor control of the disease, when FEV 1 decreases by 20% or more from the initial value, as well as in the presence of factors predisposing to the development of vaso- and bronchoconstriction and contributing to a more severe course of the disease (dysfunction of the autonomic nervous system, smooth muscle anomaly), an increase in the likelihood of premature birth, the birth of hypotrophic fetuses and the development of gestational hypertension. The condition of the fetus is an indicator of the condition of the mother.
5. The disease progresses with increasing duration to moderate and severe degrees in 30% of women with a mild course of bronchial asthma at the beginning of pregnancy. Therefore, bronchial asthma of any severity is an indication for careful monitoring of respiratory function in order to timely identify and correct the progression of the disease.

   It is necessary to remember: The key to a successful pregnancy outcome is good control of bronchial asthma.

Asthma management during pregnancy

1. The use of objective indicators to assess the severity of the disease.

   Indicators for assessing the severity of the disease.

   1. The subjective assessment of respiratory function by both the patient and the doctor is not a reliable indicator of the severity of the disease.
   2. Determination of CBS blood is not a routine activity, since it does not affect the management of most patients.
   3. FEV 1 measurement is the best method for assessing respiratory function, but requires spirometry. An indicator of less than 1 liter or less than 20% of the norm indicates a severe course of the disease.
   4. PSV approaches the accuracy of FEV 1, but its measurement is more accessible with the advent of inexpensive portable peak-flowmeters and can be performed by the patient himself. During normal pregnancy, the PSV value does not change.
2. Patient education.

   Before the onset of pregnancy, a patient with bronchial asthma should be informed about the following:

   1. It is necessary to avoid triggers for the development of an asthma attack (allergens, upper respiratory tract infections, taking aspirin, β-blockers, cold air, emotional stress, exercise).
   2. The patient should be trained to measure PEF twice daily for early detection of respiratory impairment. It is recommended to take measurements immediately after waking up and after 12 hours.
   3. The patient must have a suitable inhaler. It is recommended to use a spacer (nebulizer) to improve dispersion of the drug in the lungs and reduce the local effect of steroids on the oral mucosa, reduce absorption through it and minimize the systemic effect.
   4. All pregnant women should have a written management plan, which should indicate the medications required by the patient in accordance with the PSV and contain recommendations when this indicator decreases:
      • The maximum value of the PSV for the patient is taken as a basis. The patient should be informed about "stepwise therapy" for a transient decrease in PSV by 20% from this level.
      • It is necessary to indicate to the pregnant woman that in case of a prolonged decrease in PSV by more than 20%, it is necessary to contact a doctor.
      • A drop in PSV by more than 50% of the patient's maximum level is an indication for hospitalization in the intensive care unit.
   5. Patients need to be explained that pregnancy outcomes worsen only with poor control of bronchial asthma:
      • The patient should not stop taking medication if pregnancy is established.
      • The drugs and doses should be the same both outside of pregnancy and during it.
      • During pregnancy, preference should be given to inhalation forms of drug administration in order to reduce the systemic effect and effect on the fetus.
3. Control of environmental factors.
   • Reducing exposure to allergens and irritants can reduce the amount of medication taken to control asthma and prevent flare-ups.
   • Approximately 75-85% of patients with asthma have positive skin tests for allergens: animal dander, dust mites, cockroach waste, pollen and mold.
   • Reduce exposure to indoor allergens - house dust and animal dander: remove carpet from the bedroom, use a mite-proof mattress cover, use a pillowcase, wash bedding and curtains with hot water, remove dust accumulations.
   • If you are allergic to pet dust, they should be removed from the house. If this is not possible, animals should not be allowed into the bedroom and the carpet should be removed from the bedroom and a highly efficient air filter system should be installed.
   • Stimuli such as active and passive smoking can also worsen asthma. They should be ruled out to avoid disease progression.
   • Other non-immune factors that trigger an asthma attack should also be considered: strong odors, air pollution, exercise, dietary supplements (sulfites), medications (aspirin, β-blockers).
4. Medical treatment.
   • All medications used for AD are classified as Category B or C by the FDA (Food and Drug Administration). Unfortunately, these categories cannot fully guarantee the safety of drug use. It is necessary in each case to carefully assess the "benefit-risk" ratio and inform the patient about it.
   • Studies of medicines for the treatment of asthma, conducted in humans, have not identified drugs that significantly increase the risk of fetal malformations.

   B. Drugs for the treatment of bronchial asthma are divided into symptomatic drugs (β-agonists and ipratropium, which are used in intensive care units) and drugs for maintenance therapy (inhaled and systemic corticosteroids, leukotriene antagonists, cromolyn).

   1. Symptomatic drugs are used in emergencies. They relieve acute bronchospasm, but do not affect the underlying inflammatory process.
      1. β 2 short-acting agonists [albuterol (Ventolin), isoproterenol, isoetarin, biltolterol, pirbuterol, metaproterenol, terbutaline]. These drugs are considered safe when administered by inhalation. Albuterol is the most studied in pregnancy. It is preferable for the relief of acute symptoms of the disease. The drug has been used in many millions of patients around the world and in several thousand pregnant women. At the same time, no data have been obtained on any teratogenic effect. With inhalation use, the systemic exposure to albuterol is minimal. The second most studied drug in this group during pregnancy is metaproterenol.
      2. β 2 long-acting agonists (salmeterol). The data obtained on pregnant women are insufficient to draw a conclusion about teratogenicity in humans. Although this drug is considered safe by inhalation, it should only be used if beclomethasone and / or cromolyn are ineffective. It is possible to combine the use of salmeterol with inhaled corticosteroids or cromolyn for persistent asthma, but there is insufficient data on the benefits of such a treatment regimen.

         Remember: recent studies have shown an increase in asthma mortality due to the use of long-acting β 2 agonists. It follows that these drugs should not be used as monotherapy for asthma, but should be combined with adequate doses of inhaled corticosteroids.

      3. Inhaled anticholinergic drugs [ipratropium (Atrovent)]. Recent studies have shown that ipratropium may enhance the bronchodilatory effects of β-agonists in the management of acute asthma attacks. This allows you to actively use the drug in a short course in the intensive care unit. The absence of a teratogenic effect in ipratropium is confirmed by data on animals, but data on pregnant women are insufficient. When administered by inhalation, the drug is poorly absorbed by the mucous membrane of the bronchial tree and, therefore, has a minimal effect on the fetus.
   2. Supportive therapy drugs. Supportive therapy drugs control airway hyperresponsiveness, that is, relieve the inflammatory process underlying this hyperresponsiveness.
      1. Inhaled corticosteroids (CIs) reduce the risk of seizures, hospitalization rates (by 80%), and improve lung function.
         • The most important drugs in the maintenance therapy of asthma both outside and during pregnancy: only 4% of pregnant women who received cardiopulmonary bypass from the early stages of pregnancy developed an acute attack of the disease, of those who did not receive cardiopulmonary bypass, such an attack occurred in 17%.
         • Inhaled corticosteroids differ in the duration of their effect: short-acting - beclomethasone, intermediate - triamcinolone, long-acting - fluticasone, budesonide, flunisolid.
         • When inhaled, only a small part of the drugs is adsorbed, and they do not have a teratogenic effect.
         • More than 1 drug of this group is used in 20% of cases.

         Beclomethasone is the most commonly used bypass therapy for bronchial asthma during pregnancy. The use of beclomethasone and budesonide is considered preferable due to the fact that their action is most fully studied during pregnancy. Triamcinolone is also not considered teratogenic, although the number of observations on its use in pregnancy is less. Fluticasone has not been investigated during pregnancy, however, the minimal absorption by inhalation and the safety of other ICs makes its use justified.

