Bronchial asthma has recently receivedvery widespread - very many people know firsthand about this disease. And all would be nothing - to live with it is quite possible, and medicine allows you to keep the disease under control. But sooner or later a woman faces the question of motherhood. And here panic begins - and whether I can endure and give birth to a child: Will the baby be healthy? The doctors unequivocally answer "yes"! Bronchial asthma is not a sentence for your motherhood, because modern medicine allows women suffering from this ailment to become mothers. But the topic is very difficult, so let's deal with everything in order so that you are not completely lost. The World Health Organization gives bronchial asthma the following definition - a chronic disease in which a chronic inflammatory process develops under the influence of T-lymphocytes, eosinophils and other cellular elements in the airways. Because of asthma, bronchial obstruction to external stimuli and to various internal factors is amplified - simply put, this is the respiratory response to inflammation. And although bronchial obstruction can be of varying severity and is subject to - spontaneously or under the influence of treatment - full or partial reversibility, you need to know that in people who have a predisposition, the process of inflammation leads to the generalization of the disease. At the beginning of the eighteenth century, it was believed that attacks of suffocation were not so serious a disease to give her special attention - 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 Leiden. They identified a number of cases of suffocation, and as a consequence, described and systematized clinical manifestations, asthma was perceived as a separate disease. But still 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 in the world from 4 to 10% of the population. Age for the disease does not matter: half of the patients faced the disease before 10 years, another third - up to 40 years. Ratio of frequency of disease among children on a gender-based basis: 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 often found in clinical practice. The data of the clinical genealogical analysis show that in a third of patients the disease is hereditary. If one of the parents is sick with asthma, then the likelihood that the child will also face this disease is up to 30%, when diagnosing the disease in both parents - the probability reaches 75%. Hereditary, allergic (exogenous) asthma, in medical terminology, is called atopic bronchial asthma. Other important risk factors are harmful working conditions and adverse environmental conditions. No wonder residents of large cities suffer from bronchial asthma at times more often than those who live in rural areas. But also important are the features of nutrition, household allergens, detergents and others - in a word, it is very difficult to say what exactly can trigger the development of bronchial asthma in a particular case. 
Types of bronchial asthma
Classification of bronchial asthma is performed onthe basis of the etiology of the disease and its severity, and also depends on the peculiarities of bronchial obstruction. Especially popular is the classification by severity - 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 rates of respiratory function
- First degree: episodic
This stage is considered the easiest, sincethe symptoms do not know about themselves more often than once a week, night attacks are not more often than twice a month, and the exacerbations themselves are short-term (from an hour to several days), outside the periods of exacerbations, lung function indicators are normal.
- Second degree: light form
Asthma of a lung of constant flow: symptoms are more frequent than once a week, but not every day, exacerbations can interfere with normal sleep and daily physical activity. This form of the disease is most common.
- Third degree: medium
The average severity of the course of the bronchialasthma is characterized by daily symptoms of the disease, exacerbations interfere with sleep and physical activity, weekly multiple manifestations of nocturnal seizures. The vital volume of the lungs also decreases significantly.
- Fourth degree: heavy current
Daily symptoms of the disease, frequent exacerbations andnight manifestations of the disease, limited physical activity - all this indicates that the disease has taken the most severe form of the flow and the person must be under constant medical control.
