Pregnant Asthmatic Women Research Articles

Asthme, grossesse et allaitement

Asthma is the most common chronic disease among childbearing age women. Pregnancy can be associated with exacerbation of asthma, just like asthma can be associated with high risk pregnancy. There is a correlation between risk for pregnancy and severity or exacerbation of asthma during the months before pregnancy. Thus asthma control before and during pregnancy is a major stake in taking care of asthmatic women's pregnancy. It involves therapeutic education and multi-disciplinarity. Many asthmatic pregnant women stop their treatments by fear of teratogenicity. Studies on teratogenicity have not demonstrated an increase of the risk of fœtal malformation concerning inhaled corticosteroids and LABA. Inhaled corticosteroids such as budesonide and beclomethasone are well studied in literature and shall be preferentially used. Asthma control is the principal matter since exacerbations are a risk for pregnancy and fœtus'health; hence the balance between risk and benefice is in favor of treatments of asthma.

A Case Study of Stillbirth in a Pregnancy Complicated by Asthma

Asthma during pregnancy can be complicated by intrauterine growth restriction, preterm delivery and stillbirth. This paper reports the obstetric and respiratory history of a 23 year old woman whose pregnancy was complicated by asthma and a severe asthma exacerbation that was associated with a stillbirth at 34 weeks gestation. The article attempts to link the relationship between asthma in pregnancy and adverse fetal outcomes and therefore highlights the need for multidisciplinary care of pregnant asthmatic women and the increased need for greater awareness by health professionals and pregnant women of the use of inhaled corticosteroid (ICS) treatment during pregnancy in combination with an asthma action plan.

Asthma control in pregnancy is associated with pre-conception dietary patterns.

To examine pre-conception dietary patterns in pregnant asthmatic women and to identify associations between maternal diet and asthma control during pregnancy. Cross-sectional study. Pre-conception food frequency data were collected retrospectively. Asthma control was assessed using the Global Initiative for Asthma guidelines. Dietary patterns were derived using factor analysis. Binary logistic regression analyses were used to test the association between uncontrolled asthma and each dietary pattern (Z-score), with values presented as odds ratio and 95 % confidence interval. Antenatal clinic in a tertiary hospital, Adelaide, Australia, May 2009-July 2013. One hundred and fifty-eight asthmatic pregnant women. Three dietary patterns were identified: (i) 'high protein/fruit' (strong food group loadings for fish, meat, chicken, fruit); (ii) 'high fat/sugar/takeaway' (takeaway foods, crisps, refined grains); and (iii) 'vegetarian-type' (vegetables, fruit, soya milk, whole grains). A 1 sd increase in score on the high fat/sugar/takeaway pattern was associated with increased likelihood of uncontrolled asthma (adjusted OR=1·54; 95 % CI 1·07, 2·23; P=0·022). Women with uncontrolled asthma (n 115) had higher energy-adjusted intakes of saturated fat, monounsaturated fat, carbohydrate, sugar and fibre compared with women with controlled asthma (n 43, all P≤0·05). Pre-pregnancy dietary patterns may influence maternal asthma control. Our work highlights the importance of achieving a healthy diet before pregnancy that is low in saturated fat, sugar and takeaway foods, and therefore higher in lean meats, poultry and fish, as well as fruits, vegetables and whole grains. A healthy dietary pattern should be encouraged in all asthmatic women who are of childbearing age, and should additionally be promoted before pregnancy and beyond.

Serum Levels Evaluation of Heat Shock Protein70 during Gestation and Fetal Birth Weight in Asthmatic Women of Thi-QAR Province, Iraq

Asthma is a multifactorial inflammatory disease of the upper airways and its one of the most common diseases complicating pregnancy and represents a risk factor for several maternal and perinatal complications. The natural history of asthma is known to change in pregnancy, but very few data are available in the terms of pathomechanism of this change during gestation. Circulating heat shock protein 70 (Hsp70) levels are decreased in healthy pregnancy, which might reflect physiological immunotolerance. The aim of our study was to determine the serum levels of Hsp70 in asthmatic women during gestation. Fifty pregnant women with bronchial asthma and 50 healthy pregnant women matched for maternal and gestational age were involved in this case-control study. Serum Hsp70 levels were measured using the Bioassay ELISA Kit. In asthmatic pregnant women, an increase of serum Hsp70 levels was observed compared to healthy pregnant women (median18- 75 percentile): 0.46 ng/ml versus 0.16 ng/ml p 0.05). A statistically significant negative correlation between maternal age and serum Hsp70 concentrations (p<0.05) and a significant were detected in healthy pregnant women. This study proves an elevation of circulating Hsp70 levels during asthmatic pregnancy compared to healthy pregnant women.

