Asthma in Pregnancy

Question 1

Describe asthma and its prevalence in pregnancy

Answer 1

disease of lungs w airway remodelling affecting 17% of pregnant people

Question 2

describe the mechanisms of asthma and the early phase response

Answer 2

exposure from environment from certain allergen, injured epithelium has an early phase response which sends a signal to mast cells which activate inflam response through IgE causing transient smooth muscle contraction and mucous secretion = reduced ability to take in air

Question 3

describe the late phase response of asthma

Answer 3

airway remodelling and multiple inflam pathway activation w eosinophils leading to inflam and more cytokines causing smooth muscle contraction and mucous secretion

Question 4

compare the phenotypes of asthma

Answer 4

allergic: eosinophilic or non-eosinophilic
non-allergic: airway hyperresponsiveness, mediated by hyperactive bronchiole smooth muscle

Question 5

list the different classes of meds used to treat asthma

Answer 5

ICS, SABA, LABA, IgE inhibitors, leukotriene R antagonists, mast cell inhibitors, antibiotics, I13 or Il5 inhibs

Question 6

what is the cause of a flare up?

Answer 6

exposure to allergen, infection or stress

Question 7

what is the best treatment for a flare up?

Answer 7

PO steroids to inhib mucous production and allow for immune system and smooth muscle relaxation

Question 8

when is asthma considered controlled?

Answer 8

if no reliever needed for 4/52

Question 9

what maternal complications does asthma increase risk of in pregnancy?

Answer 9

PET, GDM, CS, APH, PPH, placenta praevia, PROM, placental abruption

Question 10

what fetal complications does asthma increase risk of in pregnancy?

Answer 10

slight increase cong malf, cleft lip, NND, lung development inhibited, LBW

Question 11

what are possible long term effects on neonate?

Answer 11

delayed learning, childhood wheeze resulting in asthma, endocrine/metabolic disorders

Question 12

describe pathophysiology of worsening asthma in pregnancy

Answer 12

Rantes and IL6 increase significantly as well as eotaxin and IL8 which all attract cells to the lungs and increase ICAM1 (cell adhesion factor) causing eosinophils, neutrophils and monocytes to enter the lungs driving up worsening symptoms, chemotactic response still upregulated which does not occur in non-asthmatic mothers in pregnancy

Question 13

how does nutrition affect lung function?

Answer 13

high fat high sugar diets increase risk of uncontrolled asthma in pregnancy with an increased production of neutrophils and more likely to have preterm

Question 14

compare affects of asthma on fetal growth between female and male fetuses

Answer 14

females will become small and prioritise survival if asthma isn’t controlled however males’ growth will be unaffected which increases the risk of IUGR, preterm or stillbirth if exacerbation occurs since they are not prepared for reduction in nutrients/oxygen

Question 15

what are the preferred treatments for asthma in pregnancy?

Answer 15

Pulmicort (inhaled glucocorticoid), prednisolone/prednisone, ICS, LABA