      2. Mast cell stabilizers (MCS) - cromolyn, nedocromil - are best used for mild asthma, when a decision is made not to use IR. It is not used to treat asthma attacks. Data obtained on pregnant women and animals indicate the absence of teratogenicity in these drugs. They are not absorbed through the mucous membrane and the part that has entered the stomach is excreted in the feces. It is believed that cromolyn is preferred during pregnancy.
      3. Leukotriene (AL) antagonists are now playing a more significant role in disease control, especially in adults. It is not used to treat asthma attacks. Zafirlukast, montelukast and zileuton. The use of AL during pregnancy, due to insufficient data on their safety for humans, is limited to those cases when there is information about good control of the disease with these drugs before pregnancy, and control cannot be achieved with other groups of drugs.
      4. Continuously Released Methylxanthines. Theophylline is an intravenous form of aminophylline; it is not a teratogen for humans. The safety of this drug has been demonstrated in pregnant women in the II and III trimesters. The metabolism of the drug undergoes changes during pregnancy, therefore, to select the optimal dose, its concentration in the blood (8-12 μg / ml) should be assessed. Theophylline refers to drugs of the 2-3 line in the treatment of bronchial asthma, its use is not effective in an acute attack of the disease.
      5. Systemic corticosteroids (SC) (oral prednisolone; intravenous methylprednisolone, hydrocortisone) are necessary in the treatment of severe asthma.
         • Most studies indicate that systemic corticosteroids do not pose a teratogenic risk to humans. Prednisolone and hydrocortisone do not cross the placenta. destroyed by its enzymes. Even at high blood concentrations, the effect of prednisolone or hydrocortisone on the hypothalamic-pituitary-adrenal axis of the fetus is minimal.
         • An increase in the frequency of occurrence of cleft upper lip and palate with the use of systemic corticosteroids, starting from the 1st trimester, 2-3 times has been shown. With inhaled forms of administration, such an increase was not noted.
         • When taking SC in the 1st trimester, when it is justified for health reasons, the patient should be informed about the risk of developing a cleft in the upper lip and palate in the fetus.
         • When administered in the II and III trimesters, SCs are not the cause of fetal malformations.
         • Betamethasone and dexamethasone cross the blood-placental barrier. There is evidence that giving more than two courses of corticosteroids for antenatal prophylaxis of respiratory distress syndrome may be associated with an increased risk of brain damage to the premature fetus. The patient should be informed about this if there is a need for the administration of large doses of corticosteroids in late pregnancy.
      6. Specific immunotherapy with allergens is the gradual introduction of increasing doses of an allergen in order to weaken the body's response to the next contact with it. This method of therapy can provoke an anaphylactic reaction and is not used during pregnancy.
   1. Light with intermittent flow
      • Use of β 2 -adrenomimetics if necessary
      • No need for daily medication
   2. Light persistent
      • Daily intake. Preferred: low-dose inhaled corticosteroids (beclomethasone or budesonide)
      • Alternative: cromolyn / nedocromil, or leukotriene receptor antagonists, or long-acting theophylline (maintaining serum concentration of 5-15 mcg / ml)
   3. Moderate persistent
      • Use of β 2 -adrenomimetics as needed
      • Daily intake. Preferred: low to medium doses
      • inhaled corticosteroids in combination with long-acting β 2 agonists
      • Alternative: Medium doses of inhaled corticosteroids; or low to moderate doses of inhaled corticosteroids plus leukotriene receptor antagonists (or theophylline for nocturnal attacks).
   4. Severe persistent
      • Use of β 2 -adrenomimetics as needed
      • Daily intake: high doses of inhaled corticosteroids and long-acting β 2 -agonists (salmeterol), or high doses of IR with aminophylline preparations, as well as daily or less frequent use of systemic steroids (prednisolone).

   The indications for hospitalization of the patient are:

   • A steady drop in PSV of less than 50-60% of the maximum value for the patient;
   • Reduction of pO 2 less than 70 mm Hg;
   • Increase in pCO 2 over 35 mm Hg;
   • Heart rate over 120 per minute;
   • The respiratory rate is more than 22 per minute.

   Important to remember:

   • an increase in pCO 2 in a pregnant woman with an asthma attack of more than 40 mm Hg indicates an increasing respiratory failure, since normal pCO 2 values \u200b\u200bduring pregnancy range from 27 to 32 mm Hg.
   • adverse prognostic signs in bronchial asthma are circadian variations in pulmonary function, severe reaction to bronchodilators, use of three or more drugs, frequent hospitalizations in the intensive care unit, and a history of life-threatening condition.
   • in the absence of the effect of the "step-by-step therapy", status asthmaticus develops - a state of severe asphyxia (hypoxia and hypercapnia with decompensated acidosis), which does not stop by conventional means for many hours or several days, sometimes leading to the development of hypoxic coma and death (0.2% of all pregnant women with bronchial asthma).

     A prolonged asthma attack is an indication for hospitalization of the patient in the intensive care unit.

   Management of an asthma attack in the intensive care unit:

   1. Treatment for an asthma attack during pregnancy is the same as outside pregnancy.
   2. Oxygen supply until saturation (SO 2) is at least 95%, PaO 2 is more than 60 mm Hg.
   3. Avoid increasing pCO 2 more than 40 mm Hg.
   4. Avoid hypotension: the pregnant woman should be in a position on the left side, adequate hydration is required (drinking, intravenous administration of an isotonic solution at a rate of 125 ml / hour).
   5. Administration of β 2 -agonists in inhalation forms until the effect is achieved or toxicity appears: albuterol (metered dose inhaler with a nebulizer) 3-4 doses or albuterol nebulizer every 10-20 minutes.
   6. Methylprednisolone 125 mg IV rapidly, followed by 40-60 mg IV every 6 hours, or hydrocortisone 60-80 mg IV every 6 hours. After improvement of the condition - transfer to tabletted prednisone (usually 60 mg / day) with a gradual decrease and complete cancellation within 2 weeks.
   7. Consider administering ipratropium (atrovent) by metered-dose inhaler (2 doses of 18 g / spray every 6 hours) or nebulizer (62.5 ml vial / nebulizer every 6 hours) in the first 24 hours after an attack.
   8. Do not use epinephrine subcutaneously in pregnant women.
   9. Timely resolve the issue of tracheal intubation: weakness, impaired consciousness, cyanosis, pCO 2 growth and hypoxemia.
   10. Control of lung function by measuring FEV 1 or PSV, continuous pulse oximetry and fetal CTG.

   Don't panic! Acute asthma attack is not an indication for labor inductionalthough the question of induction of labor should be considered in the presence of other pathological conditions in the mother and fetus.

