Bronchial asthma is a chronic pathology that often affects women of childbearing age. The uncontrolled course of the disease leads to the development of complications from both the mother and the fetus. However, concepts such as bronchial asthma and pregnancy are quite compatible. With proper treatment and constant medical supervision, there is a high probability of giving birth. healthy child and not harm your body.

Course of the disease during pregnancy

It is difficult to predict how the disease will behave during pregnancy. It was noted that in people with mild and moderate bronchial asthma, the condition either does not change or, on the contrary, improves. But in women with severe pathology, the number of attacks and their severity often increase during pregnancy. However, there are exceptions. Therefore, a woman should be under the supervision of specialists throughout the entire period of gestation.

It was also noted that during the first trimester the disease is more severe, and after the 13th week the condition improves. If the disease worsens, the woman should be hospitalized in a clinic, where the medications will be replaced with ones that are safe for the body of the mother and fetus.

Possible maternal complications

• Increased frequency of attacks.
• Development of infectious diseases of the respiratory tract.
• Premature birth.
• Threat of miscarriage.
• Development of gestosis (toxicosis).

Possible fetal complications

Asthma during pregnancy leads to insufficient oxygen supply to the placental bloodstream. Due to frequent attacks of suffocation, fetal hypoxia occurs, which is fraught with serious disorders:

• Insufficient fetal body weight.
• Child development delay.
• Disruption of the development of individual systems (nervous, muscular, cardiovascular).
• Birth injury.
• Asphyxia (suffocation).

The complications described above occur only when the disease is not treated correctly. If the correct therapy is selected for a woman, the child is born healthy and with sufficient body weight. The only complication that occurs quite often is a tendency to allergic diseases. Therefore, after giving birth, a woman should breastfeed her baby for at least 6 months and follow a hypoallergenic diet.

Bronchial asthma and childbirth

When the course of bronchial asthma is controlled, childbirth is carried out naturally. Two weeks before giving birth, the pregnant woman is hospitalized in the clinic for preparation. The vital signs of the mother and fetus are monitored more often, and childbirth is carried out in the department of pathology of pregnant women. During delivery, drugs against bronchial asthma are administered, which prevent the development of an attack and do not harm the child.

If a pregnant woman experiences frequent asthma attacks, that is, asthma is not controlled, delivery is performed by cesarean section at 38 weeks. During this period, the fetal body is sufficiently formed to exist independently. And refusal to have a cesarean section risks the complications described above.

How to treat bronchial asthma in pregnant women?

During pregnancy, you cannot take the same course of treatment as outside the position. Some medications are contraindicated for expectant mothers, and some require a dose reduction. Treatment of asthma during pregnancy is based on preventing attacks and taking medications that are safe for the child.

The main goals of therapy are:

• Improving external respiration function.
• Prevention of asthmatic attacks.
• Prevention of development side effects medicines.
• Quick relief of attacks.

In order to reduce the risk of exacerbation of the disease and prevent complications, a pregnant woman should take the following measures:

• Follow a hypoallergenic diet.
• If possible, use clothes and underwear made from natural fabrics.
• In everyday hygiene, use hypoallergenic shower gels, creams and detergents.
• Reduce contact with dust.
• Use air filters and humidifiers.
• Do not come into contact with animal fur.
• Walk more outside, away from places of air pollution.
• When working with harmful substances switch to safer work.

Treatment of asthma during pregnancy is carried out with bronchodilators and expectorants. It is also important to regularly perform breathing exercises and avoid emotional and physical stress.

What drugs are contraindicated during pregnancy?

• Adrenalin. If outside of pregnancy this drug is often used to relieve attacks, then pregnant women should not use it. Adrenaline leads to spasm of the uterine vessels, resulting in fetal hypoxia.
• Salbutamol, fenoterol and terbutaline. The drugs can be taken during pregnancy, but only under the supervision of a doctor. In the later stages, these medications help lengthen the labor period, since their analogues are used in gynecology to prevent premature birth.
• Theophylline. The medicine crosses the placenta and, when taken in the third trimester, may increase the fetal heart rate.
• Triamcinolone. It has a negative effect on the development of the fetal muscular system. Also, betamethasone and dexamethasone are contraindicated among glucocorticosteroids.
• Brompheniramine, ketotifen and other 2nd generation antihistamines.

