In the modern world, more and more women suffer from bronchial asthma. However, every woman sooner or later faces the question of motherhood. Lack of control of bronchial asthma during pregnancy can lead to various complications not only for the mother’s body, but also for the fetus.

Modern medicine claims that bronchial asthma and pregnancy are completely compatible things.

Because the right therapy and regular medical monitoring increase the chance of maintaining the health of the mother and giving birth to a healthy baby.

Course of the disease during pregnancy

It is very difficult to predict how pregnancy will progress with bronchial asthma. It was noticed that women suffering from mild or moderate asthma did not notice a deterioration in their health while carrying a child. There are cases when, on the contrary, it improved. In patients with severe disease, exacerbation of asthma was quite often observed, the number of attacks and their severity increased. To avoid such manifestations, it is necessary to be under regular supervision not only by a gynecologist, but also by a pulmonologist.

Important! If the disease begins to worsen, then hospitalization in a hospital is necessary, where the medications taken are replaced with safer ones that will not have a negative effect not only on the fetus, but also on the mother’s body.

There is also a tendency that bronchial asthma in pregnant women in the first trimester is much more severe than in subsequent weeks.

The following are the complications that may develop in the expectant mother:

• more frequent attacks;
• risk of premature birth;
• risk of miscarriage;
• the appearance of toxicosis.

A pregnant woman with asthma receives an insufficient amount of oxygen, as a result of which the placental blood flow is also less enriched with it. In addition, asthmatic bronchitis, along with asthma, can cause hypoxia in the fetus, which is fraught with the following possible complications:

• low fetal weight;
• developmental delay;
• possible disorders of the cardiovascular and muscular systems;
• the risk of injury during childbirth increases;
• suffocation.

All of the above consequences develop exclusively with incorrectly chosen therapy. With adequate treatment, pregnancy with asthma often ends in the birth of a healthy baby with normal weight. The only common consequence is the baby’s predisposition to allergic manifestations. Therefore, during breastfeeding, the mother must strictly adhere to an antiallergic diet.

Most often, a deterioration in a woman’s well-being is observed from 28-40 weeks, when a period of active fetal growth occurs, which leads to a limitation in the motor function of the lungs. However, before the delivery process, when the baby descends into the pelvic area, the mother’s well-being improves.

Usually, if the disease is not out of control and the woman is not in danger, then natural childbirth is recommended.

To do this, 2 weeks before the upcoming birth, the woman is hospitalized, where she and the baby are monitored around the clock. During delivery, she is given drugs that prevent the development of an attack and do not have a negative effect on the fetus.

On the day of birth, the woman is administered hormonal drugs every 8 hours, 100 mg, and the next day - every 8 hours, 50 mg intravenously. Then there is a gradual withdrawal of hormonal drugs or a transition to oral administration of the usual dosage.

If a woman notices a deterioration in her health, her attacks become more frequent, then at 38 weeks delivery is carried out by cesarean section. By this time, the baby becomes mature enough to live outside the mother's body. If surgical intervention is not performed, both the mother and the child increase the risk of developing the above complications. During a caesarean section, it is advisable to carry out epidural anesthesia, as general anesthesia can aggravate the situation. In the case of general anesthesia, the doctor is more careful in selecting the drug.

Treatment of the disease during pregnancy

Treatment of bronchial asthma in pregnant women is somewhat different from conventional therapy. Since some drugs are contraindicated for use, others require a significant reduction in dosage. Therapeutic actions are based on preventing exacerbation of bronchial asthma.

The main therapeutic objectives are presented below:

1. Improved respiratory function.
2. Prevention of asthma attacks.
3. Relieving an attack of suffocation.
4. Preventing the influence of side effects of medications on the fetus.

In order for asthma and ongoing pregnancy to be completely compatible with each other, a woman must follow the following recommendations:

Medicines not recommended during pregnancy

The following are drugs that require careful use or are prohibited for use during pregnancy:

Important! During pregnancy, immunotherapy using allergens is prohibited, since this procedure provides a 100% guarantee that the baby will be predisposed to developing asthma.

How to stop an asthma attack in a pregnant woman?

Unfortunately, during pregnancy, patients also experience asthma attacks, which must be quickly stopped. First of all, you should calm down, open the window for better air flow, unfasten your collar and call an ambulance.

It is better for a woman to sit on a chair facing the back, with her hands on her sides. In such a way that the chest is in an expanded position. This way you can take a relaxing position and use the auxiliary pectoral muscles. You can stop asthma attacks in the following ways:

Important! It is forbidden to use Intal aerosol to relieve an attack, as it can significantly worsen the situation. This drug is used to prevent the development of asthma attacks.

There are still many fears and misconceptions associated with bronchial asthma, and this leads to an erroneous approach: some women are afraid of pregnancy and doubt their right to have children, others overly rely on nature and stop treatment during pregnancy, considering any drugs to be absolutely harmful. this period of life. Perhaps the whole point is that modern methods of treating asthma are still very young: they are just over 12 years old. People still remember a time when asthma was a frightening and often disabling disease. Now the situation has changed, new data about the nature of the disease have led to the creation of new drugs and the development of methods for controlling the disease.

A disease called asthma

Bronchial asthma is a widespread disease, known since ancient times and described by Hippocrates, Avicenna and other greatest doctors of the past. However, in the 20th century, the number of people with asthma increased dramatically. The environment, changes in diet, smoking and much more play a significant role in this. At the moment, it has been possible to establish a number of external and internal risk factors for the development of the disease. The most important of the internal factors is atopy. This is the hereditary ability of the body to respond to the effects of allergens by producing an excess amount of immunoglobulin E - a “provocateur” of allergic reactions that appear immediately and violently after contact with the allergen. Among external risk factors, contact with environmental allergens, as well as air pollutants, and primarily tobacco smoke, should be noted. Active and passive smoking greatly increases the risk of developing asthma. The disease can begin in early childhood, but it can occur at any age, and its onset can be triggered by a viral infection, the appearance of an animal in the house, a change of place of residence, emotional stress, etc.

Until recently, it was believed that the disease was based on bronchospasm with the development of asthma attacks, so treatment was limited to the prescription of bronchodilators. It was only in the early 90s that the idea of ​​bronchial asthma as a chronic inflammatory disease was formed, the root cause of all symptoms of which is a special chronic immune inflammation in the bronchi, which persists at any severity of the disease and even beyond exacerbations. Understanding the nature of the disease has changed the principles of treatment and prevention: inhaled anti-inflammatory drugs have become the basis for the treatment of asthma.

As a matter of fact, all the main problems of pregnant women with asthma are associated not with the fact of having bronchial asthma, but with poor control of it. The greatest risk to the fetus is hypoxia (insufficient amount of oxygen in the blood), which occurs due to the uncontrolled course of bronchial asthma. If suffocation develops, not only does the pregnant woman experience difficulty breathing, but the unborn child also suffers from a lack of oxygen (hypoxia). It is hypoxia that can interfere with the normal development of the fetus, and in vulnerable periods even disrupt the normal formation of organs. To give birth to a healthy baby, it is necessary to receive treatment appropriate to the severity of the disease in order to prevent an increase in the onset of symptoms and the development of hypoxia. Therefore, it is necessary to treat asthma during pregnancy. The prognosis for children born to mothers with well-controlled asthma is comparable to that of children whose mothers do not have asthma.

