4 years ago

Asthma Outcomes and Management During Pregnancy.

Strek ME, Patterson KC, Bonham CA
Asthma during pregnancy poses a common, increasingly prevalent threat to the health of women and their children. We review recent insights gained from the epidemiology of asthma during pregnancy, demonstrating the many short and long-term risks to mother and fetus incurred by poorly controlled maternal asthma. We further discuss emerging evidence that active asthma management during pregnancy can positively influence and perhaps completely mitigate these poor outcomes. Recent high-quality trials examining best methods for asthma treatment are reviewed and synthesized to offer an evidence-based pathway for comprehensive treatment of asthma in the outpatient setting. We discuss safe and effective medications as well as non-pharmacologic interventions for asthma during pregnancy, and advise treatment of related conditions of pregnancy, including depression, rhinitis, and gastroesophageal reflux. Throughout, we emphasize that an effective treatment strategy relies upon a detailed patient evaluation, patient education, objective measurement of asthma control, and frequent and supportive follow-up. We review the cardiovascular and respiratory physiology of pregnancy and its implications for the management of patients with asthma, including patients requiring intubation and mechanical ventilation. For these situations when outpatient asthma management has failed, we detail an approach to the critically ill pregnant patient with status asthmaticus. Multidisciplinary teams that include pulmonary specialists, obstetricians, primary care providers, nurses, pharmacists, and asthma educators improve the care of pregnant women with asthma.

Publisher URL: https://www.ncbi.nlm.nih.gov/pubmed/28867295

DOI: PubMed:28867295

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