   1. Ensuring optimal disease control during pregnancy;
   2. More aggressive management of asthma attacks than non-pregnant women;
   3. Avoid delays in making a diagnosis and initiating treatment;
   4. Timely assess the need for drug therapy and its effectiveness;
   5. Providing the pregnant woman with information about her illness and teaching her the principles of self-help;
   6. Adequate treatment of rhinitis, gastric reflux and other conditions that trigger an asthma attack;
   7. Encouraging smoking cessation;
   8. Spirometry and determination of PSV at least once a month;
   9. Refusing influenza vaccination before 12 weeks of pregnancy.
   • Exacerbations of asthma during childbirth are rare. This is due to the physiological stress of birth, in which endogenous steroids and epinephrine are released, which prevent the development of an attack. Asphyxiation occurring at this time must be differentiated from pulmonary edema with heart defects, preeclampsia, massive tocolysis and septic condition, as well as from pulmonary embolism and aspiration syndrome.
   • It is important to maintain adequate oxygenation and hydration, control oxygen saturation, respiratory function, and use the drugs used to treat asthma during pregnancy.
   • Prostaglandins E 1, E 2 and oxytocin are safe in patients with bronchial asthma.
   • Prostaglandin 15-methyl F 2α ergonovine and other ergot alkaloids may cause bronchospasm and should not be used in these pregnant women. The bronchospastic action of the ergot alkaloids group is potentiated by drugs for general anesthesia.
   • Theoretically, morphine and meperidine can cause bronchospasm, since histamine is released from mast cell granules, but this practically does not happen. A large number of women receive morphine-like drugs during labor without any complications. However, a number of experts believe that butorphanol or fentanyl is preferable for women in labor with bronchial asthma, since they are less likely to promote the release of histamine.
   • If anesthesia is needed, epidural anesthesia is preferred, as general anesthesia carries the risk of chest infection and atelectasis. Epidural anesthesia reduces the intensity of bronchospasm, reduces oxygen consumption and minute ventilation. Despite the fact that general anesthesia in the form of intubation anesthesia is highly undesirable, drugs with a bronchodilatory effect - ketamine and halogens - are preferred.
   • Daily doses of systemic steroids given to the patient for several weeks suppress the hypothalamic-pituitary-adrenal interaction for the next year. This weakens the physiological release of adrenal corticosteroids in stressful situations (surgery, labor).
   • In order to prevent adrenal crisis in childbirth, empirical administration of glucocorticoids is proposed for women who have received SC therapy for at least 2-4 weeks during the last year. A number of authors believe that such therapy should be carried out if these drugs were not canceled one month before delivery.
   • If during childbirth the prophylactic administration of glucocorticoids was not carried out, in the postpartum period it is necessary to monitor the appearance of symptoms of adrenal insufficiency - anorexia, nausea, vomiting, weakness, hypotension, hyponatremia and hyperkalemia.
   • The recommended scheme for the use of glucocorticoids in labor: hydrocortisone 100 mg IV every 8 hours on the day of labor and 50 mg IV every 8 hours after birth. Next is the transition to oral maintenance drugs with gradual withdrawal.

   Remember! The risk of exacerbation of asthma after a cesarean section is 18 times higher than a vaginal birth.

   • It is not associated with an increased frequency of exacerbations of bronchial asthma.
   • Patients should use those medications that are necessary in accordance with the PSV, when measured on the first day after delivery.
   • Breathing exercises are recommended.
   • Breastfeeding is not contraindicated when taking any anti-asthma medications.
   • Breastfeeding for 1-6 months after childbirth reduces the risk of atopy in adolescents at the age of 17 by 30-50%.

   Table 1... The relative risk of premature birth and low birth weight in women with bronchial asthma. (American Academy of Allergy, Asthma and Immunology 2006)

   Sign	Relative risk
   Childbirth before 28 weeks	2,77
   Childbirth before 32 weeks	3,04
   Childbirth before 37 weeks	1,13
   Childbirth after 42 weeks	0,63
   Newborn weighing less than 1000 g	3,8
   Newborn weighing less than 1500 g	3,23
   Newborn weighing less than 2000 g	1,86
   Newborn weighing less than 2500 g	1,29

   Category	Description of the risk
   A	A sufficient number of studies in pregnant women that did not demonstrate a risk to the fetus either in the first or in subsequent trimesters of pregnancy
   IN	Animal studies have shown no risk to the fetus, and there are not enough studies in pregnant women Or Animal studies have shown adverse effects on the fetus, but a sufficient number of studies of pregnant women have not demonstrated a risk to the fetus either in the first or in subsequent trimesters of pregnancy.
   FROM	Animal studies have demonstrated a risk to the fetus; there are not enough studies on pregnant women; the potential benefit from the use of the drug outweighs the potential risk to the fetus. Or There is not enough research on either animals or pregnant women.
   D	There is evidence of harm to the human fetus, but the potential benefit of using the drug outweighs the potential risk.
   X	Animal and human studies have identified fetal abnormalities. The risks to the fetus clearly outweigh the potential benefits to the pregnant woman.

   A drug	Risk category
   Bronchodilators
   Albuterol (Ventolin, Aktsuneb)	FROM
   Pirbuterol acetate (Maxair)	FROM
   Levalbuterol HCl (Xopenex)	FROM
   Salmeterol (Serevent)	FROM
   Formoterol fumarate (foradil Aerolizer)	FROM
   Atrovent (Ipratropium bromide)	IN
   Respiratory Inhalants
   Intal (Cromolin)	IN
   Tilad (Nedokromil)	IN
   Leukotriene agents
   Zafirlukast (Aktsolat)	IN
   Montelukast (Singular)	IN
   Inhaled corticosteroids
   Budesonide (Pulmicort)	IN
   Beclomethasone dipropionate (QVAR)	FROM
   Fluticasone propionate (Flovent)	FROM
   Triamcinolone acetate (Azmakort)	FROM
   Flunisolid (AeroBid, Nazarel)	FROM
   Fluticasone propionate / salmeterol (Advair DisS cous)	FROM
   Oral corticosteroids	FROM
   Theophylline	C
   Omalizumab (Xolar)	IN

   Table 4. Typical doses of drugs used to treat bronchial asthma.

   Cromoline sodium	2 inhalations 4 times a day
   Beclomethasone	2 - 5 inhalations 2-4 times a day
   Triamcinolone	2 inhalations 3-4 times or 4 inhalations 2 times a day
   Budesonide	2-4 inhalations 2 times a day
   Fluticasone	88-220 mcg 2 times a day
   Flunisolide	2-4 inhalations 2 times a day
   Theophylline	the concentration in the blood is maintained at the level of 8-12 μg / ml. The dose is reduced by half while the administration of erythromycin or cimetidine
   Prednisone	40 mg / day for a week with an exacerbation, then during a week - a maintenance dose
   Albuterol	2 inhalations every 3-4 hours
   Montelukast	10 mg orally in the evening daily
   Zafirlukast	20 mg twice daily

   
   

   Literature

   Guryev D.L., Okhapkin M.B., Khitrov M.V. Management and delivery of pregnant women with lung diseases, guidelines, YSMA, 2007

Bronchial asthma (BA) is a chronic recurrent disease with a predominant lesion of the bronchi.

The main symptom is asthma attacks and / or asthmatic status due to spasm of smooth muscles of the bronchi, hypersecretion, discrinia and edema of the mucous membrane of the respiratory tract.

ICD-10 CODE
J45 Asthma.
J45.0 Asthma with a predominance of an allergic component.
J45.1 Non-allergic asthma.
J45.8 Mixed asthma.
J45.9 Asthma, unspecified
O99.5 Diseases of the respiratory system complicating pregnancy, childbirth and the postpartum period.

EPIDEMIOLOGY

The incidence of asthma has increased significantly over the past three decades. According to WHO experts, bronchial asthma is one of the most common chronic diseases: this disease is diagnosed in 8-10% of the adult population. More than 8 million people in Russia suffer from bronchial asthma. Women suffer from bronchial asthma twice as often as men. As a rule, bronchial asthma manifests itself in childhood, which leads to an increase in the number of patients of childbearing age.

PREVENTION OF BRONCHIAL ASTHMA DURING PREGNANCY

The basis of prevention is limiting the exposure to allergens that provoke the disease (triggers). Triggers are identified using allergy tests.

Measures to reduce exposure to household allergens:
· Use of impermeable coverings for mattresses, blankets and pillows;
· Replacement of floor carpets with linoleum or wooden floors;
· Replacement of fabric upholstery of furniture with leather;
· Replacement of curtains with blinds;
· Maintaining low humidity in the room;
· Prevention of the entry of animals into living quarters;
· to give up smoking.