Investigating Women's Experiences of Asthma Care in Pregnancy: A Qualitative Study.

Background : Most asthmatic women have normal pregnancies and complications are infrequent when their asthma is well-controlled. Symptom control and medical treatment are concerning to pregnant asthma suffers, as is the impact that their illness and treatment might have on their unborn baby. The aim was to investigate in a qualitative study the thoughts and feelings of women’s experiences of asthma in pregnancy. Twenty-two women with asthma who had a pregnancy within two years were asked to participate. Seven women were interviewed when data saturation was achieved. Interviews were transcribed and analysed using the ‘Framework’ Method, independently analysed by two researchers and consensus reached concerning the construction of themes.The key themes that emerged were Asthma and pregnancy; Pregnancy and post-natal experiences; and Health professionals.These findings are globally interesting because of the prevalence of maternal asthma and they illustrate participants’ experiences concerning their asthma care and their views on its improvement. Pregnant asthmatic women have concerns about their care and treatment which might be alleviated by outreach, joint working between respiratory doctors and nurse specialists, midwives and General Practice nurses. Targeted educational activities could form a part of this care delivery.

Validation of the Asthma Control Test in pregnant asthmatic women

To determine the validity of the Asthma Control Test (ACT) questionnaire for assessing pregnant asthmatic women. The study involved 40 pregnant asthmatic women over a total of 113 medical visits. On each occasion the participants had a pulmonary function test and a clinical evaluation to assess the level of asthma control. In addition, the ACT was carried out with the obstetrician being blinded to its results. The most accurate cut-off point was 16, with a sensitivity of 95.4%, specificity of 68.8%, a negative predictive value of 91.7% and a positive predictive value of 80.5%. The positive and negative likelihood ratios were 3.052 and 0.067 respectively. The questionnaire was found to be highly effective for discriminating between controlled and uncontrolled asthma, with an area under the receiver operating characteristic (ROC) curve of 0.846 (95%CI: 0.748-0.92). Reliability assessed in patients with the same clinical classification resulted in an intra-class correlation coefficient of 0.86 (95%CI: 0.75-0.93). Improved clinical conditions corresponded to a significant increase in the ACT score (p < 0.005), indicating good responsiveness to changes in clinical status. The ACT proved to be reliable and could discriminate between levels of asthma control in pregnant women confirming its value as a useful tool for the management of asthma during pregnancy.

Risk of congenital malformations for asthmatic pregnant women using a long-acting β2-agonist and inhaled corticosteroid combination versus higher-dose inhaled corticosteroid monotherapy

Current recommendations for managing persistent asthma during pregnancy when low-dose inhaled corticosteroids (ICSs) are insufficient include adding a long-acting β₂-agonist (LABA) or increasing the ICS dose. However, there are no data to help clinicians evaluate the safest regimen during pregnancy. We sought to compare the risk of major congenital malformations in asthmatic women exposed to a LABA plus ICS combination and those exposed to ICS monotherapy at higher doses during the first trimester. A cohort of asthmatic pregnant women exposed to ICSs during the first trimester who delivered between January 1990 and March 2009 was established. The primary outcome was major malformation recorded at birth or during the first year of life. Two subcohorts were established as follows: (1) users of a LABA plus low-dose ICS combination or users of a medium-dose ICS and (2) users of a LABA plus medium-dose ICS combination or users of a high-dose ICS. Generalized estimating equations were used to compare the risk of major malformations between the groups. In one subcohort there were 643 women who used a LABA plus low-dose ICS and 305 who used a medium-dose ICS; the other subcohort included 198 users of a LABA plus medium-dose ICS and 156 users of a high-dose ICS. The prevalence of major malformations was 6.9% and 7.2%, respectively. The adjusted odds ratio for major malformations was 1.1 (95% CI, 0.6-1.9) when a LABA plus low-dose ICS was used compared with a medium-dose ICS and 1.2 (95% CI, 0.5-2.7) when a LABA plus medium-dose ICS was used compared with a high-dose ICS. The risk of major malformations was similar with a LABA plus ICS combination and ICS monotherapy at higher doses, suggesting that both therapeutic options can be considered during pregnancy.

