Drugs for the treatment of bronchial asthma during pregnancy. Pregnancy and bronchial asthma: risks for mother and child, treatment Drugs for asthma during pregnancy

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

The doctors answer unequivocally “yes”! Bronchial asthma is not a death sentence for your motherhood, because modern medicine allows women suffering from this disease to become mothers. But the topic is very complicated, so let’s understand everything in order so that you don’t get completely confused.

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

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

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

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

Risk factors

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

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

Types of bronchial asthma

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

• First degree: episodic

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

• Second degree: mild form

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

• Third degree: medium

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

• Fourth degree: severe

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

The effect of bronchial asthma on pregnancy

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

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

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

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

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

• Collapse of the small bronchi in the lower parts of the lungs.
• Violation of the ratio of oxygen and blood supply in the respiratory apparatus and peripulmonary organs.
• Development of hypoxia and others.

This occurs because the residual lung volume approaches the functional residual capacity.

This factor can provoke, among other things, fetal hypoxia if the pregnant woman has bronchial asthma. Insufficiency of CO2 in the blood, which develops during hyperventilation of the lungs, leads to the development of spasms of the umbilical cord vessels and thus creates a critical situation. Be sure to remember this during attacks of bronchial asthma, since hyperventilation aggravates embryonic hypoxia.

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

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

The following factors potentially worsen the course of bronchial asthma: increased sensitivity of ά-adrenergic receptors, decreased expiratory reserve volume, decreased sensitivity of the expectant mother’s body to cortisol due to competition with other hormones, stressful situations, respiratory infections, various diseases of the gastrointestinal tract.

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

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

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

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

Treatment of bronchial asthma during pregnancy

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

• Eliminating allergens

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

• Medications

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

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

The effect of anti-asthma drugs on a child

• Adrenergic agonists

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

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

• Theophylline preparations

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

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

• Mucolytic agents

The most effective medications for the treatment of asthma that have an anti-inflammatory effect are glucocorticosteroids. If indicated, they can be safely prescribed to pregnant women. Triamcinolone preparations are contraindicated for short-term and long-term use ( negative impact on the development of the child’s muscles), GCS preparations (dexamethasone and betamethasone), as well as depot preparations (Depomedrol, Kenalog-40, Diprospan).

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

• Antihistamines

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

During pregnancy, under no circumstances should immunotherapy using allergens be carried out - this is an almost one hundred percent guarantee that the baby will be born with a strong predisposition to bronchial asthma.

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

Treatment of pregnancy complications

If there is a threat of miscarriage in the first trimester, asthma therapy is carried out according to generally accepted rules, without characteristic features. In the future, during the 2nd and 3rd trimester, treatment of complications typical of pregnancy should include optimization of respiratory processes and correction of the underlying pulmonary disease.

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

To prevent the development of infectious diseases to which people with bronchial asthma are susceptible, comprehensive immunocorrection is carried out. But again, I would like to draw your attention to the fact that any treatment should be carried out only under the strict supervision of a doctor. After all, what is ideal for one expectant mother may be harmful to another.

Childbirth and postpartum period

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

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

The therapy carried out is assessed in terms of effectiveness based on the results of ultrasound, fetal hemodynamics, according to CTG, by determining the hormones of the fetoplacental complex in the blood - in a word, mother and baby must be under the constant supervision of a doctor.

To prevent possible complications during childbirth, women with bronchial asthma must adhere to certain rules. They should continue basic anti-inflammatory therapy - do not interrupt treatment on the eve of a significant event in your life. For patients who have previously received systemic glucocorticosteroids, it is recommended to take hydrocortisone every 8 hours and for 24 hours after birth.

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

In the postpartum period, a new mother suffering from bronchial asthma has a very high probability of developing bronchospasm - it is the body’s response to stress, which is the birth process. To prevent it, it is necessary to exclude the use of prostaglandin and ergometrine. Also, with aspirin-induced bronchial asthma, special care should be taken when using painkillers and antipyretics.

Breast-feeding

You have received comprehensive information about pregnancy and bronchial asthma. But do not forget about breastfeeding, which is an important part of the bond between mother and child. Very often women refuse to breastfeed breastfeeding, fearing that the medications will harm the child. Of course, they are right, but only partly.