Traditional medicine in the treatment of bronchial asthma

Traditional recipes for the treatment of bronchial asthma should be used in addition to drug treatment. However, you should not use any prescription without consulting a doctor, or if you have an individual intolerance to the components of the product.

• Peel and rinse a half-liter jar of oats. Boil 2 liters of milk and 0.5 liters of water, add oats and boil for 2 hours. The result is 2 liters of decoction. To take it you need to add 1 tsp to 150 ml. honey and 1 tsp. butter. Drink the resulting product hot on an empty stomach.
• Add 2 cups of oats to 2 liters of boiling water and simmer over low heat for an hour. Then add half a liter goat milk and boil for another 30 minutes. After preparation, add honey to the broth and drink 0.5 cups 30 minutes before meals.
• Place 20 g of propolis and 100 g of beeswax in a water bath. After the mixture has warmed up, cover your head with a towel and inhale the vapors through your mouth for 15 minutes. The procedure can be carried out 2 times a day.
• To prepare propolis oil, you need to mix 10 g of propolis and 200 g vegetable oil. Heat the mixture in a water bath for 30 minutes, then strain. Take 2 times a day, 1 teaspoon.
• Extract the juice from fresh ginger root and add salt. Take approximately 30 g when an attack occurs. To prevent attacks, it is recommended to drink 1 tbsp. with honey before bed. You can take the resulting medicine with water or tea.

Bronchial asthma is a serious disease. However, with adequate therapy, the disease does not threaten even during pregnancy. The main thing is regular medical supervision and taking prescribed medications.

Treatment of bronchial asthma in women during pregnancy

The main objectives of the treatment of bronchial asthma in pregnant women include normalization of respiratory function, prevention of exacerbations of bronchial asthma, elimination of side effects of anti-asthmatic drugs, relief of attacks of bronchial asthma, which is considered the key to the correct uncomplicated course of pregnancy and the birth of a healthy child.

BA therapy in pregnant women is carried out according to the same rules as in non-pregnant women. The basic principles are increasing or decreasing the intensity of therapy as the severity of the disease changes, taking into account the characteristics of the course of pregnancy, mandatory monitoring of the course of the disease and the effectiveness of the prescribed treatment using peak flowmetry, the preferable use of the inhalation route of drug administration.

Medicines prescribed for bronchial asthma are divided into:

• basic - controlling the course of the disease (systemic and inhaled glucocorticoids, cromones, long-acting methylxanthines, long-acting β2-agonists, antileukotriene drugs), they are taken daily, for a long time;
• symptomatic, or drugs emergency care(inhaled β2-agonists fast action, anticholinergic drugs, methylxanthines, systemic glucocorticoids) - quickly eliminate bronchospasm and the accompanying symptoms: wheezing, a feeling of “tightness” in the chest, cough.

Treatment is chosen based on the severity of bronchial asthma, the availability of anti-asthmatic drugs and individual conditions the patient's life.

Among β2-adrenergic agonists during pregnancy, it is possible to use salbutamol, terbutaline, fenoterol. Anticholinergics used in the treatment of bronchial asthma in pregnant women include ipratropium bromide in the form of an inhaler or a combined drug “Ipratropium bromide + fenoterol”. Drugs of these groups (both beta2-mimetics and anticholinergics) are often used in obstetric practice to treat threatened miscarriage. Methylxanthines, which include aminophylline and aminophylline, are also used in obstetric practice in the treatment of pregnant women, in particular in the treatment of gestosis. Cromones - cromoglycic acid, used in the treatment of bronchial asthma as a basic anti-inflammatory drug for mild bronchial asthma, due to their low effectiveness, on the one hand, and the need to obtain a quick therapeutic effect, on the other (taking into account the presence of pregnancy and the risk of development or increase phenomena of fetoplacental insufficiency in conditions of unstable disease), have limited use during pregnancy. They can be used in patients who have used these drugs with sufficient effect before pregnancy, provided that the disease remains stable during pregnancy. If it is necessary to prescribe basic anti-inflammatory therapy during pregnancy, preference should be given to inhaled glucocorticoids (budesonide).