Currently, there are no measures for the prevention of bronchial asthma that could be recommended in the prenatal period. However, the appointment of a hypoallergenic diet during lactation to women at risk significantly reduces the likelihood of developing an atopic disease in a child. Exposure to tobacco smoke, both prenatal and postnatal, provokes the development of diseases accompanied by bronchial obstruction.

Screening

Careful history taking, auscultation and study of the peak expiratory flow rate using a peak flow meter allow identifying patients in need of additional examination (assessment of allergic status and study of the RF).

CLASSIFICATION OF BRONCHIAL ASTHMA

Bronchial asthma is classified based on the etiology and severity of the disease, as well as the temporal characteristics of bronchial obstruction. In practical terms, the most convenient classification of the disease by severity. This classification is used in the management of patients during pregnancy. On the basis of the noted clinical signs and FVD indices, four degrees of severity of the patient's condition before the start of treatment were identified.

Bronchial asthma of intermittent (episodic) course: symptoms occur no more than once a week, nighttime symptoms no more than twice a month, exacerbations are short (from several hours to several days), indicators of lung function without exacerbation are within normal limits.

· Mild persistent bronchial asthma: asthma symptoms occur more often than once a week, but less than once a day, exacerbations can disrupt physical activity and sleep, daily fluctuations in forced expiratory volume in 1 s or peak expiratory flow rate are 20-30%.

Moderate bronchial asthma: symptoms of the disease appear daily, exacerbations interfere with physical activity and sleep, nighttime symptoms occur more often than once a week, forced expiratory volume or peak expiratory flow rate is 60 to 80% of the required values, daily fluctuations in forced expiratory volume or peak expiratory flow rate ³30%.

Severe bronchial asthma: symptoms of the disease appear daily, exacerbations and nocturnal symptoms are frequent, physical activity is limited, forced expiratory volume or peak expiratory flow rate £ 60% of the proper value, daily fluctuations in peak expiratory flow rate ³30%.

If the patient is already undergoing treatment, it is necessary to determine the severity of the disease based on the identified clinical signs and the amount of medications taken daily. If the symptoms of mild persistent bronchial asthma persist, despite appropriate therapy, the disease is defined as persistent bronchial asthma of moderate severity. If, against the background of treatment, the patient develops symptoms of persistent bronchial asthma of moderate severity, the diagnosis is made "Bronchial asthma, severe persistent course."

ETIOLOGY (CAUSES) OF BRONCHIAL ASTHMA IN PREGNANT WOMEN

There is strong evidence that bronchial asthma is a hereditary disease. Children with BA suffer from this disease more often than children of healthy parents. The following risk factors for the development of asthma are distinguished:

Atopy;
· Hyperresponsiveness of the airways, which has a hereditary component and is closely related to the level of IgE in the blood plasma, inflammation of the airways;
· Allergens (house mites, animal hair, mold and yeast fungi, plant pollen);
· Professional sensitizing factors (more than 300 substances are known that are related to occupational bronchial asthma);
· Tobacco smoking;
· Air pollution (sulfur dioxide, ozone, nitrogen oxides);
· ARI.

PATHOGENESIS OF GESTION COMPLICATIONS

The development of complications of pregnancy and perinatal pathology is associated with the severity of the course of bronchial asthma in the mother, the presence of exacerbations of this disease during pregnancy and the quality of therapy. In women who had exacerbations of bronchial asthma during pregnancy, the likelihood of perinatal pathology is three times higher than in patients with a stable course of the disease. The immediate causes of the complicated course of pregnancy in patients with bronchial asthma include:

· Changes in FVD (hypoxia);
· Immune disorders;
· Violations of hemostatic homeostasis;
· Metabolic disorders.

FVD changes are the main cause of hypoxia. They are directly related to the severity of bronchial asthma and the quality of treatment carried out during pregnancy. Immune disorders contribute to the development of autoimmune processes (APS) and a decrease in antiviral antimicrobial protection. The listed features are the main reasons for the frequent intrauterine infection in pregnant women with bronchial asthma.

During pregnancy, autoimmune processes, in particular APS, can cause damage to the vascular bed of the placenta by immune complexes. The result is placental insufficiency and fetal growth retardation. Hypoxia and damage to the vascular wall cause a disorder of hemostatic homeostasis (the development of chronic disseminated intravascular coagulation) and impaired microcirculation in the placenta. Another important reason for the formation of placental insufficiency in women with bronchial asthma is metabolic disorders. Studies have shown that in patients with bronchial asthma, lipid peroxidation is enhanced, the antioxidant activity of the blood is reduced, and the activity of intracellular enzymes is reduced.

CLINICAL PICTURE (SYMPTOMS) OF BRONCHIAL ASTHMA IN PREGNANT WOMEN

The main clinical signs of bronchial asthma:
Asthma attacks (with difficulty in exhaling);
· Unproductive paroxysmal cough;
• noisy wheezing;
Shortness of breath.

Complications of Gestation

In bronchial asthma, in most cases, pregnancy is not contraindicated. However, with an uncontrolled course of the disease, frequent attacks of suffocation, causing hypoxia, can lead to the development of complications in the mother and the fetus. Thus, in pregnant women with BA, the development of preterm birth is noted in 14.2%, the threat of termination of pregnancy - in 26%, IGR - in 27%, fetal malnutrition - in 28%, fetal hypoxia and asphyxia at birth - in 33%, gestosis - in 48%. Surgical delivery for this disease is performed in 28% of cases.

DIAGNOSTICS OF BRONCHIAL ASTHMA DURING PREGNANCY

ANAMNESIS

When collecting anamnesis, the presence of allergic diseases in the patient and her relatives is established. In the course of the study, the features of the appearance of the first symptoms (the season of their appearance, the relationship with physical activity, exposure to allergens), as well as the seasonality of the disease, the presence of occupational hazards and living conditions (the presence of pets) are determined. The frequency and severity of symptoms and the effect of anti-asthma treatment should be clarified.

PHYSICAL STUDY

The results of the physical examination depend on the stage of the disease. During the period of remission, the study may not show any abnormalities. During the period of exacerbation, the following clinical manifestations occur: rapid breathing, increased heart rate, participation in the act of breathing of auxiliary muscles. On auscultation, hard breathing and dry wheezing are noted. Boxed sound may be heard when percussed.

LABORATORY RESEARCH

For the timely diagnosis of complications of gestation, the determination of the level of AFP, b-hCG at the 17th and 20th weeks of pregnancy is shown. The study in the blood of hormones of the fetoplacental complex (estriol, PL, progesterone, cortisol) is carried out at the 24th and 32nd weeks of pregnancy.

INSTRUMENTAL STUDIES

· Clinical blood test to detect eosinophilia.
· Revealing an increase in IgE content in blood plasma.
· Examination of sputum for the detection of Kurshmann spirals, Charcot-Leiden crystals and eosinophilic cells.
· Study of FVD to detect a decrease in the maximum expiratory flow rate, forced expiratory volume and a decrease in peak expiratory flow rate.
· ECG to establish sinus tachycardia and overload of the right heart.

DIFFERENTIAL DIAGNOSTICS

Differential diagnosis is carried out taking into account the data of the anamnesis of the results of the allergic and clinical examination. Differential diagnosis of FVD assessment (presence of reversible bronchial obstruction) with COPD, HF, cystic fibrosis, allergic and fibrosing alveolitis, occupational diseases of the respiratory system.

INDICATIONS FOR CONSULTATION OF OTHER SPECIALISTS

· Severe course of the disease with pronounced signs of intoxication.
· Development of complications in the form of bronchitis, sinusitis, pneumonia, otitis media, etc.

EXAMPLE FORMULATING A DIAGNOSIS

Pregnancy 33 weeks. Persistent bronchial asthma of moderate severity, unstable remission. The threat of premature birth.