As you know, the vast majority of medications inevitably pass into milk - this also applies to medications for bronchial asthma. Components of methylxanthine derivatives, adrenergic agonists, antihistamines and other drugs are also excreted in milk, but in much lower concentrations than they are present in the mother’s blood. And the concentration of steroids in milk is also low, but the drugs should be taken at least 4 hours before feeding.

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

However, the period of motherhood sooner or later occurs for almost every woman, but here she is faced with the question - how dangerous are pregnancy and bronchial asthma? Let's figure out whether it is possible for an asthmatic mother to carry and give birth to a baby normally, and also consider all the other nuances.

One of the main risk factors influencing the development of the disease is the poor ecology in the region of residence, as well as difficult working conditions. Statistics show that residents of megacities and industrial centers suffer from bronchial asthma many times more often than residents of villages or villages. For pregnant women, this risk is also very high.

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

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

The effect of bronchial asthma on pregnancy

Many doctors agree that treating bronchial asthma in pregnant women is a very important task. A woman’s body already endures various changes and increased stress during pregnancy, which are also complicated by the course of the disease. During this period, women experience weakened immunity, which is a natural phenomenon during pregnancy, and this also includes changes in hormones.

Asthma can cause a mother to experience a lack of air and oxygen starvation, which already poses a danger to the normal development of the fetus. In general, bronchial asthma in pregnant women occurs only in 2% of cases, so it is impossible to talk about any connection between these circumstances. But this does not mean that the doctor should not respond to this disease, because it can really harm the unborn baby.

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

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

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

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

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

It is also worth talking about those cases when a woman takes special anti-asthmatic drugs to relieve attacks. Let's consider their main groups, as well as the effect they have on the fetus.

Effect of drugs

Adrenergic agonists

During pregnancy, adrenaline, which is often used to relieve asthma attacks, is strictly prohibited. The fact is that it provokes spasm of the uterine vessels, which can lead to hypoxia. Therefore, the doctor selects more gentle drugs from this group, such as salbutamol or fenoterol, but their use is only possible according to the indications of a specialist.

Theophylline

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

Mucolytic drugs

This group contains drugs that are contraindicated for pregnant women:

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

Treatment of asthma in pregnant women should be carried out according to a special scheme. It includes constant monitoring of the condition of the mother’s lungs, as well as the choice of method of birth. The fact is that in most cases he decides to perform a caesarean section, because excess tension can provoke an attack. But such decisions are made individually, based on the specific condition of the patient.

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

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

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

Treatment of pregnancy complications

If a woman is in the first trimester, then treatment for possible pregnancy complications is carried out in the same way as in normal cases. But if there is a risk of miscarriage in the second and third trimester, then it is necessary to treat the pulmonary disease, and it is also necessary to normalize the mother’s breathing.

The following drugs are used for these purposes:

• Phospholipids, which are taken as a course, along with multivitamins.
• Actovegin.
• Vitamin E

Childbirth and postpartum period

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

To prevent possible suffocation, glucocorticosteroids are prescribed by inhalation. The administration of prednisolone during labor is also indicated.

It is very important that a woman strictly follows the doctor’s recommendations, not stopping therapy until the birth itself. For example, if a woman takes glucocorticosteroids on an ongoing basis, then she should continue taking them after the birth of the baby during the first 24 hours. The dose should be taken every eight hours.

If a caesarean section is used, epidural anesthesia is preferred. If general anesthesia is advisable, the doctor must carefully select the drugs to administer, because carelessness in this matter can lead to attacks of suffocation in the child.

After childbirth, many suffer from various bronchitis and bronchospasms, which is a completely natural reaction of the body to labor. To avoid this, you must take ergometrine or any other similar drugs. You should also be especially careful when taking antipyretics that contain aspirin.

Breast-feeding

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

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

• The water may break before labor occurs.
• Childbirth may happen too quickly.
• Abnormal labor may occur.

If the doctor decides on spontaneous childbirth, then he must perform a puncture of the epidural space. Then bupivacaine is injected there, which helps dilate the bronchi. Labor pain relief for bronchial asthma is carried out in a similar way, by administering drugs through a catheter.

If a patient experiences an asthma attack during childbirth, the doctor may decide to perform a cesarean section to reduce the risks for mother and baby.

Conclusion

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

Bronchial asthma (BA) is a chronic relapsing disease with primary damage to the bronchi.

