Thursday, February 4, 2016

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

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