eMedicine Specialties > Emergency Medicine > Obstetrics & Gynecology

Pregnancy, Asthma: Follow-up

Author: Markus Little, MD, Staff Physician, Department of Emergency Medicine, State University of New York Downstate Medical Center
Coauthor(s): Richard H Sinert, DO, Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center
Contributor Information and Disclosures

Updated: Jun 30, 2009

Follow-up

Further Inpatient Care

  • Criteria for hospital admission
    • Inadequate response to ED therapy
    • pO2 less than 70 mm Hg
    • Signs of fetal distress (eg, decreased movement, abnormal cardio tocodynamometry, uterine contractions)
    • Multiple medication use (ie, requiring 3 or more medications simultaneously)
    • A protracted course with poor response to outpatient therapy thus far instituted or history of severe asthma requiring intubation or ICU admission and inadequate home conditions and transport/access to ED care
  • Criteria for ICU admission
    • Altered level of consciousness
    • Poor air flow
    • Signs of fatigue, downhill course, or need for mechanical ventilation
    • PEFR/FEV1 less than 25% of predicted or pCO2 greater than 35 mm Hg

Further Outpatient Care

  • Criteria for home discharge
    • Symptoms and physical examination greatly improve
    • Patient able to walk out of ED without obvious distress
    • PEFR/FEV1 greater than 70% baseline
    • No fetal distress
    • Good follow-up and access to ED in case of relapse
  • Follow-up appointment 2-4 days following the ED visit is recommended.
  • Consider referral to an asthma specialist.

Inpatient & Outpatient Medications

  • Glucocorticoids at the time of discharge have proven to be useful and reduce the incidence of ED visits.

Complications

  • Respiratory failure and need for mechanical ventilation
  • Barotrauma
  • Complications of (parenteral) steroid use
  • Death

Prognosis

  • Women with mild disease are unlikely to have problems.
  • Patients with severe asthma are at greater risk of deterioration.
  • The risk of deterioration is greatest in the last portion of a pregnancy.
  • There is inconsistent evidence in mothers with asthma, with an increased incidence of the following: 
    • Pregnancy-induced hypertension (PIH)
    • Neonatal hypoglycemia, seizures, tachypnea, and NICU admissions
    • Small and preterm infants (This appears to be small and may be minimized by good control of asthma.)
    • Studies shows that low birth weight infants were more common in women with daily symptoms or low expiratory flow than in women without asthma.
    • Preterm labor

Patient Education

  • Most complications of asthma during pregnancy are from undermedication; thus, the goal is to emphasize the importance and safety of therapy. Education should cover the following aspects of asthma and pregnancy:
    • Signs and symptoms of asthma
    • Importance and safety of the medication to the fetus and to the mother
    • Warning signs that indicate they should go to the ED
    • Potential harm to their fetus and increased risk to themselves with undertreatment or unnecessary delays in seeking additional care
    • Prevention and avoidance of known triggers
    • Home use of metered-dose inhalers and peak flow meters
    • Medication adverse effects
    • Use of written diaries to record PEFR
    • Use of written guidelines for managing an exacerbation and for prudently using the ED
  • For excellent patient education resources, see eMedicine's Asthma Center. Also, visit eMedicine's patient education articles, Asthma and Asthma in Pregnancy.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, A Antoine Kazzi, MD, and Araz Marachelian, MD, to the development and writing of this article.



More on Pregnancy, Asthma

Overview: Pregnancy, Asthma
Differential Diagnoses & Workup: Pregnancy, Asthma
Treatment & Medication: Pregnancy, Asthma
Follow-up: Pregnancy, Asthma
References
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References

  1. [Guideline] Reddel HK, Taylor DR, Bateman ED, et al. An official American Thoracic Society/european Respiratory Society statement: asthma control and exacerbations: standardizing endpoints for clinical asthma trials and clinical practice. Am J Respir Crit Care Med. Jul 1 2009;180(1):59-99. [Medline].

  2. [Guideline] American College of Obstetricians and Gynecologists (ACOG). Asthma in pregnancy. ACOG practice bulletin; no. 90. Washington (DC): American College of Obstetricians and Gynecologists (ACOG). Feb 2008;[Full Text].

  3. Sly RM, O'Donnell R. Stabilization of asthma mortality. Ann Allergy Asthma Immunol. Apr 1997;78(4):347-54. [Medline].

  4. Hornby PJ, Abrahams TP. Pulmonary pharmacology. Clin Obstet Gynecol. Mar 1996;39(1):17-35. [Medline].

  5. Mabie WC. Asthma in pregnancy. Clin Obstet Gynecol. Mar 1996;39(1):56-69. [Medline].

  6. Mays M, Leiner S. Asthma. A comprehensive review. J Nurse Midwifery. May-Jun 1995;40(3):256-68. [Medline].

  7. Nelson-Piercy C, Moore-Gillon J. Asthma in pregnancy. Br J Hosp Med. Feb 7-20 1996;55(3):115-7. [Medline].

  8. Rey E, Boulet LP. Asthma in pregnancy. BMJ. Mar 17 2007;334(7593):582-5. [Medline].

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Further Reading

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Keywords

asthma in pregnancy, asthma, pregnancy, asthma guidelines, asthma assessment, asthma treatment, asthma symptoms, asthma causes, respiratory disease, asthmatic, wheeze, wheezing, noisy breathing, difficulty breathing, cough, allergy, allergic disease, reactive airway disease, bronchiolitis, bronchial asthma, acute asthma, allergies, bronchial airways, bronchial airway narrowing, inflammation of the bronchi, bronchial smooth muscle contraction, dyspnea, airway narrowing, allergic asthma, idiosyncratic asthma, treating asthma in pregnancy, maternal asthma, pulmonarydisease and pregnancy

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Contributor Information and Disclosures

Author

Markus Little, MD, Staff Physician, Department of Emergency Medicine, State University of New York Downstate Medical Center
Disclosure: Nothing to disclose.

Coauthor(s)

Richard H Sinert, DO, Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center
Richard H Sinert, DO is a member of the following medical societies: American College of Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Assaad J Sayah, MD, Chief, Department of Emergency Medicine, Cambridge Health Alliance
Assaad J Sayah, MD is a member of the following medical societies: National Association of EMS Physicians
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Mark Zwanger, MD, MBA, Assistant Professor, Department of Emergency Medicine, Thomas Jefferson University
Mark Zwanger, MD, MBA is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and American Medical Association
Disclosure: Medicines Company Consulting fee Consulting; Pfizer Salary Employment

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Pamela L Dyne, MD, Professor of Clinical Medicine/Emergency Medicine, David Geffen School of Medicine at UCLA; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center
Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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