• With intermittent bronchial asthma, most patients are not recommended to take daily medications. Treatment of exacerbations depends on the severity. If necessary, a rapid-acting inhaled beta2-agonist is prescribed to eliminate the symptoms of bronchial asthma. If severe exacerbations are observed with intermittent bronchial asthma, then such patients should be treated as patients with persistent bronchial asthma of moderate severity.
• Patients with mild persistent bronchial asthma require daily use of medications to maintain disease control. Preferable treatment with inhaled glucocorticoids (budesonide 200–400 mcg/day or
• For persistent bronchial asthma of moderate severity, combinations of inhaled glucocorticoids (budesonide 400–800 mcg/day, or beclomethasone 500–1000 mcg/day or equivalent) and long-acting inhaled beta2-agonists 2 times a day are prescribed. An alternative to a beta2-agonist in this combination therapy is long-acting methylxanthine.
• Treatment of severe persistent asthma includes high-dose inhaled glucocorticoids (budesonide > 800 mcg/day or > 1000 mcg/day beclomethasone or equivalent) in combination with long-acting inhaled β2-agonists twice daily. An alternative to long-acting inhaled β2-agonists is an oral β2-agonist or long-acting methylxanthine.Oral glucocorticoids may be prescribed.
• After achieving control of bronchial asthma and maintaining it for at least 3 months, a gradual reduction in the volume of maintenance therapy is carried out, and then the minimum concentration required to control the disease is determined.

Along with the direct effect on asthma, such treatment also affects the course of pregnancy and fetal development. First of all, these are antispasmodic and antiaggregation effects obtained with the use of methylxanthines, a tocolytic effect (decreased tone, relaxation of the uterus) with the use of β2-agonists, immunosuppressive and anti-inflammatory effects with glucorticoid therapy.

When carrying out bronchodilator therapy, patients with threatened miscarriage should give preference to tableted β2-mimetics, which, along with bronchodilator, will also have a tocolytic effect. In the presence of gestosis, it is advisable to use methylxanthines - aminophylline - as a bronchodilator. If systemic use of hormones is necessary, prednisolone or methylprednisolone should be preferred.

When prescribing pharmacotherapy to pregnant women with bronchial asthma, it should be taken into account that for most anti-asthmatic drugs no adverse effects on the course of pregnancy have been noted. At the same time, there are currently no drugs with proven safety in pregnant women, because controlled clinical trials are not conducted in pregnant women. The main task of treatment is to select the minimum required doses of drugs to restore and maintain optimal and stable bronchial patency. It should be remembered that the harm from the unstable course of the disease and the respiratory failure that develops for the mother and fetus is disproportionately higher than the possible side effects of drugs. Rapid relief of exacerbation of bronchial asthma, even with the use of systemic glucocorticoids, is preferable to a long-term uncontrolled or poorly controlled course of the disease. Refusal of active treatment invariably increases the risk of complications for both mother and fetus.

During childbirth, treatment for bronchial asthma does not need to be stopped. Therapy with inhaled drugs should be continued. For women in labor who received tableted hormones during pregnancy, prednisolone is administered parenterally.

