Bronchial asthma and pregnancy. Symptoms of asthma in a pregnant woman

For quotation: Ignatova G.L., Antonov V.N. Bronchial asthma in pregnant women // Breast cancer. Medical Review. 2015. No. 4. P. 224

The incidence of bronchial asthma (BA) in the world ranges from 4 to 10% of the population; in the Russian Federation, the prevalence among adults ranges from 2.2 to 5-7%; in the pediatric population this figure is about 10%. In pregnant women, asthma is the most common disease of the pulmonary system, the diagnosis rate of which in the world ranges from 1 to 4%, in Russia - from 0.4 to 1%. In recent years, standard international diagnostic criteria and pharmacotherapy methods have been developed, which can significantly increase the effectiveness of treatment of patients with asthma and improve their quality of life (Global Initiative for the Prevention and Treatment of Bronchial Asthma (GINA), 2014). However, modern pharmacotherapy and monitoring of asthma in pregnant women are more complex tasks, since they aim not only to preserve the health of the mother, but also to prevent the adverse effects of disease complications and side effects of treatment on the fetus.

Pregnancy has different effects on the course of asthma. Changes in the course of the disease vary widely: improvement in 18–69% of women, deterioration in 22–44%, no effect of pregnancy on the course of asthma was detected in 27–43% of cases. This is explained, on the one hand, by multidirectional dynamics in patients with varying degrees of asthma severity (with mild and moderate severity, worsening of asthma is observed in 15–22%, improvement in 12–22%), on the other hand, by insufficient diagnosis and always the right therapy. In practice, asthma is often diagnosed only in the later stages of the disease. In addition, if its onset coincides with the gestational period, the disease may remain unrecognized, since the observed respiratory disorders are often attributed to changes caused by pregnancy.

At the same time, with adequate treatment of BA, the risk of unfavorable outcome of pregnancy and childbirth is no higher than in healthy women. In this regard, most authors do not consider asthma as a contraindication to pregnancy, and recommend monitoring its course using modern treatment principles.

The combination of pregnancy and asthma requires close attention from doctors due to possible changes in the course of asthma during pregnancy, as well as the impact of the disease on the fetus. In this regard, the management of pregnancy and childbirth in a patient suffering from asthma requires careful monitoring and joint efforts of doctors of many specialties, in particular therapists, pulmonologists, obstetricians-gynecologists and neonatologists.

Changes in the respiratory system in asthma during pregnancy

During pregnancy, under the influence of hormonal and mechanical factors, the respiratory system undergoes significant changes: a restructuring of respiratory mechanics occurs, ventilation-perfusion relationships change. In the first trimester of pregnancy, hyperventilation may develop due to hyperprogesteronemia, changes in blood gas composition - increased PaCO2 content. The appearance of shortness of breath in late pregnancy is largely due to the development of a mechanical factor, which is a consequence of an increase in the volume of the uterus. As a result of these changes, disturbances in the function of external respiration are aggravated, vital capacity of the lungs, forced vital capacity of the lungs, and forced expiratory volume in 1 second (FEV1) are reduced. As the gestational age increases, vascular resistance in the pulmonary circulation increases, which also contributes to the development of shortness of breath. In this regard, shortness of breath causes certain difficulties when carrying out differential diagnosis between physiological changes in the function of external respiration during pregnancy and manifestations of broncho-obstruction.

Often, pregnant women without somatic pathology develop swelling of the mucous membranes of the nasopharynx, trachea and large bronchi. These manifestations in pregnant women with asthma can also aggravate the symptoms of the disease.

Low compliance contributes to the worsening of asthma: many patients try to stop taking inhaled glucocorticosteroids (ICS) for fear of their possible side effects. In such cases, the doctor should explain to the woman the need for basic anti-inflammatory therapy due to the negative impact of uncontrolled asthma on the fetus. Asthma symptoms may first appear during pregnancy due to altered body reactivity and increased sensitivity to endogenous prostaglandin F2α (PGF2α). Attacks of suffocation that first occurred during pregnancy may disappear after childbirth, but they can also transform into true asthma. Among the factors contributing to the improvement of asthma during pregnancy, it should be noted a physiological increase in the concentration of progesterone, which has bronchodilation properties. An increase in the concentration of free cortisol, cyclic aminomonophosphate, and an increase in histaminase activity have a beneficial effect on the course of the disease. These effects are confirmed by an improvement in the course of asthma in the second half of pregnancy, when glucocorticoids of fetoplacental origin enter the mother’s bloodstream in large quantities.

The course of pregnancy and fetal development in asthma

Current issues are the study of the effect of asthma on the course of pregnancy and the possibility of giving birth to healthy offspring in patients suffering from asthma.

Pregnant women with asthma have an increased risk of developing early toxicosis (37%), gestosis (43%), threatened miscarriage (26%), premature birth (19%), and fetoplacental insufficiency (29%). Obstetric complications usually occur in severe cases of the disease. Adequate drug control of asthma is of great importance. The lack of adequate treatment for the disease leads to the development of respiratory failure, arterial hypoxemia of the mother's body, constriction of placental vessels, resulting in fetal hypoxia. A high incidence of fetoplacental insufficiency, as well as miscarriage, is observed against the background of damage to the vessels of the uteroplacental complex by circulating immune complexes and inhibition of the fibrinolysis system.

Women suffering from asthma are more likely to give birth to children with low body weight, neurological disorders, asphyxia, and congenital defects. In addition, the interaction of the fetus with maternal antigens through the placenta influences the formation of the child’s allergic reactivity. The risk of developing an allergic disease, including asthma, in a child is 45–58%. Such children more often suffer from respiratory viral diseases, bronchitis, and pneumonia. Low birth weight is observed in 35% of children born to mothers with asthma. The highest percentage of low birth weight babies is observed in women suffering from steroid-dependent asthma. The reasons for low birth weight of newborns are insufficient control of asthma, which contributes to the development of chronic hypoxia, as well as long-term use of systemic glucocorticoids. It has been proven that the development of severe exacerbations of asthma during pregnancy significantly increases the risk of having children with low body weight.

Management and treatment of pregnant women suffering from asthma

According to the provisions of GINA-2014, the main objectives of asthma control in pregnant women are:

clinical assessment of the condition of the mother and fetus;
elimination and control of trigger factors;
pharmacotherapy of asthma during pregnancy;
educational programs;
psychological support for pregnant women.