Changes in Exhaled Breath Condensate pH in Healthy and Asthmatic Pregnant Women

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The effectiveness of non-pharmacological healthcare interventions for asthma management during pregnancy: a systematic review.

BackgroundWhile reviews have been published on asthma management in pregnant women, none has examined the effectiveness of non-pharmacological healthcare interventions for optimizing asthma management in pregnant women. This systematic review aims to identify non-pharmacological healthcare interventions for optimizing asthma management during pregnancy and to examine their effects on maternal asthma control and neonatal outcomes.MethodsThe Cochrane Central Register of Controlled Trials (CENTRAL, Cochrane Library), MEDLINE, EMBASE, PsycINFO, CINAHL Plus and International Pharmaceutical s (IPA) were searched. Two reviewers independently assessed the identified studies against the eligibility criteria and extracted relevant information. The effects of the intervention were assessed qualitatively.ResultsNine studies were identified, of which six were rejected according to the exclusion criteria. The three studies included in the final review described an education program, progressive muscle relaxation (PMR) and Fraction of exhaled Nitric Oxide (FeNO) guided management of asthma in pregnant women. The PMR and FeNO-guided interventions showed significant improvements in maternal asthma control (lung function and quality of life) and neonatal outcomes (birth weight).ConclusionsFurther evidence from well-designed studies evaluating non-pharmacological healthcare interventions for optimizing asthma management in pregnant women is required.

P76 Investigating women's experiences of asthma care in pregnacy: a qualitative study

Introduction and objectives Most asthmatic women have normal pregnancies and complications are infrequent when their asthma is controlled (BTS/SIGN 2012). Symptom control and medical treatment concern them, as does the impact of their illness and treatment on their unborn baby (Lim et al 2012). Few qualitative studies illustrate recently delivered asthmatic mothers’ feelings about their care, support and medication during their pregnancy. The aim of the study was to investigate in a qualitative study the thoughts and feelings of women’s experiences of asthma in pregnancy. Methods NHS IRAS ethical approval and trust research governance were obtained; women gave written informed consent subject to the usual ethical guarantees. Twenty-two women with asthma and a pregnancy within two years were invited to participate. Seven women were interviewed when data saturation was achieved. Data collection took place between March 2012 and September 2012. Interviews were transcribed and analysed using a phenomenological ‘Framework’ Method involving familiarisation; identifying a thematic framework; indexing; charting; mapping; interpretation. Data were independently analysed by two researchers and consensus reached concerning themes. Results Asthma and pregnancy Self-management including fears; lack of recognition of symptoms; poor knowledge of inhaled therapy Risk factors Anxieties including drugs, procedures, risks versus benefits General understanding of asthma Concealing symptoms Pregnancy and post-natal experiences Impact of exacerbations on baby; breastfeeding benefits; changes to asthma, post-natal experience Health professionals’ Lack of regular contact; midwife support; interaction with healthcare professionals, education Conclusions These findings are globally relevant because maternal asthma is so prevalent. They illustrate participants’ experiences of their asthma care and their views on its improvement. Similar to the international literature (Lim et al 2012), pregnant asthmatic women have concerns about their care and treatment, which might be alleviated by outreach, joint working between respiratory nurse specialists, midwives and GP practice nurses. References British Thoracic Society (2012). British Guideline on the Management of Asthma. Available on-line at http://www.brit-thoracic.org.uk/Portals/0/Guidelines/AsthmaGuidelines/sign101%20Jan%202012.pdf Lim AS, Stewart K, Abramson MJ, Ryan K, George J (2012) Asthma during Pregnancy: The Experiences, Concerns and Views of Pregnant Women with Asthma. J Asthma. 49(5):474–9.