The main symptom is attacks of suffocation and/or status asthmaticus due to spasm of bronchial smooth muscles, hypersecretion, discrimination and swelling of the respiratory tract mucosa.

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 Respiratory diseases complicating pregnancy, childbirth and the postpartum period.

EPIDEMIOLOGY

The incidence of asthma has increased significantly in the last three decades. According to WHO experts, bronchial asthma is one of the most common chronic diseases: this disease is detected in 8–10% of the adult population. In Russia, more than 8 million people 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 IN PREGNANCY

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

Measures aimed at reducing exposure to household allergens:
· use of impermeable coverings for mattresses, blankets and pillows;
· replacing floor carpets with linoleum or wooden floors;
· replacing fabric upholstery with leather;
· replacing curtains with blinds;
· maintaining low humidity in the room;
· preventing animals from entering residential premises;
· to give up smoking.

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

Screening

Careful history taking, auscultation and study of peak expiratory flow using a peak flow meter can identify patients who need additional examination (assessment of allergic status and pulmonary function test).

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 is by severity. This classification is used in the management of patients during pregnancy. Based on the noted clinical signs and respiratory function indicators, four degrees of severity of the patient’s condition before treatment were identified.

· Bronchial asthma of intermittent (episodic) course: symptoms occur no more than once a week, night symptoms no more than twice a month, exacerbations are short (from several hours to several days), pulmonary function indicators outside of exacerbation are within normal limits.

· Mild persistent bronchial asthma: symptoms of suffocation occur more 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 are 20–30%.

· Bronchial asthma of moderate severity: symptoms of the disease appear daily, exacerbations disrupt physical activity and sleep, nighttime symptoms occur more than once a week, forced expiratory volume or peak expiratory flow is from 60 to 80% of the proper values, daily fluctuations in forced expiratory volume or peak exhalation rate ³30%.

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

If the patient is already undergoing treatment, the severity of the disease must be determined based on the identified clinical signs and the number of medications taken daily. If symptoms of mild persistent bronchial asthma persist despite appropriate therapy, the disease is defined as moderate persistent bronchial asthma. If, during treatment, the patient develops symptoms of persistent bronchial asthma of moderate severity, a diagnosis of “Bronchial asthma, severe persistent course” is made.

ETIOLOGY (CAUSES) OF BRONCHIAL ASTHMA IN PREGNANT WOMEN

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

· atopy;
· hyperreactivity of the respiratory tract, which has a hereditary component and is closely related to the level of IgE in the blood plasma, inflammation of the respiratory tract;
· allergens (house mites, animal hair, molds and yeasts, plant pollen);
· occupational sensitizing factors (more than 300 substances are known that are related to occupational bronchial asthma);
· smoking;
· air pollution (sulfur dioxide, ozone, nitrogen oxides);
· ORZ.

PATHOGENESIS OF GESTATION COMPLICATIONS

The development of complications of pregnancy and perinatal pathology is associated with the severity 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 occurring is three times higher than in patients with a stable course of the disease. The immediate causes of complicated pregnancy in patients with bronchial asthma include:

changes in respiratory function (hypoxia);
· immune disorders;
· disturbances of hemostatic homeostasis;
· metabolic disorders.

Changes in respiratory function are the main cause of hypoxia. They are directly related to the severity of bronchial asthma and the quality of treatment provided 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 causes of common intrauterine infections 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 disruption of hemostatic homeostasis (development of chronic DIC) and disruption of 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 increased, 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:
attacks of suffocation (difficulty in exhaling);
unproductive paroxysmal cough;
· noisy wheezing;
shortness of breath.

COMPLICATIONS OF GESTATION

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

DIAGNOSIS OF BRONCHIAL ASTHMA IN PREGNANCY

ANAMNESIS

When collecting anamnesis, the presence of allergic diseases in the patient and her relatives is established. During the study, the features of the appearance of the first symptoms are clarified (the time of year of their appearance, connection with physical activity, exposure to allergens), as well as the seasonality of the disease, the presence of occupational hazards and living conditions (presence of pets). It is necessary to clarify the frequency and severity of symptoms, as well as the effect of anti-asthma treatment.

PHYSICAL INVESTIGATION

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 of auxiliary muscles in the act of breathing. On auscultation, harsh breathing and dry wheezing are noted. When percussing, a boxy sound may be heard.

