Asthma in Pregnancy

Asthma is, in basic terms, a condition characterized by the narrowing and swelling of airways, as well as the production of extra mucus. This results in challenges in breathing – effectively triggering shortness of breath, wheezing, and coughing. It is important to note there is no cure for asthma. It therefore follows that the control of asthmatic symptoms is of the essence. According to the American Lung Association (2020), a person who has a PEAK flow rate of 80% – 100% has reasonably good control of their asthma. On the other hand, as the American Lung Association further points out, “50 to 80 percent of your usual or ‘normal’ peak flow rate signals caution.” Maria’s PEAK flow performance is 60%. It should be noted that during pregnancy, uncontrolled asthma could present serious health challenges/risks for both the mother and the unborn baby. It therefore follows that that on this front, the relevance of making use of the relevant medications as well as avoiding triggers cannot be overstated.
In the present scenario, the overall goal ought to be the effective treatment of Maria’s asthma and ensuring that it is controlled well during her pregnancy. When it comes to the management of asthma during pregnancy, Murphy (2015) observes that key “goals include the prevention of chronic day and night symptoms, maintenance of optimal pulmonary function and normal activities, and prevention of exacerbations, using therapies with minimal or no adverse side-effects” (Murphy, 2015, p. 260). To a large extent, failure to effectively control Maria’s asthma during her pregnancy predisposes her to complications including, but not limited to high blood pressure. Other serious complications that could result include premature birth, restricted fetal growth – and in even still birth (in extreme cases). With a PEAK flow performance of 60%, Maria is in what is, according to the American Lung Association, referred to as the yellow zone. This essentially signals caution and is indicative of narrowing airways. Thus, intervention measures should be taken to return the PEAK flow to the green zone.
In seeking to manage Maria’s asthma, it would be necessary to put her on two medications, i.e. a rescue medication (in case she has an attack) and a long-term prevention medication so as to ensure that her asthmatic symptoms are well-controlled. Towards this end, for long-term control, Maria could be put on inhaled corticosteroids such as budesonide (Pulmicort). On the other hand, when it comes to the quick relief of symptoms, i.e. if she ends up having an attack, it would be recommended that Maria takes short-acting beta-agonists such as albuterol (Proventil). In essence, these would come in handy in the swift dilation of airways. It is important to note that the long-term medications recommended in this case ought to be taken on a daily basis - even in the absence of symptoms.
It would also be prudent to ensure that Maria’s chances of having an asthmatic attack are minimized from the onset. Thus, Maria should be advised to avoid (or minimize) exposure to her asthmatic triggers. To begin with, she ought to be advised to avoid cigarette smoke as much as possible. Next, Maria should also ensure that her home is free of all irritants as well as contaminants. It would also help to take an inventory of her known personal triggers so that she can effectively avoid them or minimize exposure. Further, it should be noted that flu increases the risk of an asthmatic attack. Thus, to further minimize the risk of an attack during pregnancy, it would be prudent for Maria to have a flu shot. Allergy shots could also be taken into consideration.
References
American Lung Association (2020). Measuring Your Peak Flow Rate. Retrieved from https://www.lung.org/lung-health-diseases/lung-disease-lookup/asthma/living-with-asthma/managing-asthma/measuring-your-peak-flow-rate
Murphy, V.E. (2015). Managing Asthma in Pregnancy. Breathe (Sheff), 11(4), 258-267.