Distribution features of biological hazardous pollutants in residential environments in Korea

This research has been conducted continuously since 2009 as part of a cohort of studies examining relationships between asthma and genetic factors, dietary habits, and environmental factors. Based on data from environmental research on house dust mites and endotoxins, which are widely known as pollutants in bedding that cause asthma in pregnant women and children, this work was conducted to obtain basic data that can be used in future cohort studies that analyze links between distribution of biological hazards and physical features of residential environments. The detection rates of house dust mite allergens, Der p1 and Der f1, were 52.7 and 86.5%, respectively, indicating that Der f1 is a dominant species in domestic indoor environments. According to comparisons between concentrations of house dust mites and endotoxins in bedding of pregnant women and children, Der p1 and endotoxins showed significantly lower concentrations in bedding of pregnant women compared with those in bedding of children, whereas Der f1 showed no significant difference in concentration according to bedding.

Relationship of Circulating Soluble Urokinase Plasminogen Activator Receptor (suPAR) Levels to Disease Control in Asthma and Asthmatic Pregnancy

Asthma has a high burden of morbidity if not controlled and may frequently complicate pregnancy, posing a risk for pregnancy outcomes. Elevated plasma level of the inflammatory biomarker soluble urokinase plasminogen activator receptor (suPAR) is related to a worse prognosis in many conditions such as infectious, autoimmune, or pregnancy-related diseases; however the value of suPAR in asthma and asthmatic pregnancy is unknown. The present study aimed to investigate the suPAR, CRP and IL-6 levels in asthma (asthmatic non-pregnant, ANP; N = 38; female N = 27) and asthmatic pregnancy (AP; N = 15), compared to healthy non-pregnant controls (HNP; N = 29; female N = 19) and to healthy pregnant women (HP; N = 58). The relationship between suPAR levels and asthma control was also evaluated. The diagnostic efficacy of suPAR in asthma control was analyzed using ROC analysis. IL-6 and CRP levels were comparable in all study groups. Circulating suPAR levels were lower in HP and AP than in HNP and ANP subjects, respectively (2.01 [1.81–2.38] and 2.39 [2.07–2.69] vs. 2.60 [1.82–3.49] and 2.84 [2.33–3.72] ng/mL, respectively, p = 0.0001). suPAR and airway resistance correlated in ANP (r = 0.47, p = 0.004). ROC analysis of suPAR values in ANP patients with PEF above and below 80% yielded an AUC of 0.75 (95% CI: 0.57–0.92, p = 0.023) and with ACT total score above and below 20 an AUC of 0.80 (95% CI: 0.64–0.95, p = 0.006). The cut-off value of suPAR to discriminate between controlled and not controlled AP and ANP was 4.04 ng/mL. In conclusion, suPAR may help the objective assessment of asthma control, since it correlates with airway resistance and has good sensitivity in the detection of impaired asthma control. Decrease in circulating suPAR levels detected both in healthy and asthmatic pregnant women presumably represents pregnancy induced immune tolerance.

Changes in exhaled breath condensate pH in healthy and asthmatic pregnant women

Asthma is a common chronic disease complicating pregnancy with a risk for perinatal complications. Control of airway inflammation in the asthmatic pregnancy improves pregnancy outcomes. Our aim was to evaluate pH of exhaled breath condensate (EBC), a non-invasive method for the assessment of asthmatic airway inflammation, in healthy and asthmatic pregnancies. Cross-sectional study. Hungarian university clinics. Seventeen healthy pregnant women, 21 asthmatic pregnant women, 23 healthy non-pregnant women and 22 asthmatic non-pregnant women. EBC samples were collected using a portable condenser, EBC pH was measured after argon deaeration. EBC pH. EBC pH (mean±SD) of healthy non-pregnant and asthmatic non-pregnant women was similar (7.75±0.27 vs. 7.54±0.57; p=0.118), probably indicating an optimal control of airway inflammation in asthmatic women. On the other hand, EBC pH was higher in healthy pregnant women compared with healthy non-pregnant women (8.02±0.43 vs. 7.75±0.27; p=0.017). Higher EBC pH accompanying healthy pregnancy was absent in asthmatic pregnant patients whose EBC pH was lower (7.65±0.38) than that of healthy pregnant women (p=0.006), and it was similar to that in asthmatic and healthy non-pregnant women (p=0.470 and p=0.300, respectively). The EBC pH in asthmatic pregnant women correlated positively with birthweight (r=0.49, p=0.047) and negatively with forced vital capacity (r=0.45, p=0.039). EBC pH was not related to blood pH. EBC pH is higher in healthy pregnant women but not in asthmatic pregnant women compared with data from healthy non-pregnant women, indicating that oxidative inflammatory processes induced by asthma may compromise the regulatory mechanisms causing alkaline pH in the airways during pregnancy.