Due to the fact that the use of β-mimetics during childbirth is associated with the risk of weakening labor activity, when carrying out bronchodilator therapy during this period, preference should be given to epidural anesthesia at the thoracic level. For this purpose, puncture and catheterization of the epidural space in the thoracic region at the level of ThVII–ThVIII is performed with the introduction of 8–10 ml of 0.125% bupivacaine solution. Epidural anesthesia allows you to achieve a pronounced bronchodilator effect and create a kind of hemodynamic protection. No deterioration of fetal-placental blood flow was observed during the administration of local anesthetic. At the same time, conditions are created for spontaneous delivery without the exception of pushing in the second stage of labor, even in severe cases of the disease that disable the patient.

Exacerbation of bronchial asthma during pregnancy is an emergency condition that threatens not only the life of the pregnant woman, but also the development intrauterine hypoxia the fetus until its death. In this regard, treatment of such patients should be carried out in a hospital setting with mandatory monitoring of the state of the function of the fetoplacental complex. The mainstay of treatment for exacerbations is the administration of β2-agonists (salbutamol) or their combination with an anticholinergic drug (ipratropium bromide + fenoterol) via nebulizer. Inhaled administration of glucocorticosteroids (budesonide - 1000 mcg) through a nebulizer is an effective component of combination therapy. Systemic glucocorticosteroids should be included in treatment if, after the first nebulized administration of β2-agonists, no sustained improvement was obtained or an exacerbation developed while taking oral glucocorticosteroids. Due to the peculiarities that occur in the digestive system during pregnancy (longer gastric emptying), parenteral administration of glucocorticosteroids is preferable to taking drugs per os.

Bronchial asthma is not an indication for termination of pregnancy. In the case of an unstable course of the disease, severe exacerbation, termination of pregnancy is associated with a high risk to the patient’s life, and after the exacerbation has stopped and the patient’s condition has stabilized, the question of the need to terminate the pregnancy disappears altogether.

Delivery of pregnant women with bronchial asthma

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 worsen the condition of the patients.

In most patients, labor ends spontaneously (83%). Among the complications of childbirth, the most common are rapid labor (24%), antepartum rupture amniotic fluid(13%). In the first stage of labor - anomalies of labor (9%). The course of the second and third stages of labor is determined by the presence of additional extragenital, obstetric pathology, and the characteristics of the obstetric and gynecological history. In connection with the available data on the possible bronchospastic effect of methylergometrine, when preventing bleeding in the second stage of labor, preference should be given to intravenous administration of oxytocin. Childbirth, as a rule, does not worsen the condition of patients. With adequate treatment of the underlying disease, careful management of labor, careful observation, pain relief and prevention of purulent-inflammatory diseases, complications in postpartum period is not observed in these patients.

However, in severe cases of the disease, disabling patients, a high risk of development, or with the presence of respiratory failure, delivery becomes a serious problem.

In pregnant women with severe bronchial asthma or uncontrolled bronchial asthma of moderate severity, status asthmaticus during this pregnancy, exacerbation of the disease at the end of the third trimester, delivery is a serious problem due to significant impairments in the function of external respiration and hemodynamics, and a high risk of intrauterine fetal suffering. This group of patients is at risk of developing severe exacerbation of the disease, acute respiratory and cardiac failure during delivery.

Considering the high degree of infectious risk, as well as the risk of complications associated with surgical trauma during serious illness with signs of respiratory failure, the method of choice is planned vaginal delivery.

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 marcaine, which provides a pronounced bronchodilator effect. Then labor is induced by amniotomy. The behavior of the woman in labor during this period is active.

With the onset of regular labor, labor pain relief begins with epidural anesthesia at the L1–L2 level.

The introduction of a long-acting anesthetic in low concentration does not limit the woman’s mobility, does not weaken efforts in the second stage of labor, has a pronounced bronchodilator effect (increasing the forced vital capacity of the lungs - FVC, FEV1, POS) and allows you to create a kind of hemodynamic protection. There is an increase in shock output of the left and right ventricles. Changes in fetal blood flow are noted - a decrease in resistance to blood flow in the vessels of the umbilical cord and the fetal aorta.

