Pulmonology Book

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Asthma in Pregnancy

Aka: Asthma in Pregnancy
  1. See Also
    1. Asthma
  2. Pathophysiology
    1. Oxygen consumption increases 25% in pregnancy
    2. Arterial pCO2 falls in pregnancy
      1. Non-pregnant pCO2 levels are red flags in pregnancy
    3. Uncontrolled Severe Asthma results in IUGR
      1. Asthma control in pregnancy is critical
      2. Bracken (2003) Obstet Gynecol 102:739-52 [PubMed]
  3. Admission Criteria
    1. Arterial pH <7.35 (normal pH 7.40)
    2. Arterial pCO2 >40 mmHg (normal pCO2 28-32 mmHg)
    3. Arterial pO2 <70 mmHg
    4. Pulse >120 beats per minute
    5. Respiratory Rate >30 breaths per minute
  4. Management: Anti-inflammatory agents
    1. Outpatient
      1. Budesonide (Pulmicort) 1-4 puffs bid
        1. Preferred Inhaled Corticosteroid in pregnancy
        2. Best studied agent in pregnancy
      2. Beclomethasone MDI (Vanceril) 2-5 sprays bid-qid
      3. Flunisolide (AeroBid) 2-4 puffs bid
      4. Fluticasone (Flovent) 2 puffs bid
      5. Cromolyn Sodium 2 sprays qid
        1. Inhaled Corticosteroids are preferred over cromolyn
    2. Outpatient exacerbation management
      1. Prednisone 40 mg bursts 7-14 days
    3. Inpatient
      1. Methylprednisolone 1 mg/kg IV bolus every 6-8 hours
    4. Precautions: Prednisone and Methylprednisolone
      1. Use systemic steroids sparingly in first trimester
      2. Risk of Cleft Palate, IUGR, and Preterm Labor
  5. Management: Bronchodilator agents
    1. Outpatient
      1. Albuterol 2 puffs every 4 hours prn
      2. Montelukast (Singulair)
      3. Zafirlukast (Accolate)
    2. Inpatient
      1. Albuterol Nebulizer 2.5 mg in 3 cc Normal Saline
      2. Theophylline (rarely used now)
    3. Emergent Management
      1. Epinephrine (1:1000)
        1. Dose: 0.01 ml/kg to 0.2-0.5 ml SC every 30 min prn

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