Asthma

Question 1

What is asthma?

Answer 1

• it is a chronic inflammatory disease of the airways, which is characterised by intermittent episodes of wheeze, shortness of breath, chest tightness and cough
• it is a variable disease in which in response to certain stimuli or triggers, inflammation and structural changes occur in the lungs
  —> this causes airway hyper-responsiveness and variable airflow obstruction leading to the symptoms described above

Question 2

What are some of the triggers for asthma?

Answer 2

• smoking
• allergens (e.g. house dust mite, pollen etc)
• exercise
• occupational exposure
• pollution
• drugs e.g. aspirin
• hormonal
• food and drinks

Question 3

What are the aims of asthma management?

Answer 3

• control of symptoms
• prevention of exacerbation
• achievement of the best pulmonary function for the patient with minimal side effects

Question 4

What are some of the issues in pregnancy?

Answer 4

• poorly controlled asthma confers an increased risk to the mother and fetus
• asthmatic women are more at risk of low birthweight neonates, pre term delivery and complications such as pre-eclampsia

Question 5

How should asthma be medically managed in pregnancy?

Answer 5

• it is important to optimise the control of the woman’s asthma, as this will reduce the potential of asthma-related morbidity during pregnancy - this includes issues relating to tiggers and adherence to medication
• inhaled corticosteroids alone or in combination with long-acting bronchodilators are safe in pregnancy

Question 6

What is the role of the midwife in pregnancy when managing asthma?

Answer 6

• educate women that well-controlled asthma is better for baby and pregnancy outcomes
• explain that asthma medication is generally safe in pregnancy
• education about good control and adherence to medication is an essential part of antenatal care
• give appropriate smoking cessation advice
• encourage attendance at parent-craft and relaxation classes

Question 7

What are some of the issues in labour?

Answer 7

• women who have been on regular oral steroids may require hydrocortisone during labour
• exacerbations of asthma in labour are rare
• ergometrine and syntometrine and prostaglandin ma cause bronchoconstriction and should be used with caution

Question 8

What is the midwives role in labour?

Answer 8

• advise women that acute asthma is rare in labour
• women should continue with their usual asthma medications in labour
• a mother who has well-controlled asthma should be able to have low risk care with labour managed normally by a midwife
• syntocinon is preferable for 3rd stage