Can Asthma Symptoms Change During Pregnancy
Yes, asthma symptoms often change during pregnancy. Sometimes they get better and sometimes they get worse. We dont really understand what causes these changes.
Getting the flu can set off serious asthma symptoms. Be sure to get a flu shot in October or November every year.
Heartburn also can make your symptoms worse. Heres what you can do to help with heartburn symptoms:
- Sleep with your head up on a pillow .
- Eat smaller meals several times a day.
- Dont eat within 2 hours of bedtime.
- Ask your provider about medicines you can take.
Guidelines For The Management Of Asthma During Pregnancy
International guidelines are available that outline the goals of successful asthma management and recommendations for clinical management of asthma in pregnancy . Goals include the prevention of chronic day and night symptoms, maintenance of optimal pulmonary function and normal activities, and prevention of exacerbations, using therapies with minimal or no adverse side-effects . During pregnancy, there is the additional goal to maintain fetal oxygenation by preventing episodes of maternal hypoxia . Achieving this requires regular monitoring of clinical symptoms, provision of self-management education and the correct use of pharmacotherapies. Multidisciplinary management by all health professionals involved in a womans care is encouraged .
A stepwise approach to asthma treatment is recommended during pregnancy as for other adults with asthma . Guidelines recommend the use of short acting -agonists as reliever medication and the use of inhaled corticosteroids for women with persistent asthma . There is much reassuring data concerning the safety of ICS medication use in pregnancy, particularly for budesonide, which has the best safety rating during pregnancy. Guidelines recommend the continued use of ICS medication that has been effective in controlling asthma prior to pregnancy .
Different Types Of Birth When You Have Asthma
Most women with asthma can aim for a vaginal birth. But if youre anxious about whether your asthma will affect you giving birth vaginally, talk to your midwife or consultant.
If, after discussion and support, you still feel youd prefer a planned caesarean, its your right to ask for one.
Home birth or midwife-led unit
As long as your asthma has been well managed during your pregnancy itll be safe for you to have your baby at home or in a midwife-led unit.
But if youve needed to increase your asthma medicines during pregnancy, or have needed hospital treatment for your asthma, youll probably be advised that its safer to give birth in hospital.
If labour needs to be induced or accelerated
If your labour has to be induced make sure you remind your doctor or midwife that you have asthma so they can use the safest medicines for you.
You also need to do this if you birth needs moving along . Ask your midwife to include details about your asthma in the birth plan and notes.
Having a C-section
Having asthma doesnt mean you need to have a C-section. But if you do have one the anaesthetist will aim to use a spinal block or epidural rather than a general anaesthetic.
Its considered a safer option for women with asthma. And its safe to use your reliever inhaler during the operation if you need to.
If you need to have a c-section under general anaesthetic, be reassured that the anaesthetist will choose the best anaesthetic medicines for you and your asthma.
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Asthma Exacerbations And Healthcare Utilisation During Pregnancy
Asthma exacerbations are a significant clinical problem during pregnancy. Up to 45% of pregnant women with asthma have moderatesevere exacerbations requiring medical intervention during pregnancy . In addition to the adverse effect on maternal health, exacerbations are a key contributor to adverse perinatal outcomes in asthma. Exacerbations, oral steroid use and severe asthma are associated with preterm delivery, possibly due to maternal hypoxia, the effects of maternal inflammation and/or changes in uterine smooth muscle function . In addition, women with exacerbations of asthma are three times more likely to have a low birth weight baby compared to asthmatic women without exacerbations , suggesting that prevention of exacerbations during pregnancy may also lead to improvements in perinatal outcomes.
These studies demonstrate the potential for asthma status to markedly change during pregnancy and from trimester to trimester. Typically, approximately at least one-third of women with asthma report a worsening in their usual symptoms, one-third have no change and one-third have an improvement . It is also recognised that women with mild disease are still at risk of severe exacerbations during pregnancy, and for this reason, regular monitoring of asthma during pregnancy is recommended .