The Long-Term Variability of FeNO in Pregnant Asthmatic Women with Controlled Asthma

Introduction: Fractional exhaled nitric oxide (FeNO) is considered a useful, noninvasive marker of airway inflammation in asthma and allergic rhinitis. It has also been suggested that anti-inflammatory treatment guided by monitoring of exhaled NO could improve overall asthma control. However, long-term intrasubject variability of this parameter as well as the rate of its change, which can be considered clinically significant, have not been established yet. The aim of our study was to assess the long-term variability of FeNO in pregnant asthmatic women with controlled asthma. Material and methods: Pregnant, non-smoking women with asthma were recruited at between 3 and 6 months of gestation. Exhaled nitric oxide (FeNO) spirometric parameters were measured, and asthma control tests (ACT) were completed at monthly visits up to delivery. The data of 26 subjects with well controlled asthma during pregnancy (ACT values within the range 20–25, normal spirometric parameters, stable treatment) were analysed. The variability of FeNO values was assessed using the variation coefficient CV (standard deviation × 100%/arithmetic mean). Results: The median level of FeNO coefficient of variation (CV) was: 33.8% (range 11.3 to 121.9) in all subjects with well controlled asthma during pregnancy. There were no statistically significant differences in FeNO variability between groups of patients who had at least one measurement of FeNO higher than 50 ppb (39%; 11.8–121.9%) and those with all FeNO values below 50 ppb (29.9%; 11.3–71.8%), as well as between atopic (35.7%; 11.8–121.9%) and nonatopic (24.2%; 11.3–71.8%) pregnant asthmatics (p = 0.95 and 0.11, respectively). Conclusions: High long-term variability of fractional exhaled nitric oxide values revealed in pregnant women with well controlled asthma indicates that changes in this parameter should be interpreted with caution when used for asthma treatment monitoring.

Mechanisims of asthma and allergic disease – 1089. The effect of the gender of the fetus on the control of asthma during pregnancy

Background Studies suggest that the presence of a female fetus worsen maternal asthma by up regulating maternal inflammatory pathways. Unlike the presence of a male fetus that produces a flow of testosterone during the second trimester which is considered a protective factor against asthma. The secretion of testosterone influences b-adrenergicmediated relaxation of bronchial tissues and obstructs response to histamine, resulting in better improvement in asthma symptoms. Methods 476 pregnant women with physician-diagnosed asthma were enrolled during the first trimester of pregnancy and were followed up with a series of controlled maternal interviews throughout the pregnancy. The interviews assessed the level of asthma control using a 5-point scale. All medical records including information on hospitalization and unscheduled clinic visits for asthma since the last menstrual period were collected. Results A higher proportion of women carrying a girl had poor asthma symptom control during the first part of pregnancy (24.1%) compared with asthmatic women carrying a boy (11.6%; p =0 .003). There was almost no difference noticed in the asthma symptom control during the second or third trimesters between women carrying a female fetus versus womwn carrying a male fetus. female-bearing pregnancy was associated with a significant increase in hospitalizations for asthma exacerbations (22.6%) compared with male-bearing pregnancy (8.8%; p =0 .01). Also the presence of a female fetus was associated with a higher incidence of unscheduled asthma visits during pregnancy (p=0.041). Conclusions In conclusion, this study illustrated that the presence of a female fetus might increase asthma exacerbations during pregnancy compared to that of a male fetus. This evidence was supported by the number of unscheduled visits and hospitalizations in comparison to that in the case of a male fetus. However, the biological mechanism which could possibly defend the influence of fetal gender on the control of maternal asthma remains unstipulated. In this study we also noted the importance of early assessment and careful monitoring of all asthmatic pregnant women beside the major role of health education and environmental control when dealing with an asthmatic patient.

