Acute exacerbation of asthma in pregnancy

• Acute Asthma: Give Drug therapy for acute asthma as for non-pregnant patient including systemic steroids and magnesium sulphate
• Acute severe asthma in pregnancy is an emergency and should be treated vigorously in hospital
• Deliver high flow oxygen immediately to maintain saturation 94–98%

British Guideline on Management of Asthma

• Drug therapy should be given as for a non-pregnant patient with acute asthma, continuous nebulised β2 agonists and early administration of steroid tablets.
•  In severe cases, intravenous β2 agonists, aminophylline, or intravenous bolus magnesium sulfate can be used as indicated
• Continuous fetal monitoring should be performed when asthma is uncontrolled or severe, or when fetal assessment on admission is not reassuring.

 Adapted from Managing Asthma During Pregnancy: Recommendations for Pharmacologic Treatment

RECOMMENDATIONS

• For management of acute exacerbation, there is consistent evidence on the use of IV Magnesium Sulphate and also systemic steroids. 
• No consistent evidence on the use of Subcutaneous Terbutaline. However they are still safe to be used in pregnancy
• For management of acute asthma overall the management is as for non-pregnant patients.

REFERENCES

1. www.uptodate.com
2. Medscape, http://www.medscape.org/viewarticle/569862
3. http://www.guidelines.co.uk/btssign/asthma-in-pregnancy
4. https://www.brit-thoracic.org.uk/document-library/clinical-information/asthma/btssign-guideline-on-the-management-of-asthma/
5. Managing Asthma During Pregnancy: Recommendations for Pharmacologic Treatment https://www.nhlbi.nih.gov/files/docs/astpreg_qr.pdf