Bronchial asthma has recently receivedvery widespread - many people know about this disease firsthand. And everything would be fine - it is quite possible to live with it, and medicine allows you to keep the disease under control. But sooner or later, a woman faces the question of motherhood. And here the panic begins - will I be able to bear and give birth to a child: Will the baby be healthy? Doctors definitely answer "yes"! Bronchial asthma is not a sentence for your motherhood, because modern medicine allows women suffering from this disease to become mothers. But the topic is very complex, so let's understand everything in order, so that you do not get completely confused. The World Health Organization gives the following definition of bronchial asthma - a chronic disease in which a chronic inflammatory process develops under the influence of T-lymphocytes, eosinophils and other cellular elements in the respiratory tract. Due to asthma, bronchial obstruction increases in response to external stimuli and various internal factors - in other words, this is the airways' response to inflammation. And although bronchial obstruction can be of varying severity and is subject to - spontaneously or under the influence of treatment - complete or partial reversibility, it is important to know that in people who have a predisposition, the inflammatory process leads to generalization of the disease. At the beginning of the eighteenth century, it was believed that asthma attacks were not such a serious disease as to pay special attention to them - doctors treated the phenomenon as a side effect of other diseases. The first systematic approach to the study of asthma was used by scientists from Germany - Kurshman and Leyden. They identified a number of cases of suffocation and, as a result, described and systematized clinical manifestations; asthma began to be perceived as a separate disease. However, the level of technical equipment of medical institutions of that time was not sufficient to establish the cause and fight the disease. Bronchial asthma affects 4 to 10% of the world's population. Age does not matter for the disease: half of the patients encountered the disease before the age of 10, another third - before the age of 40. The ratio of the frequency of the disease among children by gender: 1 (girls): 2 (boys).
Risk factors
The most important factor is genetic.Cases when the disease is transmitted from generation to generation in one family or from mother to child are quite common in clinical practice. Data from clinical and genealogical analysis indicate that in a third of patients the disease is hereditary. If one of the parents suffers from asthma, then the probability that the child will also face this disease is up to 30%, when the disease is diagnosed in both parents, the probability reaches 75%. Hereditary, allergic (exogenous) asthma, in medical terminology, is called atopic bronchial asthma. Other important risk factors are considered to be harmful working conditions and an unfavorable environmental situation. It is not for nothing that residents of large cities suffer from bronchial asthma many times more often than those who live in rural areas. But nutritional characteristics, household allergens, detergents and others are also of great importance - in a word, it is very difficult to say what exactly can provoke the development of bronchial asthma in a particular case.
Types of bronchial asthma
Classification of bronchial asthma is madebased on the etiology of the disease and its severity, and also depends on the characteristics of bronchial obstruction. The classification by severity is especially popular - it is used in the management of such patients. There are four degrees of severity of the disease during initial diagnosis - they are based on clinical signs and indicators of external respiration function
- First degree: episodic
This stage is considered the easiest, becausethe symptoms make themselves known no more than once a week, night attacks - no more than twice a month, and the exacerbations themselves are short-term (from an hour to several days), outside of periods of exacerbation - lung function indicators are normal.
- Second degree: light form
Mild asthma of constant course:symptoms occur more than once a week, but not every day, exacerbations can interfere with normal sleep and daily physical activity. This form of the disease is the most common.
- Third degree: medium
Moderate severity of bronchial diseaseasthma is characterized by daily symptoms of the disease, exacerbations interfere with sleep and physical activity, weekly multiple manifestations of night attacks. The vital capacity of the lungs is also significantly reduced.
- Fourth degree: heavy current
Daily symptoms of the disease, frequent exacerbations andnocturnal manifestations of the disease, limited physical activity - all this indicates that the disease has taken its most severe form and the person should be under constant medical supervision.