Smoking Cessation For Pregnant Women With Asthma
Smoking is a critical issue for pregnant women with asthma, with data showing that women who smoke are more likely to have exacerbations during pregnancy and to have more severe symptoms during exacerbation . Studies from around the world have suggested that pregnant women with asthma are more likely to smoke than pregnant women without asthma . The 2030% of women with asthma who continue to smoke during pregnancy are at increased risk of poor perinatal outcomes from the combined effects of smoking, asthma and severe asthma exacerbations. However, no studies have trialled smoking cessation strategies among this population of women.
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Emergency Department Management Of Asthma Exacerbations During Pregnancy
Recent data from a relatively small retrospective study of 39 women showed that pregnant women with asthma were less likely to be prescribed OCS at the time of exacerbation than nonpregnant women with asthma and where OCS were not prescribed at the first medical encounter, there was a delay in their prescription of 5.8days . OCS were prescribed during 87.5% of first-trimester exacerbations but only 70.6% of second-trimester and 66.7% of third-trimester exacerbations. While this may indicate an increasing reluctance to prescribe steroids as pregnancy progresses, it is possible that the severity of exacerbations in the third trimester was different from exacerbations earlier in pregnancy. This study also found that pregnant women were equally likely to fill their OCS prescription in the community after exacerbation as the nonpregnant women , implying that the change in OCS use in pregnancy may be more related to prescribing habits than reduced use by pregnant women themselves, consistent with studies performed in the emergency department setting.
Where To Learn More
Your doctor, pharmacist, or Certified Respiratory Educator can:
- Explain how each of your asthma medications work
- Discuss any concerns about potential side effects
- Show you how to use your medication inhalation advice
Ontario residents can reach our Certified Respiratory Educators through our toll-free Lung Health Information Line at 1-888-344-LUNG .
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Asthma And Pregnancy What To Expect
Because every pregnancy is unique, and everyones asthma is different, its hard to predict what will happen with your asthma when youre pregnant.
Some pregnant women find their asthma improves. Some don’t notice any changes in their symptoms at all. And some women especially those with severe asthma may find their symptoms get worse.
If you do notice changes in your asthma during pregnancy, these may not carry on once your baby is born. In most cases asthma goes back to how it was before you were pregnant.
If you have difficult or severe asthma ask your GP or asthma nurse if you need an asthma specialist to support you during your pregnancy. Its important to keep an eye on your symptoms, and make sure the medicines youre taking are working well.
Some women notice asthma symptoms for the first time during pregnancy
If this happens to you it probably means you had mild asthma without realising it. And pregnancy hormones in pregnancy have triggered your symptoms.
While Waiting For Medical Help To Arrive:
- Have person sit up with arms resting on a table .
- Do not have person breathe into a bag.
- Stay calm, reassure the person, and stay by his/her side.
- Notify emergency contact if known.
After youve had a worsening of your asthma or an asthma attack, make an appointment with your health-care provider. There may be a need to adjust the doses of your medications. You can also discuss possible reasons why your asthma got out of control and find ways to prevent this in the future.
Different people have different asthma symptoms, which can change over time or depending on the situation. Common asthma signs and symptoms include:
- Feeling short of breath
- Chest tightness
These symptoms can also be caused by other conditions. If you have these symptoms or if you think you might have asthma, see your doctor for a proper diagnosis.
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Arterial Blood Gas Level
Arterial blood gas analysis indicates the level of oxygenation and respiratory compensation, giving objective information to the patient’s clinical presentation. Partial pressure of carbon dioxide in the arterial blood is generally low in the early stages of an exacerbation as a result of hyperventilation. An increase in PaCO2 can be a sign of impending respiratory failure. ABG results often show a decrease in PaO2. Physiologic changes that accompany pregnancy in the pulmonary system slightly alter normal ABG values: pH = 7.4-7.45, pO2 = 95-105 mm Hg, pCO2 = 28-32 mm Hg, and bicarbonate = 18-31 mEq/L.
