Respiratory Disorders Flashcards
(25 cards)
What are the respiratory changes in pregnancy?
20% increase in demand for oxygen
Increase in tidal volume required
Resulting in increasing tidal volume but not resp rate.
Why is increase in tidal volume required in pregnancy?
Progesterone increases sensitivity of respiratory centre to CO2 and effects smooth muscle of the bronchioles
Relaxation of intercostal muscles
Subcostal angle increases
Diaphragm rises.
why may physiological breathlessness occur?
-Englarging uterus pressing up on the base of the lungs.
-Progesterone causes hyperventilation
-Increase in maternal weight
-Nasal congestion
Anaemia.
What my physiological breathlessness present as and when may it be worse?
Presents as air ‘hunger’ without increased resp rate
Worde when sitting/talking, alleviated by mild exertion.
What are some red flags in pregnant patients presenting with breathlessness?
Sudden-onset breathlessness
Orthopnoea (breathlessness when lying down)
Breathlessness with chest pain or syncope (fainting)
Resp rate >20
O2 sats <94% or falls to <94% on exertion
Breathlessness associated with tachy
What is the definition of asthma?
Chronic inflammatory disease of the airways characterised by episodes of wheeze, shortness of breath, chest tightness and cough.
An acute asthmatic attack can range in severity from mild SOB to resp failure and death.
What can be triggers of asthma? (Thomson, 2015; Wylie and Bryce, 2016; Robson and Waugh, 2013)
Smoking
Infection
Diet
Pollution
Exposure to allergens
Exercise
Medication- NSAIDs/ Beta Blockers
Hormonal- Pregnancy
Develops over hours/days
Symptoms are variable intermittent and worse at night.
What is the name of stage 1 of the aetiology of asthma
Hyperreactivity
What is meant by stage 1:hyperreactivity of asthma?
Wylie and Bryce, 2016
Smooth muscles in the airways constrict and narrow inappropriately in response to an inhaled allergen
Unlike a healthy person, the muscles of the airway do not relax again
This prevents deep breathing.
What is the name of stage 2 of the aetiology of asthma?
Inflammatory response
What does stage 2: Inflammatory response for asthma aetiology mean?
- The immune system then triggers an inflammatory response to the allergen.
- WBCs are delivered to the airways.
- This causes the airway to swell, fill with fluid and produce mucus.
-The alveoli of the lungs stay partially inflated preventing sufficient oxygen from silling them
-This results in wheeze, SOB and increase ventilation depth and speed.
What does asthma in pregnancy look like? (BTS/sign 2019)
-1/3 of women notice an improvement in their asthma, 1/3 experience a worsening of symptoms, and 1/3 remain the same in pregnancy.
-The course of asthma in similar in successive pregnancies.
- Severe asthma is more likely to worsen during pregnancy than mild asthma
- Most likely to experience worsening symptoms between the 24th and 36th week of pregnancy.
- Symptoms reduce significantly in last 4 weeks and 90% have no asthma symptoms in the labour/ birth- due nature steroid production.
Potential complications of asthma in pregnancy (BTS/SIGN, 2019)
Hyperemesis
Hypertension
Pre-eclampsia
GDM
Fetal growth restriction
Preterm birth
Complicated labour
CS
Vaginal haemorrhage
Neonatal hypoxia
Increased perinatal mortality.
What is management of asthma in pregnancy?
(Wylie and Bryce, 2016)
-Counsel women regarding the importance and safety of continuing their asthma medications during pregnancy.
-?Steroid tablets association with cleft lip.
- Maternal and fetal risks of uncontrolled asthma are much greater than the risks from using conventional asthma medications
- Vit D
-Smoking cessation support
-?Offer advice on non-pharmacological control of asthma.
What are signs of acute asthma in pregnancy?
Wylie and Bryce, 2016
RR>25
P>110
Use of accessory muscles of respiration
An inability to complete a sentence in one breath.
What are the signs of acute severe asthma? Wylie and Bryce, 2016
Cyanosis
Feeble respiratory effort
Exhaustion
Confusion
Bradycardia
Acute severe asthma in pregnancy is an emergency and should be treated vigorously in hospital.
What is the management of asthma in labour?
-Acute asthma attacks are very rare in labour
-Advise women to continue their usual asthma medications in labour
-Increased risk of CS
If anaesthesia is required, regional blockade is preferable to general anaesthesia due to potential risk of bronchospasm
- Avoid pethidine/ morphine if recent acute asthma attack.
-Use prostaglandin with extreme caution because of the risk of inducing bronchoconstriction.
-Omit ergometrine.
What is the management of asthma in the postnatal period? (BTS/SIGN, 2019)
-The risk of postpartum asthma attacks is increased in women having CS
-Encourage women with asthma to BF- protective against asthma
- Use asthma medications as normal during lactation, in line with manufacturers recommendations
-Vigilant infection control- oral corticosteroids can cause immunosuppression
- Avoid NSAIDSs/ beta-blockers
Why is the influenza vaccine offered in pregnancy?
Increased risk of catching flu in pregnancy
Increased mortality and morbidity for both mother and fetus
All pregnant women to be offered the flu vaccine between sept-March
32.1% uptake of flu vaccine in the pregnant pop 2023-24
This is the lowest end of season uptake on record since 2011 to 2012 (UK health security agency, 2023)
Why is the pertussis (whooping cough) vaccine offered in pregnancy and what are the acceptance rates?
Almost all deaths from whooping cough occur in young babies before they’ve had a chance to be vaccinated.
Babies can be protected by vaccinating the mother during pregnancy
Whooping cough vaccine coverage was 58.^% in the 2023/24 financial year
Uptake has dropped to its lowest level in 7 years (UK health security agency, 2023)
Why is the respiratory syncytial virus (RSV) vaccine offered in pregnancy?
Can cause pneumonia and bronchiolitis
Babies can be protected by vaccinating the mother from 28 weeks of pregnancy.
39.4% vaccine coverage 2024 (UK health security agency, 2025)
Why is the Covid 19 vaccine offered to pregnant women and what is the uptake?
Increased risk of catching COVID-19 in pregnancy.
Increase mortality and morbidity for both mother and fetus
All pregnant women to be offered the COVID-19 vaccine between sept-March
27 of the 33 women who died from Covid 19 were eligible for and could have received two doses of the vaccine before they died (MBBRACE-UK, 2023)
Which groups of women were most likely to get confused messaging due to lack of research evidence and consequent widespread vaccine hesitancy? (MBBRACE-UK, 2023)
Women amongst disadvantaged backgrounds and ethnic minority groups.
How can we maximise vaccination uptake?
MBRRACE-UK (2023) key message: Prepare a route to enable rapid dissemination of updated advice and data concerning new vaccines and treatments to both women and their clinicians in the future.
Offer at the same time
Provide UKHSA leaflets on flu, whooping cough and COVID-19
MECC
