REVERSAL OF INTRACTABLE ACUTE SEVERE ASTHMA BY FIRST-TRIMESTER TERMINATION OF PREGNANCY

A 19-year-old woman was admitted with acute severe asthma in her eleve nth week of pregnancy. Despite vigorous therapy, severe hypoventilatio n and hypoxemia persisted with mechanical ventilation. Termination of pregnancy resulted in dramatic improvement in airflow. Her course was complicated by pneumonia, barotrauma, and atelectasis accompanying her moribund state. Although she immediately improved following abortion (within 2 hr, peak airway pressure fel I from >70 to 38 cmH(2)O, witho ut change in plateau pressure), superimposed morbidities improved more slowly, and the patient made a complete recovery. The mechanism accou nting for this observation is unknown but the rapid improvement follow ing abortion suggests that increased bronchomotor tone predominated in flammatory changes in causing flow limitation.