Dang Thi Thuan Thao, PhD
The Pharmacy Department - Tu Du hospital
In general, asthma is a serious medical status and account for approximately 4-8% of pregnant women.
Prevalence and development of asthma the disease is now increasing, although the morbility rate due to asthma decreased in recent years.
II. The requests
During pregnancy, pregnant women with asthma should be treated with drugs will be safer than enduring symptoms because symptoms may be more serious.
Asthma is not always worse in pregnancy. In fact, it can improve or continue not to change. However, there are about 30% the number of worse cases.
A number of surveys showed that asthma makes pregnancy more complicated and increases the risk of perinatal mortality, pre-eclampsia, premature birth, and reduce body weight babies.
The evaluation of asthma, includes the subjective evaluation and testing of lung function.
During pregnancy, the main goal of asthma treatment is to maintain sufficient oxygen for the fetus by preventing reduction oxygen of tissue in the mother, which make sure to supply enough oxygen to the fetus. Steps of treatment are very detailed in order to adjust drug doses in accordance with state of aggravation of asthma.
For persistent asthma during pregnancy, first therapy includes the use of inhaled corticosteroids.
Avoiding to take corticoid by oral as possible. Corticoid can cause cleft palate, low birth weight, but injecting or taking corticoid in a short time is considered safe. Cleft palate almost did not happen except when the mother takes prednison daily. Many surveys showed that taking oral corticoid in the first trimester of pregnancy is associated with risk of Cleft palate. Moreover, taking corticoid also associated with risk of pre-eclampsia, premature birth and low birth weight.
Pregnant women with asthma are often treated inadequately and the guideline shows that the lack of treatment brings greater risk to the baby than the use of inhaled corticoid.
The survey showed that inhaled corticoid therapy is safe during pregnancy. Renee Ahrens Thomas PhD, Shenandoah University in Winchester, Virginia (USA), said: "The new guide emphasizes that long-term studies shows no relation between defects birth and corticosteroid inhalers. In fact, if we don’t use them, the ability of low birth weight and premature birth will be higher”.
During pregnancy, inhaled corticosteroids, Budesonide,is preferred.
For pregnant women with asthma, therapy is recommended is inhaled albuterol.
Health of the mother can be increased without medication by recognizing and controlling or avoiding exposure to tobacco smoke and other agents of allergic and other irritations.
Immune therapy continue to be recommended on the women who use the maintenance dose with no harmful effects.
During lactation, not contraindicating the use of prednisone, theophylline, oral anti histamines, inhaled corticosteroids, beta2-agonists, and cromolyn. Only a small amount of asthma medication through breast milk.
Severe cases of asthma and poorly control may be related to premature status, pre-eclampsia, limited development in the uterus, complications around perinatal period, and the sickness and death in the mother.
III. The additional requests
1. Self-management of asthma
Self-control disease
Knowledge of the use of inhaled forms
Comply with long-term treatment of asthma plan.
Identify the bad symptoms of asthma quickly.
2. Recognize severe symptoms of asthma
Wheezing: often heard when breathing out.
Cough: extends and often occurs. Cough is also a severe sign of asthma at night.
Stretch chest: feeling like chest was tight.
Short breath: breathe in hard, especially breathing out.
3. Methods of diagnosis
Preferred measurements of lung capacity is a method of testing pulmonary function during examination outpatient. However, measurements with peak flow equipment is appropriate.
For women with severe and average asthma, consider checking the fetal ultrasound before birth.
Pregnant women with asthma should be monitored by peak flow volume test and breathing out volumn, concurrently monitored symptoms of asthma during pregnancy. This measure also applies to patients with mild and well controlled disease.
Pregnant women with long-term asthma status should be evaluated lung function every day, because lung function and severe asthma status may change during pregnancy.
"The proper study shows that women who have well controlled asthma can have a healthy pregnancy with good results on the mother and the perinatal period."
"The ultimate goal of controlling asthma during pregnancy is to ensure that the fetus continues to develop with enough oxygen by preventing asthma attacks."
IV. Drugs treatment for asthma in pregnancy
1. Mild asthma
Use albuterol as needed, and do not use asthma medication every day.
2. Mild persistent asthma
Most appropriatetreatment is low-dose inhaled corticosteroid
Alternative drug is cromolyn, a Leukotriene receptor antagonist, or theophylline aim to achieve plasma concentrations of about 5 to 12 μg / mL.
3. Average persistent asthma
Appropriate therapy is low-dose inhaled corticosteroid and salmeterol, or medium dose inhaled corticosteroids or the average dose inhaled corticosteroid and salmeterol come as needed.
Alternative treatment is low-dose or medium dose (when necessary inhaled corticosteroids, combination of two drugs: Leukotriene receptor antagonist drugs or theophylline to achieve target plasma concentrations of 5 to 12 μg / mL.
4. Severe persistent asthma
Appropriate therapy is high dose inhaled corticosteroid and salmeterol, additional oral corticosteroids as needed.
Alternative treatment is high dose of inhaled corticosteroids and theophylline to achieve plasma concentrations of 5 to 12 μg / mL, additional oral corticosteroids as needed.
V. Conclusion
"The best way to control asthma during pregnancy includes objective monitoring of lung function, preventing or controlling triggers asthma and educating patients. Pharmacological therapy aims to maintain lung functions normally. "
Preferences:
- National Institutes of Health, New Treatment Guidelines for Pregnant Women with Asthma, 2006
- Goodman and Gilman’s, The Pharmaceutical Basis of Therapeutics, 3rd edition
- Brian s.Katcher, Lloyd Yee Young, Mary Anne Koda – kimble, Applied Therapeutics – The Clinical Use of Drugs,3rd edition
