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Asthma in pregnancy: Physiology, management and recommendations for midwives

02 July 2018
Clinical Practice
02 July 2018
Volume 26 · Issue 7

Abstract

Asthma in pregnancy is a common respiratory co-morbidity, but if this serious condition is not addressed appropriately, acute exacerbations may contribute to maternal mortality and morbidity. Indeed, any acute episode of asthma can quickly become life-threatening, and midwives should be aware of the need for urgent referral. The importance of effectively managing asthma in pregnancy includes the immediate detection of a worsening condition, along with immediate referral to a physician in order to minimise the complications associated with acute exacerbations. In order to minimise poor outcomes for women, midwives should be aware of evidence-based practice guidelines for managing asthma and to avoid complacency, midwives must be aware of the most recent report, Why Asthma Still Kills. Furthermore, as part of their scope of practice, midwives should ensure that all women have access to personalised asthma action plans, and should work across the multidisciplinary team to promote smoking cessation, infection control and vaccination against influenza. Importantly, midwives should assess compliance with women's prescribed short- and long-acting asthma medication.

Midwives will be aware that pregnant women are reflective of the society in which they live. This incudes the prevalence of medical conditions; therefore, it is useful to set the context for asthma as a respiratory condition.

Asthma has been defined as:

‘A heterogeneous disease usually characterised by chronic airway inflammation. It is defined by the history of respiratory symptoms such as, wheeze, shortness of breath, chest tightness and cough that vary over time and in intensity, together with variable expiratory airflow limitation.’

Moderate/severe disease is associated with poor outcomes and is defined as:

‘Patients who have no clinical improvement with initial standard therapy and those whose presenting peak expiratory flow is less than 25%–30% of predicted’

The hypothesis regarding the aetiology of asthma is associated with an immature neonatal immune system, which prompts an exaggerated response to an allergen (Borish, 2016).

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Asthma
Pregnancy
PAAP
Emergency care
National guidelines