Pregnancy Complicated with Asthma

　　The etiology of asthma in pregnant women is complex, generally dominated by genetic and environmental factors. The specific introduction is as follows:

　　1. It is currently believed that asthma is a polygenic genetic disease with a heritability of 70% to 80%. At present, the related genes of asthma have not been fully identified. Some studies have shown that there may be asthma-specific genes, IgE regulatory genes, and specific immune response genes.

　　2. Environmental factors include specific allergens or food, infection that directly damages the respiratory tract epithelium, causing increased respiratory tract reactivity. Certain drugs, air pollution, dust sports, cold air stimulation, mental stimulation, and social, family psychological factors can all trigger asthma.

　　Asthma in pregnant women can complicate with pneumothorax, mediastinal emphysema, acute pulmonary heart disease, and even respiratory failure and death. Factors such as airway obstruction, infection, hypoxia, hypercapnia, acidosis, and increased blood viscosity, as well as worsening bronchospasm, can promote the formation of mucus plugs in the airways. Since mucus plugs block the small bronchi, and due to the thickening of the bronchial wall and the congestion and edema of the mucosa forming folds, atelectasis can occur.

　　The severity of asthma in pregnant women varies. At the beginning of the attack, it may only be simple cough, which is often misdiagnosed. During a marked attack, there may be difficulty breathing, cough, and wheezing. Due to acute bronchospasm leading to airway obstruction, the patient often has a tight chest, wheezing, and may experience severe hypoxia.

　　Reasonable prevention is the key to reducing the occurrence of the disease. Next, let me introduce the common preventive measures for pregnant women with asthma:

　　1. It is very important to closely monitor the changes in the condition and detect them in a timely manner. Once the patient shows symptoms such as cough, upper respiratory tract infection, chest pain, or pulmonary congestion, preventive treatment should be given to prevent asthma attacks.

　　2. Avoid contact with known allergens and factors that may promote asthma attacks, such as dust, spices, cigarette smoke, cold air, etc. Aspirin, food preservatives, and hydrogen sulfite can trigger asthma and should be avoided. Gastroesophageal reflux can induce bronchospasm, so appropriate antacid drugs should be given before bedtime to alleviate gastric acid reflux. At the same time, raise the head of the bed, avoid fatigue and mental stress, and prevent respiratory tract infections.

　　Immunotherapy can be carried out after 3 months of pregnancy, and the use of influenza vaccine for the treatment of chronic asthma has a good therapeutic effect.

　　The examination of pregnant women with asthma usually includes the following two points:

　　1. Pulmonary function test

　　Measure the peak expiratory flow rate (PEFR) at dawn, dusk, and before bedtime every day. If the change range of the three measurements is greater than 20%, or if the PEFR value increases by 15% to 20% after inhaling antispasmodic drugs, it indicates bronchial asthma.

　　2. X-ray examination

　　During an acute asthma attack, the lungs become more transparent due to overinflation, and common lung markings increase.

　　There are no special dietary requirements for pregnant women with asthma, and normal diet is generally sufficient. Attention should be paid to a rich diet and balanced nutrition. Ensure the needs of calories, proteins, and vitamins required for normal human metabolism. Appropriately increase the intake of vegetables and fruits. In terms of health care, it is important to relax the mind, build confidence, maintain a good attitude, and actively cooperate with the doctor's treatment.

　　After considering the situation of pregnancy, asthma should be treated actively. The treatment of asthma attacks includes the use of bronchodilator drugs and symptomatic treatment, which is introduced as follows:

　　1. β2-adrenergic receptor agonists: They have a strong bronchodilatory effect and are the first-line drugs for controlling asthma. This class of drugs combines with β receptors to promote the synthesis of cAMP, causing bronchial smooth muscle relaxation, and can stabilize the mast cell membrane to reduce the release of cell mediators.

　　2. Treatment of Severe Asthma and Persistent State: Due to severe hypoxia, it can cause premature birth and intrauterine fetal death, which must be treated urgently.

　　3. Symptomatic Treatment: Pregnant women with bronchial asthma often show symptoms of nervousness and restlessness, and appropriate drugs that inhibit the function of the cerebral cortex, such as phenobarbital (Rumina), diazepam, etc., can be administered. However, it should be avoided to use sedatives and anesthetics that inhibit respiration, such as morphine, pethidine (Duret), etc., to prevent aggravating respiratory failure and having adverse effects on the fetus. Intravenous fluid replacement should be considered when necessary, and attention should be paid to correcting electrolyte imbalances and acidosis. To prevent or control respiratory tract infections, sputum culture and drug sensitivity test can be performed, and broad-spectrum antibiotics that are effective and have no adverse effects on the fetus can be selected.