During pregnancy, the severity of asthma often changes. It is believed that in about a third of pregnant women, asthma improves, in a third it worsens, and in a third it remains unchanged. But rigorous scientific research is less optimistic: asthma improves in only 14% of cases. Therefore, you should not rely on this chance in the hope that all problems will be resolved by themselves. The fate of a pregnant woman and her unborn child is in her own hands - and in the hands of her doctor.

Preparing for pregnancy

Pregnancy with bronchial asthma should be planned. Even before it begins, it is necessary to visit a pulmonologist to select planned therapy, learn inhalation techniques and self-control methods, as well as an allergist to determine causally significant allergens. Patient education plays an important role: understanding the nature of the disease, awareness, ability to correctly use medications and self-control skills are necessary conditions for successful treatment. Many clinics, hospitals and centers have asthma schools and allergy schools.

A pregnant woman with asthma needs more careful medical supervision than before pregnancy. You should not take any medications, even vitamins, without consulting your doctor. If there are concomitant diseases that require treatment (for example, hypertension), consultation with an appropriate specialist is necessary to adjust therapy taking into account pregnancy.

Smoking is a fight!

Pregnant women should absolutely not smoke! It is also necessary to carefully avoid any contact with tobacco smoke. Staying in a smoky atmosphere causes enormous harm to both the woman and her unborn child. Even if only the father smokes in the family, the likelihood of developing asthma in a child predisposed to it increases by 3-4 times.

Limiting contact with allergens

In young people, in most cases, one of the main factors provoking the disease is allergens. Reducing or, if possible, completely eliminating contact with them makes it possible to improve the course of the disease and reduce the risk of exacerbations with the same or even less volume of drug therapy, which is especially important during pregnancy.

Modern homes are usually overloaded with objects that accumulate dust. House dust is a whole complex of allergens. It consists of textile fibers, particles of dead skin (deflated epidermis) of humans and domestic animals, mold fungi, allergens of cockroaches and the smallest arachnids living in dust - house dust mites. A pile of upholstered furniture, carpets, curtains, stacks of books, old newspapers, scattered clothes serve as an endless reservoir of allergens. The conclusion is simple: you should reduce the number of items that collect dust. The amount of upholstered furniture should be kept to a minimum, carpets should be removed, vertical blinds should be hung instead of curtains, books and trinkets should be stored on glass shelves.

Excessively dry air in the house will lead to dry mucous membranes and an increase in the amount of dust in the air; too humid air creates conditions for the proliferation of mold fungi and house dust mites - the main source of household allergens. The optimal humidity level is 40-50%.

To clean the air from dust and allergens, special devices have been created - air purifiers. It is recommended to use purifiers with HEPA filters (the English abbreviation, which means “highly efficient particle filter”) and their various modifications: ProHEPA, ULPA, etc. Some models use highly efficient photocatalytic filters. Devices that do not have filters and purify the air only through ionization should not be used: their operation produces ozone - a chemically active and toxic compound in large doses, which has an irritating and damaging effect on the respiratory system and is dangerous for pulmonary diseases in general, and for pregnant women and young children in particular.

If a woman does the cleaning herself, she should wear a respirator that protects against dust and allergens. Daily wet cleaning has not lost its relevance, but a modern home cannot be done without a vacuum cleaner. In this case, you should prefer vacuum cleaners with HEPA filters, specially designed for the needs of allergy sufferers: a regular vacuum cleaner retains only large dust, and the smallest particles and allergens “slip through” it and enter the air again.

The bed, which serves as a place of rest for a healthy person, turns into the main source of allergens for an allergy sufferer. Dust accumulates in ordinary pillows, mattresses and blankets; wool and feather fillings serve as an excellent breeding ground for the development and reproduction of mold fungi and house dust mites - the main sources of household allergens. Bedding should be replaced with special hypoallergenic ones - made from light and airy modern materials (polyester, hypoallergenic cellulose, etc.). Fillers that use glue or latex (for example, padding polyester) to hold the fibers together should not be used.

Bedding also requires proper care: regular fluffing and airing, frequent washing at a temperature of 60 ° C and above (ideally once a week). Modern fillers are easily washed and restore their shape after repeated washings. To reduce the frequency of washing, as well as for washing items that cannot withstand high temperatures, special additives have been developed to kill house dust mites (acaricides) and eliminate major allergens. Similar products in the form of sprays are intended for treating upholstered furniture and textiles.

Acaricides of chemical (Akarosan, Akaril), plant (Milbiol) origin and complex action have been developed (Allcrgoff, combining plant, chemical and biological agents against ticks), as well as plant-based products to neutralize tick allergens, pets and molds (Mite -NIX). An even higher level of protection against allergens is provided by anti-allergenic protective covers for pillows, mattresses and blankets. They are made of a special densely woven fabric that allows air and water vapor to pass freely, but is impermeable even to small dust particles. In addition, in the summer it is useful to dry the bedding in direct sunlight, and in the winter - to freeze it at a low temperature.

Types of asthma

There are many classifications of bronchial asthma that take into account the characteristics of its course, but the main and most modern one is depending on the severity. There are mild intermittent (episodic), mild persistent (with mild but regular symptoms), moderate and severe bronchial asthma. This classification reflects the degree of activity of chronic inflammation and allows you to select the required amount of anti-inflammatory therapy. Today the medicine arsenal has quite effective means to achieve disease control. Thanks to modern approaches to treatment, it is no longer even appropriate to say that people suffer from asthma. Rather, we can talk about the problems that arise in a person diagnosed with bronchial asthma.

Treatment of bronchial asthma during pregnancy

Many pregnant women try to avoid taking medications. But it is necessary to treat asthma: the harm that a severe uncontrolled disease causes and the resulting hypoxia (lack of oxygen) of the fetus is immeasurably higher than the possible side effects of medications. Not to mention the fact that allowing asthma to worsen means creating a huge risk for the life of the woman herself.

In the treatment of asthma, preference is given to topical (locally acting) inhaled drugs, which have maximum effectiveness in the bronchi with a minimum concentration of the drug in the blood. It is recommended to use inhalers that do not contain freon (in this case, the inhaler has the inscription “does not contain freon”; “ECO” or “N” may be added to the name of the medicine). Metered aerosol inhalers should be used with a spacer (an auxiliary device for inhalation - a chamber, into which the aerosol from the canister enters before the patient inhales it). The spacer increases the efficiency of inhalation by eliminating problems with the correct execution of the inhalation maneuver, and reduces the risk of side effects associated with aerosol settling in the mouth and pharynx.

Planned therapy (basic therapy to control the disease). As mentioned above, all the symptoms of asthma are based on chronic inflammation in the bronchi, and if you only fight the symptoms and not their cause, the disease will progress. Therefore, when treating asthma, planned (basic) therapy is prescribed, the volume of which is determined by the doctor depending on the severity of asthma. It includes medications that must be used systematically, daily, regardless of how the patient feels or whether there are symptoms. Adequate basic therapy significantly reduces the risk of exacerbations, minimizes the need for drugs to relieve symptoms and prevents the occurrence of fetal hypoxia, i.e. contributes to the normal course of pregnancy and the normal development of the child. Basic therapy is not stopped even during childbirth to avoid exacerbation of asthma.

