什么是足够安全的——妊娠期哮喘——当前文献综述与建议

What is safe enough - asthma in pregnancy - a review of current literature and recommendations.

作者信息

Labor Slavica, Dalbello Tir Alba Maria, Plavec Davor, Juric Iva, Roglic Mihovil, Pavkov Vukelic Justinija, Labor Marina

机构信息

1Faculty of Medicine, J.J. Strossmayer University of Osijek, Osijek, Croatia.

2Department of Pulmonology, University Hospital Centre Osijek, Osijek, Croatia.

出版信息

Asthma Res Pract. 2018 Dec 27;4:11. doi: 10.1186/s40733-018-0046-5. eCollection 2018.

Abstract

BACKGROUND

Although asthma is one of the most serious diseases causing complications during pregnancy, half of the women discontinue therapy thus diminishing the control of the disease, mostly due to the inadequate education and fear of adverse events. Sadly, this is sometimes encouraged by insufficiently educated physicians. Since the incidence and the prevalence of asthma is increasing, it is important to arouse the importance of proper asthma therapy during pregnancy. Inadequate therapy, as well as interrupting or discontinuing therapy, may result in adverse perinatal outcomes for both mother and child.

MAIN BODY

The main goal of asthma control during pregnancy is control of symptoms and prevention of exacerbations, same as in every asthmatic, but even more important. Maintaining optimal lung function, as well as regular daily activities, ensures maintenance of optimal fetal oxygenation. The therapy should be adapted depending on the frequency and severity of daily and nocturnal symptoms, demand for reliever therapy, by the limitations in everyday activities and the frequency of emergency asthma-related hospitalizations. Pre-conceptual education and therapy are very important and should be supported by an asthma action plan adjusted for the period of pregnancy. It is very important to note that most of the drugs used before pregnancy can be safely continued during pregnancy. Pharmacological and non-pharmacological therapy should be used in parallel. Pregnant women should be informed about the nature of the disease, therapy used during pregnancy, possible complications, avoidance of triggers, proper administration of therapy and, most important, why should the therapy be continued throughout the pregnancy on individual basis. Although drug treatment should be based on using drugs with less harm risk, if control of severe symptoms is needed to be achieved in order to protect both mother and child, any anti-asthmatic drug would have the beneficial benefit/harm ratio.

CONCLUSION

There is no solid evidence that asthma treatment during pregnancy causes adverse outcomes for the mother and child but for many, especially new drugs, there is not enough data gathered. On the other hand, harmfulness of uncontrolled asthma during pregnancy is well documented so every effort should be put on preserving good control of asthma during pregnancy.

摘要

背景

尽管哮喘是孕期引发并发症的最严重疾病之一,但仍有半数女性中断治疗,从而削弱了对该疾病的控制,这主要是由于教育不足和对不良事件的恐惧。遗憾的是,有时教育程度不足的医生也会助长这种情况。由于哮喘的发病率和患病率在不断上升,因此唤起孕期适当哮喘治疗的重要性很重要。治疗不足以及中断或停止治疗可能会对母婴产生不良围产期结局。

正文

孕期哮喘控制的主要目标是控制症状并预防病情加重,这与所有哮喘患者相同,但更为重要。维持最佳肺功能以及日常规律活动可确保维持最佳胎儿氧合。治疗应根据每日和夜间症状的频率和严重程度、缓解药物治疗的需求、日常活动的限制以及与哮喘相关的急诊住院频率进行调整。孕前教育和治疗非常重要,应由针对孕期调整的哮喘行动计划提供支持。需要注意的是,孕期前使用的大多数药物在孕期可安全继续使用。应同时使用药物治疗和非药物治疗。应告知孕妇疾病的性质、孕期使用的治疗方法、可能的并发症、避免触发因素、正确的治疗给药方法,最重要的是,为何应在孕期根据个人情况持续治疗。尽管药物治疗应基于使用危害风险较小的药物,但如果需要控制严重症状以保护母婴,任何抗哮喘药物都将具有有益的利弊比。

结论

没有确凿证据表明孕期哮喘治疗会对母婴产生不良结局,但对于许多药物,尤其是新药,收集的数据不足。另一方面,孕期未控制的哮喘的危害性已有充分记录,因此应尽一切努力在孕期保持对哮喘的良好控制。

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