Pregnancy

Asthma ◽  
2014 ◽  
pp. 367-376
Author(s):  
Jennifer A. Namazy ◽  
Michael Schatz ◽  
Sandra Gonzalez-Diaz
Keyword(s):  
Inhaled Corticosteroids ◽  
Medical Condition ◽  
Action Plan ◽  
Safety Information ◽  
Asthma Management ◽  
Perinatal Outcomes ◽  
Chronic Medical Condition ◽  
Monthly Basis ◽  
Maternal Quality Of Life ◽  
Therapy Education

Asthma is the most common chronic medical condition to affect pregnancy. Asthma may adversely affect maternal quality of life and perinatal outcomes, as well as the course of asthma. Management of asthma during pregnancy should optimize the health of both the mother and her baby. Adherence to treatment, specifically inhaled corticosteroids, has been a problem for many pregnant asthmatic women and is usually due to concerns regarding the safety of these medications during pregnancy. Symptoms and pulmonary function need to be monitored on a monthly basis in pregnant asthmatic women so that any change in course can be matched with an appropriate change in therapy. Education is an important part of managing the pregnant asthmatic patient and includes explaining the relationship between asthma and pregnancy, identifying asthma triggers, providing training on correct use of inhalers, and establishing an asthma action plan. One of the most important needs for the future is the availability of further safety information for asthma medications used during pregnancy that can also account for asthma control.

scholarly journals Managing asthma in pregnancy

Breathe ◽  
2015 ◽  
Vol 11 (4) ◽  
pp. 258-267 ◽  
Author(s):  
Vanessa E. Murphy
Keyword(s):  
Pregnant Women ◽  
Inhaled Corticosteroids ◽  
Action Plan ◽  
Asthma Management ◽  
Perinatal Outcomes ◽  
List Type ◽  
Night Time ◽  
Exacerbation Rate ◽  
Common Chronic Disease ◽  
In Pregnancy

Asthma is a common comorbidity during pregnancy and its prevalence is increasing in the community. Exacerbations are a major clinical problem during pregnancy with up to 45% of women needing to seek medical help, resulting in poor outcomes for mothers and their babies, including low birth weight and preterm delivery. The goals of effective asthma management in pregnancy are to maintain the best possible asthma control and prevent exacerbations. This is achieved by aiming to prevent day- and night-time symptoms, and maintain lung function and normal activity. In addition, maintaining fetal oxygenation is an important consideration in pregnancy. Guidelines recommend providing asthma advice and review prior to conception, and managing asthma actively during pregnancy, with regular 4-weekly review, provision of a written action plan, use of preventer medications as indicated for other adults with asthma, and management of comorbid conditions such as rhinitis.Improvements have been made in recent years in emergency department management of asthma in pregnancy, and multidisciplinary approaches are being proposed to optimise both asthma outcomes and perinatal outcomes. One strategy that has demonstrated success in reducing exacerbations in pregnancy is treatment adjustment using a marker of eosinophilic lung inflammation, the exhaled nitric oxide fraction (FeNO). The use of an algorithm that adjusted inhaled corticosteroids (ICS) according toFeNOand added long-acting β-agonists when symptoms remained uncontrolled resulted in fewer exacerbations, more women on ICS but at lower mean doses, and improved infant respiratory health at 12 months of age. Further evidence is needed to determine whether this strategy can also improve perinatal outcomes and be successfully translated into clinical practice.Key pointsAsthma is the most common chronic disease to affect pregnant women.Exacerbations occur in up to 45% of pregnant women with asthma.Asthma should be managed during pregnancy as for other adults.Treatment adjustment using a marker of airway inflammation reduces the exacerbation rate in pregnancy.Educational aimsTo identify the goals of and steps associated with effective asthma management in pregnancy.To understand the maternal and perinatal risks associated with asthma during pregnancy.To describe a management strategy that has been shown to reduce exacerbations in pregnant women with asthma.

scholarly journals Asthma knowledge, care, and outcome during pregnancy: The QAKCOP study

