Powrie Raymond O, Larson Lucia, Miller Margaret
Brown Medical School, Providence, Rhode Island, USA.
Treat Respir Med. 2006;5(1):1-10. doi: 10.2165/00151829-200605010-00001.
Pregnancy does not appear to have a consistent effect on the frequency or severity of asthma. The most common cause of worsening asthma in pregnancy is likely to be noncompliance with medication. Emphasizing to the patient in advance that fetal well-being is dependent on maternal well-being may help prevent this.In general, well controlled asthma is not associated with a higher risk of adverse pregnancy outcomes. Essential to successful asthma management is patient education that helps to ensure effective medication use, avoidance of triggers, and prompt treatment. This education should include measurement of peak expiratory flow rate and a written asthma action plan. Most of the medications that are used to control asthma in the general population can be safely used in pregnant women. Inhaled beta-adrenoceptor agonists (beta-agonists), cromolyn sodium (sodium cromoglycate), and inhaled and systemic corticosteroids all appear to be very well tolerated by the fetus. Budesonide and beclomethasone should be considered as the preferred inhaled corticosteroids for the treatment of asthma in pregnancy. Use of the leukotriene receptor antagonists zafirlukast and montelukast in pregnancy is probably safe but should be limited to special circumstances, where they are viewed essential for asthma control. Zileuton should not be used in pregnancy.Acute asthma exacerbations in pregnant women should be treated in a similar manner to that in non-pregnant patients. Maternal blood glucose levels should be monitored periodically in pregnant women receiving systemic corticosteroids because of the deleterious effects of hyperglycemia upon embryos and fetuses. During pregnancy, maternal arterial oxygen saturations should be kept above 95% if possible for fetal well-being. Ambulatory oxygenation should be checked prior to discharge to ensure that women do not desaturate with their daily activities.Acute exacerbations of asthma during labor and delivery are rare. Dinoprost, ergometrine, and other ergot derivatives can cause severe bronchospasm, especially when used in combination with general anesthesia, and should be avoided in asthmatic patients. Pregnant women who have been treated with corticosteroids in the past year may require stress-dose corticosteroids during labor and delivery. Most asthma medications, including oral prednisone, are considered compatible with breast-feeding.
妊娠似乎对哮喘的发作频率或严重程度没有一致的影响。孕期哮喘恶化的最常见原因可能是不遵医嘱用药。提前向患者强调胎儿的健康依赖于母亲的健康可能有助于预防这种情况。一般来说，哮喘得到良好控制与不良妊娠结局的风险增加无关。成功管理哮喘的关键是对患者进行教育，以确保有效用药、避免触发因素并及时治疗。这种教育应包括测量呼气峰值流速和制定书面哮喘行动计划。大多数用于普通人群控制哮喘的药物在孕妇中可以安全使用。吸入性β-肾上腺素能激动剂（β-激动剂）、色甘酸钠、吸入性和全身性皮质类固醇似乎都能被胎儿很好地耐受。布地奈德和倍氯米松应被视为孕期治疗哮喘的首选吸入性皮质类固醇。孕期使用白三烯受体拮抗剂扎鲁司特和孟鲁司特可能是安全的，但应限于特殊情况，即认为它们对控制哮喘至关重要的情况。齐留通不应在孕期使用。孕妇急性哮喘发作的治疗方式应与非孕妇相似。由于高血糖对胚胎和胎儿有有害影响，接受全身性皮质类固醇治疗的孕妇应定期监测母体血糖水平。孕期应尽可能将母体动脉血氧饱和度保持在95%以上以保障胎儿健康。出院前应检查动态氧合情况，以确保女性在日常活动中不会出现血氧饱和度下降。分娩期间哮喘急性发作很少见。地诺前列素、麦角新碱和其他麦角衍生物可引起严重支气管痉挛，尤其是与全身麻醉联合使用时，哮喘患者应避免使用。过去一年接受过皮质类固醇治疗的孕妇在分娩时可能需要应激剂量的皮质类固醇。大多数哮喘药物，包括口服泼尼松，被认为与母乳喂养兼容。
