Practice

Asthma in pregnancy

BMJ 2007; 334 doi: http://dx.doi.org/10.1136/bmj.39112.717674.BE (Published 15 March 2007) Cite this as: BMJ 2007;334:582
  1. Evelyne Rey, internist1,
  2. Louis-Philippe Boulet, pneumologist2
  1. 1Departments of Medicine and Obstetrics and Gynaecology, Faculty of Medicine, University of Montreal, CHU Ste-Justine, 3175 Côte-Ste-Catherine, Montreal, QC, Canada H3T 1C5
  2. 2Institut de cardiologie et de pneumologie de l'Université Laval, Hôpital Laval, 2725 Chemin Sainte-Foy, Québec City, QC, Canada G1V 4G5
  1. Correspondence to: E Reyevelyne_rey{at}ssss.gouv.qc.ca

    Doctors often encounter pregnant patients who have asthma but have limited knowledge of asthma and its optimal treatment (see Scenario box). After treating an acute episode in a presenting patient, the doctor should advise her about asthma, its impact on pregnancy, and the best way to manage her asthma.

    Scenario

    A 30 year old woman presented to the emergency department complaining of breathlessness. She was 22 weeks pregnant, and her pregnancy had been complicated by nausea and gastric pain. She had had asthma since childhood, had visited the emergency room at least once a year in the previous three years, but had not been followed up regularly. She had used inhaled budesonide irregularly in the past and stopped this medication when she became pregnant. She had been having flu-like symptoms in the previous week and used inhaled salbutamol three or four times a day with partial relief.

    On examination, we observed a low grade temperature, normal blood pressure, tachycardia (120 beats/min), tachypnoea (28 breaths/min), expiratory wheezes on chest auscultation, and a normal fetal heart rate. Her oxygen saturation was 96% and spirometry showed a forced expiratory volume in one second of 42% predicted.

    The initial treatment was inhaled salbutamol, oxygen at 5 l/min, and oral prednisone 40 mg. She improved sufficiently within 24 hours to be discharged with prednisone for a week, in addition to regular budesonide and (on demand) terbutaline, medication which was used until delivery. She was referred to an asthma educator and regular medical follow-up appointments were scheduled.

    How common is asthma in pregnancy?

    Asthma is a serious health problem worldwide, and its prevalence has increased in the past two decades.w1 With 3.4%-12.4% of pregnant women having asthma, it is the most common chronic condition in pregnancy.w2 w3 The many national and international guidelines on the management of asthma apply also to …

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