Effect of bronchial asthma on pregnancy
Doctors rightly believe that treatmentbronchial asthma in expectant mothers - a particularly important problem that requires a careful approach. The course of the disease is affected by cardinal changes in the hormonal background, specificity of the function of the external breath of a pregnant woman and a weakened immune system. By the way, weakening of 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 by the attending physician. Between pregnancy and bronchial asthma there is no direct connection, as the disease occurs in only 1-2% of pregnant women. But, taking into account all mentioned factors, asthma requires special intensive treatment - otherwise there is a danger that the baby will have health problems. 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, due to the increase in the uterus, the abdominal organs change their position, and the vertical dimensions of the thorax decrease. These changes are compensated by an increase in the circumference of the chest and increased diaphragmatic breathing. At the first stages of pregnancy, the respiratory volume increases due to an increase in lung ventilation by 40-50% and a decrease in the reserve volume of exhalation, and at later times increases alveolar ventilation to 70%. Increased alveolar ventilation leads to an increase in oxygen levels in the blood and, accordingly, is in direct connection with an increased level of progesterone which acts sometimes as a direct stimulant and leads to an increased sensitivity of the respiratory apparatus to CO2. The consequence of hyperventilation is respiratory alkalosis - it's easy to guess what problems this may turn out. The decrease in the volume of exhalation, due to the increase in the 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 fact that the residual volumelung approaches the functional residual capacity. This factor can provoke, in particular, hypoxia of the fetus, if the pregnant woman has bronchial asthma. Insufficiency of CO2 in the blood, which develops during hyperventilation of the lungs, leads to the development of spasms of the umbilical cord and thus creates a critical situation. Be sure to remember this in case of bouts of bronchial asthma, because hyperventilation aggravates hypoxia of the embryo. The physiological changes described above in the body of a woman during pregnancy are a consequence of the activity of hormones. Thus, the effect of estrogen is marked by an increase in the number of ά-adrenergic receptors, a decrease in the clearance of cortisol, an enhanced bronchodilating effect of β-adrenomimetics, and the effect of progesterone - an increase in the amount of cortisol-binding globulin, relaxation of 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 apparatus, increases the sensitivity of the lungs to CO2 and leads to hyperventilation. Improvement in the course of asthma is facilitated by the following factors: high estrogen level, estrogen potentiation of bronchodilating action of β-adrenomimetics, low plasma histamine level, increased level of free cortisol and, as a result, increase in the number and affinity of β-adrenoceptors, an increase in the half-life of bronchodilators, especially methylxanthines . Potentially worsen the course of bronchial asthma following factors: increased sensitivity of the ά-adrenergic receptors, a decrease in the reserve volume of exhalation, a decrease in the susceptibility of the future mother 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, showed an increase in the risk of preterm delivery and neonatal mortality. Inadequate control of the course of the disease, as already mentioned, can cause the development of the most serious complications - from premature birth to the death of the mother and / or the child. Therefore, always visit your doctor regularly! During pregnancy, one-third of patients experience improvement, another third - worsening, while the rest - a stable state. As a rule, worsening of the condition is observed in patients suffering from severe forms of the disease, and patients with mild form either have an improvement, or their condition is stable. Deterioration of the state of pregnant women with bronchial asthma occurs late in life and usually after acute respiratory illness or other unfavorable factors. Particularly critical are the 24-36th week, and the improvement in the condition is observed in the last month. The picture of possible complications in patients with bronchial asthma in the percentage ratio is as follows: gestosis - in 47% of cases, hypoxia, as well as baby asphyxia when born - in 33%, fetal hypotrophy - 28%, delay in child development - 21% the threat of abortion - in 26%, the development of preterm labor - in 14.2%. 
Treatment of bronchial asthma in pregnancy
For pregnant women there is a special schemetreatment of bronchial asthma. It includes: evaluation and continuous monitoring of the lungs of the mother, preparation and selection of the optimal method of delivery. By the way about sorts: in a similar situation doctors often choose deliveries through cesarean section - excessive physical stress can lead to the next strong attack of a bronchial asthma. However, of course, everything is decided individually, in each specific situation. But let's go back to the ways of treating the disease:
- Elimination of allergens
Successful therapy of atopic bronchial asthmaassumes, as an obligatory condition, the removal of allergens from the environment in which the sick woman is. Fortunately, technical progress to date allows us to expand the possibilities for this condition: washing vacuum cleaners, air filters, hypoallergenic bed linens, after all! And it goes without saying that in this case cleaning should not be done by a future mother!
- Medications
For successful treatment it is very important to collectthe correct history, the presence of concomitant diseases, the tolerability of drugs - non-steroidal anti-inflammatory drugs, as well as the means containing them (theofedrine 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 by choosing drugs for a future mother. Since most pharmaceuticals affect the future baby in one way or another, the main task in the treatment of asthma is the use of effective drugs that do not harm the development of the baby's future.
The effect of anti-asthma drugs on a child
- Adrenomimetics
When pregnancy is strictly contraindicated adrenaline,which is usually used to relieve acute asthma attacks, since vasospasm associated with the uterus can lead to fetal hypoxia. Therefore, for future mothers doctors choose more sparing 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 for the doctor's prescription and under his supervision. In late pregnancy, the use of β2-adrenomimetics can lead to an increase in the duration of the birth period, because similar drugs (partusisten, ritodrin) are also used to prevent preterm labor.
- Theophylline preparations
Theophylline clearance in pregnant women in the third trimesterthe doctor should take into account the fact that the half-life of the drug is increased to 13 hours compared with 8.5 hours in the postpartum period and the binding of theophylline to plasma proteins is reduced. In addition, the use of methylxanthines may cause postpartum tachycardia in the child, since these drugs have a high concentration in the fetal blood (they penetrate the placenta). To avoid adverse effects on the fetus, the use of powders according to Kogan - antastaman, theoephedrine, is highly not recommended. They are contraindicated because of the bellatus and barbiturate extracts contained in them. Compared with them, ipratropinum bromide (inhalation anticholinergic) does not adversely affect fetal development.