TREATMENT OF BRONCHIAL ASTHMA DURING PREGNANCY

PREVENTION AND PREDICTION OF GESTION COMPLICATIONS

Prevention of complications of gestation in pregnant women with bronchial asthma consists in full treatment of the disease. If necessary, carry out basic therapy using inhaled glucocorticosteroids according to
the recommendations of the group of the Global Initiative on Asthma (GINA). Treatment of chronic foci is mandatory
infections: colpitis, periodontal diseases, etc.

FEATURES OF TREATMENT OF COMPLICATIONS OF GESTATION

Treatment of complications of gestation by trimester

In the first trimester, the treatment of bronchial asthma when there is a threat of termination of pregnancy has no specific features. The therapy is carried out according to generally accepted rules. In the second and third trimester, treatment of obstetric and perinatal complications should include correction of the underlying pulmonary disease, optimization of redox processes. To reduce the intensity of lipid peroxidation, stabilize the structural and functional properties of cell membranes, normalize and improve fetal trophism, the following drugs are used:

· Phospholipids + multivitamins, 5 ml intravenously for 5 days, then 2 tablets 3 times a day for three weeks;
· Vitamin E;
· Actovegin © (400 mg intravenously for 5 days, then 1 tablet 2-3 times a day for two weeks).

To prevent the development of infectious complications, immunocorrection is performed:
Immunotherapy with interferon-a2 (500 thousand rectally twice a day for 10 days, then twice a day
every other day for 10 days);
Anticoagulant therapy:
- sodium heparin (for normalization of hemostasis parameters and binding of circulating immune complexes);
- antiplatelet agents (to increase the synthesis of prostacyclin by the vascular wall, which makes it possible to reduce intravascular platelet aggregation): dipyridamole 50 mg 3 times a day, aminophylline 250 mg 2 times a day for two weeks.

When an increased level of IgE in the blood plasma, markers of autoimmune processes (lupus
anticoagulant, antibodies to hCG) with signs of intrauterine fetal suffering and the lack of a sufficient effect from
conservative therapy is indicated for therapeutic plasmapheresis. Carry out 4-5 procedures 1-2 times a week with
elimination of up to 30% of the circulating plasma volume. Indications for inpatient treatment - the presence of gestosis,
threats of termination of pregnancy, signs of PN, RRP 2-3 degrees, fetal hypoxia, severe exacerbation of asthma.

Treatment of complications in childbirth and the postpartum period

During childbirth, therapy continues, aimed at improving the functions of the fetoplacental complex. Therapy includes the introduction of drugs that improve placental blood flow - xanthinol nicotinate (10 ml with 400 ml of isotonic sodium chloride solution), as well as taking piracetam for the prevention and treatment of intrauterine fetal hypoxia (2 g in 200 ml of 5% glucose solution intravenously). To prevent asthma attacks that provoke the development of fetal hypoxia, bronchial asthma therapy using inhaled glucocorticoids is continued during childbirth. Patients taking systemic glucocorticosteroids, as well as with an unstable course of bronchial asthma, need parenteral administration of prednisolone at a dose of 30-60 mg (or dexamethasone in an adequate dose) at the beginning of the first stage of labor, and if the duration of labor is more than 6 hours, the glucocorticosteroid injection is repeated at the end of the second period childbirth.

ASSESSMENT OF TREATMENT EFFICIENCY

The effectiveness of the therapy is assessed by the results of determining the hormones of the fetoplacental complex in the blood, ultrasound of fetal hemodynamics and CTG data.

CHOICE OF TIME AND METHOD OF DELIVERY

Delivery of pregnant women with a mild course of the disease with adequate anesthesia and corrective drug therapy is not difficult and does not worsen the patient's condition. In most patients, labor ends spontaneously. Among the complications of childbirth, the most often observed:

· Rapid course of labor;
· Prenatal outpouring of OS;
· Abnormalities of labor.

In connection with the possible bronchospastic effect of methylergometrine in the prevention of bleeding in the second stage of labor, intravenous administration of oxytocin should be preferred. In pregnant women with severe asthma, uncontrolled course of moderate asthmaticus, status asthmaticus during this pregnancy, or exacerbation of the disease at the end of the third trimester, delivery is associated with the risk of severe exacerbation of the disease, acute respiratory failure, and intrauterine fetal hypoxia. Given the high risk of infection and the occurrence of complications associated with surgical trauma, planned delivery through the vaginal birth canal is considered the method of choice for severe illness with signs of respiratory failure. When delivering through the vaginal birth canal, puncture and catheterization of the epidural space in the thoracic region at the ThVIII – ThIX level with the introduction of 0.125% bupivacaine solution, which gives a pronounced bronchodilator effect, is performed before labor induction. Then, labor is induced by the amniotomy method. The behavior of the woman in labor during this period is active. After the beginning of regular labor, labor is anesthetized by epidural anesthesia at the LI – LII level. The introduction of an anesthetic with a prolonged effect in a low concentration does not limit the mobility of the woman in labor, does not weaken the attempts in the second stage of labor, has a pronounced bronchodilator effect (an increase in the forced vital capacity of the lungs, the volume of forced expiration, the peak expiratory flow rate) and allows you to create a kind of hemodynamic protection. As a result, spontaneous delivery is possible, without the exception of attempts, in patients with obstructive breathing disorders. To shorten the second stage of labor, an episiotomy is performed.

In the absence of sufficient experience or technical capabilities for performing epidural anesthesia at the thoracic level, delivery by the CS should be performed. The method of choosing anesthesia during a cesarean section is epidural anesthesia. Indications for operative delivery in pregnant women with bronchial asthma are signs of cardiopulmonary insufficiency in patients after the relief of severe prolonged exacerbation or status asthmaticus and a history of spontaneous pneumothorax. Caesarean section can be performed according to obstetric indications (for example, the presence of an inconsistent scar on the uterus after a previous CS, a narrow pelvis, etc.).

PATIENT INFORMATION

Therapy of bronchial asthma during pregnancy is required. There are drugs for the treatment of bronchial asthma that are approved for use during pregnancy. With a stable condition of the patient and the absence of exacerbations of the disease, pregnancy and childbirth proceed without complications. It is necessary to take classes at the Asthma School or independently familiarize yourself with the materials of the educational program for patients.

Bronchial asthma is one of the most common lung diseases in pregnant women. In connection with the increase in the number of people prone to allergies, in recent years, cases of bronchial asthma have become more frequent (from 3 to 8% in different countries; moreover, the number of such patients increases by 1-2% every decade).
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 vast majority of cases, bronchial asthma is an allergic disease, when in response to exposure to an allergen, bronchial spasm occurs, manifested by suffocation.

VARIETIES

There are 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.
Predastma includes chronic asthmoid bronchitis and chronic pneumonia with bronchospasm elements. 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, chest tightness, 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 does not stop 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 effect 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 choking, 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 prednisolone, and the dose has to be increased.
Patients with bronchial asthma more often than healthy women develop early toxicosis (37%), the threat of termination of pregnancy (26%), labor disorders (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 with 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 risk 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 to treat 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 asthma attacks. 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 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 risk of developing hypoxemia - a lack of oxygen in the blood, from which the fetus is very seriously affected.
Treatment with prednisone 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 prednisone tablets. This drug is harmless. It does not stop the developed attack of suffocation, 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 for prophylactic purposes 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 berotek 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 bronchodilator 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 helping to remove the contents of the bronchi; 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, terpine hydrate in 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 set 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 the 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 treatment with antibiotics, physiotherapy procedures, expectorants, for the prophylactic administration of drugs that dilate the bronchi, or to increase their dose. In case of 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 of abortion in the early stages of pregnancy or early delivery of the patient arise.

