Volume. 35, No. 2 july. 2011 - The Chest and Heart Association of ...

Asthma in Pregnancy – An overviewMd.Abdul Qayyum et al.Patient Education for Self-Treatment of Asthma during pgSubjectRecommendationGeneral informationUse of inhaler deviceAdherence to treatmentProvide basic information about asthma and relationship between asthmaand pregnancyDemonstrate proper technique for specific device and ask patient to performthe technique ;demonstrate use of spacer device for matered dose inhalerDiscuss self-reported adherence to treatment with controller medicationand if needed ,address barrier to optimal adherenceSelf-treatment action plan Provide schedule for maintenance medication and dose of rescue therapyfor increased symptoms,explain when & how to increase controllermedication & when & how to use prednisolone ,explain how to recognize asevere exacerbation &when &how to seek urgent or emergency careEnvironmental Control Measures to Reduce Exposure to AllergensAllergen Instructions Level of EvidenceAnimal dander Remove pet from house; if removal not acceptable, Consensus judgementkeep pet out of bedroomDust mites Encase pillow &other mattress with impermeable Data from several RCTscovers,wash sheets & blankets weekly in hot waterCockroaches Do not leave food or garbage exposed; use poison Few RCTsbaits or traps rather than chemical agents ,which can aggravate asthmaManagement of acute severe asthmaAcute severe attacks of asthma are dangerous andshould be vigorously managed in hospitalTreatment is no defferent from the emergencymanagement of acute severe asthma outsidepregnancy .• Oxygen• Nebulised â 2agonists• Nebulilised ipratropium• Oral or i.v steroids and in severe cases• Intravenous aminophylline or• Intravenous â2 agonists should be used asindicatedSadly,pregnant women receive appropriatetreatment with corticosteroids less commonly thannon-pregnant women. 10Management of asthma during labour anddelivery• Acute attacks of asthma during labour anddelivery are extremely rare• Women should be reassured accordingly• Women may continue their regular inhalersthroughout labour• Those on oral steroids at the onset of labour ordelivery should receive parenteral steroids• Prostaglandin E2 used to induce labour ,to ripenthe cervix,or for early termination of pregnancyis a bronchodilator and is safe• Prostaglandin F2á ,indicated for severe postpartum haemorrhage ,should be used withcaution as it may cause bronchospasm• Asthmatic women may safely use all forms ofpain relief in labour including epidural analgesia• Opiates should be avoided• Ergometrine has been reported to causebronchospasm 11 .Management of asthma in breast feedingmotherWomen with asthma should be encouraged tobreast feed111