- Mucolytic agents
The most effective medicines for treatmentAsthma, having an anti-inflammatory effect, are glucocorticosteroids. If there is evidence, they can be safely prescribed for pregnant women. Contraindicated for short-term and long-term use of drugs triamtsinolona (negative impact on the development of the muscles of the child), drugs GCS (dexamethasone and betamethasone), as well as depot preparations (Depomedrol, Kenalog-40, Diprospan). If there is a need for use, then it is preferable to use effective medications, such as prednisolone, prednisone, inhaled corticosteroids (beclomethasone dipropionate).
- Antihistamines
The appointment of antihistamines in the treatmentasthma is not always advisable, but since during pregnancy such a necessity may arise, it should be remembered that the preparation of the group of alkylamines - brompheniramine is absolutely contraindicated. Alkylamines are included in other medications recommended for the treatment of colds (Fervex et al.) And rhinitis (Koldakt). Also categorically not recommended is the use of ketotifen (due to the lack of safety data) and other antihistamines of the previous, second generation. During pregnancy, under no pretext, immunotherapy with the use of allergens should not be carried out - this is practically a 100% guarantee that the baby will be born with a strong predisposition to bronchial asthma. Also, the use of antibacterial drugs is limited. Atopic asthma, preparations based on penicillin are strictly contraindicated. In other forms of asthma, it is preferable to use ampicillin or amoxicillin, or preparations in which they are together with clavulanic acid (Augmentin, Amoxiclav).
Treatment of complications of pregnancy
If there is a threat of abortion in the firstTrimester therapy for asthma is carried out according to generally accepted rules, without distinctive features. Further, during the second and third trimester, treatment of complications typical of pregnancy should include optimization of respiratory processes and correction of the underlying pulmonary disease. To prevent hypoxia, improve and normalize the processes of the future baby's cellular nutrition, the following medicines are used: phospholipids + multivitamins, vitamin E; actovegin. The doctor selects the dosage of all preparations individually, having made a preliminary assessment of the severity of the disease and the general condition of the woman's body. To prevent the development of infectious diseases, to which people with bronchial asthma are exposed, complex immunocorrection is carried out. But again I want 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 future mother, can harm another.
Childbirth and the puerperium
Therapy during childbirth first of all shouldbe aimed at improving the blood system of the mother and fetus - that's why the introduction of drugs that improve placental blood flow is recommended. And the future mother should not abandon the therapy offered by the doctor - you do not want the health of your crumbs to suffer? Not to do without the use of inhaled glucocorticosteroids, which prevent attacks of suffocation, and hence the subsequent development of fetal hypoxia. At the beginning of the first period of labor, women who regularly take glucocorticosteroids, as well as those expectant mothers who have asthma unstable, necessarily require prednisolone. The performed therapy is evaluated from the point of view of the effectiveness of ultrasound, fetal hemodynamics, according to CTG, by definition in the blood of the hormones of the fetoplacental complex - in short, the mother and baby should be under the vigilant control of the doctor. To prevent possible complications during childbirth, women with bronchial asthma must adhere to certain rules. They should continue the main anti-inflammatory therapy - do not interrupt treatment on the eve of a momentous event in your life. Patients who received systemic glucocorticosteroids are recommended to take hydrocortisone every 8 hours and within 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 necessary by caesarean section. When conducting labor by caesarean section, epidural anesthesia is preferred. 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 generic process. To prevent it, it is necessary to exclude the use of prostaglandin and ergometrine. Also with aspirin bronchial asthma, special care should be taken when using painkillers and antipyretic agents. 
Breast-feeding
About pregnancy and bronchial asthma you gotexhaustive information. But do not forget about breastfeeding, which is an important part of the connection between mother and child. Very often, women refuse to breastfeed, fearing that the drugs will harm the child. Of course, they are right, but only in part. As you know, the vast majority of drugs inevitably fall into the milk - this applies to drugs for bronchial asthma. Components of methylxanthines, adrenomimetics, antihistamines and other drugs are also excreted together with milk, but at a much lower concentration than they are 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, we can draw the following conclusions: with proper management, bronchial asthma and pregnancy are completely compatible, and even childbirth proceeds without special complications. Carrying a baby, safely carry the delivery, without jeopardizing the life and health of the mother and child - all this is feasible with proper treatment and care. So do not despair - bronchial asthma in no way hinders the joy of motherhood.