Against this background, spontaneous delivery becomes possible without the exception of pushing in patients with obstructive 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 cesarean section. Due to the fact that endotracheal anesthesia poses the greatest risk, the method of choice for pain relief for caesarean section is epidural anesthesia.

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 supervision 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 spontaneous interruption pregnancy.
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 takes a severe course with more frequent attacks, a planned C-section 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.

On later 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:

ethnoscience

Unconventional methods treatments 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 of 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, eliminates the effect 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 Everyday 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.

Preservation normal indicators external respiration function (ERF) during gestation (bearing a child) is necessary to maintain wellness women and proper fetal development. Otherwise, hypoxia occurs - oxygen starvation, which entails many adverse consequences. Let's figure out what features bronchial asthma has during pregnancy and what are the basic principles of treating the disease and preventing exacerbations.

Causes

Although the development of asthma may coincide with the period of pregnancy, a woman usually suffers from this disease even before conception, often from childhood. There is no single cause of the inflammatory process in the respiratory system, but there are quite a few a large number of provoking factors (triggers):

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

Patients suffer from asthma throughout their lives, and the course of the disease usually worsens in the first trimester and stabilizes (with adequate therapy) in the second half of pregnancy. Between periods of remission (no symptoms), exacerbations occur due to a number of triggers:

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

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

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

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

Why is asthma dangerous during pregnancy?

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

• early toxicosis;
• formation of a threat of termination of pregnancy;
• development of labor disorders;
• spontaneous abortion.

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

Symptoms

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

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

Soon you can observe a combination of characteristic signs:

1. Shortness of breath with difficulty in exhaling.
2. Paroxysmal cough.
3. Noisy breathing that can be heard at a distance from the patient.
4. Whistling dry rales in the lungs.

Woman takes a sitting position and tenses her muscles chest, shoulder girdle and neck to relieve difficulty breathing. She has to rest her hands on a hard surface. The face takes on a bluish tint, and cold sweat breaks out on the skin. The separation of viscous, “glassy” sputum indicates the end of the attack.

During pregnancy, there is also a risk of status asthmaticus - a severe attack in which conventional medications do not work, and airway patency decreases sharply, leading to suffocation (asphyxia). In this case, the patient limits physical activity, taking a forced position with support on his hands, is silent, breathes quickly or, on the contrary, rarely, superficially. There may be no wheezing (“silent lung”), consciousness is depressed to the point of coma.

Diagnostics

The examination program is based on such methods as:

• survey;
• inspection;
• laboratory tests;
• functional tests to assess respiratory function.

When talking with the patient, you need to determine what causes the attack and understand whether there is a hereditary predisposition to asthma. The examination allows you to find out the characteristics of the current objective condition. As for laboratory tests, they can have a general or specific focus:

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

The “gold standard” of functional tests is spirography and peak flowmetry - measurement using special devices of such parameters of respiratory function as:

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

Skin tests with allergens are prohibited during pregnancy.

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

Treatment

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

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

Principles of pregnancy management

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

Drug therapy

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

• no side effects for mother/fetus when taken in standard therapeutic dosages (B);
• toxic effects have been documented in humans and animals, but the risk of discontinuing the drug is higher than the likelihood of side effects (C).

There are no Category A medications available to treat asthma (meaning studies have shown no risk to the fetus). However correct application level B and, if necessary, level C funds usually do not entail negative consequences. For basic or basic therapy the following are used:

The therapy is stepwise: for mild asthma, medications are used as required (usually Salbutamol, Ipratropium bromide), and then other medications are added (depending on the severity of the condition). If a woman was taking leukotriene receptor antagonists before pregnancy, it is advisable to continue therapy with them.

Help with exacerbations

If a pregnant woman has an asthma attack, you must:

• stop the trigger (if it can be identified - food, cosmetics, etc.);
• open a window or window if the situation occurs indoors;
• unbutton or remove clothing that interferes with breathing (shirt buttons, heavy coat);
• help use a medicine inhaler - for example, Salbutamol;
• Call an ambulance.