Cromones (INTAL, TAILED) are used only for mild asthma. If the drug is prescribed for the first time during pregnancy, sodium cromoglycate (INTAL) is used. If cromones do not provide adequate disease control, they should be replaced with inhaled hormonal drugs. The purpose of the latter during pregnancy has its own characteristics. If the drug is to be prescribed for the first time, BUDESONIDE or BEKJ1O-METHASONE is preferred. If asthma was successfully controlled with another inhaled hormonal drug before pregnancy, continuation of this therapy may be possible. The doctor prescribes medications individually, taking into account not only the clinical picture of the disease, but also peak flowmetry data.

Peak Flowmetry and Asthma Action Plan. For self-monitoring of asthma, a device called a peak flow meter has been developed. The indicator it records - peak expiratory flow, abbreviated PEF - allows you to monitor the condition of the disease at home. PEF data is also used as a guide when drawing up an Action Plan for Asthma - detailed doctor’s recommendations that outline basic therapy and necessary actions in case of changes in condition.

PEF should be measured 2 times a day, morning and evening, before using medications. The data is recorded in the form of a graph. An alarming symptom is “morning dips” - periodically recorded low readings in the morning. This is an early sign of worsening asthma control, ahead of the onset of symptoms, and if treated early, a flare-up can be avoided.

Medicines to relieve symptoms. A pregnant woman should not endure or wait out attacks of suffocation so that the lack of oxygen in the blood does not harm the development of the unborn child. This means that a drug is needed to relieve asthma symptoms. For this purpose, selective inhaled 32-agonists with a rapid onset of action are used. In Russia, salbutamol (SALBUTAMOL, VENTOLIN, etc.) is more often used. The frequency of use of bronchodilators (drugs that dilate the bronchi) is an important indicator of asthma control. If the need for them increases, you should contact a pulmonologist to enhance planned (basic) therapy to control the disease.

During pregnancy, the use of any ephedrine preparations (TEOPHEDRINE, Kogan powders, etc.) is absolutely contraindicated, since ephedrine causes constriction of the uterine vessels and aggravates fetal hypoxia.

Treatment of exacerbations. The most important thing is to try to prevent aggravations. But exacerbations still occur, and the most common cause is ARVI. Along with the danger to the mother, exacerbation poses a serious threat to the fetus, so delay in treatment is unacceptable. When treating exacerbations, inhalation therapy is used using a nebulizer - a special device that converts liquid medicine into a fine aerosol. The initial stage of treatment consists of the use of bronchodilators; In our country, the drug of choice is salbutamol. To combat fetal hypoxia, oxygen is prescribed. In case of exacerbation, it may be necessary to prescribe systemic hormonal drugs, preferring PREDNISOONE or METHYLPRED-NIZOLONE and avoiding the use of trimcinolone (POLCORTOLONE) due to the risk of affecting the muscular system of the mother and fetus, as well as dexamethasone and betamethasone. Both in connection with asthma and allergies during pregnancy, the use of deposited forms of long-acting systemic hormones - KENALOG, DIPROSPAN - is strictly excluded.

Will the baby be healthy?

Any woman is concerned about the health of her unborn child, and hereditary factors certainly take part in the development of bronchial asthma. It should be immediately noted that we are not talking about the inevitable inheritance of bronchial asthma, but about the general risk of developing an allergic disease. But other factors also play a role in the realization of this risk: the ecology of the home, contact with tobacco smoke, feeding, etc. Breastfeeding is given special importance: you need to breastfeed your baby for at least 6 months. But at the same time, the woman herself must follow a hypoallergenic diet and obtain from a specialist recommendations on the use of medications during breastfeeding.

Pregnancy and asthma are not mutually exclusive. This combination occurs in one woman out of a hundred. Asthma is a chronic disease of the respiratory system, which is accompanied by frequent attacks of coughing and suffocation. In general, the disease is not an absolute contraindication for bearing a child.

It is necessary to closely monitor the health of pregnant women with this diagnosis in order to identify possible complications in time. With the right treatment tactics, childbirth takes place without consequences, and the child is born completely healthy. In most cases, a woman is given low-toxic drugs that help stop attacks and alleviate the course of the disease.

This disease is considered the most common among pathologies of the respiratory system. In most cases, asthma begins to progress during pregnancy, and symptoms become more severe (short-term attacks of suffocation, cough without phlegm, shortness of breath, etc.).

An exacerbation is observed in the second trimester of pregnancy, when hormonal changes occur in the body. In the last month, the woman feels much better, this is due to an increase in the amount of cortisol (a hormone produced by the adrenal glands).

Many women are interested in whether it is possible for a woman with this diagnosis to become pregnant. Experts do not consider asthma a contraindication to bearing a child. In a pregnant woman with bronchial asthma, health monitoring should be more strict than in women without pathologies.

To reduce the risk of complications, you need to take all the necessary tests and undergo comprehensive treatment when planning a pregnancy. During the period of bearing the baby, maintenance drug therapy is prescribed.

Why is bronchial asthma dangerous during pregnancy?

A woman suffering from bronchial asthma during pregnancy is more likely to experience toxicosis. Lack of treatment entails the development of severe consequences for both the mother and her unborn child. Complicated pregnancy is accompanied by the following pathologies:

• respiratory failure;
• arterial hypoxemia;
• early toxicosis;
• gestosis;
• miscarriage;
• premature birth.

Pregnant women with severe asthma have a higher risk of dying from preeclampsia. In addition to a direct threat to the life of a pregnant woman, bronchial asthma has a negative impact on the fetus.

Possible complications

Frequent exacerbations of the disease lead to the following consequences:

• low birth weight of the baby;
• intrauterine development disorders;
• birth injuries that occur when the baby has difficulty passing through the birth canal;
• acute lack of oxygen (fetal hypoxia);
• intrauterine death due to lack of oxygen.

With severe forms of asthma in the mother, children are born with pathologies of the cardiovascular system and respiratory organs. They fall into the group of potential allergy sufferers, and over time, many of them are diagnosed with bronchial asthma.

That is why the expectant mother needs to be especially careful about her health when planning a pregnancy, as well as during the entire period of bearing the baby. Failure to comply with medical recommendations and improper treatment increases the risk of complications.

It is worth noting that pregnancy itself also affects the development of the disease. With hormonal changes, the level of progesterone increases, due to changes in the respiratory system, the content of carbon dioxide in the blood increases, breathing becomes more frequent, and shortness of breath is more common.

As the baby grows, the uterus rises in the diaphragm, thereby putting pressure on the respiratory organs. Very often during pregnancy, a woman experiences swelling of the mucous membrane in the nasopharynx, which leads to exacerbation of asthma attacks.

If the disease manifests itself in the early stages of pregnancy, then diagnosing it is quite difficult. According to statistics, the progression of asthma during pregnancy is more common in severe forms. But this does not mean that in other cases a woman can refuse drug therapy.