Given the importance of achieving control over asthma symptoms, mandatory examinations by a pulmonologist are recommended between 18 and 20 weeks. gestation, 28–30 weeks. and before childbirth, in case of unstable asthma - as necessary. When managing pregnant women with asthma, one should strive to maintain lung function close to normal. Peak flowmetry is recommended to monitor respiratory function.

Due to the high risk of developing fetoplacental insufficiency, it is necessary to regularly assess the condition of the fetus and the uteroplacental complex using ultrasound fetometry, ultrasound Doppler ultrasound of the vessels of the uterus, placenta and umbilical cord. In order to increase the effectiveness of therapy, patients are recommended to take measures to limit contact with allergens, quit smoking, including passive smoking, strive to prevent ARVI, and avoid excessive physical activity. An important part of the treatment of asthma in pregnant women is the creation of educational programs that allow the patient to establish close contact with the doctor, increase the level of knowledge about her disease and minimize its impact on the course of pregnancy, and teach the patient self-control skills. The patient must be trained in peak flowmetry in order to monitor the effectiveness of treatment and recognize early symptoms of exacerbation of the disease. For patients with moderate and severe asthma, it is recommended to perform peak flow measurements in the morning and evening hours every day, calculate daily fluctuations in the peak volumetric expiratory flow rate and record the obtained indicators in the patient’s diary. According to the 2013 Federal Clinical Guidelines for the Diagnosis and Treatment of Bronchial Asthma, it is necessary to adhere to certain provisions (Table 1).

The principal approaches to pharmacotherapy of asthma in pregnant women are the same as in non-pregnant women (Table 2). For the basic therapy of mild BA, it is possible to use montelukast; for moderate and severe BA, it is preferable to use inhaled corticosteroids. Among the inhaled corticosteroids available today, only budesonide was classified as category B at the end of 2000. If it is necessary to use systemic corticosteroids (in extreme cases) in pregnant women, it is not recommended to prescribe triamcinolone preparations, as well as long-acting corticosteroids (dexamethasone). It is preferable to prescribe prednisolone.

Of the inhaled forms of bronchodilators, the use of fenoterol (group B) is preferable. It should be taken into account that β2-agonists are used in obstetrics to prevent premature birth; their uncontrolled use can cause an extension of the duration of labor. Prescribing depot forms of GCS drugs is strictly prohibited.

Exacerbation of asthma in pregnant women

Main activities (Table 3):

Assessment of condition: examination, measurement of peak expiratory flow (PEF), oxygen saturation, assessment of fetal condition.

Initial therapy:

β2-agonists, preferably fenoterol, salbutamol – 2.5 mg via nebulizer every 60–90 minutes;
oxygen to maintain saturation at 95%. If saturation<90%, ОФВ1 <1 л или ПСВ <100 л/мин, то:
Continue administering selective β2-agonists (fenoterol, salbutamol) via nebulizer every hour.

If there is no effect:

budesonide suspension – 1000 mcg via nebulizer;
add ipratropium bromide through a nebulizer - 10-15 drops, since it has category B.

If there is no further effect:

prednisolone – 60–90 mg IV (this drug has the lowest rate of passage through the placenta).

If the therapy is ineffective and long-acting theophyllines are not available in treatment before exacerbation of the disease:

administer theophylline intravenously in usual therapeutic dosages;
administer β2-agonists and budesonide suspension every 1–2 hours.

When choosing therapy, it is necessary to take into account the risk categories of prescribing medications for pregnant women, established by Physicians Desk Reference:

bronchodilators - all categories C, except ipratropium bromide, fenoterol, which belong to category B;
ICS – all categories C, except budesonide;
antileukotriene drugs – category B;
Cromony - category B.

Treatment of asthma during childbirth

Delivery of pregnant women with a controlled course of asthma and the absence of obstetric complications is carried out at full-term pregnancy. Preference should be given to vaginal delivery. Caesarean section is performed for appropriate obstetric indications. During labor, the woman should continue to take standard basic therapy (Table 4). If it is necessary to stimulate labor, preference should be given to oxytocin and avoid the use of PGF2α, which can stimulate bronchoconstriction.

Vaccinal prevention during pregnancy

When planning pregnancy, it is necessary to vaccinate against:

rubella, measles, mumps;
hepatitis B;
diphtheria, tetanus;
polio;
pathogens of respiratory infections;
influenza virus;
pneumococcus;
Haemophilus influenzae type b.

Timing for administering vaccines before pregnancy:

Viral vaccines:

rubella, measles, mumps - within 3 months. and more;
polio, hepatitis B – for 1 month. and more;
influenza (subunit and split vaccines) – 2–4 weeks.

Toxoids and bacterial vaccines:

diphtheria, tetanus – 1 month. and more;
pneumococcal and hemophilic infections - for 1 month. and more.

Vaccination schedule before pregnancy:

Vaccination starts at least 3 months in advance. before conception.

Stage I – administration of vaccines against rubella, measles (for 3 months), mumps, hepatitis B (1st dose), Haemophilus influenzae type b.

Stage II – administration of vaccines against polio (2 months in advance, once), hepatitis B (2nd dose), pneumococcus.

Stage III – administration of vaccines against diphtheria, tetanus (for 1 month), hepatitis B (3rd dose), influenza (Table 5).

The combination of vaccines may vary depending on the woman's condition and the season.

When preparing for pregnancy, vaccination against pneumococcal, hemophilus influenza type b, and influenza is most important for women with children, since they are the main source of the spread of respiratory infections.

BA and pregnancy are mutually aggravating conditions, so management of pregnancy complicated by BA requires careful monitoring of the condition of the woman and the fetus. Achieving asthma control is an important factor contributing to the birth of a healthy child.

