ASTHMA in PREGNANCY

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ASTHMA in PREGNANCY:

ASTHMA in PREGNANCY CLINICAL LECTURE Bambang Widjanarko, dr, SpOG Departement Of Obstetrics and Gynaecology School of Health and Medicine Muhammadiyah University Jakarta

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CHRONIC INFLAMMATORY DISEASE of the airways that is characterized by increased responsiveness of the tracheobronchial tree to multiple stimuli. It is the most COMMON CHRONIC CONDITION in pregnancy. The disease is EPISODIC , being characterized by ACUTE EXACERBATIONS intermingled with SYMPTOM-FREE PERIODS . Most attacks prove to be SHORT-LIVED , lasting minutes to hours. Develop chronic airflow limitations .

ETIOLOGIC FACTORS IN ASTHMA:

ETIOLOGIC FACTORS IN ASTHMA ALLERGENS : pollens, house-dust mites, cockroach antigen, animal dander, molds, and Hymenoptera stings IRRITANTS : cigarette smoke, wood smoke, air pollution, strong odors, occupational dust, and chemicals MEDICAL CONDITIONS : viral upper respiratory tract infections, sinusitis, esophageal reflux, and Ascaris infestations DRUGS and CHEMICALS : aspirin, nonsteroidal anti-inflammatory drugs, beta blockers, radiocontrast media, and sulfites Exercise Cold air Menses Emotional stress

OUTCOMES and COMPLICATIONS of ASTHMA in PREGNANCY:

OUTCOMES and COMPLICATIONS of ASTHMA in PREGNANCY Severe and/or poorly controlled asthma has been associated with numerous adverse PERINATAL OUTCOMES , including the following: Preeclampsia Pregnancy-induced hypertension Uterine hemorrhage Preterm labor Premature birth Congenital anomalies Fetal growth restriction Low birth weight Neonatal hypoglycemia, seizures, tachypnea, and neonatal intensive care unit (ICU) admission

MORBIDITIES IN PREGNANT WOMEN:

MORBIDITIES IN PREGNANT WOMEN Respiratory failure and the need for mechanical ventilation Barotrauma Complications of (parenteral) steroid use Death.

PATHOPHYSIOLOGIC MECHANISMS:

PATHOPHYSIOLOGIC MECHANISMS PREGNANCY : significant effect on the respiratory physiology Physiologic changes is a HYPERVENTILATORY PICTURE as a normal state of affairs in the later half of pregnancy. chronic respiratory alkalosis partial pressure of carbon dioxide (pCO 2 )  , bicarbonate (HCO2-)  , pH  . A normal pCO 2 in a pregnant patient may signal impending respiratory failure .

ASTHMA DIFFERENTIAL DIAGNOSIS:

ASTHMA DIFFERENTIAL DIAGNOSIS Airway obstruction Amniotic fluid embolism Acute congestive heart failure (CHF), secondary to peripartum cardiomyopathy Physiologic dyspnea of pregnancy

HISTORY FINDINGS:

HISTORY FINDINGS Cough Shortness of breath Chest tightness Noisy breathing Nocturnal awakenings Recurrent episodes of symptom complex Exacerbations possibly provoked by nonspecific stimuli Personal or family history of other atopic disease (eg, hay fever, eczema

GENERAL PHYSICAL EXAMINATION FINDINGS :

GENERAL PHYSICAL EXAMINATION FINDINGS Tachypnea Retraction (sternomastoid, abdominal, pectoralis muscles) Agitation, usually a sign of hypoxia or respiratory distress Pulsus paradoxicus (>20 mm Hg)

PULMONARY FINDINGS:

PULMONARY FINDINGS DIFFUSE WHEEZES - Long, high-pitched sounds on expiration and, occasionally, on inspiration) DIFFUSE RHONCHI - Short, high- or low-pitched squeaks or gurgles on inspiration and/or expiration BRONCHOVESICULAR SOUNDS

SIGNS OF COMPLICATED ASTHMA :

SIGNS OF COMPLICATED ASTHMA EQUALITY OF BREATH SOUNDS : Check for equality of breath sounds (pneumonia, mucous plugs, barotrauma). The amount of wheezing does not always correlate with the severity of the attack. A silent chest in someone in distress is more worrisome. JUGULAR VENOUS DISTENSION from increased intrathoracic pressure (from a coexistent pneumothorax) HYPOTENSION and TACHYCARDIA (think tension pneumothorax) FEVER , a sign of upper or lower respiratory infections

BLOOD WORK:

BLOOD WORK Complete blood count with differential Degree of nonspecific inflammation possibility of a comorbid anemia or Thrombocytopenia. Leukocytosis Arterial blood gas level Arterial blood gas (ABG) analysis indicates the level of oxygenation and respiratory compensation. Partial pressure of carbon dioxide in the arterial blood (PaCO 2 ) is generally low in the early stages of an exacerbation as a result of hyperventilation.

CHEST RADIOGRAPHY:

CHEST RADIOGRAPHY A normal chest radiograph in late pregnancy typically reveals an ENLARGED HEART and some PROMINENT LUNG MARKINGS from elevation of the diaphragm. Chest radiography is indicated when the other coexistent conditions, such as pneumonia, barotrauma, CHF, or chronic obstructive pulmonary disease , are likely. Chest radiographs (2 views) with a shielded maternal abdomen expose the fetus to approximately 0.00005 rad.

PULMONARY FUNCTION TESTING:

PULMONARY FUNCTION TESTING Changes in pulmonary function during acute asthma include the following: Decreased peak expiratory flow rate (PEFR) and forced expiratory volume in 1 second (FEV 1 ) Mild reduction in the forced vital capacity (FVC) An increased of : residual volume (RV), functional residual capacity (FRC), and total lung capacity (TLC) Normal diffusing capacity

ANTIASTHMA DRUGS:

ANTIASTHMA DRUGS Almost all antiasthma drugs ARE SAFE TO USE in pregnancy and during breastfeeding. CORTICOSTEROIDS can be used in the acute and outpatient setting and have been shown to be relatively safe in pregnancy. A longer-acting BETA2-ADRENORECEPTOR AGONIST (eg, salmeterol), the bronchodilator effects of which last at least 12 hours, is an effective treatment for nocturnal asthma. EPINEPHRINE use should be avoided in the pregnant patient. In general, epinephrine is used only in the most severe asthma exacerbations. In pregnancy, employment of the drug can lead to possible : congenital malformations, fetal tachycardia, and vasoconstriction of the uteroplacental circulation.

THANK YOU:

THANK YOU Bambang Widjanarko, dr, SpOG Departement Of Obstetrics and Gynaecology School of Health and Medicine Muhammadiyah University of Jakarta

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