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Family Medicine

Answer 5
  1. Administer both inhaled and oral systemic corticosteroids. Maternal asthma has been shown to increase the risk of perinatal mortality, preeclampsia, preterm birth, and low birth weight.2 The risk of asthma exacerbations associated with pregnancy can be reduced and lung function can be improved with the use of inhaled corticosteroid therapy. No studies to date, including studies of large birth registries, have related inhaled corticosteroid use to an increased risk of congenital malformations or other adverse perinatal outcomes. Patients with mild to moderate asthma exacerbations can be managed as outpatients if their peak expiratory flow is 70% or greater, their response is sustained at least 1 hour after the last treatment, they have a normal physical examination, are in no distress, and have reassuring fetal status.2 If peak flow is less than 50%, as seen in the case patient, the exacerbation is classified as severe. The patient should be treated initially with a nebulized ß2-agonist and ipratropium every 20 minutes for the first hour and be given oxygen to maintain the Sao2 above 95% as well as oral systemic corticosteroids.2 Albuterol, not terbutaline, is the preferred ß2-agonist in pregnancy.2

    2. National Asthma Education and Prevention Program. Working Group Report on managing asthma during pregnancy: recommendations for pharmacologic treatment—update 2004. NIH Publication No. 05-5236. Bethesda (MD): U.S. Department of Health and Human Services; National Institutes of Health; National Heart, Lung, and Blood Institute; 2005. Available at www.nhlbi.nih.gov/health/prof/lung/asthma/astpreg/astpreg_full.pdf. Accessed 22 Jul 2008.

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