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

Management of childbirth

It is carried out against the background of basic therapy for asthma, which the patient received during gestation. In the absence of attacks, respiratory function indicators are assessed every 12 hours, in case of exacerbation - as needed. If a woman was prescribed systemic glucocorticosteroids during pregnancy, she is switched from Prednisolone to Hydrocortisone - for the period of labor and for 24 hours after the birth of the child.

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

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

To prevent exacerbation of bronchial asthma, it is necessary:

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

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

Asthma occurs in 4-8% of pregnant women. When pregnancy occurs, approximately one third of patients experience improvement in symptoms, a third experience worsening (usually between 24 and 36 weeks), and another third experience no change in the severity of symptoms.

Asthma exacerbations during pregnancy significantly impair fetal oxygenation. Severe, uncontrolled asthma is associated with complications in both women (preeclampsia, vaginal bleeding, obstructed labor) and newborns (increased perinatal mortality, intrauterine growth restriction, premature birth, reduced weight of newborns, hypoxia in the neonatal period). In contrast, women with controlled asthma who receive adequate therapy have minimal risk of complications. First, in pregnant patients with asthma, it is important to assess the severity of symptoms.

Management of pregnant patients with bronchial asthma includes:

• lung function monitoring;
• limiting the factors that cause attacks;
• patient education;
• selection of individual pharmacotherapy.

In patients with a persistent form of bronchial asthma, indicators such as peak expiratory flow - PEF (must be at least 70% of the maximum), forced expiratory volume (FEV), and regular spirometry should be monitored.

Stepped therapy is selected taking into account the patient’s condition (the minimum effective dose of drugs is selected). In patients with severe asthma, in addition to the above measures, ultrasound should be constantly performed to monitor the child’s condition.

Regardless of the severity of symptoms, the most important principle in the management of pregnant patients with bronchial asthma is to limit exposure to factors that cause attacks; With this approach it is possible to reduce the need for drugs.

If the course of asthma cannot be controlled by conservative methods, it is necessary to prescribe anti-asthmatic drugs. Table 2 provides information about their safety (FDA safety categories).

Short acting beta agonists

To relieve attacks, it is preferable to use selective beta-agonists. Salbutamol, the most commonly used drug for these purposes, is classified as FDA category C.

In particular, salbutamol can cause tachycardia and hyperglycemia in the mother and fetus; hypotension, pulmonary edema, congestion of the systemic circulation in the mother. Use of this drug during pregnancy may also cause retinal circulatory problems and retinopathy in newborns.

Pregnant women with intermittent asthma who need to take short-acting beta-agonists more than twice a week may be prescribed long-term basal therapy. Similarly, disease-modifying medications may be prescribed to pregnant women with persistent asthma when short-acting beta-agonists are required 2 to 4 times per week.

Long acting beta agonists

For severe persistent asthma, the Asthma in Pregnancy Study Group ( Asthma and Pregnancy Working Group) recommends a combination of long-acting beta-agonists and inhaled glucocorticoids as the drugs of choice.

The use of the same therapy is possible in case of moderate persistent asthma. In this case, salmaterol is preferable to formoterol due to the longer experience with its use; this drug is the most studied among its analogues.

The FDA safety category for salmeterol and formoterol is C. The use of adrenaline and drugs containing alpha-adrenergic agonists (ephedrine, pseudoephedrine) to relieve attacks of bronchial asthma (ephedrine, pseudoephedrine) is contraindicated (especially in the first trimester), although all of them also belong to category C.

For example, the use of pseudoephedrine during pregnancy is associated with an increased risk of fetal gastroschisis.

Inhaled glucocorticoids

Inhaled glucocorticoids are the group of choice for pregnant women with asthma who require basic therapy. These drugs have been shown to improve lung function and reduce the risk of worsening symptoms. At the same time, the use of inhaled glucocorticoids is not associated with the occurrence of any congenital anomalies in newborns.