Literature

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Bratchik A.M., Zorin V.N. Obstructive pulmonary diseases and pregnancy // Medical practice. 1991. No. 12. P. 10-13.
Vavilonskaya S.A. Optimization of management of bronchial asthma in pregnant women: abstract. dis. ...cand. honey. Sci. M., 2005.
Vaccination of adults with bronchopulmonary pathology: a guide for doctors / ed. M.P. Kostinova. M., 2013.
Makhmutkhodzhaev A.Sh., Ogorodova L.M., Tarasenko V.I., Evtushenko I.D. Obstetric care for pregnant women with bronchial asthma // Current issues in obstetrics and gynecology. 2001. No. 1. P. 14-16.
Ovcharenko S.I. Bronchial asthma: diagnosis and treatment // Breast cancer. 2002. T. 10. No. 17.
Pertseva T.A., Chursinova T.V. Pregnancy and bronchial asthma: state of the problem // Health of Ukraine. 2008. No. 3/1. pp. 24-25.
Fassakhov R.S. Treatment of bronchial asthma in pregnant women // Allergology. 1998. No. 1. P. 32-36.
Chernyak B.A., Vorzheva I.I. Beta2-adrenergic receptor agonists in the treatment of bronchial asthma: issues of effectiveness and safety // Consilium medicum. 2006. T. 8. No. 10.
Federal clinical guidelines for the diagnosis and treatment of bronchial asthma // http://pulmonology.ru/publications/guide.php (appeal 01/20/2015).
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European Respiratory Monograph: Respiratory Diseases in women / Ed. by S. Bust, C.E. Mapp. 2003. Vol. 8 (Monograph 25). R. 90-103.
Global Initiative for Asthma3. 2014. (GINA). http://www.ginasthma.org.
Masoli M., Fabian D., Holt S., Beasley R. Global Burden of Asthma. 2003. 20 r.
Rey E., Boulet L.P. Asthma and pregnancy // BMJ. 2007. Vol. 334. P. 582-585.

– the most common respiratory disease in pregnant women. It occurs in approximately every hundredth woman bearing a child.
In our article we will talk about the effect of asthma on the development of the fetus and the course of pregnancy, how the disease itself changes during this important period of a woman’s life, we will recall the basic recommendations for the management of pregnancy, childbirth, and the postpartum period, we will talk about the treatment of asthma during pregnancy and period breastfeeding.

When carrying a child, it is very important to constantly monitor the pregnant woman and monitor her condition. When planning pregnancy or at least in its early stages, it is necessary to take all measures to achieve control of the disease. These include both the selection of therapy and allergens. The patient must observe and under no circumstances smoke or be exposed to tobacco smoke.
Before a planned pregnancy occurs, a woman should be vaccinated against influenza, pneumococcal and Haemophilus influenzae type b. Vaccine prevention of rubella, measles, mumps, hepatitis B, diphtheria and tetanus, and polio is also desirable. This vaccination begins 3 months before the expected conception and is carried out in stages under the supervision of a doctor.

The effect of asthma on pregnancy

The condition of the fetus must be regularly monitored

Asthma is not a contraindication for pregnancy. With proper control of the disease, a woman is able to carry and give birth to a healthy baby.
If the treatment of the disease does not achieve its goal, and the woman is forced to use it to relieve asthma attacks, then the amount of oxygen in her blood decreases and the level of carbon dioxide increases. The blood vessels of the placenta are developing and narrowing. As a result, the fetus experiences oxygen starvation.
As a result, women with poor health have an increased risk of developing the following complications:

early toxicosis;
gestosis;
fetoplacental insufficiency;
threat of miscarriage;
premature birth.

These complications occur more often in patients with severe disease. Children born in such conditions suffer from allergic diseases in half of the cases, including atopic asthma. In addition, the likelihood of having a child with low body weight, developmental defects, disorders of the nervous system, and asphyxia (lack of spontaneous breathing) increases. Children especially often suffer from exacerbations of asthma during pregnancy and the mother takes large doses of systemic glucocorticoids.
Subsequently, such children more often suffer from colds, bronchitis, and pneumonia. They may lag somewhat behind their peers in physical and mental development.

The effect of pregnancy on the course of asthma

The course of asthma in a pregnant woman may change

During pregnancy, a woman's respiratory system changes. In the first trimester, the content of progesterone and carbon dioxide in the blood increases, which causes increased breathing - hyperventilation. In later stages, shortness of breath is mechanical in nature and is associated with an elevated diaphragm. During pregnancy, pressure in the pulmonary artery system increases. All these factors lead to a decrease in the vital capacity of the lungs and slow down the rate of forced expiration per second, that is, they worsen spirometry in patients. Thus, a physiological deterioration in respiratory function occurs, which can be difficult to distinguish from a decrease in asthma control.
Any pregnant woman may experience swelling of the mucous membrane of the nose, trachea, and bronchi. In patients with asthma, this may cause an attack of suffocation.
Many patients stop using them during pregnancy, fearing their harmful effects on the fetus. This is very dangerous, since exacerbation of asthma will cause much more harm to the child if treatment is discontinued.
Signs of the disease may first appear during pregnancy. Subsequently, they either disappear after childbirth or turn into true atopic asthma.
In the second half of pregnancy, the patient's health often becomes better. This is due to an increase in the level of progesterone in her blood, which dilates the bronchi. In addition, the placenta itself begins to produce glucocorticoids, which have an anti-inflammatory effect.
In general, an improvement in the course of the disease during pregnancy is observed in 20–70% of women, a deterioration in 20–40%. With a mild and moderate course of the disease, the chances of a change in condition in one direction or another are equal: in 12–20% of patients the disease recedes, and in the same number of women it progresses. It is worth noting that asthma that begins during pregnancy is usually not diagnosed in the early stages, when its manifestations are attributed to physiological shortness of breath in pregnant women. A woman is first diagnosed and prescribed treatment already in the third trimester, which adversely affects the course of pregnancy and childbirth.

Treatment of asthma in pregnant women

Treatment must be ongoing

Patients with asthma must be examined by a pulmonologist at 18–20 weeks, 28–30 weeks and before childbirth, and if necessary, more often. It is recommended to maintain respiratory function close to normal and carry out daily exercises. To assess the condition of the fetus, it is necessary to regularly conduct ultrasound examinations of the fetus and Doppler measurements of the vessels of the uterus and placenta.
carried out depending on the severity of the disease. Conventional drugs are used without any restrictions:

(fenoterol);
ipratropium bromide in combination with fenoterol;
(budesonide is best);
theophylline preparations for intravenous administration - mainly for exacerbations of asthma;
in severe cases of the disease, systemic glucocorticoids (mainly prednisolone) can be prescribed with caution;
If leukotriene antagonists helped the patient well before pregnancy, they can also be prescribed during pregnancy.

Treatment of exacerbations of asthma in pregnant women is carried out according to the same rules as outside this condition:

if necessary, systemic ones are prescribed;
in case of severe exacerbation, treatment is indicated in a pulmonology hospital or in the department of extragenital pathology;
Oxygen therapy should be used to maintain oxygen saturation in the blood at least 94%;
if the need arises, the woman is transferred to the intensive care unit;
During treatment, the condition of the fetus must be monitored.