Statistics indicate that with frequent exacerbations of bronchial asthma attacks in the first months of pregnancy, children born into the world suffer from heart defects, pathologies of the gastrointestinal tract, spine and nervous system. They have low body resistance, so more often than other children they suffer from influenza, ARVI, bronchitis and other diseases of the respiratory system.

Treatment of asthma during pregnancy

Treatment of chronic bronchial asthma in pregnant women is carried out under the strict supervision of a doctor. First of all, it is necessary to carefully monitor the woman’s condition and fetal development.

For previously diagnosed bronchial asthma, it is recommended to replace the medications that were taken. The basis of therapy is the prevention of exacerbations of symptoms and the normalization of respiratory function in the fetus and expectant mother.

Doctors carry out mandatory monitoring of external respiration function using peak flowmetry. For early diagnosis of fetoplacental insufficiency, a woman is prescribed fetometry and Dopplerography of blood flow in the placenta.

Drug therapy is selected taking into account the severity of the pathology. It should be borne in mind that many drugs are prohibited for pregnant women. The group of medications and dosage are selected by a specialist. Most often used:

• bronchodilators and expectorants;
• asthma inhalers with drugs that stop an attack and prevent unpleasant symptoms;
• bronchodilators, help relieve cough attacks;
• antihistamines help reduce allergies;
• systemic glucocorticosteroids (for severe forms of the disease);
• leukotriene antagonists.

The most effective methods

Inhalation therapy is considered the most effective. For this purpose:

• portable pocket devices into which the required volume of medication is administered using a special dispenser;
• spacers, which are a special attachment for an inhaler;
• nebulizers (with their help the drug is sprayed, thus ensuring the maximum therapeutic effect).

Successful treatment of asthma in pregnant women is facilitated by the following recommendations:

1. Eliminating potential allergens from the diet.
2. Using clothes made from natural materials.
3. Use of products with a neutral pH and hypoallergenic composition for hygienic procedures.
4. Elimination of potential allergens from the environment (animal hair, dust, perfume smell, etc.).
5. Carrying out daily wet cleaning of residential premises.
6. Frequent exposure to fresh air.
7. Elimination of physical and emotional stress.

An important stage of therapeutic therapy is breathing exercises; it helps to establish proper breathing and provide the body of the woman and the fetus with sufficient oxygen. Here are some effective exercises:

• bend your knees and tuck your chin while exhaling through your mouth. Perform 10-15 approaches;
• Close one nostril with your index finger and inhale through the other. Then close it and exhale through the second one. The number of approaches is 10-15.

They can be performed independently at home, but before starting classes, you should definitely consult a doctor.

Forecast

If all risk factors are excluded, the treatment prognosis is favorable in most cases. Following all medical recommendations and regularly visiting your doctor is the key to the health of the mother and her unborn child.

In severe forms of bronchial asthma, a woman is placed in a hospital, where her condition is monitored by experienced specialists. Among the mandatory physiotherapeutic procedures, oxygen therapy should be highlighted. It increases saturation and helps relieve asthma attacks.

In the later stages, drug therapy involves taking not only basic medications for asthma, but also vitamin complexes and interferons to strengthen the immune system. During the treatment period, it is necessary to take tests to determine the level of hormones produced by the placenta. This helps to monitor the dynamic condition of the fetus and diagnose the early development of pathologies of the cardiovascular system.

During pregnancy, it is prohibited to take adrenergic blockers, some glucocorticosteroids, and 2nd generation antihistamines. They tend to penetrate the systemic bloodstream and reach the fetus through the placenta. This negatively affects intrauterine development, increasing the risk of developing hypoxia and other pathologies.

Childbirth with asthma

Most often, birth in patients with asthma occurs naturally, but sometimes a caesarean section is prescribed. Exacerbation of symptoms during labor is a rare occurrence. As a rule, a woman with such a diagnosis is placed in a hospital in advance and her condition is monitored before the onset of labor.

During childbirth, she is necessarily given anti-asthma drugs, which help stop a possible asthma attack. These medications are absolutely safe for the mother and fetus and do not have a negative effect on the birth process.

With frequent exacerbations and transition of the disease to a severe form, the patient is prescribed a planned cesarean section, starting from the 38th week of pregnancy. If you refuse, the risk of complications during natural childbirth increases, and the risk of death of the child increases.

Among the main complications that occur in women giving birth with bronchial asthma are:

• Early discharge of amniotic fluid.
• Rapid birth.
• Complications of childbirth.

In rare cases, an attack of suffocation is possible during labor, and the patient develops heart and pulmonary failure. Doctors decide on an emergency caesarean section.

It is strictly forbidden to use drugs from the prostaglandin group after the onset of labor, as they provoke the development of bronchospasm. To stimulate contraction of the uterine muscles, oxytocin can be used. For severe attacks, epidural anesthesia can be used.

Postpartum period and asthma

Very often, asthma after childbirth can be accompanied by frequent bronchitis and bronchospasm. This is a natural process that is the body’s reaction to the load it has endured. To avoid this, women are prescribed special medications; it is not recommended to use medications containing aspirin.

The postpartum period for asthma includes the mandatory use of medications, which are selected by a specialist. It is worth noting that most of them tend to pass into breast milk in small quantities, but this is not a direct contraindication for use during breastfeeding.

As a rule, after delivery, the number of attacks decreases, the hormonal levels return to normal, and the woman feels much better. It is imperative to exclude any contact with potential allergens that could provoke an exacerbation. If you follow all medical recommendations and take the necessary medications, there is no risk of developing postpartum complications.

In cases of severe disease after childbirth, the woman is prescribed glucocorticosteroids. Then the question may arise about abolishing breastfeeding, since these medications, penetrating into milk, can harm the baby’s health.

According to statistics, severe exacerbation of asthma is observed in women 6-9 months after childbirth. At this time, the level of hormones in the body returns to normal, the menstrual cycle may resume, and the disease worsens.

Planning pregnancy with asthma

Asthma and pregnancy are compatible concepts, provided the correct approach to the treatment of this disease. In case of previously diagnosed pathology, it is necessary to regularly monitor the patient even before pregnancy and prevent exacerbations. This process includes regular examinations with a pulmonologist, taking medications, and breathing exercises.

If the disease manifests itself after pregnancy, then asthma control is carried out with redoubled attention. When planning to conceive, a woman needs to minimize the influence of negative factors (tobacco smoke, animal hair, etc.). This will help reduce the number of asthma attacks.

A prerequisite is vaccination against many diseases (flu, measles, rubella, etc.), which is carried out several months before the planned pregnancy. This will help strengthen the immune system and develop the necessary antibodies to pathogens.

Bronchial asthma has recently become very widespread - many people know firsthand about this disease. And everything would be fine - it’s quite possible to live with it, and medicine allows you to keep the disease under control. But sooner or later a woman faces the question of motherhood. And here the panic begins - will I be able to bear and give birth to a child: Will the baby be healthy?

The doctors answer unequivocally “yes”! Bronchial asthma is not a death sentence for your motherhood, because modern medicine allows women suffering from this disease to become mothers. But the topic is very complicated, so let’s understand everything in order so that you don’t get completely confused.