The drug of choice is budesonide - this is the only drug in this group that is classified as safety category B by the FDA, which is due to the fact that it (in the form of inhalation and nasal spray) has been studied in prospective studies.

An analysis of data from three registries, covering 99% of pregnancies in Sweden from 1995 to 2001, confirmed that the use of inhaled budesonide was not associated with the occurrence of any congenital anomalies. At the same time, the use of budesonide is associated with premature birth and low birth weight of newborns.

All other inhaled glucocorticoids used to treat asthma are category C. However, there is no evidence that they may be unsafe during pregnancy.

If asthma is successfully controlled with any inhaled glucocorticoid, changing therapy during pregnancy is not recommended.

Glucocorticosteroids for systemic use

All oral glucocorticoids are classified as FDA safety category C. The Asthma in Pregnancy Study Group recommends the addition of oral glucocorticoids to high-dose inhaled glucocorticoids in pregnant women with uncontrolled severe persistent asthma.

If it is necessary to use drugs of this group in pregnant women, triamcinolone should not be prescribed due to the high risk of developing myopathy in the fetus. Long-acting medications such as dexamethasone and betamethasone (both FDA Category C) are also not recommended. Preference should be given to prednisolone, the concentration of which decreases by more than 8 times when passing through the placenta.

A recent study showed that the use of oral glucocorticoids (especially in early pregnancy), regardless of the drug, slightly increases the risk of cleft palates in children (by 0.2-0.3%).

Other possible complications problems associated with taking glucocorticoids during pregnancy include preeclampsia, premature birth, and low birth weight of newborns.

Theophylline preparations

According to the recommendations of the Asthma in Pregnancy Study Group, theophylline at recommended doses (serum concentration 5-12 mcg/ml) is an alternative to inhaled glucocorticoids in pregnant patients with mild persistent asthma. It can also be added to glucocorticoids in the treatment of moderate to severe persistent asthma.

Taking into account the significant decrease in the clearance of theophylline in the third trimester, it is optimal to study the concentration of theophylline in the blood. It should also be taken into account that theophylline freely passes through the placenta, its concentration in the fetal blood is comparable to the maternal one, when used in high doses shortly before birth, a newborn may experience tachycardia, and with prolonged use, the development of withdrawal syndrome.

The use of theophylline during pregnancy has been suggested (but not proven) to be associated with preeclampsia and an increased risk of preterm birth.

Cromony

The safety of sodium cromoglycate preparations in the treatment of mild bronchial asthma was proven in two prospective cohort studies, the total number of patients receiving cromones was 318 out of 1917 pregnant women examined.

However, data on the safety of these drugs during pregnancy are limited. Both nedocromil and cromoglycate are classified as FDA safety category B. Cromones are not the group of choice in pregnant patients due to their lower effectiveness compared to inhaled glucocorticoids.

Leukotriene receptor blockers

Information on the safety of drugs in this group during pregnancy is limited. If a woman is able to control her asthma with zafirlukast or montelukast, the Asthma in Pregnancy Study Group does not recommend interrupting therapy with these drugs during pregnancy.

Both zafirlukast and montelukast are classified as safety category B by the FDA. When taken during pregnancy, no increase in the number of congenital anomalies was observed. Only hepatotoxic effects have been reported in pregnant women when using zafirluxt.

On the contrary, the lipoxygenase inhibitor zileuton in animal experiments (rabbits) increased the risk of cleft palate by 2.5% when used in doses similar to the maximum therapeutic one. Zileuton is classified as safety category C by the FDA.

The Asthma in Pregnancy Study Group allows the use of leukotriene receptor inhibitors (except zileuton) in minimal therapeutic doses in pregnant women with mild persistent asthma, and in the case of moderate persistent asthma, the use of drugs in this group (except zileuton) in combination with inhaled glucocorticoids.

Adequate asthma control is essential for the best pregnancy outcome (for both mother and baby). The attending physician should inform the patient about possible risks associated with the use of drugs, and the risks in the absence of pharmacotherapy.