- Risk factors
- Types of asthma
- The impact of asthma on pregnancy
- Treatment of asthma during pregnancy
- The impact of asthma medication on a child
- Treatment of complications of pregnancy
- Childbirth and the postpartum period
Asthma has recently received very widespread - many people do not know firsthand about the disease. And nothing - live with it is quite possible, and allows the medicine to keep the disease under control. But sooner or later before the woman raises the question of motherhood. And here begins the panic - and if I can carry and give birth to a child: Will there be a healthy baby?
Physician clearly answer "yes"! Bronchial asthma - is not a sentence to your maternity, because modern medicine allows women suffering from this disease, to become mothers. But the issue is very difficult, so let's deal in everything in order, so you finally lost.
The World Health Organization gives asthma following definition - a chronic disease in which under the action of T-lymphocytes, eosinophils and the other cell elements to develop chronic airway inflammation. Because asthma is enhanced bronchial obstruction to external stimuli and to various internal factors - in other words, is a response to the inflammation of the airways.
Although bronchial obstruction can be different degrees of severity and is subject to - either spontaneously or under the influence of treatment - complete or partial reversibility, need to know that people who have a predisposition, inflammatory process leads to the generalization of the disease.
In the early eighteenth century, it was believed that asthma is not as serious illness, to give it special attention - doctors treated the phenomenon as a side effect of other diseases. For the first time a systematic approach to the study of asthma applied scientists from Germany - Kurshmana and Leiden. They identified a number of cases of suffocation, and as a result, described and systematized the clinical manifestations of asthma have become perceived as a single disease. Yet the level of technical equipment of medical institutions at that time was not sufficient in order to establish the cause and fight disease.
Asthma worldwide suffer from 4 to 10% of the population. Age for the disease does not matter: half of patients with the disease have faced up to 10 years, another third - to 40 years. The ratio of the frequency of the disease among children by gender-principle 1 (girls): 2 (boys).
The most important factor - genetic. Cases where the disease is transmitted from generation to generation in the same family, or from mother to child, often encountered in clinical practice. These clinical and genealogical analysis shows that one third of patients the disease is hereditary. If asthma sick one parent, then the probability that a child will face this disease, up to 30% in the diagnosis of the disease in both parents - the probability reaches 75%. Hereditary, allergic (extrinsic) asthma, in medical terminology, is called atopic asthma.
Other important risk factors are considered to be harmful working conditions and environmental insults. No wonder the residents of large cities suffer from asthma at times more likely than those living in rural areas. But it is also of great importance especially food, household allergens, detergents and others - in a word, it is very difficult to say what could trigger the development of asthma in an individual case.
Types of asthma
Classification of asthma is based on the etiology of the disease and its severity, and also depends on the characteristics of bronchial obstruction. Especially popular is the classification of the severity - and it applies in the conduct of such patients. There are four degrees of severity of the disease at initial diagnosis - they are based on clinical signs and indicators of respiratory function
This stage is considered to be the easiest, because the symptoms make themselves felt only once a week, night attacks - no more than twice a month, and themselves aggravation - short-term (hours to days), is the period of exacerbation - lung function in OK.
Asthma lung DC currents: the symptoms are more often than once a week but not every day, exacerbation may interfere with normal sleep and daily physical activity. This form of the disease occurs most often.
The average severity of bronchial asthma is characterized by daily symptoms of the disease, prevent aggravation of sleep and physical activity, weekly multiple manifestations of night attacks. Vital lung capacity is also significantly reduced.
- Fourth degree: severe course
Daily symptoms, frequent exacerbations and night symptoms of the disease, limited physical activity - all this testifies to the fact that the disease has taken the most severe form of the course and a person should be under constant medical supervision.
The impact of asthma on pregnancy
Doctors rightly believe that the treatment of asthma in future mothers - particularly important issue that requires careful consideration. In the course of the disease affect the state of dramatic changes in hormonal levels, the specificity of respiratory function of the pregnant woman and a weakened immune system. Incidentally, weakened immunity during pregnancy - a prerequisite for carrying a baby. Oxygen starvation caused by asthma is a serious risk factor for the development of the fetus, and requires active intervention by the attending physician.