What Causes Adults To Develop Asthma
At least 30% of adult asthma cases are triggered by allergies. People who are allergic to cats may have an increased risk for developing adult onset asthma. Exposure to allergens or irritants such as cigarette smoke, chemicals, mold, dust, or other substances commonly found in the persons environment might trigger the first asthma symptoms in an adult.
Prolonged exposure to certain workplace materials may set off asthma symptoms in adults.
Hormonal fluctuations in women may play a role in adult onset asthma. Some women first develop asthma symptoms during or after a pregnancy. Women going through menopause can develop asthma symptoms for the first time.
Different illnesses, viruses, or infections can be a factor in adult onset asthma. A bad cold or a bout with the flu is often a factor in adult onset asthma.
Smoking does not cause adult onset asthma however, if you smoke or if you are exposed to cigarette smoke , it may provoke asthma symptoms.
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Treatment Of Asthma During Pregnancy
Like normal people with asthma, pregnant women should also have an action plan to control and treat asthma. However, it is not entirely safe for pregnant women to take all medicines. Hence, the treatment plan for pregnant women is different. Some of the common and safe treatment options of asthma in pregnancy include
Possible Complications For The Mother
When not controlled, asthma can put extra stress on the mother, as well as on the baby. Lack of oxygen will not only affect the mother, but also the baby. Other complications from uncontrolled asthma for the mother are:
Preeclampsia . This is a health problem of pregnancy marked by raised blood pressure, water retention, and protein in the urine.
Bleeding in pregnancy or hemorrhage after giving birth
The baby doesn’t get enough oxygen
The baby dies
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Tips For Staying Well With Your Asthma Through Your Pregnancy
Heres how you can lower your risk of asthma symptoms and asthma attacks:
- Keep taking your asthma medicines as prescribed. Theyre safe to take when youre pregnant. In fact, your baby is more at risk if you stop taking your medicines and have symptoms and asthma attacks.
- Have an asthma review. Your GP can check your asthma medicines, your inhaler technique and update your . Book further appointments if you notice symptoms during your pregnancy.
- Tell your midwife you have asthma. Make sure asthmas in your notes and included in your birth plan. Looking after your asthma needs to be part of your overall antenatal care plan.
- Stop smoking. Smoking while youre pregnant means your babys more likely to have breathing problems, including asthma. It also puts you more at risk of both miscarriage and premature labour. And avoid breathing in secondhand smoke too. Theres lots of support to help you give up.
- Have the flu jab. Pregnant women, and people with asthma, are more at risk of complications from flu, like chest infections or pneumonia. The flu jab is safe in pregnancy. It will also help protect your baby from flu in their first few months.
Interventions For Improving Asthma Management During Pregnancy
There have been very few recent RCTs of interventions for managing asthma during pregnancy. A 2014 Cochrane review summarised eight RCTs involving 1181 women with asthma . Five of the trials assessed pharmacological interventions and three assessed nonpharmacological interventions. The trials were of moderate quality overall and did not lead to any firm conclusions regarding optimal asthma management in pregnancy, due to a lack of clear benefits of pharmacological approaches over current practice and a lack of power in the nonpharmacological interventions to detect differences in perinatal outcomes .
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Is It Safe To Take Asthma Medications In Pregnancy
Most asthma medicines have been shown to be extremely safe for both you and your developing baby, and will ensure that your asthma symptoms are not left untreated for the duration of your pregnancy. Untreated symptoms may be harmful for the baby. Your asthma management plan should be reviewed regularly throughout pregnancy. Uncontrolled asthma is usually far more of a danger to your pregnancy than any of your prescribed asthma medicines.
If your asthma is being treated with oral steroid medication , check with your doctor about the safety of this treatment while pregnant.
Do not stop taking either your preventer or reliever asthma medicines without consulting your doctor first. Always check with your doctor before starting or stopping taking any types of medicines during pregnancy.