Effect of bronchial asthma on pregnancy
Doctors rightly believe that treatmentbronchial asthma in expectant mothers is a particularly important problem that requires a thorough approach. The course of the disease is affected by dramatic changes in hormonal levels, the specificity of the external respiratory function of a pregnant woman, and a weakened immune system. Incidentally, weakened immunity during pregnancy is a prerequisite for bearing a baby. Oxygen starvation caused by bronchial asthma is a serious risk factor for fetal development and requires active intervention from the attending physician. There is no direct connection between pregnancy and bronchial asthma, since the disease occurs in only 1-2% of pregnant women. But, taking into account all the factors mentioned, asthma requires special intensive treatment - otherwise there is a risk that the baby will have health problems. The body of a pregnant woman and the fetus have an increasing need for oxygen. This causes some changes in the basic functions of the respiratory system. During pregnancy, due to the enlargement of the uterus, the abdominal organs change their position, and the vertical dimensions of the chest decrease. These changes are compensated by an increase in the circumference of the chest and increased diaphragmatic breathing. In the early stages of pregnancy, the respiratory volume increases due to an increase in lung ventilation by 40-50% and a decrease in the expiratory reserve volume, and in later stages, alveolar ventilation increases to 70%. An increase in alveolar ventilation leads to an increase in the volume of oxygen in the blood and, accordingly, is directly related to the increased level of progesterone, which sometimes acts as a direct stimulant and leads to increased sensitivity of the respiratory system to CO2. Hyperventilation results in respiratory alkalosis - it is easy to guess what problems this can lead to. A decrease in exhalation volume, due to an increase in respiratory volume, provokes the possibility of a number of changes:
- Collapse of small bronchi in the lower parts of the lungs.
- Infringement of parities of receipt of oxygen and a blood in the respiratory device and okolopolegochnyh organs.
- Development of hypoxia and others.
This is due to the residual volumelungs approaches the functional residual capacity. This factor can provoke, among other things, fetal hypoxia if the pregnant woman has bronchial asthma. Insufficiency of CO2 in the blood, which develops with hyperventilation of the lungs, leads to the development of spasms of the umbilical cord vessels and thus creates a critical situation. Be sure to remember this during attacks of bronchial asthma, since hyperventilation aggravates hypoxia of the embryo. The physiological changes in the woman's body during pregnancy described above are a consequence of hormonal activity. Thus, the effect of estrogen is noted by an increase in the number of ά-adrenergic receptors, a decrease in the clearance of cortisol, an increased bronchodilator effect of β-adrenergic agonists, and the effect of progesterone is an increase in the amount of cortisol-binding globulin, relaxation of the smooth muscles of the bronchi, a decrease in the tone of all smooth muscles in the body. Progesterone competes with cortisol for receptors in the respiratory system, increases the sensitivity of the lungs to CO2 and leads to hyperventilation. The following factors contribute to the improvement of the course of asthma: high estrogen levels, potentiation of the bronchodilator effect of β-adrenergic agonists by estrogen, low histamine levels in plasma, increased free cortisol levels and, as a consequence, an increase in the number and affinity of β-adrenergic receptors, an increase in the half-life of bronchodilators, especially methylxanthines. The following factors potentially worsen the course of bronchial asthma: increased sensitivity of α-adrenergic receptors, decreased expiratory reserve volume, decreased sensitivity of the expectant mother's body to cortisol due to competition with other hormones, stressful situations, respiratory infections, various diseases of the gastrointestinal tract. Long-term observations of pregnancy in women suffering from bronchial asthma, unfortunately, have shown an increased risk of premature birth, as well as 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 the mother and / or child. Therefore, be sure to visit your doctor regularly! During pregnancy, a third of patients experience an improvement in their condition, another third - a deterioration, and the rest - a stable condition. As a rule, deterioration in the condition is noted in patients suffering from severe forms of the disease, and patients with a mild form either have an improvement or their condition is stable. Deterioration in the condition of pregnant women with bronchial asthma occurs in the later stages and usually after an acute respiratory disease or other unfavorable factors. Particularly critical are the 24th-36th weeks, and an improvement in the condition is observed in the last month. The percentage of possible complications in patients with bronchial asthma is as follows: gestosis - in 47% of cases, hypoxia, as well as asphyxia of the baby at birth - in 33%, fetal hypotrophy - in 28%, delayed development of the child - in 21%, threat of termination of pregnancy - in 26%, development of premature birth - in 14.2%.
