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Case Discussion: Asthma in Pregnancy. May 2014. Consider Jane…. Jane 23 yo child care worker Presents 10/40 pregnant unplanned pregnancy G1 P0 EDC 23 September Smoker 25/day Significantly cut back since becoming pregnant Live in partner is smoker Only PMH is asthma since childhood

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Case Discussion: Asthma in Pregnancy


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Presentation Transcript
consider jane
Consider Jane…
  • Jane 23 yo child care worker
  • Presents 10/40 pregnant unplanned pregnancy
  • G1 P0 EDC 23 September
  • Smoker 25/day
    • Significantly cut back since becoming pregnant
    • Live in partner is smoker
  • Only PMH is asthma since childhood
    • Needs salbutamol script
    • Wants to do shared care
asthma in pregnancy
Asthma in Pregnancy…
  • Jane advises you that she usually only uses her salbutamol puffer occasionally and whilst she has had a preventer in the past, she stopped using it because she ran out and never got a new prescription
  • Started smoking “here and there” at age 15/16 but regularly by 18
  • Currently Jane is not worried about her asthma control and thinks she only needs the ventolinoccasionally
  • On direct questioning…
    • Uses her puffer when she gets SOB running around at work 1-2 times/day most days
    • Will need it a couple of times on weekends when friends come over & everybody is smoking
    • Doesn’t really exercise so doesn’t know if she needs it with exercise
    • Needs it regularly (3-4 hrly) first couple of days when she has a cold
examination findings
Examination findings…
  • Ht: 165 cm Wt: 71kg BMI: 26.1
  • Afebrile
  • ENT: NAD
  • Chest: Clear good AE occasional expiratory wheeze bilaterally
  • Spirometry:
    • Pre-bronchodilator:
    • PEFR: 330 (exp 440) ie 75% expected
    • FEV1/FVC:82% (exp 85%)
    • Post-bronchodilator:
    • PEFR: 396 (exp 440) ie 90% expected
    • FEV1/FVC 84% (exp 85%)
questions to consider
Questions to consider:
  • What are the extra issues you need to consider in managing Jane during this pregnancy?
  • What do you advise Jane about her and her partner smoking in pregnancy?
  • What are Jane’s options to assist with stopping smoking in pregnancy?
  • What is the significance of contracting influenza in pregnancy?
  • What do you advise about immunisation against influenza during pregnancy?
  • Why is asthma control important in pregnancy?
  • How do you manage Jane’s asthma this pregnancy?
  • What non-pharmacological management could be offered?
  • What pharmacological management could be offered?
slide6

Take Home Messages…

  • Harmful effects of direct and passive smoking in pregnancy and on the health of babies and children have been well established
  • There is currently a lack of evidence on the safety of nicotine replacement therapy (NRT) in pregnancy but reports of expert committees have recommended its use in certain circumstances. NRT should be considered when a pregnant woman is otherwise unable to quit, and when the likelihood and benefits of cessation outweigh the risks of NRT and potential continued smoking
  • Pregnancy increases the risk of contracting influenza and developing serious complications from influenza
  • The vaccine is safe to give in all stages of pregnancy.
  • Maternal asthma has been shown to contribute to significant complications of pregnancy
  • These outcomes are likely to be reduced with well managed asthma; women with well managed asthma can expect the same outcomes as women without asthma
  • Short acting b 2 agonists and inhaled corticosteroidsare the mainstay of treatment for asthma and appear to be safe in pregnancy; most evidence for safety is for budesonide (ADEC category A)