Bronchial asthma and pregnancy

Bronchial asthma is a chronic inflammatory disease of the respiratory tract, in which many cells and cellular elements play a role. Chronic inflammation causes a concomitant increase in airway hyperreactivity, leading to repeated episodes of wheezing, shortness of breath, chest tightness and coughing, especially at night or early morning. These episodes are usually associated with a common, but changing in severity of bronchial obstruction, reversible spontaneously or under the influence of treatment.

ICD-10:

• J45 Asthma.

Epidemiology of bronchial asthma in pregnancy

The incidence of bronchial asthma has increased significantly in the past three decades, and, according to WHO experts, it is considered one of the most common chronic human diseases. In 8-10% of the adult population, bronchial asthma is detected, and among children, depending on the region, from 5 to 15%. At the same time, the number of sick children grows every year. In our country, this disease affects more than 8 million people.

Women suffer from bronchial asthma 2 times more often than men. The disease manifests, as a rule, at a young age, which certainly leads to an increase in the number of patients with AD of childbearing age.

Prevalence of bronchial asthma in pregnancy

The prevalence of bronchial asthma in pregnant women varies from 1 to 8%. It has been proved that bronchial asthma leads to a complicated course of pregnancy. The most frequent complications are gestosis (46.8%), threat of termination of pregnancy (27.7%), fetoplacental insufficiency (53.2%). Among newborns, intrauterine growth retardation is detected in 28.9%, cerebral circulation of hypoxic genesis in 25.1%, intrauterine infection in 28%.

Symptoms of bronchial asthma in pregnancy

Clinical diagnosis "Bronchial asthma" is established in the presence of the following symptoms: episodic dyspnea, wheezing, a feeling of tightness in the chest. The presence in the family history of bronchial asthma and atopic disease also helps diagnose bronchial asthma.

Because the symptoms of bronchial asthma are variable enough, the results of a physical examination can sometimes not reveal pathology. Usually at auscultation dry rales are heard. Despite the fact that whistling dry wheezing is considered to be the most frequent symptoms of bronchial asthma, they can be absent in severe exacerbation ("mute lung"). In this condition, the patients reveal other signs that reflect the severity of the exacerbation: tachycardia, cyanosis, the involvement of additional muscles in the act of breathing, the entrainment of the intercostal spaces, drowsiness, difficulty in speaking.

Bronchial asthma in pregnancy - Symptoms

Diagnosis of bronchial asthma in pregnancy

Evaluation of lung function, especially the reversibility of its disorders, provides the most accurate assessment of airway obstruction. Measurement of the variability of the speed indicators allows an indirect assessment of the hyperreactivity of the airways.

The most important value for assessing the degree of bronchial obstruction is: the volume of the formed expiration in 1 s (FEV1) and the associated forced vital capacity of the lungs (FVC), as well as PSV. Measurement of FEV1 and FVC is performed using a spirometer (spirometry). The proper values of the indicators are determined by the results of population studies based on the age, sex and growth of the patient. In view of the fact that a number of diseases, in addition to causing bronchial obstruction, can lead to a decrease in FEV1, it is useful to apply the ratio of FEV1 to FVC. With normal lung function, it is> 80%. Lower values suggest bronchial obstruction. An increase in FEV1 by more than 12% indicates a predominance of the functional component of obstruction and confirms the diagnosis of bronchial asthma. Measurement of PEF with the help of a peak meter (peakflowmetry) allows for home monitoring and an objective assessment of the degree of pulmonary function dysfunction. At the same time, the severity of bronchial asthma reflects not only the average level of bronchial obstruction, but also the PSV fluctuations within 24 hours. PSV should be measured in the morning when the indicator is at the lowest level, and in the evening when PSV is usually the highest. The daily spread of PSV indicators by more than 20% should be considered as a diagnostic sign of bronchial asthma, and the magnitude of the deviation is directly proportional to the severity of the disease.

Treatment of bronchial asthma in pregnancy

The main tasks of treating bronchial asthma in pregnant women include the normalization of FVD, the prevention of exacerbations of bronchial asthma, the elimination of side effects of antiasthmatics, relief of asthma attacks, which is considered a guarantee of the correct uncomplicated course of pregnancy and the birth of a healthy child.

Therapy of bronchial asthma in pregnant women is carried out according to the same rules as non-pregnant ones. The main principles are increasing or decreasing the intensity of therapy as the severity of the disease changes, taking into account the characteristics of the course of pregnancy, mandatory monitoring of the course of the disease and the effectiveness of the prescribed treatment by peakflowmetry, the preferred use of an inhalation route for the administration of medications.

Bronchial asthma in pregnancy - Treatment

Preventive maintenance of a bronchial asthma at pregnancy

Bronchial asthma is the most common serious disease that complicates the course of pregnancy. Asthma can debut or be diagnosed for the first time during pregnancy, and the severity of the course may change with the course of pregnancy. Approximately 1/3 of women report improvement, 1/3 - do not notice changes in the course of the disease during pregnancy, 1/3 - indicate a worsening of the condition. More than half of pregnant women are experiencing an exacerbation of the disease during pregnancy. In this case, most often, exacerbations occur in the second trimester of pregnancy. In the subsequent pregnancy, 2/3 of women experience the same changes in the course of the disease as in the first pregnancy.

Causes of a complicated course of pregnancy and perinatal pathology

The development of complications of pregnancy and perinatal pathology is associated with the severity of bronchial asthma, the presence of exacerbations of bronchial asthma during pregnancy and the quality of therapy. The number of complications of pregnancy increases in proportion to the severity of the disease. In severe bronchial asthma, perinatal complications are recorded 2 times more often than with mild asthma. It is important to note that in women who have exacerbations of asthma during pregnancy, perinatal pathology is encountered 3 times more often than in patients with a stable course of the disease.

Bronchial asthma in pregnancy - Prevention

[1], [2], [3], [4], [5], [6], [7], [8], [9]