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

Asthma is a disease that has a recurrent course. The disease occurs with the same frequency in men and women. Its main symptoms are attacks of lack of air due to spasm of the smooth muscles of the bronchi and the release of viscous and abundant mucus.

As a rule, pathology first manifests itself in childhood or adolescence. If asthma occurs while carrying a child, pregnancy management requires increased medical supervision and adequate treatment.

Asthma in pregnant women - how dangerous it is

If the expectant mother ignores the symptoms of the disease and does not seek medical help, the ailment negatively affects both her health and the well-being of the fetus. Bronchial asthma is most dangerous in the early stages of gestation. Then the course becomes less aggressive, and the symptoms decrease.

Can you get pregnant with asthma? Despite its severe course, the disease is compatible with bearing a child. With proper therapy and constant monitoring of the doctor, dangerous complications can be avoided. If a woman is registered, receives medications and is regularly examined by a doctor, the threat of a complicated pregnancy and childbirth is minimal.

However, sometimes the following deviations appear:

1. More frequent attacks.
2. Attachment of viruses or bacteria with the development of the inflammatory process.
3. Worsening of the course of attacks.
4. The threat of spontaneous abortion.
5. Severe toxicosis.
6. Premature delivery.

In the video, the pulmonologist tells in detail about the disease while carrying a child:

The effect of the disease on the fetus

Pregnancy changes the way the respiratory system works. The level of carbon dioxide rises, and the woman's breathing quickens. The ventilation of the lungs increases, which is why the expectant mother notes shortness of breath.

At a later stage, the location of the diaphragm changes: the growing uterus raises it. Because of this, the pregnant woman has an increased feeling of lack of air. The condition worsens with the development of bronchial asthma. With each attack, placental hypoxia is caused. This entails intrauterine oxygen starvation in the baby with the appearance of various disorders.

The main deviations in the crumbs:

• lack of weight;
• intrauterine growth retardation;
• the formation of pathologies in the cardiovascular, central nervous system, muscle tissue;
• with severe oxygen starvation, asphyxia (choking) of the baby may develop.

If the disease becomes severe, there is a high risk of giving birth to a baby with heart defects. In addition, the infant will inherit a predisposition to respiratory diseases.

How is childbirth with asthma

If the bearing of the child was controlled throughout the pregnancy, spontaneous childbirth is quite possible. 2 weeks before the estimated date, the patient is hospitalized and prepared for the event. When a pregnant woman receives large doses of Prednisolone, during the expulsion of the fetus from the uterus, she is given injections of Hydrocortisone.

The doctor strictly controls all indicators of the expectant mother and crumbs. During childbirth, a woman is injected with a medicine that prevents an asthmatic attack. It will not harm the fetus, it has a beneficial effect on the patient's well-being.

When bronchial asthma takes a severe course with increased attacks, a planned cesarean section is performed at 38 weeks. By this time, the child is fully formed, viable and considered full-term. During the operation, it is better to use a regional blockade than inhalation anesthesia.

The most common complications during delivery caused by bronchial asthma:

• premature rupture of amniotic fluid;
• rapid childbirth, badly affecting the health of the baby;
• discoordination of labor.

It happens that the patient gives birth on her own, but an asthmatic attack begins, accompanied by cardiopulmonary failure. Then intensive therapy and emergency caesarean section are performed.

How To Fight Asthma During Pregnancy - Proven Ways

If you received medications for the disease, but became pregnant, the course of therapy and medications are replaced with a more gentle option. Doctors do not allow some medicines to be used during gestation, while the doses of others should be adjusted.

Throughout pregnancy, the doctor monitors the condition of the crumbs by performing an ultrasound scan. If an exacerbation has begun, oxygen therapy is performed, which prevents the baby's oxygen deprivation. The doctor monitors the patient's condition, paying close attention to changes in the uterine and placental vessels.

The main principle of treatment is the prevention of asthma attacks and the selection of harmless therapy for mother and baby. The tasks of the attending physician are the restoration of external respiration, the elimination of asthma attacks, the relief of side effects from drugs and the control of the disease.

For the treatment of mild asthma, bronchodilators are prescribed. They allow you to relieve spasm of smooth muscles in the bronchi.

Long-acting drugs are used during pregnancy (Salmeterol, Formoterol). They are available in aerosol cans. They are used daily and prevent the development of nocturnal attacks of suffocation.

Other basic drugs are glucocorticosteroids (Budesonide, Beclomethasone, Flutinazone). They are produced in the form of an inhaler. The doctor calculates the dosage, taking into account the severity of the disease.

If you are prescribed hormonal medications, do not be afraid to use them daily. Medicines will not harm the baby and prevent the development of complications.

When the expectant mother suffers from late gestosis, methylxanthines (Euphyllin) are used as a bronchodilator. They relax the muscles of the bronchi, stimulate the respiratory center, and improve alveolar ventilation.

Expectorants (Mukaltin) are used to remove excess mucus from the airways. They stimulate the work of the bronchial glands, increase the activity of the ciliated epithelium.

In the later stages, the doctor prescribes supportive therapy. It is aimed at restoring intracellular processes.

Treatment includes the following medications:

• Tocopherol - reduces tone, relaxes the muscles of the uterus;
• multivitamins - replenish the insufficient content of vitamins in the body;
• anticoagulants - normalize blood clotting.

What drugs should not be taken by pregnant women for treatment

During the period of bearing a child, it is not worth using drugs without medical advice, and even more so with bronchial asthma. You need to follow all appointments exactly.

There are medications that are contraindicated in asthmatic women. They can adversely affect the prenatal health of the baby and the condition of the mother.

List of prohibited drugs:

Drug name	Negative influence	In what period are contraindicated
Adrenalin	Causes oxygen starvation of the fetus, provokes the development of vascular tone in the uterus	Throughout pregnancy
Short-acting bronchodilators - Fenoterol, Salbutamol	Complicate and delay childbirth	Late gestation
Theophylline	It enters the fetal circulation through the placenta, causing a rapid heartbeat of the crumbs	In the 3rd trimester
Some glucocorticoids - Dexamethasone, Betamethasone, Triamcinolone	Negatively affects the muscular system of the fetus	Throughout pregnancy
II generation antihistamines - Loratadin, Dimetinden, Ebastine	The resulting side effects adversely affect the health of women and children.	During the entire gestational period
Selective β2-blockers (Ginipral, Anaprilin)	Causes bronchospasm, significantly worsening the patient's condition	Contraindicated in bronchial asthma, regardless of gestational age
Antispasmodics (No-shpa, Papaverine)	Provokes the development of bronchospasm and anaphylactic shock	It is undesirable to use for asthma, regardless of gestational age

ethnoscience

Non-traditional methods of treatment are widely used by patients with bronchial asthma. Such funds cope well with attacks of suffocation and do not harm the body.

Use folk recipes only as an adjunct to conservative therapy. Do not use them without first consulting your doctor or if you identify an individual allergic reaction to the components of the product.

How to deal with asthma with traditional medicine recipes:

1. Oat broth.Cook and rinse well with 0.5kg of oats. Put 2 liters of milk on the gas, add 0.5 ml of water. Bring to a boil, add cereal there. Cook for another 2 hours to make 2 liters of broth. Take the product hot on an empty stomach. Add 1 tsp in 1 glass of drink. honey and butter.
2. Oat broth with goat milk. Pour 2 liters of water into a saucepan. Bring to a boil, then add 2 cups of oats. Boil the product over low heat for about 50-60 minutes. Then pour in 0.5 l of goat's milk and boil for another half hour. Before taking the broth, you can add 1 teaspoon of honey. Drink ½ cup 30 minutes before meals.
3. Inhalation with propolis and beeswax.Take 20 g of propolis and 100 g of beeswax. Heat the mixture in a water bath. When she gets warm, she covers her head with a towel. Then inhale the product through your mouth for about 15 minutes. Repeat these procedures in the morning and evening.
4. Propolis oil. Mix 10 g of propolis with 200 g of sunflower oil. Put the product to warm up in a water bath. Strain it and take 1 tsp. morning and evening.
5. Ginger juice.Squeeze the juice from the root of the plant with a little salt. The drink is used to combat seizures and as a prophylactic agent. To stop choking, take 30 g. To prevent shortness of breath, drink 1 tbsp daily. l. juice. For taste, add 1 tsp there. honey, washed down with water.