Is Asthma Worse When Youre Pregnant
Pregnancy can be a difficult time for many women, but especially for those with the added burden of asthma.
Asthma, a chronic disease of the airways of the lungs, is one of the most common medical problems that occurs during pregnancy. Sonali Bose, MD, a pulmonologist at the Mount Sinai National Jewish Health Respiratory Institute, explains how asthma can affect both the mother and child, and what you can do about it.
Why is my asthma worse when I am pregnant?Asthma control during pregnancy can be unpredictable. Asthma may get worse during pregnancy because of the effects of hormonal changes associated with pregnancy. Some experts have proposed that changes in the hormone progesterone can have effects on the mothers airways, such as influencing airway inflammation or its sensitivity, but the exact mechanisms are still unclear.
Another major reason that asthma may get worse during pregnancy is that many pregnant women tend to stop or decrease their asthma medications because they are worried about how these medications may affect their unborn child, which in turn may cause the mothers to have worse control of their asthma.
Can asthma be transferred from mother to child?Asthma does run in families. Children of mothers with uncontrolled asthma may have a higher risk of developing asthma and other allergic diseases and chest infections, or have lower lung function during childhood.
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How Can Adult Onset Asthma Be Managed
If you manage your asthma, you can expect to lead a normal lifestyle. Basically, there are four key steps to managing asthma successfully:
1. Learn about asthma and stay up-to-date on new developments.
2. Take prescribed medications. Dont make any changes until you check with your physician. Dont use over- the-counter medications unless prescribed by your physician!
3. Check your lungs daily at home by using a peak flow meter. Asthma patients often can detect lung changes with a peak flow meter before they actually experience any changes. Visit your physician regularly for further in-office tests. Lung testing is painless and provides valuable data that helps your physician make adjustments in your medication.
4. Make an asthma management plan with your physician. A plan establishes guidelines that tell you what to do if your asthma symptoms get worse.
Can I Use My Inhaler During Pregnancy
If you donât control your asthma properly during pregnancy, youâre much more likely to harm yourself and your baby than if you use the right drugs to control your asthma.
Itâs OK to use an inhaler. Short-acting medications in your daily use inhaler, like albuterol, levalbuterol, pirbuterol, and ipratropium, are all safe for mother and baby. Also, treating asthma lowers your risk of attacks and helps make your lungs work better.
The best thing to do is to talk to your doctor, who will look at how severe your asthma is and what treatment is right for you while you’re pregnant.
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Are Allergy Shots Safe During Pregnancy
If you are already receiving allergy shots , you can usually continue if you are not having reactions.
As an extra precaution, though, your allergist may cut the dosage of the allergy extract to reduce the chance of a severe allergic reaction, or at a minimum keep the dose the same. But the dose should not be increased during pregnancy since that increases the chance of a reaction.
Which Medications Treat And Manage Asthma During Pregnancy
Most people with asthma take at least two medications: one for long-term prevention and control of asthma symptoms and one for quick “rescue” in case of an attack. The long-term medications are taken daily, even if there are no symptoms.
During pregnancy, inhaled corticosteroids are the mainstay for long-term control. Long-term medications are sometimes combined into single preparations, such as an inhaled steroid and a long-acting beta-agonist.
Rescue medications are taken only when symptoms appear. Inhaled short-acting beta-agonists are usually the first choice for fast relief of symptoms.
Control and Preventive Medications
Inhaled corticosteroids: Corticosteroids prevent symptoms by preventing the swelling and mucus secretion that go along with inflammation. They help prevent severe asthma attacks. They are the most popular long-acting asthma drugs for pregnant women because they work well and are considered to be safe in pregnancy. They cause few side effects. Examples include budesonide and beclomethasone .
Leukotriene inhibitors: These drugs work by blocking a substance that is produced by cells in your body that causes swelling and spasm of airways. These drugs are considered safe during pregnancy, but in general they do not work for as many people as inhaled steroids. Examples are montelukast , zafirlukast , and zileuton .
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