Facilitators of and Barriers to Optimal Asthma Management during Pregnancy

Objectives To investigate the management of asthma in pregnant women from the perspectives of both pregnant women and prescribers, and to explore the reasons for their behaviours. Methods In-depth interviews with a purposive sample of women (n=25) at various stages of pregnancy and with varying severity of asthma were conducted in June-Sept 2011. A pre-piloted, anonymous questionnaire was sent to all general practitioners (GPs) (n=842) involved in shared maternity care at six maternity hospitals in Victoria, Australia. Results Pregnant women were found to decrease or discontinue their asthma medications, without consulting their doctors. Reasons behind their decisions included lack of support and information, concerns about the safety of medications, past experiences and a desire for an “all natural” pregnancy. Asthma monitoring and communication between pregnant women and health professionals regarding asthma management were poor. GPs were hesitant to continue asthma medications during pregnancy. In response to vignettes, a quarter (25.8%) of GP respondents would stop or decrease patients’ inhaled corticosteroid doses during pregnancy, even when asthma was well controlled by current therapy. In addition, 12.1% were not sure how to manage deteriorating asthma during pregnancy and opted to refer to a specialist. Conclusions Despite the evidence for rigorously managing pregnant women with asthma; management of asthma in pregnant women is still suboptimal. A lack of confidence and/or knowledge among GPs in managing deteriorating asthma in pregnancy was observed. Furthermore, pregnant women have not been well supported in managing their asthma during pregnancy, causing them concern. Interventions targeting pregnant women should be developed and evaluated, with a focus on the balance of risks and benefits of taking asthma medication during pregnancy versus the potential harm of uncontrolled asthma.

Relation of circulating T cell profiles to airway inflammation and asthma control in asthmatic pregnancy

Asthmatic inflammation during pregnancy poses a risk for maternal and fetal morbidities. Circulating T cell immune phenotype is known to correlate with airway inflammation (detectable by fractional concentration of nitric oxide present in exhaled breath (FENO)) in non-pregnant allergic asthmatics. The aim of this study was to assess the relationship of peripheral T cell phenotype to FENO and clinical variables of asthma during pregnancy.We examined 22 pregnant women with allergic asthma in the 2nd/3rd trimester. The prevalence of Th1, Th2, regulatory T (Treg) and natural killer (NK) cell subsets was identified with flow cytometry using cell-specific markers. FENO, Asthma Control Test (ACT) total score and lung function were evaluated.Peripheral blood Th1, Th2, Treg, and NK cell prevalence were not significantly correlated to airway inflammation assessed by FENO in asthmatic pregnant women (all cells p > 0.05; study power > 75%). However, an inverse correlation was detected between Th2 cell prevalence and ACT total scores (p = 0.03) in asthmatic pregnancy.Blunted relationship between T cell profile and airway inflammation may be the result of pregnancy induced immune tolerance in asthmatic pregnancy. On the other hand, increased Th2 response impairs disease control that supports direct relationship between symptoms and cellular mechanisms of asthma during pregnancy.

Asthma Management in Pregnancy: Young Female Doctors Knowledge and Practice

Abstract Background: Optimal asthma control in pregnant women is very much essential for the good health of both mother and the fetus. Maternal and fetal compli-cations occur due to poor control of asthma. There are concerns that management of bronchial asthma in pre-gnant women should be optimal by the health pro-fessionals. Objective: The aim of the study was to evaluate the knowledge and practices of young female doctors abo-ut the bronchial asthma management in pregnancy. Study Design: Randomized evidence based. Study Setting: Punjab Public Service Commission (PPSC) interviews for women medical officers and female doctors working in different medical units and chest unit of Mayo Hospital – a tertiary care hospital affiliated with King Edward Medical University, La-hore. Materials and Methods: A questionnaire based sur-vey of knowledge and practices of one hundred and one female doctors in the management of bronchial asthma was made. Amongst these, 32 doctors were FCPS – 1 in medicine and gynecology. Remaining 69 doctors were in the pipeline and they have completed one year house job in different specialties. The case scenario was “Asthma management approach during pregnancy in a stable patient of moderate severity”. Inclusion Criteria 1. All those female doctors who have completed one year house job. 2. Female doctors working in gynecology, medicine, surgery and allied specialties. Results: Overall 14 (13.6%) doctors {5 (35.7%) PGs and 9 (64.3%) Non PGs} have the standard prescrip-tion of inhaled corticosteroids with long acting inhaled B 2 agonists and montelukast as controller medication and short acting inhaled B 2 agonist as needed as reli-ever medication according to the standard guidelines. Conclusion: The majority of young female doctors had the suboptimal knowledge and practice of asthma management in pregnancy. We suggest initiating the training programs to optimize their knowledge and practices. Keywords: Bronchial Asthma, pregnant women, moderate, PGs (Postgraduate i.e. FCPS – 1) Non PGs (MBBS + one year house job) , nebulization ICS – in-haled corticosteroids , TDS – thrice daily, bd – twice daily , Tab – Tablet. Inj- injection, OD – once daily, antibiotics.