Prevention of the disease

Doctors advise asthmatic women to control the disease even when planning a pregnancy. At this time, the doctor selects the correct and safe treatment, eliminates the effect of irritating factors. Such activities reduce the risk of developing seizures.

The pregnant woman herself can also take care of her health. It is imperative to stop smoking. If loved ones living with the expectant mother smoke, you should avoid inhaling the smoke.

To improve your health and reduce the risk of relapse, try to follow simple rules:

1. Review your diet, exclude foods that cause allergies from the menu.
2. Wear clothes and bedding made from natural materials.
3. Take a shower every day.
4. Do not contact animals.
5. Use hypoallergenic hygiene products.
6. Use special humidifier devices that maintain the necessary humidity and purify the air from dust and allergens.
7. Take long walks in the fresh air.
8. If you are working with chemicals or toxic fumes, move to a safe area.
9. Beware of large crowds, especially in the autumn-spring season.
10. Avoid allergens in your daily routine. Damp rooms regularly to avoid inhaling household chemicals.

At the stage of planning your baby, try to get vaccinated against dangerous microorganisms - hemophilus influenzae, pneumococcus, hepatitis virus, measles, rubella and pathogens of tetanus, diphtheria. Vaccination is carried out 3 months before planning the child under the supervision of the attending doctor.

Conclusion

Bronchial asthma and pregnancy are not mutually exclusive. Often the disease arises whether it aggravates when the "interesting situation" occurs. Do not ignore the manifestations: asthma can adversely affect the health of the mother and child.

Do not be afraid that the disease will cause any complications for the crumbs. With proper medical supervision and adequate therapy, the prognosis is good.

It was considered a serious obstacle to carrying a pregnancy. Often with such a diagnosis, if the attacks were frequent, women were forbidden to become pregnant and give birth. But today, the attitude towards this diagnosis has been significantly revised, and doctors around the world no longer consider the presence of bronchial asthma to be a reason for a ban on bearing and even natural birth of a baby. But it is quite obvious that during such a gestation there are peculiarities, nuances, and on the part of doctors, a specific attitude is needed towards the woman and the fetus she carries, which must be known in advance.

What is bronchial asthma?

Today bronchial asthma is considered one of the most common pathologies of the bronchopulmonary system during pregnancy. This is especially true for atopic (allergic) type of asthma, which is associated with an increase in the total number of women with allergies.

note

According to allergists and pulmonologists, the number of cases of asthma ranges from 3-4 to 8-9% of all allergy sufferers, and their number is constantly increasing by about 2-3% per decade.

If we talk about the nature of the pathology, it is a chronically current inflammatory process in the area of \u200b\u200bthe mucous membranes of the bronchi with the simultaneous formation of their narrowing, a temporary spasm of smooth muscle elements, which reduces the airway lumen and makes breathing difficult.

Attacks are associated with an increase in the reactivity (excitability) of the walls of the bronchi, their abnormal reactions in response to various types of influences. Do not think that bronchial asthma is always an allergic pathology, such a condition of the respiratory tract is possible after suffering brain injuries, severe infectious diseases, due to pronounced endocrine disorders and other influences . In most cases, the development of asthma is provoked by the influence of allergens, and in some cases a milder form of pathology (c) is initially formed, and then the transition to damage to the bronchopulmonary system and asthmatic attacks with the formation of shortness of breath, wheezing and choking.

Asthma options: allergies and more

By their nature, there are two types of bronchial asthma - an infectious-allergic course and an allergic one, without the participation of an infectious factor. If we talk about the first option, such bronchial asthma can form after suffering serious infectious lesions of the respiratory system - these are, severe, or. Various pathogens, often of microbial or fungal origin, act as provocateurs and allergenic components.

The infectious-allergic form is one of the most common among all the variants of the course; episodes of its development account for up to 2/3 of all variants of asthmatic attacks in women.

If we talk about atopic (purely allergic, without microbes) bronchial asthma, then for it various substances can act as allergens, both organic (plant, animal, artificial synthesis) and inorganic (environmental substances). The most common are such provocateurs as wind-pollinated pollen, household or professional dust, outdoor dust, components of wool, feathers, down of animals, birds. Food components can also become provocateurs of attacks - these are citruses, bright berries with a high allergenic potential, as well as some types of medicines (salicylates, synthetic vitamins).

A separate place is assigned to professional, chemical allergens, which in the form of suspension, dust, aerosol get into the air and into the respiratory system. These can be various compounds of perfumery, household chemicals, varnishes and paints, aerosols, etc.

For atopic asthma and its development, the woman's hereditary predisposition to any allergy is extremely important.

How do seizures manifest?

Regardless of the form in which the patient has bronchial asthma, there are three stages in its development, which can successively replace each other. This is pre-asthma, then typical asthmatic attacks (with, whistling or suffocation), gradually turning into the formation of asthmatic status. All three of these options are quite likely to occur during pregnancy:

• If speak about pre-asthmatic condition , for him are typical attacks of obstructive, asthmatic bronchitis or frequent pneumonia with bronchospasm. However, episodes of severe suffocation typical of bronchial asthma have not yet been observed.
• On initial stage of asthma typical attacks with suffocation occur from time to time, and against the background of an infectious-allergic form of the condition, it can manifest itself with an exacerbation of any chronic bronchopulmonary diseases (bronchitis, pneumonia). Asthmatic attacks are usually easily recognized, their onset usually occurs at night, they can last within a few minutes, although a protracted course is possible - from an hour or more.

  note

  Choking attacks may be preceded by certain precursors - a burning sensation with severe sore throat, a runny nose or sneezing, a feeling of pressure, a sharp tightness in the chest.

  The attack itself usually starts as a persistent cough without phlegm, after which there is a sharply difficult exhalation, almost complete nasal congestion and a feeling of compression in the chest. To breathe easier, the woman sits down and strains the auxiliary muscles in the chest and neck, shoulder girdle, which helps to exhale air with effort. Typically noisy and hoarse breathing with whistles heard from a distance. Initially, breathing becomes more frequent, but then due to the hypoxia of the respiratory center, it decreases to 10-15 breaths per minute. The patient's skin becomes covered with perspiration, the face may become red or cyanotic, at the end of the attack, when coughing, a lump of viscous, like shards of glass, sputum may come off.

• occurrence status asthmaticus - an extremely dangerous condition that threatens the life of both. With it, the arising attack of suffocation does not stop for a long time for several hours, or even days in a row, and respiratory disorders are expressed to the maximum extent. At the same time, all the medications that are usually taken by the patient do not give any effect.

Bronchial asthma: the effect of attacks on the fetus

Against the background of pregnancy, hormonal changes naturally occur in the body of the expectant mother, as well as specific deviations in the work of the immune system so that the fetus, which is half of the father's genes, is not rejected. Therefore, at this time, the course of bronchial asthma can both worsen and improve. Naturally, the presence of seizures will negatively affect the condition of the pregnant woman herself, as well as the course of pregnancy.

Often, bronchial asthma is present even before pregnancy, although it is quite possible that it develops already during gestation, especially against the background of previously existing allergic manifestations, including hay fever. There is also a hereditary predisposition, a tendency to asthma in the relatives of a pregnant woman, including the presence of asthmatics.