The World Health Organization defines bronchial asthma as a chronic disease in which a chronic inflammatory process develops in the airways under the influence of T-lymphocytes, eosinophils and other cellular elements. Asthma increases bronchial obstruction to external irritants and various internal factors - simply put, this is the response of the airways to inflammation.

And although bronchial obstruction varies in severity and is subject - spontaneously or under the influence of treatment - to full or partial reversibility, you need to know that in people who have a predisposition, the process of inflammation leads to generalization of the disease.

At the beginning of the eighteenth century, it was believed that attacks of suffocation were not a serious enough disease to pay special attention to it - doctors treated the phenomenon as a side effect of other diseases. For the first time, a systematic approach to the study of asthma was used by scientists from Germany – Kurshman and Leiden. They identified a number of cases of suffocation, and, as a result, described and systematized the clinical manifestations; asthma began to be perceived as a separate disease. But still, the level of technical equipment of medical institutions of that time was not sufficient to establish the cause and fight the disease.

Bronchial asthma affects 4 to 10% of the world's population. Age does not matter for the disease: half of the patients encountered the disease before 10 years of age, another third before 40 years of age. The ratio of the incidence of the disease among children by gender is: 1 (girls) : 2 (boys).

Risk factors

The most important factor is genetic. Cases where the disease is transmitted from generation to generation in the same family or from mother to child are quite common in clinical practice. Data from clinical and genealogical analysis indicate that in a third of patients the disease is hereditary. If one of the parents has asthma, then the probability that the child will also encounter this disease is up to 30%; if both parents are diagnosed with the disease, the probability reaches 75%. Hereditary, allergic (exogenous) asthma, in medical terminology, is called atopic bronchial asthma.

Other important risk factors are harmful working conditions and unfavorable environmental conditions. It is not for nothing that residents of large cities suffer from bronchial asthma many times more often than those who live in rural areas. But dietary habits, household allergens, detergents and others are also of great importance - in a word, it is very difficult to say what exactly can trigger the development of bronchial asthma in a particular case.

Types of bronchial asthma

The classification of bronchial asthma is made based on the etiology of the disease and its severity, and also depends on the characteristics of bronchial obstruction. The classification according to severity is especially popular - it is used in the management of such patients. There are four degrees of severity of the disease at initial diagnosis - they are based on clinical signs and indicators of respiratory function

• First degree: episodic

This stage is considered the easiest, since the symptoms make themselves known no more than once a week, night attacks - no more than twice a month, and the exacerbations themselves are short-term (from an hour to several days), outside periods of exacerbations - indicators of lung function in normal.

• Second degree: mild form

Mild persistent asthma: symptoms occur more than once a week, but not every day, exacerbations can interfere with normal sleep and daily physical activity. This form of the disease occurs most often.

• Third degree: medium

The average severity of bronchial asthma is characterized by daily symptoms of the disease, exacerbations that interfere with sleep and physical activity, and weekly repeated manifestations of night attacks. The vital volume of the lungs is also significantly reduced.

• Fourth degree: severe

Daily symptoms of the disease, frequent exacerbations and nighttime manifestations of the disease, limited physical activity - all this indicates that the disease has taken the most severe form of the course and the person should be under constant medical supervision.

The effect of bronchial asthma on pregnancy

Doctors rightly believe that the treatment of bronchial asthma in expectant mothers is a particularly important problem that requires a careful approach. The course of the disease is influenced by cardinal changes in hormonal levels, the specificity of the pregnant woman’s external respiration function and a weakened immune system. By the way, weakening of the immune system during pregnancy is a prerequisite for bearing a baby. Oxygen starvation caused by bronchial asthma is a serious risk factor for fetal development and requires active intervention from the attending physician.

There is no direct connection between pregnancy and bronchial asthma, since the disease occurs in only 1-2% of pregnant women. But, taking into account all the factors mentioned, asthma requires special intensive treatment - otherwise there is a danger that the baby will have health problems.

The body of a pregnant woman and the fetus have an increasing need for oxygen. This causes some changes in the basic functions of the respiratory system. During pregnancy, due to the enlargement of the uterus, the abdominal organs change their position, and the vertical dimensions of the chest decrease. These changes are compensated by an increase in chest circumference and increased diaphragmatic breathing. In the early stages of pregnancy, the tidal volume increases due to an increase in pulmonary ventilation by 40-50% and a decrease in the reserve volume of exhalation, and in later stages, alveolar ventilation increases to 70%.

An increase in alveolar ventilation leads to an increase in the volume of oxygen in the blood and, accordingly, is in direct connection with an increased level of progesterone, which sometimes acts as a direct stimulant and leads to increased sensitivity of the respiratory apparatus to CO2. The consequence of hyperventilation is respiratory alkalosis - it’s easy to guess what problems this can lead to.

A decrease in expiratory volume, due to an increase in tidal volume, provokes the possibility of a number of changes:

• Collapse of the small bronchi in the lower parts of the lungs.
• Violation of the ratio of oxygen and blood supply in the respiratory apparatus and peripulmonary organs.
• Development of hypoxia and others.

This occurs because the residual lung volume approaches the functional residual capacity.

This factor can also provoke fetal hypoxia if the pregnant woman has bronchial asthma. Insufficiency of CO2 in the blood, which develops during hyperventilation of the lungs, leads to the development of spasms of the umbilical cord vessels and thus creates a critical situation. Be sure to remember this during attacks of bronchial asthma, since hyperventilation aggravates embryonic hypoxia.

The physiological changes described above in a woman’s body during pregnancy are a consequence of the activity of hormones. Thus, the influence of estrogen is noted by an increase in the number of ά-adrenergic receptors, a decrease in cortisol clearance, and an enhanced bronchodilator effect of β-adrenergic agonists, and the influence of progesterone is noted by an increase in the amount of cortisol-binding globulin, relaxation of bronchial smooth muscles, and a decrease in the tone of all smooth muscles in the body. Progesterone competes with cortisol for receptors in the respiratory system, increases the sensitivity of the lungs to CO2 and leads to hyperventilation.

The following factors contribute to the improvement of asthma: high levels of estrogen, estrogen potentiation of the bronchodilator effect of β-adrenergic agonists, low levels of histamine in plasma, increased levels of free cortisol and, as a consequence, an increase in the number and affinity of β-adrenergic receptors, increased half-life of bronchodilators, especially methylxanthines .

The following factors potentially worsen the course of bronchial asthma: increased sensitivity of ά-adrenergic receptors, decreased expiratory reserve volume, decreased sensitivity of the expectant mother’s body to cortisol due to competition with other hormones, stressful situations, respiratory infections, various diseases of the gastrointestinal tract.

Long-term observations of pregnancy in women suffering from bronchial asthma, unfortunately, showed an increase in the risk of premature birth, as well as neonatal mortality. Inadequate control of the course of the disease, as already mentioned, can cause the development of the most severe complications - from premature birth to death of the mother and/or child. Therefore, be sure to visit your doctor regularly!