Asthma attacks rarely occur during childbirth. A woman should receive her usual medications without restrictions. If asthma is well controlled and there is no exacerbation, then in itself it is not an indication for cesarean section. If anesthesia is necessary, regional blockade rather than inhalation anesthesia is preferable.
If a woman received systemic glucocorticosteroids in a dose greater than 7.5 mg of prednisolone during pregnancy, then during childbirth these tablets are discontinued and replaced with hydrocortisone injections.
After childbirth, the patient is recommended to continue basic therapy. Breastfeeding is not only not prohibited, it is preferable for both mother and child.

Maintaining normal indicators of external respiration function (ERF) during gestation (bearing a child) is necessary to maintain the woman’s well-being and the proper development of the fetus. Otherwise, hypoxia occurs - oxygen starvation, which entails many adverse consequences. Let's figure out what features bronchial asthma has during pregnancy and what are the basic principles of treating the disease and preventing exacerbations.

Causes

Although the development of asthma may coincide with the period of pregnancy, a woman usually suffers from this disease even before conception, often from childhood. There is no single cause of the inflammatory process in the respiratory system, but there are a fairly large number of provoking factors (triggers):

Genetic predisposition.
Taking medications.
Infections (viral, bacterial, fungal).
Smoking (active, passive).
Frequent contact with allergens (household dust, mold, professional triggers - latex, chemicals).
Unfavorable environmental conditions.
Poor nutrition.
Stress.

Patients suffer from asthma throughout their lives, and the course of the disease usually worsens in the first trimester and stabilizes (with adequate therapy) in the second half of pregnancy. Between periods of remission (no symptoms), exacerbations occur due to a number of triggers:

contact with allergens;
unfavorable weather conditions;
excessive physical activity;
a sharp change in the temperature of inhaled air;
dustiness of premises;
stressful situations.

Asthma that develops in the initial trimester of pregnancy may spontaneously disappear by the end of the first half of the gestation period.

This phenomenon is observed in women whose mothers suffered episodes of bronchial obstruction (narrowing of the airways as a result of spasm) during their own pregnancy. However, it does not occur often. Attacks of suffocation can not only disappear without a trace, but also transform into the so-called true, already chronic asthma.

Although the disease is not always associated with allergies, immune disorders underlie the pathogenesis (mechanism of development) of most episodes. The key link in the formation of the reaction is hyperreactivity, or increased, heightened sensitivity of the bronchi to irritants of various natures.

Why is asthma dangerous during pregnancy?

In addition to the usual risks associated with suffocation and hypoxia (oxygen starvation), bronchial asthma during pregnancy increases the likelihood of such conditions and consequences as:

early toxicosis;
formation of a threat of termination of pregnancy;
development of labor disorders;
spontaneous abortion.

In addition, the mother’s illness can affect the health of the fetus (during exacerbations, it suffers from hypoxia) and the newborn child. Symptoms of asthma may appear in the first year of life, although most episodes of hereditary asthma are still recorded in children older than this age. There is also a tendency to diseases of the respiratory system - including infectious pathologies.

Symptoms

During the period of remission of asthma, a pregnant woman feels well, but in the event of a relapse, an attack of suffocation develops. An exacerbation usually begins at night and lasts from several minutes to hours. First, “harbingers” appear:

runny nose;
sore throat;
sneezing;
discomfort in the chest.

Soon you can observe a combination of characteristic signs:

Shortness of breath with difficulty in exhaling.
Paroxysmal cough.
Noisy breathing that can be heard at a distance from the patient.
Whistling dry rales in the lungs.

The woman takes a sitting position and tenses the muscles of the chest, shoulder girdle and neck to ease difficulty breathing. She has to rest her hands on a hard surface. The face takes on a bluish tint, and cold sweat breaks out on the skin. The separation of viscous, “glassy” sputum indicates the end of the attack.

During pregnancy, there is also a risk of status asthmaticus - a severe attack in which conventional medications do not work, and airway patency decreases sharply, leading to suffocation (asphyxia). In this case, the patient limits physical activity, taking a forced position with support on her hands, is silent, breathes quickly or, on the contrary, rarely, superficially. There may be no wheezing (“silent lung”), consciousness is depressed to the point of coma.

Diagnostics

The examination program is based on such methods as:

survey;
inspection;
laboratory tests;
functional tests to assess respiratory function.

When talking with the patient, you need to determine what causes the attack and understand whether there is a hereditary predisposition to asthma. The examination allows you to find out the characteristics of the current objective condition. As for laboratory tests, they can have a general or specific focus:

Blood test (erythrocytes, leukocytes, formula calculation, gas composition).
Determination of the concentration of class E immunoglobulins (IgE), or antibodies - protein complexes responsible for the development of allergic reactions.
Sputum analysis (search for an increased number of eosinophil cells, Kurshman spirals, Charcot-Leyden crystals).

The “gold standard” of functional tests is spirography and peak flowmetry - measurement using special devices of such parameters of respiratory function as:

forced expiratory volume in the first second (FEV1);
vital capacity of the lungs (VC);
peak expiratory flow (PEF).

Skin tests with allergens are prohibited during pregnancy.

They are not performed regardless of the duration and condition of the patient, since there is a high risk of developing anaphylactic shock.

Treatment

Therapy for asthma during pregnancy is not much different from standard regimens. Although during gestation it is recommended to stop taking drugs from the group of H1-histamine receptor blockers (Suprastin, Tavegil, etc.), the woman should continue and, if necessary, plan or supplement the course of treatment.

Modern medications used for basic therapy do not have a negative effect on the fetus. If the course of the disease is controllable (stable), patients use topical (local) forms of medications - this allows the drug to be concentrated in the area of inflammation and eliminate or significantly reduce the systemic (on the entire body as a whole) effect.

Principles of pregnancy management

It is necessary to determine the severity of asthma and the level of risk for mother and child. Regular examinations by a pulmonologist are recommended - for controlled BA three times: at 18-20, 28-30 weeks and before birth, for unstable forms - as needed. Also required:

Drug therapy

Since uncontrolled asthma is dangerous for both the mother and the fetus, pharmacological drugs occupy an important place in the treatment algorithms for asthma during pregnancy. They are assigned, selected in accordance with the safety category:

no side effects for mother/fetus when taken in standard therapeutic dosages (B);
toxic effects have been documented in humans and animals, but the risk of discontinuing the drug is higher than the likelihood of side effects (C).

