Asthma is one of the most common chronic diseases in pregnancy and can complicate 4 to 8% of pregnancies. Patient education on proper inhaler technique, recognition of triggering factors, and an action plan for asthma exacerbations is an integral part of the therapeutic approach. Schedule an examination!
Asthma is one of the most common chronic diseases in pregnancy and can complicate 4 to 8% of pregnancies. Therefore, a large number of women face challenges in controlling asthma during a period when their body and immune system undergo significant changes. Worsening of asthma symptoms during pregnancy is also a major clinical issue, as it can simultaneously endanger both the mother and the child. Rapid and adequate diagnosis, effective treatment, and regular check-ups are of key importance for the health and quality of life of both the future mother and the child.
Many physiological changes that occur during pregnancy can affect the clinical course and symptoms of asthma exacerbations. Asthma can also be newly diagnosed during pregnancy.
Metabolic needs during pregnancy increase by around 15%, which results in increased oxygen consumption as the main fuel for tissues and organs, requiring adaptation of lung function and respiratory centre function to meet these demands.
One of the first symptoms caused by increased estrogen secretion is swelling of the nasal and sinus mucosa, i.e. the appearance of so-called rhinosinusitis, which occurs in about 20% of pregnant women and independently of an asthma diagnosis.
Data show that approximately one third of women experience worsening asthma symptoms during pregnancy, another third may even experience improvement or disappearance of previous symptoms, while in one third asthma remains at the same level as before pregnancy.
Exacerbation symptoms are most often related to the last trimester of pregnancy, while they rarely occur during labour itself.
Symptoms vary in intensity, usually occurring at night and in the early morning hours, and are often triggered by viral infections, allergic rhinitis, changes in weather conditions, physical exertion, heartburn, and similar factors.
A detailed medical history, including potential “triggers,” along with a physical examination, is the first step in confirming the diagnosis. Lung function tests such as spirometry and bronchodilator testing can be safely performed during pregnancy, while bronchoprovocation tests are not recommended. Allergy testing such as skin prick tests should be avoided during pregnancy.
Additional diagnostics in this regard can be performed using blood tests.
The goals of treatment are: prevention of day and night symptoms such as cough, shortness of breath and wheezing; maintenance of optimal lung function and oxygenation; and prevention of exacerbations through appropriate therapy with minimal adverse and systemic effects.
In this regard, according to current guidelines, active monitoring of patients throughout the entire pregnancy is recommended, with check-ups every 4 weeks through a multidisciplinary approach.
Diagnosis and treatment of associated conditions such as allergic rhinitis and gastroesophageal reflux are extremely important, as these conditions are among the most common triggers of worsening or poor asthma control.
Thanks to modern inhalation therapy, only a very small percentage of pregnant women require hospital treatment and monitoring. On the other hand, poorly controlled asthma carries a risk of premature birth and congenital complications. Continuous monitoring and regular use of therapy reduce the risk of potential complications.
Inhaled corticosteroids form the basis of long-term control therapy and are considered safe for use during pregnancy. Patient education on proper inhaler technique, recognition of triggering factors, and an action plan for asthma exacerbations is an integral part of the therapeutic approach.
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Prim. dr sc. med. Senka Milutinov Ilić – Specijalista pulmologije | Regena Polyclinic