During pregnancy, a third of patients experience an improvement in their condition, another third have a deterioration, and the rest have a stable condition. As a rule, deterioration of the condition is noticed in patients suffering from severe forms of the disease, and patients with a mild form either improve or their condition is stable.

The deterioration of the condition of pregnant women with bronchial asthma occurs in the later stages and usually after an acute respiratory disease or other adverse factors. The 24th-36th weeks are especially critical, and improvement is observed in the last month.

The picture of possible complications in patients with bronchial asthma in percentage terms looks like this: gestosis - in 47% of cases, hypoxia, as well as asphyxia of the baby at birth - in 33%, fetal malnutrition - in 28%, delayed development of the child - in 21%, threat of miscarriage – in 26%, development of premature birth – in 14.2%.

Treatment of bronchial asthma during pregnancy

For pregnant women, there is a special treatment regimen for bronchial asthma. It includes: assessment and constant monitoring of the mother’s lung function, preparation and selection of the optimal method of labor management. Speaking of childbirth: in such a situation, doctors often choose childbirth through a cesarean section - excessive physical stress can lead to another severe attack of bronchial asthma. However, of course, everything is decided individually, in each specific situation. But let's get back to the methods of treating the disease:

• Eliminating allergens

Successful therapy of atopic bronchial asthma requires, as a prerequisite, the removal of allergens from the environment in which the sick woman is located. Fortunately, technological progress today allows us to expand the possibilities for this condition: washing vacuum cleaners, air filters, hypoallergenic bedding, after all! And it goes without saying that the cleaning in this case should not be done by the expectant mother!

• Medications

For successful treatment, it is very important to collect a correct medical history, the presence of concomitant diseases, tolerability of drugs - non-steroidal anti-inflammatory drugs, as well as drugs containing them (theophedrine and others), and, especially, acetylsalicylic acid. When diagnosing aspirin-induced bronchial asthma in a pregnant woman, the use of non-steroidal analgesics is excluded - the doctor must remember this when selecting medications for the expectant mother.

Since most pharmaceutical drugs affect the unborn baby in one way or another, the main task in treating asthma is to use effective medications that do not harm the development of the unborn baby.

The effect of anti-asthma drugs on a child

• Adrenergic agonists

During pregnancy, adrenaline, which is usually used to relieve acute asthma attacks, is strictly contraindicated, since spasm of blood vessels associated with the uterus can lead to fetal hypoxia. Therefore, for expectant mothers, doctors select more gentle drugs that will not harm the baby.

Aerosol forms of β2-adrenergic agonists (fenoterol, salbutamol and terbutaline) are safer and more effective, but they can only be used as prescribed by a doctor and under his supervision. In late pregnancy, the use of β2-adrenergic agonists can lead to an increase in the duration of the labor period, since drugs with similar effects (partusisten, ritodrine) are also used to prevent premature birth.

• Theophylline preparations

The clearance of theophylline in pregnant women in the third trimester is significantly reduced, therefore, when prescribing intravenous theophylline preparations, the physician must take into account that the half-life of the drug increases to 13 hours compared to 8.5 hours in the postpartum period and the binding of theophylline to plasma proteins decreases. In addition, the use of methylxanthine drugs can cause postpartum tachycardia in a child, since these drugs have a high concentration in the fetal blood (they penetrate the placenta).

To avoid adverse effects on the fetus, the use of Kogan powders - antastaman, theophedrine - is highly discouraged. They are contraindicated due to the belladonna extracts and barbiturates they contain. In comparison, ipratropinum bromide (an inhaled anticholinergic) does not have a negative effect on fetal development.

• Mucolytic agents

The most effective medications for the treatment of asthma that have an anti-inflammatory effect are glucocorticosteroids. If indicated, they can be safely prescribed to pregnant women. Triamcinolone preparations (negative effects on the development of the child’s muscles), GCS preparations (dexamethasone and betamethasone), as well as depot preparations (Depomedrol, Kenalog-40, Diprospan) are contraindicated for short-term and long-term use.

If there is a need for use, it is preferable to use effective medications such as prednisolone, prednisone, inhaled corticosteroids (beclomethasone dipropionate).

• Antihistamines

Prescribing antihistamines in the treatment of asthma is not always advisable, but since such a need may arise during pregnancy, it should be remembered that the drug of the alkylamine group, brompheniramine, is absolutely contraindicated. Alkylamines are also included in other medications recommended for the treatment of colds (Fervex, etc.) and rhinitis (Koldakt). The use of ketotifen (due to lack of safety information) and other antihistamines of the previous, second generation is also strictly not recommended.

During pregnancy, under no circumstances should immunotherapy using allergens be carried out - this is an almost one hundred percent guarantee that the baby will be born with a strong predisposition to bronchial asthma.

The use of antibacterial drugs is also limited. In atopic asthma, penicillin-based drugs are strictly contraindicated. For other forms of asthma, it is preferable to use ampicillin or amoxicillin, or drugs in which they are found together with clavulanic acid (Augmentin, Amoxiclav).

Treatment of pregnancy complications

If there is a threat of miscarriage in the first trimester, asthma therapy is carried out according to generally accepted rules, without characteristic features. In the future, during the 2nd and 3rd trimester, treatment of complications typical of pregnancy should include optimization of respiratory processes and correction of the underlying pulmonary disease.

To prevent hypoxia, improve and normalize the processes of cellular nutrition of the unborn baby, the following medications are used: phospholipids + multivitamins, vitamin E; Actovegin. The doctor selects the dosage of all drugs individually, having made a preliminary assessment of the severity of the disease and the general condition of the woman’s body.

To prevent the development of infectious diseases to which people with bronchial asthma are susceptible, comprehensive immunocorrection is carried out. But again, I would like to draw your attention to the fact that any treatment should be carried out only under the strict supervision of a doctor. After all, what is ideal for one expectant mother may be harmful to another.

Childbirth and postpartum period

Therapy during childbirth should primarily be aimed at improving the circulatory systems of the mother and fetus - which is why the introduction of drugs that improve placental blood flow is recommended. And the expectant mother should under no circumstances refuse the therapy suggested by the doctor - you don’t want your baby’s health to suffer, do you?

One cannot do without the use of inhaled glucocorticosteroids, which prevent attacks of suffocation, and hence the subsequent development of fetal hypoxia. At the beginning of the first stage of labor, women who are constantly taking glucocorticosteroids, as well as those expectant mothers whose asthma is unstable, must be given prednisolone.

The therapy carried out is assessed in terms of effectiveness based on the results of ultrasound, fetal hemodynamics, according to CTG, by determining the hormones of the fetoplacental complex in the blood - in a word, mother and baby must be under the constant supervision of a doctor.

To prevent possible complications during childbirth, women with bronchial asthma must adhere to certain rules. They should continue basic anti-inflammatory therapy - do not interrupt treatment on the eve of a significant event in your life. For patients who have previously received systemic glucocorticosteroids, it is recommended to take hydrocortisone every 8 hours and for 24 hours after birth.

