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ir
months
2 weeks of drug discontinuation
1 week cough, sputum and dyspnea
She is 3 mo pregnant
She is concerned about her chest
disease during pregnancy
Is it really asthma?
Why me? I had no family history.
Does pregnancy cause my asthma to be
exacerbated?
Can my asthma be cured?
Can moisturizers help me to improve?
How does asthma affect my fetus?
Are asthma drugs risky for my fetus?
Is my child more prone to asthma?
Can heartburn cause my asthma?
Should I get flu shot?
What should I do in the case of asthma
attack?
Can I do NVD for termination of
Pregnancy dyspnea
Increased tidal volume
Decreased ERV and RV and FRC
Intact FEV1
Less than normal PCo2
Above normal PO2
suggests asthma
pregnant women
susceptible person,
who exposed to specific etiologic factors
twins
exacerbation
Discontinuation of drugs
Viral infections
outcome in pregnancy
confirm control by
Spirometry
Monthly
Peak flow metry
Twice daily
Upon awakening
After 12 hr
As asthma is an inflammatory
(controllers)
You treat your patient's disease, and
You can control inflammation
You reduce the risk of
Asthma attack
Airway remodeling in your patient
Safety
Salbutamol
Inhaled
corticosteroids
Cromolyn
Theophylline
Category B, Budesonide
Safe
Safe (5-12 mcg/ml)
clearance in 3rdtrimester
Cord blood level the same
Load 5-6 mg/kg
Maintenance 0.5mg/kg/hr
Delayed labor
Drug
Safety
LABA
Adrenaline
Not reassuring
Not for asthma
Systemic steroids
Pre-eclampsia, GDM
Prematurity, LBW
Atroent
Leukotrene
Safe
Ziluten not assessed
Zafirleukast,
antagonists
monteleukast
probably safe
Mild intermittent
PRN Salbutamol
Mild persistent
Inhaled corticoteroid
Moderate persistent
Inhaled corticoteroid
Severe persistent
+ LABA
Inhaled corticoteroid
+ LABA
Drug
y
Age
Beclomethasone
Budesonide
Budesonide-Neb
Inhalation Suspension
Ciclesonide
>5y
Age
200-500
<5y
100-200
200-600
100200
>5y
80 160
<5y5
>500-1000
>200-400
600-1000
>200-400
250500
Age
>500-
>400
>400
>1000
1000
80-160
>160-320
>160-320
>320-1280
>750-1250
>2000
>1250
>200-500
>500
>500
Flunisolide
500-1000
750
500-
>1000-2000
Fluticasone
100-250
200
100-
>250-500
Mometasone furoate
200-400
200
100-
> 400-800
>200-400
>800-1200
Triamcinolone acetonide
400-1000
800
400-
>1000-2000
>800-1200
>2000
>320
>400
>1200
Drug
y
Age
Beclomethasone
Budesonide
Budesonide-Neb
Inhalation Suspension
Ciclesonide
>5y
Age
200-500
<5y
100-200
200-600
100200
>5y
80 160
<5y5
>500-1000
>200-400
600-1000
>200-400
250500
Age
>500-
>400
>400
>1000
1000
80-160
>160-320
>160-320
>320-1280
>750-1250
>2000
>1250
>200-500
>500
>500
Flunisolide
500-1000
750
500-
>1000-2000
Fluticasone
100-250
200
100-
>250-500
Mometasone furoate
200-400
200
100-
> 400-800
>200-400
>800-1200
Triamcinolone acetonide
400-1000
800
400-
>1000-2000
>800-1200
>2000
>320
>400
>1200
Drug
y
Age
Beclomethasone
Budesonide
Budesonide-Neb
Inhalation Suspension
Ciclesonide
>5y
Age
200-500
<5y
100-200
200-600
100200
>5y
80 160
<5y5
>500-1000
>200-400
600-1000
>200-400
250500
Age
>500-
>400
>400
>1000
1000
80-160
>160-320
>160-320
>320-1280
>750-1250
>2000
>1250
>200-500
>500
>500
Flunisolide
500-1000
750
500-
>1000-2000
Fluticasone
100-250
200
100-
>250-500
Mometasone furoate
200-400
200
100-
> 400-800
>200-400
>800-1200
Triamcinolone acetonide
400-1000
800
400-
>1000-2000
>800-1200
>2000
>320
>400
>1200
Drug
y
Age
Beclomethasone
Budesonide
Budesonide-Neb
Inhalation Suspension
Ciclesonide
>5y
Age
200-500
<5y
100-200
200-600
100200
>5y
80 160
<5y5
>500-1000
>200-400
600-1000
>200-400
250500
Age
>500-
>400
>400
>1000
1000
80-160
>160-320
>160-320
>320-1280
>750-1250
>2000
>1250
>200-500
>500
>500
Flunisolide
500-1000
750
500-
>1000-2000
Fluticasone
100-250
200
100-
>250-500
Mometasone furoate
200-400
200
100-
> 400-800
>200-400
>800-1200
Triamcinolone acetonide
400-1000
800
400-
>1000-2000
>800-1200
>2000
>320
>400
>1200
Choice of drug
categories in pregnancy
Category
Drug of choice
SABA
LABA
Salbutamol
Salmetrol
ICS
Budesonide
to become worse
Room humidity of > 50%
speed up growth of mites and fungi
Avoidance from
allergens,
irritants and
air pollution
pregnant woman
period.
(GERD)
Allergic rhinitis (AD)
Be suspicious to GERD if
Your asthmatic patient become poorly
controllable
Your asthmatic patient is worse at night
Your asthmatic patient has symptoms
when lies down
Patient complains of GERD symptoms
asthma symptoms
Continue anti GERD drugs for at least
2-3 months
Be suspicious to AD if
Your asthmatic patient complains of
Treat AD with
Intranasal corticosteroids
Antihistamines (2nd generation in
pregnancy)
Allergen avoidance
trimester
In cold months
ml/hour
Seated position
Fetal monitoring
different
IV aminophylline NOT generally
recommended
IV Mg sulfate may be beneficial
Concomitant hypertension
Preterm contraction
patients
Usually viral
No difference
PG F2 analogues should not be used
in asthmatics
for termination of pregnancy
avoided
Fentanyl is an appropriate alternative
section
Epidural anesthesia is the favoured
anesthesia
Decreses O2 consumption and minute
ventilation
Summary
Careful assessment and
monitoring
Avoidance and controll
of triggers
Maintenance rather than
symptomatic therapy
Aggressive treatment of
exacerbations