ASTHMA - MANAGEMENT DURING PREGNANCY

Asthma is one of the most common diseases complicating pregnancy, Unco ntrolled asthma can produce serious maternal and fetal complications; prompt initiation of effective treatment, both pharmacologic and nonph armacologic, is critical. With attentive and appropriate management mo st asthmatics can anticipate a pregnancy outcome similar to an average uncomplicated pregnancy. In patients with severe asthma there remains a higher incidence of preterm delivery and low infant birth weights, The physiologic changes of pregnancy do not alter spirometry and peak expiratory flow rates, which can be employed to monitor the severity o f asthma during pregnancy. Early fetal monitoring with sonography prov ides a benchmark for progressive fetal growth, Sequential sonographic evaluations are indicated if asthma is moderate or severe or if growth retardation is suspected. Patients with anything more than mild occas ional asthma should be treated with anti-inflammatory agents (inhaled steroids or cromolyn/nedocromil), Long-acting beta-2 agonists and/or t heophylline can then be added. Only 10% of women with asthma have an e xacerbation during labor. Patients receiving recent oral corticosteroi ds should receive stress dose steroids during labor and for 24 hours p ostpartum.