Respiratory diseases in pregnancy bullet 1: Asthma in pregnancy

Nelson‐Piercy, Catherine

doi:10.1136/thorax.56.4.325

Cited by 64 publications

(48 citation statements)

References 33 publications

(43 reference statements)

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“…As the average height of each group was only available, we could be out of range for 1 or several subject(s). Furthermore, these equations do not apply for pregnant women who have a reduced FRC compared with nonpregnant women (Garcia-Rio et al 1996;Nelson-Piercy 2001), and as the size of the lungs varies with ethnic group (Yang et al 1991;Cotes 1993), they are only available for Caucasians. Consequently, individual FRC values are useful information and we recommend that they should be made available when reporting results from human subject experiments.…”

Section: Discussionmentioning

confidence: 99%

Categorization of Lung Morphology Based on FRC and Height: Computer Simulations of Aerosol Deposition

Pichelin

Caillibotte

Katz

et al. 2012

Aerosol Science and Technology

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The aim of this study was to compare the human subject experimental measurements of particle deposition within the lungs using the aerosol bolus technique with the results of analytical modeling as a basis for assessing the influence of lung morphology on inhaled particle deposition patterns. A methodology for scaling the lung morphology, based on a classic symmetric dichotomous model, as a function of both functional residual capacity and height of the investigated population is presented. Because of the availability of deposition data for male and female lung morphologies, these were used as an example to address the importance of adjusting lung morphology in calculating the aerosol deposition rates. In order to represent the 2 groups based on gender enrolled in the experimental study, 2 lung morphologies have been built. An analytical and mechanistic model was used to mimic the bolus delivery technique and simulate the aerosol deposition in each of the 2 groups. Predicted results were compared with experimental data for both total deposition fraction and bolus recovery (fraction of exhaled particles compared with inhaled particles) for 3 flow rates and 3 particle sizes. Good agreement was found between theoretical and measured data, showing the primary importance of the differentiation of the lung morphology to predict the aerosol deposition within human lungs. This study presents a morphological lung model that is adaptable to specific populations (e.g., gender or race), groups (e.g., a clinical study population), or even individuals.

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Section: Discussionmentioning

confidence: 99%

Categorization of Lung Morphology Based on FRC and Height: Computer Simulations of Aerosol Deposition

Pichelin

Caillibotte

Katz

et al. 2012

Aerosol Science and Technology

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“…Despite reports indicating the safety of corticosteroid use for asthma treatment during pregnancy, both pregnant subjects [101,140,141] and physicians [23,113,[140][141][142][143] remain apprehensive about using these medications. A recent survey of 501 asthmatic females of child-bearing age reported that 82% of subjects who used ICS were concerned about their effects on the foetus [144].…”

Section: The Treatment and Management Of Asthma During Pregnancymentioning

confidence: 99%

“…The pregnancy-associated rise in serum-free cortisol may contribute to improvements in asthma during pregnancy [8,113], since cortisol has anti-inflammatory properties. In addition, oestradiol and progesterone concentrations increase significantly during pregnancy [75].…”

Section: Exacerbations Of Asthma During Pregnancymentioning

confidence: 99%

Asthma during pregnancy: mechanisms and treatment implications

Murphy

Gibson²,

Smith³

et al. 2005

European Respiratory Journal

156

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Asthma is becoming increasingly prevalent worldwide. Numerous historical and prospective cohort studies have investigated the effects of maternal asthma on pregnancy outcome; however, the data has been conflicting and many studies have not used standard classifications for asthma severity. Overall, the literature suggests that asthmatic females are more at risk of low birth weight neonates, pre-term delivery and complications such as preeclampsia, especially in the absence of actively managed asthma treated with inhaled corticosteroids. Pregnancy with a female foetus may particularly increase the risk of these outcomes.In addition, pregnancy has an effect on the course of asthma. The risk of an exacerbation requiring medical intervention may be as high as 50% in females with severe asthma and this may further increase the risk of poor outcomes, particularly low birth weight and pre-term delivery.The mechanisms responsible for changes in asthma with pregnancy, or alterations in pregnancy outcomes due to asthma have not been thoroughly explored. Maternal inflammatory pathways may contribute to reduced foetal growth through alterations in placental function.Asthma treatment, by reducing maternal inflammation and preventing exacerbations, is safe for use in pregnant females and contributes to improved outcomes for both mother and foetus.

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“…This risk may be reduced by breastfeeding. All inhaled preparations, oral steroids and methylxanthines are safe when breastfeeding [30].…”

Section: Breastfeeding and Asthmamentioning

confidence: 99%

Asthma and pregnancy: interactions and management

Gaga

Οικονομίδου

Ζervas

et al. 2007

Breathe

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Key pointsAsthma is one of the most common diseases complicating pregnancy.Pregnancy influences the control of asthma; its effect may be beneficial or detrimental.Asthma during pregnancy should be treated according to its severity in a step-wise manner and as aggressively as asthma in nonpregnant patients.It is safer for pregnant women with asthma to be treated with asthma medications than to have asthma symptoms and exacerbations.Uncontrolled and severe asthma is associated with adverse pregnancy outcomes for both mother and foetus.Frequent monitoring, severity-based pharmacotherapy, and prevention and prompt treatment of exacerbations are very important for the safe delivery of a healthy baby.Breastfeeding is strongly recommended for asthmatic females; it is associated with a reduction in the development of atopy in children, and the use of asthma medications is safe during breastfeeding.Integrated care (obstetrics and pulmonary), patient education, compliance with treatment and avoidance of triggering factors are key issues in the management of a pregnant asthmatic patient.Educational aimsTo describe interactions between asthma and pregnancy.To present management guidelines and discuss the use of specific asthma medications during pregnancy.SummaryAsthma is one of the most common diseases complicating pregnancy. It can lead to significant morbidity for both mother and foetus. Pregnancy may also affect asthma control and severity. Therefore, pregnant asthmatic patients should receive integrated obstetric and respiratory care.The focus of asthma treatment remains the control of symptoms and maintenance of normal lung function of the mother. However, during pregnancy, the safe delivery of a healthy baby is an additional goal. It is safer for pregnant women with asthma to be treated with asthma medications than for them to have asthma symptoms and exacerbations.Asthma treatment during pregnancy follows the same step-wise approach as normal, and studies have shown that first-line asthma medications (such as inhaled glucocorticosteroids and ß2-agonists) are not associated with an increased incidence of foetal abnormalities. Moreover, inhaled glucocorticosteroids have been shown to prevent exacerbations of asthma in pregnancy and should be used in persistent asthma to control the disease and prevent exacerbations. If acute exacerbations develop, they should be treated promptly and aggressively in order to avoid foetal hypoxia.Good pregnancy and asthma outcomes are achieved through integrated obstetric and respiratory care, close monitoring, meticulous tailoring of pharmacotherapy, patient education and reassurance. This review describes interactions between asthma and pregnancy and briefly presents treatment guidelines.

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Respiratory diseases in pregnancy bullet 1: Asthma in pregnancy

Cited by 64 publications

References 33 publications

Categorization of Lung Morphology Based on FRC and Height: Computer Simulations of Aerosol Deposition

Categorization of Lung Morphology Based on FRC and Height: Computer Simulations of Aerosol Deposition

Asthma during pregnancy: mechanisms and treatment implications

Asthma and pregnancy: interactions and management

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