Since thiopental, morphine, tubocurarine have a histamine-releasing effect and can provoke an attack of suffocation, they are excluded if a cesarean section is necessary. When delivering by caesarean section, epidural anesthesia is preferred. And if there is a need for general anesthesia, the doctor will choose the drug especially carefully

In the postpartum period, a new mother suffering from bronchial asthma has a very high probability of developing bronchospasm - it is the body’s response to stress, which is the birth process. To prevent it, it is necessary to exclude the use of prostaglandin and ergometrine. Also, with aspirin-induced bronchial asthma, special care should be taken when using painkillers and antipyretics.

Breast-feeding

You have received comprehensive information about pregnancy and bronchial asthma. But do not forget about breastfeeding, which is an important part of the bond between mother and child. Very often, women refuse to breastfeed for fear that the medications will harm the baby. Of course, they are right, but only partly.

As you know, the vast majority of medications inevitably pass into milk - this also applies to medications for bronchial asthma. Components of methylxanthine derivatives, adrenergic agonists, antihistamines and other drugs are also excreted in milk, but in much lower concentrations than they are present in the mother’s blood. And the concentration of steroids in milk is also low, but the drugs should be taken at least 4 hours before feeding.

Bronchial asthma is one of the most common lung diseases in pregnant women. Due to the increase in the number of people prone to allergies, cases of bronchial asthma have become more frequent in recent years (from 3 to 8% in different countries; with each decade the number of such patients increases by 1-2%).
This disease is characterized by inflammation and temporary obstruction of the airways and occurs against a background of increased excitability of the airways in response to various influences. Bronchial asthma can be of non-allergic origin - for example, after brain injury or due to endocrine disorders. However, in the vast majority of cases, bronchial asthma is an allergic disease, when in response to exposure to an allergen, bronchospasm occurs, manifested by suffocation.

VARIETIES

There are infectious-allergic and non-infectious-allergic forms of bronchial asthma.
Infectious-allergic bronchial asthma develops against the background of previous infectious diseases of the respiratory tract (pneumonia, pharyngitis, bronchitis, tonsillitis); in this case, the allergen is microorganisms. Infectious-allergic bronchial asthma is the most common form, accounting for more than 2/3 of all cases of the disease.
In the non-infectious-allergic form of bronchial asthma, the allergen can be various substances of both organic and inorganic origin: pollen, street or house dust, feathers, animal and human hair and dander, food allergens (citrus fruits, strawberries, strawberries, etc.), medicinal substances (antibiotics, especially penicillin, vitamin B1, aspirin, pyramidon, etc.), industrial chemicals (most often formalin, pesticides, cyanamides, inorganic salts of heavy metals, etc.). When non-infectious allergic bronchial asthma occurs, hereditary predisposition plays a role.

SYMPTOMS

Regardless of the form of bronchial asthma, three stages of its development are distinguished: pre-asthma, asthma attacks and status asthmaticus.
All forms and stages of the disease occur during pregnancy.
minorities.
Pre-asthma includes chronic asthmatic bronchitis and chronic pneumonia with elements of bronchospasm. There are no pronounced attacks of suffocation at this stage yet.
In the initial stage of asthma, asthma attacks develop periodically. In the infectious-allergic form of asthma, they appear against the background of some chronic disease of the bronchi or lungs.
Choking attacks are usually easy to recognize. They begin more often at night and last from several minutes to several hours. Choking is preceded by a scratching sensation in the throat, sneezing, runny nose, and tightness in the chest. The attack begins with a persistent paroxysmal cough, no sputum. There is a sharp difficulty in exhaling, tightness in the chest, and nasal congestion. The woman sits down, strains all the muscles of the chest, neck, and shoulder girdle to exhale air. Breathing becomes noisy, whistling, hoarse, audible at a distance. At first, breathing is rapid, then becomes less frequent - up to 10 respiratory movements per minute. The face takes on a bluish tint. The skin is covered with perspiration. Towards the end of the attack, sputum begins to separate, which becomes more and more liquid and abundant.
Status asthmaticus is a condition in which a severe attack of breathlessness does not stop for many hours or several days. In this case, the medications that the patient usually takes are ineffective.

FEATURES OF BRONCHIAL ASTHMA DURING PREGNANCY AND BIRTH

As pregnancy progresses, women with bronchial asthma experience pathological changes in the immune system, which have a negative impact on both the course of the disease and the course of pregnancy.
Bronchial asthma usually begins before pregnancy, but may first appear during pregnancy. Some of these women also had mothers with asthma. In some patients, asthma attacks develop at the beginning of pregnancy, in others - in the second half. Asthma that occurs at the beginning of pregnancy, like early toxicosis, may disappear by the end of the first half. In these cases, the prognosis for the mother and fetus is usually quite favorable.
Bronchial asthma, which began before pregnancy, can occur in different ways during pregnancy. According to some data, during pregnancy, 20% of patients maintain the same condition as before pregnancy, 10% experience improvement, and in most women (70%) the disease is more severe, with moderate and severe forms of exacerbation predominating with daily repeated attacks suffocation, periodic asthmatic conditions, unstable treatment effect.
The course of asthma usually worsens already in the first trimester of pregnancy. In the second half, the disease progresses more easily. If a deterioration or improvement of the condition occurred during a previous pregnancy, then it can be expected in subsequent ones.
Attacks of bronchial asthma during childbirth are rare, especially with the prophylactic use of glucocorticoid drugs (prednisolone, hydrocortisone) or bronchodilators (aminophylline, ephedrine) during this period.
After childbirth, the course of bronchial asthma improves in 25% of women (these are patients with a mild form of the disease). In 50% of women, the condition does not change, in 25% it worsens, they are forced to constantly take prednisolone, and the dose has to be increased.
Patients with bronchial asthma more often than healthy women develop early toxicosis (in 37%), threatened miscarriage (in 26%), labor disturbances (in 19%), rapid and rapid labor, which results in high birth traumatism ( in 23%), premature and low birth weight babies may be born. Pregnant women with severe bronchial asthma experience a high percentage of spontaneous miscarriages, premature births and cesarean sections. Cases of fetal death before and during childbirth are observed only in severe cases of the disease and inadequate treatment of asthmatic conditions.
The mother's illness can affect the baby's health. 5% of children develop asthma in the first year of life, and 58% develop asthma in subsequent years. Newborns in the first year of life often develop upper respiratory tract diseases.
The postpartum period in 15% of postpartum women with bronchial asthma is accompanied by an exacerbation of the underlying disease.
Patients with bronchial asthma during full-term pregnancy usually give birth through the birth canal, since attacks of suffocation during childbirth are not difficult to prevent. Frequent attacks of suffocation and asthmatic conditions observed during pregnancy, the ineffectiveness of the treatment provided are indications for early delivery at 37-38 weeks of pregnancy.