There are no Category A medications available to treat asthma (meaning studies have shown no risk to the fetus). However, the correct use of level B and, if necessary, level C products usually does not entail negative consequences. For basic or basic therapy the following are used:

Pharmacological group		Example of a drug	Safety category
Beta2-agonists	Short acting	Salbutamol	C
Beta2-agonists	Prolonged	Formoterol	C
Glucocorticosteroids	Inhalation	Budesonide	B
Glucocorticosteroids	System	Prednisolone
Anticholinergics		Ipratropium bromide
Monoclonal antibodies		Omalizumab
Mast cell membrane stabilizers		Nedocromil
Methylxanthines		Theophylline	C
Leukotriene receptor antagonists		Zafirlukast	B

The therapy is stepwise: for mild asthma, medications are used as required (usually Salbutamol, Ipratropium bromide), and then other medications are added (depending on the severity of the condition). If a woman was taking leukotriene receptor antagonists before pregnancy, it is advisable to continue therapy with them.

Help with exacerbations

If a pregnant woman has an asthma attack, you must:

stop the trigger (if it can be identified - food, cosmetics, etc.);
open a window or window if the situation occurs indoors;
unbutton or remove clothing that interferes with breathing (shirt buttons, heavy coat);
help use a medicine inhaler - for example, Salbutamol;
Call an ambulance.

If possible, they resort to administering drugs through a nebulizer - this is a device that creates a medicinal aerosol from small particles that penetrate even into areas of the respiratory tract that are difficult to reach with conventional means. However, only a mild attack can be stopped on your own; a severe exacerbation requires emergency hospitalization of the pregnant woman in the hospital - sometimes directly to the intensive care ward.

Management of childbirth

It is carried out against the background of basic therapy for asthma, which the patient received during gestation. In the absence of attacks, respiratory function indicators are assessed every 12 hours, in case of exacerbation - as needed. If a woman was prescribed systemic glucocorticosteroids during pregnancy, she is switched from Prednisolone to Hydrocortisone - for the period of labor and for 24 hours after the birth of the child.

The presence of bronchial asthma in a pregnant woman does not mean the impossibility of natural childbirth.

On the contrary, surgery is seen as a last resort as it entails additional risks. It is used when there is a direct threat to the life of the mother/child, and the need for surgery is determined by obstetric indications (placenta previa, abnormal fetal position, etc.).

To prevent exacerbation of bronchial asthma, it is necessary:

Avoid contact with allergens and other attack triggers.
Follow your doctor's recommendations regarding basic therapy.
Do not refuse treatment or reduce the dosage of medications on your own.
Keep a diary of external respiratory function indicators and, if there are significant fluctuations, visit a doctor.
Remember about scheduled consultations with specialists (therapist, pulmonologist, obstetrician-gynecologist) and do not miss visits.
Avoid excessive physical activity and stress.

A woman suffering from bronchial asthma is recommended to get vaccinated against influenza at the stage of pregnancy planning, since this variant of acute respiratory infection can significantly worsen the course of the underlying disease. Vaccination is also allowed during the gestation period, taking into account the patient’s health status.

Asthma is a disease characterized by a relapsing course. The disease appears with equal frequency in men and women. Its main symptoms are attacks of lack of air due to spasm of the smooth muscles of the bronchi and the secretion of viscous and copious mucus.

As a rule, the pathology first appears in childhood or adolescence. If asthma occurs during pregnancy, pregnancy management requires increased medical supervision and adequate treatment.

Asthma in pregnant women - how dangerous is it?

If the expectant mother ignores the symptoms of the disease and does not seek medical help, the disease negatively affects both her health and the well-being of the fetus. Bronchial asthma is most dangerous in the early stages of gestation. Then the course becomes less aggressive and the symptoms decrease.

Is it possible to get pregnant with asthma? Despite its severe course, the disease is compatible with bearing a child. With proper therapy and constant doctor monitoring, dangerous complications can be avoided. If a woman is registered, receives medications and is regularly examined by a doctor, the risk of complications during pregnancy and childbirth is minimal.

However, sometimes the following deviations appear:

Increased frequency of attacks.
The attachment of viruses or bacteria with the development of the inflammatory process.
Worsening of attacks.
Threat of spontaneous abortion.
Severe toxicosis.
Premature delivery.

In the video, the pulmonologist talks in detail about the disease during pregnancy:

The effect of the disease on the fetus

Pregnancy changes the functioning of the respiratory organs. The level of carbon dioxide rises, and the woman’s breathing quickens. Ventilation of the lungs increases, causing the expectant mother to experience shortness of breath.

At a later stage, the location of the diaphragm changes: the growing uterus lifts it. Because of this, the pregnant woman has an increased feeling of lack of air. The condition worsens with the development of bronchial asthma. With each attack, placental hypoxia is caused. This entails intrauterine oxygen starvation in the baby with the appearance of various disorders.

The main deviations in the baby:

lack of weight;
intrauterine growth retardation;
formation of pathologies in the cardiovascular, central nervous system, muscle tissue;
with severe oxygen starvation, asphyxia (suffocation) of the baby may develop.

If the disease takes a severe form, there is a high risk of giving birth to a baby with heart defects. In addition, the baby will inherit a predisposition to respiratory diseases.

How does childbirth occur with asthma?

If the gestation of the child was controlled throughout the pregnancy, spontaneous childbirth is quite possible. 2 weeks before the expected date, the patient is hospitalized and prepared for the event. When a pregnant woman receives large doses of Prednisolone, she is given Hydrocortisone injections during the expulsion of the fetus from the uterus.

The doctor strictly monitors all indicators of the expectant mother and baby. During childbirth, the woman is given a medicine to prevent an asthma attack. It will not harm the fetus and has a beneficial effect on the patient’s well-being.

When bronchial asthma becomes severe with frequent attacks, a planned caesarean section is performed at 38 weeks. By this time, the child is fully formed, viable and considered full-term. During the operation, it is better to use a regional block than inhalation anesthesia.

The most common complications during childbirth caused by bronchial asthma:

premature rupture of amniotic fluid;
rapid birth, which has a negative impact on the baby’s health;
discoordination of labor.

It happens that the patient gives birth on her own, but an asthmatic attack begins, accompanied by cardiopulmonary failure. Then intensive care and emergency caesarean section are performed.

How to deal with asthma during pregnancy - proven methods

If you received medications for the disease, but became pregnant, the course of therapy and medications are replaced with a more gentle option. Doctors do not allow use of some medications during pregnancy, while the doses of others should be adjusted.