LABORATORY RESEARCH

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

INSTRUMENTAL RESEARCH

· Clinical blood test to detect eosinophilia.
· Detection of increased IgE levels in blood plasma.
· Examination of sputum to detect Kurschmann spirals, Charcot-Leyden crystals and eosinophilic cells.
· Study of respiratory function to detect a decrease in maximum expiratory flow, forced expiratory volume and a decrease in peak expiratory flow.
· ECG to establish sinus tachycardia and overload of the right heart.

DIFFERENTIAL DIAGNOSTICS

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

INDICATIONS FOR CONSULTATION WITH 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 OF FORMULATION OF DIAGNOSIS

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

TREATMENT OF BRONCHIAL ASTHMA DURING PREGNANCY

PREVENTION AND PREDICTION OF GESTATION COMPLICATIONS

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

FEATURES OF TREATMENT OF GESTATIONAL COMPLICATIONS

Treatment of gestational complications by trimester

In the first trimester, treatment of bronchial asthma in the event of a threat of miscarriage does not have any characteristic features. 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 and 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 carried out:
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 (to normalize hemostasis and bind circulating immune complexes);
- antiplatelet agents (to increase the synthesis of prostacyclin by the vascular wall, which reduces intravascular platelet aggregation): dipyridamole 50 mg 3 times a day, aminophylline 250 mg 2 times a day for two weeks.

If an increased level of IgE is detected in the blood plasma, markers of autoimmune processes (lupus
anticoagulant, anti-hCG) with signs of intrauterine fetal suffering and lack of sufficient effect from
Conservative therapy requires therapeutic plasmapheresis. Carry out 4–5 procedures 1–2 times a week with
removing up to 30% of the volume of circulating plasma. Indications for inpatient treatment - the presence of gestosis,
threat of miscarriage, signs of PN, grade 2–3 FGR, fetal hypoxia, severe exacerbation of asthma.

Treatment of complications during childbirth and the postpartum period

During childbirth, therapy aimed at improving the functions of the fetoplacental complex is continued. Therapy includes the administration 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, therapy for bronchial asthma using inhaled glucocorticoids is continued during childbirth. Patients taking systemic glucocorticosteroids, as well as with unstable bronchial asthma, require parenteral administration of prednisolone in a dose of 30–60 mg (or dexamethasone in an adequate dose) at the beginning of the first stage of labor, and if labor lasts more than 6 hours, the glucocorticosteroid injection is repeated at the end of the second stage childbirth

ASSESSMENT OF TREATMENT EFFECTIVENESS

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

CHOICE OF DATE AND METHOD OF DELIVERY

Delivery of pregnant women with a mild course of the disease with adequate pain relief and corrective drug therapy does not present any difficulties and does not cause a deterioration in the patients’ condition. In most patients, labor ends spontaneously. The most common complications of childbirth are:

· rapid course of labor;
· antenatal rupture of agents;
· abnormalities of labor.

Due to the possible bronchospastic effect of methylergometrine, when preventing bleeding in the second stage of labor, preference should be given to intravenous administration of oxytocin. In pregnant women with severe asthma, uncontrolled asthma of moderate severity, status asthmaticus during this pregnancy, or exacerbation of the disease at the end of the third trimester, delivery is associated with the risk of developing severe exacerbation of the disease, acute respiratory failure, and intrauterine fetal hypoxia. Considering the high risk of infection and complications associated with surgical trauma, planned vaginal delivery is considered the method of choice for severe illness with signs of respiratory failure. During vaginal delivery, before induction of labor, puncture and catheterization of the epidural space in the thoracic region at the ThVIII–ThIX level is performed with the introduction of a 0.125% solution of bupivacaine, which gives a pronounced bronchodilator effect. Then labor is induced by amniotomy. The behavior of the woman in labor during this period is active. After the onset of regular labor, labor anesthesia is carried out using epidural anesthesia at the level LI–LII. The introduction of a long-acting anesthetic in low concentration does not limit the mobility of the woman in labor, does not weaken efforts in the second stage of labor, has a pronounced bronchodilator effect (increasing the forced vital capacity of the lungs, forced expiratory volume, peak expiratory flow) and allows for the creation of a kind of hemodynamic protection. As a result, spontaneous delivery is possible without the exception of pushing 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 to perform epidural anesthesia at the thoracic level, delivery should be performed by CS. The method of choice for pain relief during a cesarean section is epidural anesthesia. Indications for surgical delivery in pregnant women with bronchial asthma are signs of cardiopulmonary failure in patients after relief of a severe long-term exacerbation or status asthmaticus and the presence of a history of spontaneous pneumothorax. A caesarean section can be performed for obstetric indications (for example, the presence of an incompetent scar on the uterus after a previous CS, a narrow pelvis, etc.).