Treatment of bronchial asthma in pregnancy
There is a special scheme for pregnant women.treatment of bronchial asthma. It includes: assessment and constant monitoring of the mother's lung function, preparation and selection of the optimal method of labor. Speaking of labor: in such a situation, doctors often choose a cesarean section - excessive physical stress can lead to another severe attack of bronchial asthma. However, of course, everything is decided individually, in each specific situation. But let's get back to the methods of treating the disease:
- Elimination of allergens
Successful therapy of atopic bronchial asthmaassumes, as a mandatory condition, the removal of allergens from the environment in which the sick woman is located. Fortunately, technical progress today allows us to expand the possibilities for this condition: washing vacuum cleaners, air filters, hypoallergenic bed linen, in the end! And it goes without saying that in this case, the cleaning should not be done by the expectant mother!
- Medications
For successful treatment it is very important to collectcorrect anamnesis, presence of concomitant diseases, tolerance of drugs - non-steroidal anti-inflammatory drugs, as well as products containing them (theophedrine and others), and, especially, acetylsalicylic acid. When diagnosing aspirin bronchial asthma in a pregnant woman, the use of non-steroidal analgesics is excluded - the doctor should remember this when choosing drugs for the expectant mother. Since most pharmaceutical drugs in one way or another affect the future baby, the main task in treating asthma is the use of effective drugs that do not harm the development of the future baby.
The effect of anti-asthma drugs on a child
- Adrenomimetics
Strictly contraindicated during pregnancyadrenaline, which is usually used to relieve acute asthma attacks, since spasm of the vessels associated with the uterus can lead to fetal hypoxia. Therefore, for expectant mothers, doctors select more gentle drugs that will not harm the baby. Aerosol forms of β2-adrenomimetics (fenoterol, salbutamol and terbutaline) are safer and more effective, but they can only be used as prescribed by a doctor and under his supervision. In late pregnancy, the use of β2-adrenomimetics can lead to an increase in the duration of the labor period, since drugs with similar effects (partusisten, ritodrine) are also used to prevent premature birth.
- Theophylline preparations
Theophylline clearance in pregnant women in the third trimestersignificantly decreases, therefore, when prescribing theophylline preparations intravenously, the doctor must take into account that the half-life of the drug increases to 13 hours compared to 8.5 hours in the postpartum period and the binding of theophylline to plasma proteins decreases. In addition, the use of methylxanthine preparations can cause postpartum tachycardia in the child, since these drugs have a high concentration in the fetal blood (they penetrate the placenta). In order to avoid adverse effects on the fetus, it is highly recommended not to use Kogan's powders - antastaman, theophedrine, They are contraindicated due to the belladonna extracts and barbiturates they contain. Compared to them, ipratropium bromide (an inhalation anticholinergic) does not have a negative effect on fetal development.
- Mucolytic agents
The most effective drugs for treatmentasthma, which have an anti-inflammatory effect, are glucocorticosteroids. If indicated, they can be safely prescribed to pregnant women. Contraindicated for short-term and long-term use are triamcinolone preparations (negative impact on the development of the child's muscles), GCS preparations (dexamethasone and betamethasone), as well as depot preparations (Depomedrol, Kenalog-40, Diprospan). If there is a need for use, it is preferable to use effective drugs such as prednisolone, prednisone, inhalation GCS preparations (beclomethasone dipropionate).