Throughout pregnancy, the doctor monitors the condition of the baby by performing ultrasound examinations. If an exacerbation begins, oxygen therapy is carried out, which prevents oxygen starvation of the baby. The doctor monitors the patient’s condition, paying close attention to changes in the uterine and placental vessels.

The main principle of treatment is the prevention of asthma attacks and the selection of harmless therapy for mother and baby. The tasks of the attending physician are to restore external respiration, eliminate asthma attacks, relieve side effects from drugs and control the disease.

Bronchodilators are prescribed to treat mild asthma. They allow you to relieve spasm of smooth muscles in the bronchi.

During pregnancy, long-acting drugs (Salmeterol, Formoterol) are used. They are available in the form of aerosol cans. They are used daily and prevent the development of nighttime asthma attacks.

Other basic drugs are glucocorticosteroids (Budesonide, Beclomethasone, Flutinasone). They are released in the form of an inhaler. The doctor calculates the dosage, taking into account the severity of the disease.

If you have been prescribed hormonal medications, do not be afraid to use them daily. The medications will not harm the baby and will prevent the development of complications.

When the expectant mother suffers from late gestosis, methylxanthines (Eufillin) are used as a bronchodilator. They relax the muscles of the bronchi, stimulate the respiratory center, and improve alveolar ventilation.

Expectorants (Mukaltin) are used to remove excess mucus from the respiratory tract. They stimulate the work of the bronchial glands and increase the activity of the ciliated epithelium.

In later stages, the doctor prescribes maintenance therapy. It is aimed at restoring intracellular processes.

Treatment includes the following medications:

Tocopherol - reduces tone, relaxes the muscles of the uterus;
multivitamins - replenish insufficient vitamin content in the body;
anticoagulants - normalize blood clotting.

What drugs should not be taken by pregnant women for treatment?

During the period of bearing a child, you should not use medications without medical advice, and even more so if you have bronchial asthma. You must follow all instructions exactly.

There are medications that are contraindicated for asthmatic women. They can have a harmful effect on the fetal health of the baby and the condition of the mother.

List of prohibited drugs:

Drug name	Negative influence	During what period are they contraindicated?
Adrenalin	Causes oxygen starvation of the fetus, provokes the development of vascular tone in the uterus	Throughout pregnancy
Short-acting bronchodilators – Fenoterol, Salbutamol	Complicates and delays childbirth	In late gestation
Theophylline	Enters the fetal circulation through the placenta, causing rapid heartbeat in the baby	In the 3rd trimester
Some glucocorticoids – Dexamethasone, Betamethasone, Triamcinolone	Negatively affects the fetal muscular system	Throughout pregnancy
II generation antihistamines – Loratadine, Dimetindene, Ebastine	The resulting side effects negatively affect the health of the woman and child	During the entire gestational period
Selective β2-blockers (Ginipral, Anaprilin)	Causes bronchospasm, significantly worsening the patient's condition	Contraindicated in bronchial asthma, regardless of pregnancy duration
Antispasmodics (No-shpa, Papaverine)	Provokes the development of bronchospasm and anaphylactic shock	It is undesirable to use for asthma, regardless of gestational age.

ethnoscience

Non-traditional treatment methods are widely used by patients with bronchial asthma. Such remedies cope well with attacks of suffocation and do not harm the body.

Use folk recipes only as a complement to conservative therapy. Do not use them without first consulting with your doctor or if you have identified an individual allergic reaction to the components of the product.

How to fight asthma with traditional medicine recipes:

Oatmeal broth. Prepare and wash 0.5 kg of oats well. Put 2 liters of milk on gas, add 0.5 ml of water. Bring to a boil, pour in the cereal. Cook for another 2 hours to obtain 2 liters of broth. Take the product hot on an empty stomach. Add 1 tsp to 1 glass of drink. honey and butter.
Oatmeal broth with goat milk. Pour 2 liters of water into the pan. Bring to a boil, then stir in 2 cups oats. Boil the product over low heat for about 50–60 minutes. Then pour in 0.5 liters of goat milk and boil for another half hour. Before taking the decoction, you can add 1 teaspoon of honey. Drink ½ glass 30 minutes before meals.
Inhalation with propolis and beeswax. Take 20 g of propolis and 100 g of beeswax. Heat the mixture in a water bath. When she warms up, cover her head with a towel. After this, inhale the product through your mouth for about 15 minutes. Repeat these procedures in the morning and evening.
Propolis oil. Mix 10 g of propolis with 200 g of sunflower oil. Heat the product in a water bath. Strain it and take 1 tsp. in the morning and in the evening.
Ginger juice. Extract the juice from the root of the plant, adding a little salt. The drink is used to combat attacks and as a preventive measure. To relieve choking, take 30 g. To prevent difficulty breathing, drink 1 tbsp daily. l. juice For taste, add 1 tsp. honey, washed down with water.

Disease prevention

Doctors advise asthmatic women to control the disease even when planning pregnancy. At this time, the doctor selects the correct and safe treatment and eliminates the effects of irritating factors. Such measures reduce the risk of seizures.

The pregnant woman herself can also take care of her health. Smoking must be stopped. If loved ones living with the expectant mother smoke, you should avoid inhaling smoke.

To improve your health and reduce the threat of relapse, try to follow simple rules:

Review your diet, exclude foods that cause allergies from the menu.
Wear clothes and use bedding made from natural materials.
Take a shower every day.
Do not contact animals.
Use hygiene products that have a hypoallergenic composition.
Use special humidifier devices that maintain the necessary humidity and clean the air of dust and allergens.
Take long walks in the fresh air.
If you work with chemicals or toxic fumes, move to a safe work area.
Beware of large crowds of people, especially in the autumn and spring seasons.
Avoid allergens in your daily life. Wet clean rooms regularly, avoiding inhalation of household chemicals.

At the stage of planning your baby, try to get vaccinated against dangerous microorganisms - Haemophilus influenzae, pneumococcus, hepatitis virus, measles, rubella and the causative agents of tetanus, diphtheria. Vaccination is carried out 3 months before planning a child under the supervision of the attending doctor.

Conclusion

Bronchial asthma and pregnancy are not mutually exclusive. Often the disease occurs or worsens when an “interesting situation” occurs. Don't ignore symptoms: asthma can negatively affect the health of mother and child.

Do not be afraid that the disease will cause any complications for the baby. With proper medical monitoring and adequate therapy, the prognosis is favorable.