INFORMATION FOR THE PATIENT

Treatment of bronchial asthma during pregnancy is mandatory. There are drugs for the treatment of bronchial asthma that are approved for use during pregnancy. If the patient's condition is stable and there are no exacerbations of the disease, pregnancy and childbirth proceed without complications. It is necessary to take classes at the Asthma School or familiarize yourself with the materials educational program for patients.

Pregnancy and asthma are not mutually exclusive. This combination occurs in one woman out of a hundred. Asthma is a chronic disease of the respiratory system, which is accompanied by frequent attacks of coughing and suffocation. In general, the disease is not an absolute contraindication for bearing a child.

It is necessary to closely monitor the health of pregnant women with this diagnosis in order to identify possible complications in time. With the right treatment tactics, childbirth takes place without consequences, and the child is born completely healthy. In most cases, a woman is given low-toxic drugs that help stop attacks and alleviate the course of the disease.

This disease is considered the most common among pathologies of the respiratory system. In most cases, asthma begins to progress during pregnancy, and symptoms become more severe (short-term attacks of suffocation, cough without phlegm, shortness of breath, etc.).

An exacerbation is observed in the second trimester of pregnancy, when hormonal changes occur in the body. In the last month, the woman feels much better, this is due to an increase in the amount of cortisol (a hormone produced by the adrenal glands).

Many women are interested in whether it is possible for a woman with this diagnosis to become pregnant. Experts do not consider asthma a contraindication to bearing a child. In a pregnant woman with bronchial asthma, health monitoring should be more strict than in women without pathologies.

To reduce the risk of complications, you need to take all the necessary tests and undergo comprehensive treatment when planning a pregnancy. During the period of bearing the baby, maintenance drug therapy is prescribed.

Why is bronchial asthma dangerous during pregnancy?

A woman suffering from bronchial asthma during pregnancy is more likely to experience toxicosis. Lack of treatment entails the development of severe consequences for both the mother and her unborn child. Complicated pregnancy is accompanied by the following pathologies:

• respiratory failure;
• arterial hypoxemia;
• early toxicosis;
• gestosis;
• miscarriage;
• premature birth.

Pregnant women with severe asthma have a higher risk of dying from preeclampsia. In addition to a direct threat to the life of a pregnant woman, bronchial asthma has a negative impact on the fetus.

Possible complications

Frequent exacerbations of the disease lead to the following consequences:

• low birth weight of the baby;
• intrauterine development disorders;
• birth injuries that occur when the baby has difficulty passing through the birth canal;
• acute lack of oxygen (fetal hypoxia);
• intrauterine death due to lack of oxygen.

With severe forms of asthma in the mother, children are born with pathologies of the cardiovascular system and respiratory organs. They fall into the group of potential allergy sufferers, and over time, many of them are diagnosed with bronchial asthma.

That is why the expectant mother needs to be especially careful about her health when planning a pregnancy, as well as during the entire period of bearing the baby. Failure to comply with medical recommendations and improper treatment increases the risk of complications.

It is worth noting that pregnancy itself also affects the development of the disease. With hormonal changes, the level of progesterone increases, due to changes in the respiratory system, the content of carbon dioxide in the blood increases, breathing becomes more frequent, and shortness of breath is more common.

As the baby grows, the uterus rises in the diaphragm, thereby putting pressure on the respiratory organs. Very often during pregnancy, a woman experiences swelling of the mucous membrane in the nasopharynx, which leads to exacerbation of asthma attacks.

If the disease manifests itself in the early stages of pregnancy, then diagnosing it is quite difficult. According to statistics, the progression of asthma during pregnancy is more common in severe forms. But this does not mean that in other cases a woman can refuse drug therapy.

Statistics indicate that with frequent exacerbations of bronchial asthma attacks in the first months of pregnancy, children born into the world suffer from heart defects, pathologies of the gastrointestinal tract, spine and nervous system. They have low body resistance, so more often than other children they suffer from influenza, ARVI, bronchitis and other diseases of the respiratory system.

