Asthma management across ages Asthma in pregnancy Rule

  • Slides: 10
Download presentation

Asthma management across ages Asthma in pregnancy Rule of one thirds (BTS/SIGN 2004) Ø

Asthma management across ages Asthma in pregnancy Rule of one thirds (BTS/SIGN 2004) Ø 1/3 improvement Ø 1/3 worsening Ø 1/3 stay the same

Asthma management across ages Asthma in pregnancy Ø Asthma needs to be monitored more

Asthma management across ages Asthma in pregnancy Ø Asthma needs to be monitored more closely during pregnancy Ø Medication concerns Ø Risks to fetus greater from poorly controlled maternal asthma

Asthma management across ages Asthma in pregnancy Ø Asthma medications should be continued during

Asthma management across ages Asthma in pregnancy Ø Asthma medications should be continued during pregnancy and modified to control symptoms Ø Reassurance of safety of asthma treatments is essential

Asthma management across ages Asthma in pregnancy Midwives Ø May not be familiar with

Asthma management across ages Asthma in pregnancy Midwives Ø May not be familiar with asthma drugs or appropriate management Ø They need support to help manage asthma so that treatment is not stopped unnecessarily Ø Asthma training issues for midwives to be addressed

Asthma management across ages Asthma in pregnancy Ø Asthma is treated in exactly the

Asthma management across ages Asthma in pregnancy Ø Asthma is treated in exactly the same way Ø Exception LTRAs should not be started during pregnancy (limited evidence for safety) Ø LTRAs can be continued during pregnancy if they have contributed to significant improvement in asthma control (BTS/SIGN 2004) Ø If oral steroids are required for poorly controlled asthma they should not be withheld because of pregnancy

Asthma management across ages Asthma in pregnancy During delivery Ø Asthma attacks Rare due

Asthma management across ages Asthma in pregnancy During delivery Ø Asthma attacks Rare due to large amount of endogenous circulating steroids Ø If oral steroids > 7. 5 mg/day > 2 weeks give 100 mg parenteral Hydrocortisone every 6 -8 hours during labor

Asthma management across ages Asthma in pregnancy Breast feeding Ø Encourage breast feeding Ø

Asthma management across ages Asthma in pregnancy Breast feeding Ø Encourage breast feeding Ø Asthma treatment taken normally Ø No clinical significant risk of Prednisolone: minimal concentration in breast milk (BTS/SIGN 2004)

Asthma management across ages Asthma in pregnancy Smoking Ø Pregnant should not smoke Ø

Asthma management across ages Asthma in pregnancy Smoking Ø Pregnant should not smoke Ø More important for those who have asthma to cease smoking Ø Need advise and support to help them stop Ø NRT is not advocated in pregnancy But balance benefits and risks