18.05.2007

Bronchial asthma- one of the most common lung diseases in pregnant women. Due to the increase in the number of people prone to allergies, in recent years, cases of bronchial asthma(from 3 to 8% in different countries; and every decade the number of such patients increases by 1-2%).

This disease is characterized by inflammation and temporary obstruction of the airways and occurs against a background of increased excitability of the airways in response to various influences. Bronchial asthma may be of non-allergic origin- for example, after brain injuries or due to endocrine disorders. However, in the vast majority of cases bronchial asthma is an allergic disease when, in response to exposure to an allergen, bronchospasm occurs, manifested by suffocation.

Types of bronchial asthma

There are infectious-allergic and non-infectious-allergic forms of bronchial asthma.

Infectious-allergic bronchial asthma develops against the background of previous infectious diseases of the respiratory tract (pneumonia, pharyngitis, bronchitis, tonsillitis); in this case, the allergen is microorganisms. Infectious-allergic bronchial asthma is the most common form, accounting for more than 2/3 of all cases of the disease.
At non-infectious-allergic form In case of bronchial asthma, the allergen can be various substances of both organic and inorganic origin: plant pollen, street or house dust, feathers, animal and human hair and dander, food allergens (citrus fruits, wild strawberries, strawberries, etc.), medicinal substances (antibiotics, especially penicillin, vitamin B1, aspirin, pyramidon, etc.), industrial chemicals (most often formalin, pesticides, cyanamides, inorganic salts of heavy metals, etc.). When non-infectious allergic bronchial asthma occurs, hereditary predisposition plays a role.

Symptoms of bronchial asthma

Regardless of the form of bronchial asthma There are three stages of its development - preasthma, asthma attacks and status asthmaticus.

All forms and stages of the disease occur during pregnancy.

TO betrayal include chronic asthmatic bronchitis and chronic pneumonia with elements of bronchospasm. There are no pronounced attacks of suffocation at this stage yet.

In the initial stage of asthma, asthma attacks develop periodically. At infectious-allergic form of asthma they appear against the background of some chronic disease of the bronchi or lungs.

Attacks of suffocation in bronchial asthma usually easy to recognize. They begin more often at night and last from several minutes to several hours. Choking is preceded by a scratching sensation in the throat, sneezing, runny nose, and tightness in the chest. The attack begins with a persistent paroxysmal cough, no sputum. There is a sharp difficulty in exhaling, tightness in the chest, and nasal congestion. The woman sits down, strains all the muscles of the chest, neck, and shoulder girdle to exhale air. Breathing becomes noisy, whistling, hoarse, audible at a distance. At first, breathing is rapid, then becomes less frequent - up to 10 respiratory movements per minute. The face takes on a bluish tint. The skin is covered with perspiration. Towards the end of the attack, sputum begins to separate, which becomes more and more liquid and abundant.

Asthmatic status is a condition in which a severe attack of suffocation does not stop for many hours or several days. In this case, the medications that the patient usually takes are ineffective.

Features of the course of bronchial asthma during pregnancy and childbirth

As pregnancy progresses, women with bronchial asthma experience pathological changes in the immune system, which have a negative impact on both the course of the disease and the course of pregnancy.

Asthma usually begins before pregnancy, but may appear for the first time during it. Some of these women also had mothers with asthma. In some patients, asthma attacks develop at the beginning of pregnancy, in others - in the second half. Asthma that occurs at the beginning of pregnancy, like early toxicosis, may disappear by the end of the first half. In these cases, the prognosis for the mother and fetus is usually quite favorable.

Bronchial asthma, which began before pregnancy, can occur in different ways during pregnancy. According to some data, during pregnancy, 20% of patients maintain the same condition as before pregnancy, 10% experience improvement, and in most women (70%) the disease is more severe, with moderate and severe forms of exacerbation predominating with daily repeated attacks suffocation, periodic asthmatic conditions, unstable treatment effect.

Course of asthma usually worsens already in the first trimester of pregnancy. In the second half, the disease progresses more easily. If a deterioration or improvement of the condition occurred during a previous pregnancy, then it can be expected in subsequent ones.

Attacks of bronchial asthma during childbirth are rare, especially with the prophylactic use of glucocorticoid drugs (prednisolone, hydrocortisone) or bronchodilators (aminophylline, ephedrine) during this period.

After childbirth, the course of bronchial asthma improves in 25% of women (these are patients with a mild form of the disease). In 50% of women, the condition does not change, in 25% it worsens, they are forced to constantly take prednisolone, and the dose has to be increased.

Patients with bronchial asthma more often than healthy women develop early toxicosis (in 37%), threatened miscarriage (in 26%), labor disturbances (in 19%), rapid and rapid labor, which results in high birth traumatism ( in 23%), premature and low birth weight babies may be born. Pregnant women with severe bronchial asthma experience a high percentage of spontaneous miscarriages, premature births and cesarean sections. Cases of fetal death before and during childbirth are observed only in severe cases of the disease and inadequate treatment of asthmatic conditions.

The mother's illness can affect the baby's health. 5% of children develop asthma in the first year of life, and 58% develop asthma in subsequent years. Newborns in the first year of life often develop upper respiratory tract diseases.

The postpartum period in 15% of postpartum women with bronchial asthma is accompanied by an exacerbation of the underlying disease.

Patients with bronchial asthma during full-term pregnancy usually give birth through the vaginal birth canal, since attacks of suffocation during childbirth are not difficult to prevent. Frequent attacks of suffocation and asthmatic conditions observed during pregnancy, the ineffectiveness of the treatment provided are indications for early delivery at 37-38 weeks of pregnancy.

Treatment of bronchial asthma during pregnancy

In the treatment of bronchial asthma in pregnant women It should be borne in mind that all drugs used for this purpose pass through the placenta and can cause harm to the fetus, and since the fetus is often in a state of hypoxia (oxygen starvation), a minimum amount of drugs should be administered. If asthma during pregnancy does not worsen, there is no need for drug therapy. With a mild exacerbation of the disease, you can limit yourself to mustard plasters, cupping, and inhalation of saline solution. However, it should be borne in mind that severe and poorly treated asthma poses a much greater danger to the fetus than the drug therapy used to treat it. But in all cases, a pregnant woman suffering from bronchial asthma should use medications only as prescribed by a doctor.

The main treatment of bronchial asthma includes bronchodilators (sympathomimetics, xanthine derivatives) and anti-inflammatory drugs (intal and glucocorticoids).