Treatment of asthma during pregnancy

Treatment of chronic bronchial asthma in pregnant women is carried out under the strict supervision of a doctor. First of all, it is necessary to carefully monitor the woman’s condition and fetal development.

For previously diagnosed bronchial asthma, it is recommended to replace the medications that were taken. The basis of therapy is the prevention of exacerbations of symptoms and the normalization of respiratory function in the fetus and expectant mother.

Doctors carry out mandatory monitoring of external respiration function using peak flowmetry. For early diagnosis of fetoplacental insufficiency, a woman is prescribed fetometry and Dopplerography of blood flow in the placenta.

Drug therapy is selected taking into account the severity of the pathology. It should be borne in mind that many drugs are prohibited for pregnant women. The group of medications and dosage are selected by a specialist. Most often used:

• bronchodilators and expectorants;
• asthma inhalers with drugs that stop an attack and prevent unpleasant symptoms;
• bronchodilators, help relieve cough attacks;
• antihistamines help reduce allergies;
• systemic glucocorticosteroids (for severe forms of the disease);
• leukotriene antagonists.

The most effective methods

Inhalation therapy is considered the most effective. For this purpose:

• portable pocket devices into which the required volume of medication is administered using a special dispenser;
• spacers, which are a special attachment for an inhaler;
• nebulizers (with their help the drug is sprayed, thus ensuring the maximum therapeutic effect).

Successful treatment of asthma in pregnant women is facilitated by the following recommendations:

1. Eliminating potential allergens from the diet.
2. Using clothes made from natural materials.
3. Use of products with a neutral pH and hypoallergenic composition for hygienic procedures.
4. Elimination of potential allergens from the environment (animal hair, dust, perfume smell, etc.).
5. Carrying out daily wet cleaning of residential premises.
6. Frequent exposure to fresh air.
7. Elimination of physical and emotional stress.

An important stage of therapeutic therapy is breathing exercises; it helps to establish proper breathing and provide the body of the woman and the fetus with sufficient oxygen. Here are some effective exercises:

• bend your knees and tuck your chin while exhaling through your mouth. Perform 10-15 approaches;
• Close one nostril with your index finger and inhale through the other. Then close it and exhale through the second one. The number of approaches is 10-15.

They can be performed independently at home, but before starting classes, you should definitely consult a doctor.

Forecast

If all risk factors are excluded, the treatment prognosis is favorable in most cases. Following all medical recommendations and regularly visiting your doctor is the key to the health of the mother and her unborn child.

In severe forms of bronchial asthma, a woman is placed in a hospital, where her condition is monitored by experienced specialists. Among the mandatory physiotherapeutic procedures, oxygen therapy should be highlighted. It increases saturation and helps relieve asthma attacks.

In the later stages, drug therapy involves taking not only basic medications for asthma, but also vitamin complexes and interferons to strengthen the immune system. During the treatment period, it is necessary to take tests to determine the level of hormones produced by the placenta. This helps to monitor the dynamic condition of the fetus and diagnose the early development of pathologies of the cardiovascular system.

During pregnancy, it is prohibited to take adrenergic blockers, some glucocorticosteroids, and 2nd generation antihistamines. They tend to penetrate the systemic bloodstream and reach the fetus through the placenta. This negatively affects intrauterine development, increasing the risk of developing hypoxia and other pathologies.

Childbirth with asthma

Most often, birth in patients with asthma occurs naturally, but sometimes a caesarean section is prescribed. Exacerbation of symptoms during labor is a rare occurrence. As a rule, a woman with such a diagnosis is placed in a hospital in advance and her condition is monitored before the onset of labor.

During childbirth, she is necessarily given anti-asthma drugs, which help stop a possible asthma attack. These medications are absolutely safe for the mother and fetus and do not have a negative effect on the birth process.

With frequent exacerbations and transition of the disease to a severe form, the patient is prescribed a planned cesarean section, starting from the 38th week of pregnancy. If you refuse, the risk of complications during natural childbirth increases, and the risk of death of the child increases.

Among the main complications that occur in women giving birth with bronchial asthma are:

• Early discharge of amniotic fluid.
• Rapid birth.
• Complications of childbirth.