Asthma attacks can begin in the first weeks, or join in the second half of the gestational period. The presence of asthma in the early stages, similar to the manifestations of the early, can spontaneously disappear in the second half. Making preliminary forecasts in such cases for a woman and her child will be most favorable.

The course of seizures by trimester

If asthma was present before pregnancy, then during gestation its course can be unpredictable, although doctors reveal certain patterns.

In about 20% of pregnant women, the condition remains at the same level, as it was before pregnancy, about 10% of mothers note relief of attacks and significant improvement, and the remaining 70% have a much more severe illness than before.

In the latter case, both moderate and severe attacks prevail, which occur daily, or even several times a day. From time to time, attacks can be delayed, the effect of treatment is rather weak. Often, the first signs of deterioration are noted already from the first weeks of the first trimester, but by the second half of gestation it becomes easier. If during the previous pregnancy there was a trend in a positive or negative direction, subsequent gestations usually repeat the scenario.

Asthmatic attacks during childbirth are rare, especially if bronchodilators or hormonal agents are used for prophylactic purposes in women during this period. After childbirth, about a quarter of women with mild asthma experience improvement. Another 50% do not notice changes in their condition, and the remaining 25% have a worsening condition, and they are forced to constantly take hormonal drugs, the doses of which are constantly increasing.

Influence of bronchial asthma on a woman and a fetus

Against the background of existing bronchial asthma, women more often than healthy women suffer from early toxicosis of pregnancy, they have a higher threat and disorders in labor... Often there can be rapid or rapid childbirth, which is why the percentages of birth injuries are high for both the mother and the baby. They also often have small or premature babies.

Against the background of severe attacks, the percentage of and is high, as well. Serious complications for the fetus and its death are possible only in case of an extremely serious condition and inadequate treatment. But the presence of a mother's illness can negatively affect the child in the future. About 5% of babies may suffer from asthma, which develops in the first three years of life, in subsequent years the chances of it reaching 60%. Newborns are prone to frequent pathologies from the respiratory tract.

If a woman suffers from bronchial asthma and the pregnancy is full-term, childbirth is carried out naturally, as possible attacks of suffocation can be easily stopped. If attacks are frequent or status asthmaticus threatens, the effectiveness of treatment is low, and there may be indications for early delivery after 36-37 weeks.

The problem of asthma therapy during gestation

For a long time, experts believed that the basis of the disease is a spasm of smooth muscle elements in the bronchi, which leads to asthma attacks. Therefore, the treatment was based on drugs with a bronchodilator effect. Only in the 90s of the last century it was determined that the basis of asthma is chronic inflammation, which has an immune nature, and the bronchi remain inflamed in any course and severity of the pathology, even when there are no exacerbations. The discovery of this fact led to a change in the fundamental approaches to the therapy of asthma and its prevention. ... Today, the basic drugs for asthmatics are anti-inflammatory drugs in inhalers.

If we talk about pregnancy and its combination with bronchial asthma, then the problems are associated with the fact that during gestation it can be poorly controlled by medications. Against the background of seizures, the greatest risk for the fetus is the presence of hypoxia - oxygen deficiency in the maternal blood. Due to asthma, this problem becomes several times more acute. When an attack of suffocation is formed, it is felt not only by the mother herself, but also by the fetus, which is completely dependent on her and suffers sharply from a lack of oxygen. It is the frequent bouts of hypoxia that lead to disturbances in the development of the fetus, and in critical periods of development they can even lead to disturbances in the laying of tissues and organs.

For the birth of a relatively healthy baby, complete and adequate treatment is necessary, which fully corresponds to the severity of bronchial asthma. This will not allow more frequent attacks and increased hypoxia.

During pregnancy, treatment should be mandatory, and the prognosis for those women in whom asthma is completely under control regarding the health of children is very favorable.

Planning pregnancy, preparing for it

It is important to approach pregnancy with bronchial asthma with all responsibility, in advance of it against the background of all the necessary measures for treatment and prevention. It is important to visit a pulmonologist or allergist in advance with the selection of basic treatment, as well as training in self-control over the condition and inhalation administration of drugs. It is necessary for the allergic nature of the attacks to conduct tests and tests in order to fully determine the spectrum of dangerous allergens and exclude contact with them. Immediately after conception, a woman needs close medical supervision; it is prohibited to take any medications without his permission. If there are concomitant pathologies, treatment is also carried out taking into account the condition and the presence of asthma.

Measures to prevent attacks and exacerbations

It is strictly forbidden to smoke during pregnancy and even contact with tobacco smoke... Its components lead to irritation of the bronchi and the formation of their inflammation, an increase in the reactivity of the immune system. It is important to convey this information to the future father, if he smokes, the risk of having an asthmatic child increases by 4 times.

It is equally important to exclude possible contact with allergens, which most often provoke asthma attacks, especially in the warm season. There are also options for year-round allergic asthma, for which you need to create a special hypoallergenic lifestyle that reduces the load on the woman's body and leads to an improvement in the course of the disease, and a decrease in the risk of complications. This allows you to reduce (but not completely eliminate) medications during gestation.

How is bronchial asthma treated in pregnant women?

Often, women during pregnancy try to refuse to take medications, but this is not the case with asthma, its treatment is simply necessary. The harm that can be caused to the fetus by severe attacks that are not controlled, as well as episodes of hypoxia, are much more dangerous to the fetus than the possible side effects that are likely to occur when taking medications. If you refuse to treat asthma, this can threaten a woman with status asthmaticus, then both can die.

Today, in treatment, the use of topical inhalation drugs is preferred, which act locally, have the maximum activity in the bronchial region, while creating the lowest possible concentration of drugs in the blood plasma. In treatment, it is recommended to use freon-free inhalers, they usually have the markings "ECO" or "N", there is a phrase "without freon" on the packages. If it is a metered-dose aerosol inhaler, it should be used in combination with a spacer - this is an additional chamber into which the aerosol is supplied from the balloon before the patient inhales. Due to the spacer, the effect of inhalation increases, problems with the use of the inhaler are eliminated and the risk of side effects that are possible due to aerosol getting on the mucous membranes of the pharynx and mouth decreases.

Basic therapy: what and why?

In order to control the condition of a woman during pregnancy, it is necessary to use basic therapy that suppresses the process of inflammation in the bronchi. Without it, fighting only the symptoms of the disease will lead to the progression of the pathology. The volume of basic treatment is selected by the doctor, taking into account the severity of asthma and the condition of the expectant mother. These medications need to be taken constantly, every day, regardless of how you feel and whether there are seizures. This treatment can significantly reduce the number and severity of seizures and reduce the need for additional medication, which helps in the normal development of the child. Basic therapy is carried out throughout pregnancy and throughout childbirth. Then it is carried out already after the birth of the baby.

With a mild course of pathology, hormones are used (Tayled or Intal drugs), and if asthma arose for the first time during pregnancy, they start with Intal, but if adequate control over it is not achieved, then they are replaced with hormonal inhalation drugs. During pregnancy, Budesonide or Beclomethasone are used from this group, if asthma was even before gestation, it was controlled by some other hormonal drug, you can continue therapy with it. Drugs are selected only by a doctor, based on the state data and peak flow metrics (measurement of the peak expiratory flow rate).

To monitor the state of the house, today they use portable devices - peak flow meters, which measure respiration indicators. Doctors are guided by their data when they draw up a therapy plan. Readings are measured twice a day, in the morning and in the evening, before taking the drugs. The data is recorded in a graph, and then shown to the doctor so that he can assess the dynamics of the condition. In the presence of "morning dips", low rates, it is important to correct therapy, this is a sign of a possible exacerbation of asthma.