Overview

• Chronic inflammatory airway disease characterised by variable reversible airway obstruction, hypersensitive airway and bronchial inflammation.
• Most common chronic disease in pregnancy. Most occur between 24-36 weeks.

Making Diagnosis

Clinical Features

• Wheeze + Breathlessness + Cough → worse in morning and at night.
• History of atopy.
• Tachypnoea, prolonged expiratory phase, polyphonic wheeze, hyperinflated chest.

Investigations

• PEFR Monitoring → diary.

Management Plan

• Continue regular medications throughout pregnancy.
  • Avoid Bronchoconstrictors (eg. Ergometrine) intrapartum (during labour).
• Encourage smoking cessation and manage exacerbations aggressively.
• Flu vaccine and monitor foetal movements daily after 28 weeks.
• Acute Management → high flow oxygen, salbutamol nebuliser, ipratropium, steroids (hydrocortisone or prednisolone), IV magnesium sulphate.