In rare cases, an attack of suffocation is possible during labor, and the patient develops heart and pulmonary failure. Doctors decide on an emergency caesarean section.

It is strictly forbidden to use drugs from the prostaglandin group after the onset of labor, as they provoke the development of bronchospasm. To stimulate contraction of the uterine muscles, oxytocin can be used. For severe attacks, epidural anesthesia can be used.

Postpartum period and asthma

Very often, asthma after childbirth can be accompanied by frequent bronchitis and bronchospasm. This is a natural process that is the body’s reaction to the load it has endured. To avoid this, women are prescribed special medications; it is not recommended to use medications containing aspirin.

The postpartum period for asthma includes the mandatory use of medications, which are selected by a specialist. It is worth noting that most of them tend to pass into breast milk in small quantities, but this is not a direct contraindication for use during breastfeeding.

As a rule, after delivery the number of attacks decreases, hormonal background gets in shape, the woman feels much better. It is imperative to exclude any contact with potential allergens that could provoke an exacerbation. If you follow all medical recommendations and take the necessary medications, there is no risk of developing postpartum complications.

In cases of severe disease after childbirth, the woman is prescribed glucocorticosteroids. Then the question may arise about abolishing breastfeeding, since these medications, penetrating into milk, can harm the baby’s health.

According to statistics, severe exacerbation of asthma is observed in women 6-9 months after childbirth. At this time, the level of hormones in the body returns to normal, the menstrual cycle may resume, and the disease worsens.

Planning pregnancy with asthma

Asthma and pregnancy are compatible concepts, provided the right approach to the treatment of this disease. In case of previously diagnosed pathology, it is necessary to regularly monitor the patient even before pregnancy and prevent exacerbations. This process includes regular examinations with a pulmonologist, taking medications, and breathing exercises.

If the disease manifests itself after pregnancy, then asthma control is carried out with redoubled attention. When planning to conceive, a woman needs to minimize the influence of negative factors (tobacco smoke, animal hair, etc.). This will help reduce the number of asthma attacks.

A prerequisite is vaccination against many diseases (flu, measles, rubella, etc.), which is carried out several months before the planned pregnancy. This will help strengthen the immune system and develop the necessary antibodies to pathogens.

Asthma is a disease characterized by a relapsing course. The disease appears with equal 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 secretion of viscous and copious mucus.

As a rule, the pathology first appears in childhood or adolescence. If asthma occurs during pregnancy, pregnancy management requires increased medical supervision and adequate treatment.

Asthma in pregnant women - how dangerous is it?

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

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

However, sometimes the following deviations appear:

1. Increased frequency of attacks.
2. The attachment of viruses or bacteria with the development of the inflammatory process.
3. Worsening of attacks.
4. Threat of spontaneous abortion.
5. Severe toxicosis.
6. Premature delivery.

In the video, the pulmonologist talks in detail about the disease during pregnancy:

The effect of the disease on the fetus

Pregnancy changes the functioning of the respiratory organs. The level of carbon dioxide rises, and the woman’s breathing quickens. Ventilation of the lungs increases, causing the expectant mother to experience shortness of breath.

At a later stage, the location of the diaphragm changes: the growing uterus lifts 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 leads to intrauterine oxygen starvation in the baby with the appearance of various disorders.

The main deviations in the baby:

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

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

How does childbirth occur with asthma?

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

The doctor strictly monitors all indicators of the expectant mother and baby. During childbirth, a woman is given a medicine to prevent an asthma attack. It will not harm the fetus and has a beneficial effect on the patient’s well-being.

When bronchial asthma becomes severe with frequent attacks, a planned caesarean 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 block than inhalation anesthesia.

The most common complications during childbirth caused by bronchial asthma:

• premature rupture of amniotic fluid;
• rapid birth, which has a negative impact on the baby’s health;
• discoordination of labor.

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

How to deal with asthma during pregnancy - proven methods

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 the use of some medications during pregnancy, while the doses of others should be adjusted.

Throughout pregnancy, the doctor monitors the condition of the baby, performing ultrasonography. If an exacerbation begins, oxygen therapy is carried out, which prevents oxygen starvation of the baby. 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 to restore external respiration, eliminate asthma attacks, relieve side effects from medications and control the disease.

Bronchodilators are prescribed to treat mild asthma. They allow you to relieve spasm of smooth muscles in the bronchi.