TREATMENT OF BRONCHIAL ASTHMA DURING PREGNANCY

When treating bronchial asthma in pregnant women, it should be borne in mind that all drugs used for this purpose pass through the placenta and can cause harm to the fetus, and since the fetus is often in a state of hypoxia (oxygen starvation), a minimum amount of drugs should be administered. If asthma does not worsen during pregnancy, there is no need for drug therapy. With a mild exacerbation of the disease, you can limit yourself to mustard plasters, cupping, and inhalation of saline solution. However, it should be borne in mind that severe and poorly treated asthma poses a much greater danger to the fetus than the drug therapy used to treat it. But in all cases, a pregnant woman suffering from bronchial asthma should use medications only as prescribed by a doctor.
The main treatment of bronchial asthma includes bronchodilators (sympathomimetics, xanthine derivatives) and anti-inflammatory drugs (intal and glucocorticoids).
The most widely used drugs are from the group of sympathomimetics. These include isadrin, euspiran, novodrin. Their side effect is increased heart rate. It is better to use so-called selective sympathomimetics; they cause relaxation of the bronchi, but this is not accompanied by palpitations. These are drugs such as salbutamol, bricanil, salmeterol, berotec, alupent (asthmopent). When used inhalation, sympathomimetics act faster and stronger, so during an attack of suffocation, take 1-2 breaths from the inhaler. But these medications can also be used as prophylactics.
Adrenaline also belongs to sympathomimetics. Its injection can quickly eliminate an attack of suffocation, but it can cause spasm of peripheral vessels in the woman and fetus and worsen uteroplacental blood flow. Ephedrine is not contraindicated during pregnancy, but it is ineffective.
It is interesting that sympathomimetics have found wide use in obstetrics for the treatment of miscarriage. An additional beneficial effect of these drugs is the prevention of distress syndrome - breathing problems in newborns.
Methylxanthines are the most preferred treatment for asthma during pregnancy. Eufillin is administered intravenously for severe attacks of suffocation. Aminophylline tablets are used as a prophylactic agent. Recently, extended-release xanthines - theophylline derivatives, such as Teopec - have become increasingly widespread. Theophylline preparations have a beneficial effect on the body of a pregnant woman. They improve uteroplacental circulation and can be used to prevent distress syndrome in newborns. These drugs increase renal and coronary blood flow and reduce pulmonary artery pressure.
Intal is used after 3 months of pregnancy for non-infectious allergic forms of the disease. In severe cases of the disease and asthmatic conditions, this drug is not prescribed. Intal is used only for the prevention of bronchospasm, but not for the treatment of already developed asthma attacks: this can lead to increased suffocation. Intal is taken in the form of inhalations.
Among pregnant women, more and more often there are patients with severe forms of bronchial asthma who are forced to receive hormone therapy. They usually have a negative attitude towards taking glucocorticoid hormones. However, during pregnancy, the danger associated with the administration of glucocorticoids is less than the risk of developing hypoxemia - a lack of oxygen in the blood, from which the fetus suffers very seriously.
Treatment with prednisolone must be carried out under the supervision of a physician, who sets an initial dose sufficient to eliminate an exacerbation of asthma in a short period of time (1-2 days), and then prescribes a lower maintenance dose. In the last two days of treatment, inhalations of becotide (beclamide), a glucocorticoid that has a local effect on the respiratory tract, are added to prednisolone tablets. This drug is harmless. It does not stop the developing attack of suffocation, but serves as a preventive measure. Inhaled glucocorticoids are currently the most effective anti-inflammatory drugs for the treatment and prevention of bronchial asthma. During exacerbations of asthma, without waiting for the development of severe attacks, the dose of glucocorticoids should be increased. The doses used are not dangerous for the fetus.
Anticholinergics are drugs that reduce the narrowing of the bronchi. Atropine is administered subcutaneously during an attack of suffocation. Platyphylline is prescribed in powders prophylactically or to stop an attack of bronchial asthma - subcutaneously. Atrovent is a derivative of atropine, but with a less pronounced effect on other organs (heart, eyes, intestines, salivary glands), which is associated with its better tolerability. Berodual contains Atrovent and Berotec, which was mentioned above. It is used to suppress acute attacks of asthma and to treat chronic bronchial asthma.
The well-known antispasmodics papaverine and no-spa have a moderate bronchodilator effect and can be used to suppress mild attacks of suffocation.
In case of infectious-allergic bronchial asthma, it is necessary to stimulate the removal of sputum from the bronchi. Regular breathing exercises, toileting of the nasal cavity and oral mucosa are important. Expectorants serve to thin sputum and promote the removal of bronchial contents; they moisturize the mucous membrane and stimulate coughing. For this purpose the following can be used:
1) inhalation of water (tap or sea), saline solution, soda solution, heated to 37°C;
2) bromhexine (bisolvon), mucosolvin (in the form of inhalations),
3) ambroxol.
3% solution of potassium iodide and solutan (containing iodine) are contraindicated for pregnant women. An expectorant mixture with marshmallow root and terpin hydrate in tablets can be used.
It is useful to drink medicinal mixtures (if you are not intolerant to the components of the collection), for example, from wild rosemary herb (200 g), oregano herb (100 g), nettle leaves (50 g), birch buds (50 g). They need to be crushed and mixed. Pour 2 tablespoons of the mixture into 500 ml of boiling water, boil for 10 minutes, then leave for 30 minutes. Drink 1/2 glass 3 times a day.
Recipe for another collection: plantain leaves (200 g), St. John's wort leaves (200 g), linden flowers (200 g), chop and mix. Pour 2 tablespoons of the collection into 500 ml of boiling water, leave for 5-6 hours. Drink 1/2 cup 3 times a day before meals, warm.
Antihistamines (diphenhydramine, pipolfen, suprastin, etc.) are indicated only for mild forms of non-infectious allergic asthma; in the infectious-allergic form of asthma, they are harmful because they contribute to the thickening of the secretions of the bronchial glands.
In the treatment of bronchial asthma in pregnant women, it is possible to use physical methods: physical therapy, a set of gymnastic exercises that facilitate coughing, swimming, inductothermy (warming) of the adrenal gland area, acupuncture.
During childbirth, treatment for bronchial asthma does not stop. The woman is given humidified oxygen and drug therapy continues.
Treatment of status asthmaticus must be carried out in a hospital in the intensive care unit.

PREVENTION OF PREGNANCY COMPLICATIONS

It is necessary for the patient to eliminate risk factors for exacerbation of the disease. In this case, removing the allergen is very important. This is achieved by wet cleaning of the room, excluding allergy-causing foods from food (oranges, grapefruits, eggs, nuts, etc.) and nonspecific food irritants (pepper, mustard, spicy and salty foods).
In some cases, the patient needs to change jobs if it involves chemicals that act as allergens (chemicals, antibiotics, etc.).
Pregnant women with bronchial asthma should be registered with a antenatal clinic physician. Each “cold” disease is an indication for treatment with antibiotics, physiotherapeutic procedures, expectorants, for the prophylactic administration of drugs that dilate the bronchi, or for increasing their dose. In case of exacerbation of asthma at any stage of pregnancy, hospitalization is carried out, preferably in a therapeutic hospital, and in case of symptoms of a threat of miscarriage and two weeks before the due date, in a maternity hospital to prepare for childbirth.
Bronchial asthma, even its hormone-dependent form, is not a contraindication for pregnancy, as it is amenable to drug and hormonal therapy. Only with recurring asthmatic conditions may the question of abortion in the early stages of pregnancy or early delivery of the patient arise.

Pregnant women with bronchial asthma should be regularly monitored by an obstetrician and a antenatal clinic physician. Treatment of asthma is complex and must be managed by a doctor.