- Antihistamines
Prescribing antihistamines forIt is not always advisable to use it in the treatment of asthma, but since such a need may arise during pregnancy, it should be remembered that the alkylamine drug brompheniramine is absolutely contraindicated. Alkylamines are also included in other drugs recommended for the treatment of colds (Fervex, etc.) and rhinitis (Coldact). It is also strictly not recommended to use ketotifen (due to the lack of safety information) and other antihistamines of the previous, second generation. During pregnancy, immunotherapy using allergens should not be carried out under any circumstances - this is almost a 100% guarantee that the baby will be born with a strong predisposition to bronchial asthma. The use of antibacterial drugs is also limited. Penicillin-based drugs are strictly contraindicated in atopic asthma. For other forms of asthma, it is preferable to use ampicillin or amoxicillin, or preparations in which they are found together with clavulanic acid (Augmentin, Amoxiclav).
Treatment of complications of pregnancy
In case of threat of termination of pregnancy in the firstIn the first trimester, asthma therapy is carried out according to generally accepted rules, without any characteristic features. Later, during the second and third trimesters, treatment of complications typical for pregnancy should include optimization of respiratory processes and correction of the underlying pulmonary disease. To prevent hypoxia, improve and normalize the processes of cellular nutrition of the future baby, the following medications are used: phospholipids + multivitamins, vitamin E; actovegin. The doctor selects the dosage of all drugs individually, having carried out a preliminary assessment of the severity of the disease and the general condition of the woman's body. In order to prevent the development of infectious diseases that people with bronchial asthma are susceptible to, complex immunocorrection is carried out. But again, I would like to draw your attention - any treatment should be carried out only under the strict supervision of a doctor. After all, what is ideal for one expectant mother can be harmful to another.
Childbirth and the puerperium
Therapy during labor should primarily focus onbe aimed at improving the circulatory systems of the mother and fetus - that is why it is recommended to administer drugs that improve placental blood flow. And the expectant mother should never refuse the therapy proposed by the doctor - you do not want your baby's health to suffer, do you? You cannot do without the use of inhaled glucocorticosteroids, which prevent asthma attacks, and therefore the subsequent development of fetal hypoxia. At the beginning of the first stage of labor, women who constantly take glucocorticosteroids, as well as those expectant mothers whose asthma is unstable, must be given prednisolone. The therapy is assessed from the point of view of effectiveness based on the results of ultrasound, fetal hemodynamics, CTG data, by determining the hormones of the fetoplacental complex in the blood - in a word, the mother and baby must be under the constant supervision of the doctor. To prevent possible complications during childbirth, women with bronchial asthma should follow certain rules. They should continue the main anti-inflammatory therapy - do not interrupt treatment on the eve of a significant event in your life. Patients who have previously received systemic glucocorticosteroids are recommended to take hydrocortisone every 8 hours and for 24 hours after the birth of the child. Since thiopental, morphine, tubocurarine have a histamine-releasing effect and can provoke an attack of suffocation, they are excluded if a cesarean section is necessary. When performing childbirth by cesarean section, epidural anesthesia is preferable. And in the event that there is a need for general anesthesia, the doctor will choose the drug especially carefully. In the postpartum period, a new mother suffering from bronchial asthma has a very high probability of developing bronchospasm - it is the body's response to stress, which is the birth process. To prevent it, it is necessary to exclude the use of prostaglandin and ergometrine. Also, in aspirin-induced bronchial asthma, special caution should be exercised when using painkillers and antipyretics.
Breast-feeding
About pregnancy and bronchial asthmareceived comprehensive information. But do not forget about breastfeeding, which is an important part of the bond between mother and child. Very often women refuse to breastfeed, fearing that medications will harm the child. Of course, they are right, but only partly. As is known, the vast majority of drugs inevitably get into milk - this also applies to drugs for bronchial asthma. Components of methylxanthine derivatives, adrenomimetics, antihistamines and other drugs are also excreted with milk, but in a much lower concentration than they are present in the mother's blood. And the concentration of steroids in milk is also low, but drugs should be taken at least 4 hours before feeding. From all of the above, the following conclusions can be drawn: with proper management, bronchial asthma and pregnancy are quite compatible, and even childbirth occurs without any particular complications. Carrying a baby, successfully enduring childbirth, without risking the life and health of the mother and child - all this is possible with proper treatment and care. So do not despair - bronchial asthma in no way interferes with the joy of motherhood.