Between pregnancy and asthma there is no direct connection, because the disease occurs in 1-2% of all pregnant women. However, taking into account all these factors, asthma requires special intensive treatment - otherwise there is a risk that the baby will have problems with health.
The body of the pregnant woman and the fetus have a growing need for oxygen. This causes some changes in the basic functions of the respiratory system. During pregnancy because of increased uterine abdominal organs change their position and the vertical dimensions of the chest are reduced. These changes are compensated by the increase in the circumference of the chest and diaphragmatic breathing increased. In the first pregnancy tidal volume increases due to increase ventilation by 40-50% and reduce expiratory reserve volume, and at a later date - alveolar ventilation increases to 70%.
Increasing alveolar ventilation leads to an increase in the volume of oxygen in the blood and, therefore, is in direct relation with the increased level of progesterone which acts as a direct stimulant sometimes leads to increased sensitivity to CO2-contained breathing apparatus. The result is a respiratory alkalosis hyperventilation - not hard to guess what problems it can turn.
The decline in the exhalation, due to an increase in tidal volume, provokes an opportunity to a number of changes:
- The collapse of the small airways in the lower lung.
- Violation ratios of oxygen and blood to the respiratory apparatus and okololegochnyh bodies.
- Hypoxia and others.
This comes from the fact that the residual lung volume approaching functional residual capacity.
This factor may provoke, including fetal hypoxia and if pregnant has asthma. Lack of CO2 in the blood, which develops during hyperventilation, leads to the development of vasospasm cord and thus creates a critical situation. Be sure to remember this during an episode of asthma as hyperventilation worsens hypoxia embryo.
The above physiological changes in a woman's body during pregnancy are the result of the activity of hormones. Thus, the effect of estrogen is marked increase in the number of ά-adrenergic receptors, reduced clearance of cortisol, enhanced bronchodilator effect of β-agonists, and the effect of progesterone - an increase in the number of kortizolsvyazyvayuschego globulin, bronchial smooth muscle relaxation, decreased tone of smooth muscles in the body. Progesterone c cortisol competes for receptors of the respiratory apparatus, increases sensitivity to light and CO2 leads to hyperventilation.
Advancement of asthma by the following factors: high levels of estrogen, potentiation estrogen bronchodilatory action of β-agonists, low histamine levels in the plasma, increasing the levels of free cortisol and, consequently, an increase in the number and affinity of β-adrenergic receptors, increase half-life, bronchodilators, particularly methylxanthines .
Potentially worsen asthma following factors: increased sensitivity ά-adrenergic receptors, decreasing expiratory reserve volume, reducing the body's sensitivity to cortisol expectant mother because of competition with other hormones, stress, respiratory infections, various diseases of the gastrointestinal tract.
Long-term monitoring of pregnancy in women who suffer from asthma, unfortunately, showed increase in the risk of preterm birth and neonatal mortality. Inadequate control of the disease, as already mentioned, can cause the development of the most severe complications - from premature birth to the death of mother and / or child. Therefore, be sure to regularly visit your doctor!
During pregnancy, a third of patients experiencing improvement, the other one-third - the deterioration, and the rest - in a stable condition. Usually, the deterioration observed in patients suffering from severe forms of the disease, and patients with mild or have improved or their stable condition.
The deterioration of pregnant women with asthma occurs in the late stages and usually after an acute respiratory illness or other adverse factors. Especially critical are the 24-36 th week, and improvement is observed in the last month.
Picture of complications in patients with bronchial asthma as a percentage as follows: gestosis - in 47% of cases, hypoxia and asphyxia baby at birth - 33%, malnutrition fetus - 28%, delay the child's development - 21% the threat of termination of pregnancy - 26% of preterm birth - 14, 2%.