Management of asthma in pregnant women by general practitioners: A cross sectional survey

BackgroundPoorly controlled asthma can lead to maternal and fetal complications. Despite the known risks of poorly controlled asthma during pregnancy and the need for stepping up therapy when appropriate, there are concerns that management is suboptimal in primary care.Our objective was to investigate the management of asthma during pregnancy by general practitioners providing shared maternity care.MethodsA pre-piloted, anonymous mail survey was sent to all general practitioners (n = 842) involved in shared maternity care at six maternity hospitals in Victoria, Australia. Respondents were asked about their perceived safety of individual asthma medications during pregnancy. Approach to asthma management during pregnancy was further explored using scenarios of pregnant women with stable and deteriorating asthma and poor medication adherence.ResultsInhaled corticosteroids (ICS) were perceived to be the safest and were the preferred preventive medication in first trimester (74.1%), whilst leukotriene receptor antagonists were the least preferred (2.9%). A quarter (25.8%) of respondents would stop or decrease patients' ICS doses during pregnancy, even when their asthma was well controlled by current therapy. In addition, 12.1% of respondents were not sure how to manage deteriorating asthma during pregnancy and opted to refer to another health professional. Almost half the respondents (48.9%) reported encountering medication nonadherence during pregnancy.ConclusionA lack of confidence and/or knowledge among general practitioners in managing deteriorating asthma in pregnancy was observed despite a good understanding of the safety of asthma medications during pregnancy, compliance with evidence-based guidelines in the selection of preventive medications, and self reported good asthma knowledge.

Peripheral Th1/Th2/Th17/regulatory T-cell balance in asthmatic pregnancy

Asthma is a common chronic disease that may complicate pregnancy and a risk factor for complications; however, immunological mechanisms of the bilateral interactions between asthma and pregnancy are not fully understood. Healthy gestation is characterized by a sensitive balance of T(h)1/T(h)2/T(h)17/regulatory T (Treg) cells that may be altered in asthmatic pregnancy. The aim of this study was to describe the prevalence of these cell subsets in asthmatic compared with healthy pregnancy. The prevalence of T(h)1, T(h)2, T(h)17 and Treg lymphocytes was identified by cell surface and intracellular marker staining in blood samples of 24 healthy non-pregnant (HNP), 23 healthy pregnant (HP), 15 asthmatic non-pregnant (ANP) and 15 asthmatic pregnant (AP) women using flow cytometry. The T(h)1/T(h)2 cell ratio was decreased in both HP and ANP compared with HNP women; however, no further decrease was observed in the AP group. The T(h)17/Treg ratio was decreased in HP, but not in AP women, compared with HNP data. Healthy pregnancy increased Treg cell prevalence compared with HNP data (4.64% versus 2.98%; P < 0.05), and this pregnancy-induced elevation was absent in AP women (2.52% versus 4.64%; P < 0.05). T(h)17 cell prevalence was similar in the HP and HNP groups (2.78% versus 3.17%; P > 0.05). Asthma increased T(h)17 prevalence in non-pregnant patients (3.81% versus 3.17%; P < 0.05), and this asthma-specific increase of T(h)17 cell prevalence was also observed in AP patients (AP versus HP: 3.44% versus 2.78%; P < 0.05). The abnormal asthma-dependent T(h)17 elevation together with blunted Treg increase may play a role in the compromised immune tolerance characterizing asthmatic pregnancy.