Daily Archive 11.11.2019

Bronchial asthma during pregnancy

Features of the course of bronchial asthma during pregnancy . Pregnancy can cause an improvement and worsening of the course of bronchial asthma. Approximately 40% of women experience remission, 35 – the course does not change, in 25% there is an exacerbation; sometimes the first attack occurs during pregnancy. A certain prognostic value is the severity of the disease before pregnancy. The course of a mild form of bronchial asthma does not change or improve; severe bronchial asthma is prone to exacerbation. Deterioration is most often observed and most pronounced in the last months of pregnancy. The effect of pregnancy on the subsequent course of the disease is variable. In 25-30% of patients, it noticeably worsens. Responsible for the immediate period after childbirth. Mothers with asthma have an increased risk of antenatal and neonatal fetal death. The mechanism of the effect of pregnancy on the course of bronchial asthma is not precisely established. Several factors are attached importance: a gradual increase in the level of plasma glucocorticosteroids by 2-2.5 times (positive factor), with which, possibly, an increase in the level of cAMP in the plasma of pregnant women, which is a good prognostic sign; increased progesterone content. having a different effect – a weak bronchodilating effect and increased shortness of breath due to excitation of the respiratory center; a decrease in the function of cellular immunity with possible consequences in the form of a change in the severity of allergies and an increase in the likelihood of an exacerbation of a bacterial infection of the respiratory tract; an increase in the size of the fetus and the associated increase in the diaphragm and a change in the respiratory volume of the lungs (the hormonal or metabolic nature of these changes is also assumed); allergic mothers with fetal antigens, which causes the development of an immunological conflict involving the lungs. The basic principles of treating bronchial asthma during pregnancy are the minimum risk for the mother and the fetus, the prevention of complications in the neonatal and perinatal periods. In the early stages of pregnancy, drugs that can stimulate uterine contractions should be avoided. Adrenergic drugs (3-stimulating drugs are well tolerated, however, since the initial clinical trials of these substances did not study their effect on pregnant women, it is not recommended to use them in the first trimester . The same applies to intal. Antibiotics of the tetracycline group for the treatment of bronchial asthma during pregnancy. contraindicated due to teratogenic effects Methylxanthines are safe and can be used, although they can increase nausea and vomiting in the first trimester of pregnancy. idnye drugs are prescribed, if necessary; the risk of complications for the mother as a result of glucocorticosteroid therapy does not increase, but may develop transient suppression of fetal adrenal glands, resulting in the glucocorticosteroid insufficiency in neonates with stress (eg, infection). In the first six weeks after birth.