Treatment of asthma during pregnancy
For pregnant women, there is a special scheme of treatment of bronchial asthma. It includes: evaluation and constant monitoring of lung function in the mother, the preparation and selection of the optimal method of delivery management. Speaking of labor: in this situation, doctors often choose birth through Caesarean section - excessive physical stress can lead to another severe attack of asthma. But, of course, everything is solved individually in each situation. But let's go back to the methods of treating the disease:
Successful treatment of atopic asthma suggest as a prerequisite, removing allergens from the environment in which the sick woman. Fortunately, technological progress to date, to extend the capabilities for this condition: vacuum cleaners, filters for air-allergenic bedding, in the end! And it goes without saying that the cleaning in this case must be held at the expectant mother!
For successful treatment it is important to collect the correct history, presence of concomitant diseases, tolerance to drugs - NSAIDs, as well as means of containing (Teofedrin and others), and, especially, of acetylsalicylic acid. In the diagnosis of aspirin-induced asthma in pregnant women the use of non-steroidal analgesics excluded - the physician should be aware of this, picking up medication for the mother.
Since the majority of pharmaceuticals in any way affects the unborn baby, the primary goal in the treatment of asthma is the use of effective drugs is not harmful to the development of the unborn baby.
The impact of asthma medication on a child
Strictly contraindicated in pregnancy adrenalin which is commonly used for the relief of acute episodes of asthma as vasospasm associated with the uterus can lead to fetal hypoxia. Therefore, for pregnant women, doctors selected more sparing medicines that will not harm the crumbs.
Aerosol forms of β2-agonists (fenoterol, salbutamol and terbutaline) are safer and more effective, but they can be used only on prescription and under his control. In later pregnancy, the use of β2-agonists may result in an increase in the duration of labor time, as similar on the Effects of Drugs (partusisten, ritodrine) are also used to prevent preterm birth.
- Preparations theophylline
The clearance of theophylline in pregnant women in the III trimester is considerably reduced, so when prescribing theophylline intravenously, the physician should take into account that the half-life of the drug is increased to 13 hours, compared with 8, 5 hours in the postpartum period, and decreased theophylline binding to plasma proteins. Furthermore, the use of drugs, methylxanthines can cause tachycardia postnatal child, since a large concentration of these drugs in the fetal blood (they penetrate the placenta).
To avoid adverse effects on the fetus, it is not recommended to use powders for Kogan - antastamana, teofedrina, they are contraindicated because they contain extracts of belladonna and barbiturates. Compared to them ipratropinum bromide (inhaled anticholinergic) has no negative effects on fetal development.
The most effective medications for the treatment of asthma, anti-inflammatory effect, are steroids. Where indicated, they can be safely used during pregnancy. Contraindicated for short and long-term use of the drug triamcinolone (a negative impact on the development of the muscles of the child), medicines corticosteroids (dexamethasone, betamethasone), as well as depot preparations (Depomedrol, Kenalog-40 Diprospan).
If you need to use, it is preferable to use effective medications such as prednisolone, prednisone, inhaled corticosteroids drugs (beclomethasone dipropionate).
Appointment of antihistamines in the treatment of asthma is not always appropriate, but because during pregnancy may be such a need, it must be remembered that drug group alkylamines - brompheniramine absolutely contraindicated. Alkyl amines, and include parts of other drugs that are recommended for the treatment of the common cold (Fervex et al.) And rhinitis (Koldakt). Also not recommended the use of ketotifen (due to lack of information security) and other antihistamines previous, second generation.
During pregnancy, for any reason shall not be carried out with the use of allergen immunotherapy - is almost one hundred percent guarantee that the crumb will be born with the strongest predisposition to asthma.
It is also limited to the use of antibacterial drugs. When atopic asthma is strictly contraindicated drugs based on penicillin. In other forms of asthma, preferably using ampicillin or amoxicillin, or preparations in which they are located, together with clavulanate (Augmentin, Amoksiklav).
Treatment of complications of pregnancy
With the threat of termination of pregnancy in the first trimester of asthma therapy is conducted according to generally accepted rules, no special features. Subsequently, during the second-II and III-trimester treatment complications typical of pregnancy should include optimization of the respiratory process and correction of the underlying lung disease.