During pregnancy, long-acting drugs (Salmeterol, Formoterol) are used. They are available in the form of aerosol cans. They are used daily and prevent the development of nighttime asthma attacks.

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

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

When the expectant mother suffers from late gestosis, methylxanthines (Eufillin) 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 respiratory tract. They stimulate the work of the bronchial glands and increase the activity of the ciliated epithelium.

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

Treatment includes the following medications:

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

What drugs should pregnant women not take for treatment?

During the period of bearing a child, you should not use medications without medical advice, and even more so if you have bronchial asthma. You must follow all instructions exactly.

There are medications that are contraindicated for asthmatic women. They can have a harmful effect on the fetal health of the baby and the condition of the mother.

List of prohibited drugs:

Drug name	Negative influence	During what period are they contraindicated?
Adrenalin	Causes oxygen starvation of the fetus, provokes the development of vascular tone in the uterus	Throughout pregnancy
Short-acting bronchodilators – Fenoterol, Salbutamol	Complicates and delays childbirth	In late gestation
Theophylline	Enters the fetal circulation through the placenta, causing rapid heartbeat in the baby	In the 3rd trimester
Some glucocorticoids – Dexamethasone, Betamethasone, Triamcinolone	Negatively affects the fetal muscular system	Throughout pregnancy
Second generation antihistamines - Loratadine, Dimetindene, Ebastine	The resulting side effects negatively affect the health of the woman and child.	During the entire gestational period
Selective β2-blockers (Ginipral, Anaprilin)	Causes bronchospasm, significantly worsening the patient's condition	Contraindicated in bronchial asthma, regardless of pregnancy duration
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 treatment methods are widely used by patients with bronchial asthma. Such remedies cope well with attacks of suffocation and do not harm the body.

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

How to fight asthma with traditional medicine recipes:

1. Oatmeal broth. Prepare and wash 0.5 kg of oats well. Put 2 liters of milk on gas, add 0.5 ml of water. Bring to a boil, pour in the cereal. Cook for another 2 hours to obtain 2 liters of broth. Take the product hot on an empty stomach. Add 1 tsp to 1 glass of drink. honey and butter.
2. Oatmeal broth with goat milk. Pour 2 liters of water into the pan. Bring to a boil, then stir in 2 cups oats. Boil the product over low heat for about 50–60 minutes. Then pour in 0.5 liters of goat milk and boil for another half hour. Before taking the decoction, you can add 1 teaspoon of honey. Drink ½ glass 30 minutes before meals.
3. Inhalation with propolis and beeswax. Take 20 g of propolis and 100 g beeswax. Heat the mixture in a water bath. When she warms up, cover her head with a towel. After this, inhale the product through your mouth for about 15 minutes. Repeat these procedures morning and evening.
4. Propolis oil. Mix 10 g of propolis with 200 g of sunflower oil. Heat the product in a water bath. Strain it and take 1 tsp. in the morning and in the evening.
5. Ginger juice. Extract the juice from the root of the plant, adding a little salt. The drink is used to combat attacks and as a preventive measure. To relieve choking, take 30 g. To prevent difficulty breathing, drink 1 tbsp daily. l. juice For taste, add 1 tsp. honey, washed down with water.

Disease prevention

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

The pregnant woman herself can also take care of her health. Smoking must be stopped. If relatives living with expectant mother, smoke, you should avoid inhaling smoke.

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

1. Review your diet, exclude foods that cause allergies from the menu.
2. Wear clothes and use bedding made from natural materials.
3. Take a shower every day.
4. Do not contact animals.
5. Use hygiene products that have a hypoallergenic composition.
6. Use special humidifier devices that maintain the necessary humidity and clean the air of dust and allergens.
7. Take long walks in the fresh air.
8. If you work with chemicals or toxic fumes, move to a safe work area.
9. Beware of large crowds of people, especially in the autumn and spring seasons.
10. Avoid allergens in your daily life. Wet clean rooms regularly, avoiding inhalation of household chemicals.

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

Conclusion

Bronchial asthma and pregnancy are not mutually exclusive. Often the disease occurs or worsens when an “interesting situation” occurs. Don't ignore symptoms: asthma can negatively affect the health of mother and child.

Do not be afraid that the disease will cause any complications for the baby. With proper medical monitoring and adequate therapy, the prognosis is favorable.