The most widely used drugs for bronchial asthma are from the group of sympathomimetics. These include isadrin, euspiran, novodrin. Their side effect is increased heart rate. It is better to use so-called selective sympathomimetics; they cause relaxation of the bronchi, but this is not accompanied by palpitations. These are drugs such as salbutamol, bricanil, salmeterol, berotec, alupent (asthmopent). When used inhalation, sympathomimetics act faster and stronger, so during an attack of suffocation, take 1-2 breaths from the inhaler. But these medications can also be used as prophylactics against bronchial asthma.

TO sympathomimetics also applies to adrenaline. Its injection can quickly eliminate an attack of suffocation, but it can cause spasm of peripheral vessels in the woman and fetus and worsen uteroplacental blood flow. Ephedrine is not contraindicated during pregnancy, but it is ineffective.

It is interesting that sympathomimetics have found wide use in obstetrics for the treatment of miscarriage. An additional beneficial effect of these drugs is the prevention of distress syndrome - breathing problems in newborns.

Methylxanthines- most preferred means asthma treatment during pregnancy. Eufillin is administered intravenously for severe attacks of suffocation. Aminophylline tablets are used as a prophylactic agent. Recently, extended-release xanthines - theophylline derivatives, such as Teopec - have become increasingly widespread. Theophylline preparations have a beneficial effect on the body of a pregnant woman. They improve uteroplacental circulation and can be used to prevent distress syndrome in newborns. These drugs increase renal and coronary blood flow and reduce pulmonary artery pressure.

Intal is used after 3 months of pregnancy for non-infectious allergic forms of the disease. In severe cases of the disease and asthmatic conditions, this drug is not prescribed. Intal is used only for the prevention of bronchospasm, but not for the treatment of already developed asthma attacks: this can lead to increased suffocation. Intal is taken in the form of inhalations.

Among pregnant women, more and more often there are patients with severe forms of bronchial asthma who are forced to receive hormone therapy. They usually have a negative attitude towards taking glucocorticoid hormones. However, during pregnancy, the danger associated with the administration of glucocorticoids is less than the risk of developing hypoxemia - a lack of oxygen in the blood, from which the fetus suffers very seriously.

Treatment with prednisolone must be carried out under the supervision of a physician, who sets an initial dose sufficient to eliminate an exacerbation of asthma in a short period of time (1-2 days), and then prescribes a lower maintenance dose. In the last two days of treatment, inhalations of becotide (beclamide), a glucocorticoid that has a local effect on the respiratory tract, are added to prednisolone tablets. This drug is harmless. It does not stop the developing attack of suffocation, but serves as a preventive measure. Inhaled glucocorticoids are currently the most effective anti-inflammatory drugs for the treatment and prevention of bronchial asthma. During exacerbations of asthma, without waiting for the development of severe attacks, the dose of glucocorticoids should be increased. The doses used are not dangerous for the fetus.

Anticholinergics- drugs that reduce the narrowing of the bronchi. Atropine is administered subcutaneously during an attack of suffocation. Platyphylline is prescribed in powders prophylactically or to stop an attack of bronchial asthma - subcutaneously. Atrovent is a derivative of atropine, but with a less pronounced effect on other organs (heart, eyes, intestines, salivary glands), which is associated with its better tolerability. Berodual contains Atrovent and Berotec, which was mentioned above. It is used to suppress acute attacks of asthma and to treat chronic bronchial asthma.

Well known antispasmodics papaverine and no-spa have a moderate bronchodilator effect and can be used to suppress mild attacks of asthma.

In case of infectious-allergic bronchial asthma, it is necessary to stimulate the removal of sputum from the bronchi. Regular breathing exercises, toileting of the nasal cavity and oral mucosa are important. Expectorants serve to thin sputum and promote the removal of bronchial contents; they moisturize the mucous membrane and stimulate coughing. For this purpose the following can be used:

inhalation of water (tap or sea), saline solution, soda solution, heated to 37°C;
bromhexine (bisolvon), mucosolvin (in the form of inhalations),
ambroxol.

3% solution of potassium iodide and solutan (containing iodine) are contraindicated for pregnant women. An expectorant mixture with marshmallow root and terpin hydrate tablets can be used.

Drinking is good for you medicinal fees(unless you are intolerant to the components of the collection), for example, from wild rosemary herb (200 g), oregano herb (100 g), nettle leaves (50 g), birch buds (50 g). They need to be crushed and mixed. Pour 2 tablespoons of the mixture into 500 ml of boiling water, boil for 10 minutes, then leave for 30 minutes. Drink 1/2 glass 3 times a day.

Recipe for another collection: Chop and mix plantain leaves (200 g), St. John's wort leaves (200 g), linden flowers (200 g). Pour 2 tablespoons of the collection into 500 ml of boiling water, leave for 5-6 hours. Drink 1/2 cup 3 times a day before meals, warm.

Antihistamines(diphenhydramine, pipolfen, suprastin, etc.) are indicated only for mild forms of non-infectious allergic asthma; in the infectious-allergic form of asthma they are harmful, because contribute to the thickening of the secretions of the bronchial glands.

In the treatment of bronchial asthma in pregnant women, it is possible to use physical methods: physical therapy, a set of gymnastic exercises that facilitate coughing, swimming, inductothermy (warming) of the adrenal gland area, acupuncture.

During childbirth, treatment for bronchial asthma does not stop. The woman is given humidified oxygen and drug therapy continues.

Treatment of status asthmaticus must be carried out in a hospital in the intensive care unit.

Preventing pregnancy complications

It is necessary for the patient to eliminate risk factors for exacerbation of the disease. In this case, removing the allergen is very important. This is achieved by wet cleaning of the room, excluding from food foods that cause allergies (oranges, grapefruits, eggs, nuts, etc.) and nonspecific food irritants (pepper, mustard, spicy and salty foods).

In some cases, the patient needs to change jobs if it involves chemicals that act as allergens (chemicals, antibiotics, etc.).

Pregnant women with bronchial asthma should be registered with a antenatal clinic physician. Each “cold” disease is an indication for treatment with antibiotics, physiotherapeutic procedures, expectorants, for the prophylactic administration of drugs that dilate the bronchi, or for increasing their dose. In case of exacerbation of asthma at any stage of pregnancy, hospitalization is carried out, preferably in a therapeutic hospital, and in case of symptoms of a threat of miscarriage and two weeks before the due date, in a maternity hospital to prepare for childbirth.

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