2018 ◽  
Vol 16 ◽  
pp. 147997231876771 ◽  
Author(s):  
Wanis H Ibrahim ◽  
Fatima Rasul ◽  
Mushtaq Ahmad ◽  
Abeer S Bajwa ◽  
Laith I Alamlih ◽  
...  
Keyword(s):  
Health Care ◽  
Asthma Control ◽  
Inhaled Corticosteroids ◽  
Medical Condition ◽  
Action Plan ◽  
Well Being ◽  
Chronic Medical Condition ◽  
Uncontrolled Asthma ◽  
Asthma Care ◽  
In Pregnancy

Asthma is the most common chronic medical condition affecting pregnancy. Optimizing asthma management in pregnancy is paramount for the well-being of both the mother and the baby. The primary objectives of this study were to assess patient’s knowledge about asthma, the level of asthma care, and fetal and maternal outcomes among pregnant asthmatic women in this wealthy country with tremendous improvement in maternal and fetal health care. The secondary objective was to identify barriers to asthma control. This was a cross-sectional, face-to-face, prospective study of 80 pregnant women with physician-diagnosed asthma. About 56% of patients reported worsening of their asthma control during pregnancy, of which 52.3% felt this worsening in the third trimester. About 65% of patients had uncontrolled asthma during their pregnancy, and inhaler technique was incorrect in 64.4%. Only 38% of patients knew the difference between controller and reliever asthma medications, 12.7% of patients had received written asthma action plan, 17% had a spirometry done in the previous 5 years, and 3.8% had peak expiratory flow meter at home. The main reasons for uncontrolled asthma were lack of knowledge about right asthma medications in 30% and fear of side effects of inhaled corticosteroids in 19% of patients. No financial reason was reported. Significant associations between total number of pregnancies, poor perception of asthma medications, asthma exacerbation during delivery and poor asthma control were observed. Preeclampsia and congenital anomalies occurred at higher rates than previously reported among general population in this country. The tremendous improvements in maternal health care and socioeconomic status do not seem to be a barrier to the globally recognized poor asthma care in pregnancy. Important strategies are much needed.

scholarly journals Canadian Thoracic Society Asthma Management Continuum – 2010 Consensus Summary for Children Six Years of Age and Over, and Adults

2010 ◽  
Vol 17 (1) ◽  
pp. 15-24 ◽  
Author(s):  
M Diane Lougheed ◽  
Catherine Lemière ◽  
Sharon D Dell ◽  
Francine M Ducharme ◽  
J Mark FitzGerald ◽  
...  
Keyword(s):  
Inhaled Corticosteroids ◽  
Immunoglobulin E ◽  
Action Plan ◽  
Age Groups ◽  
Asthma Management ◽  
Accurate Diagnosis ◽  
Objective Measures ◽  
High Dose ◽  
Adult Asthma ◽  
Long Acting

BACKGROUND/OBJECTIVE: To integrate new evidence into the Canadian Asthma Management Continuum diagram, encompassing both pediatric and adult asthma.METHODS: The Canadian Thoracic Society Asthma Committee members, comprised of experts in pediatric and adult respirology, allergy and immunology, emergency medicine, general pediatrics, family medicine, pharmacoepidemiology and evidence-based medicine, updated the continuum diagram, based primarily on the 2008 Global Initiative for Asthma guidelines, and performed a focused review of literature pertaining to key aspects of asthma diagnosis and management in children six years of age and over, and adults.RESULTS: In patients six years of age and over, management of asthma begins with establishing an accurate diagnosis, typically by supplementing medical history with objective measures of lung function. All patients and caregivers should receive self-management education, including a written action plan. Inhaled corticosteroids (ICS) remain the first-line controller therapy for all ages. When asthma is not controlled with a low dose of ICS, the literature supports the addition of long-acting beta2-agonists in adults, while the preferred approach in children is to increase the dose of ICS. Leukotriene receptor antagonists are acceptable as second-line monotherapy and as an alternative add-on therapy in both age groups. Anti-immunoglobulin E therapy may be of benefit in adults, and in children 12 years of age and over with difficult to control allergic asthma, despite high-dose ICS and at least one other controller.CONCLUSIONS: The foundation of asthma management is establishing an accurate diagnosis based on objective measures (eg, spirometry) in individuals six years of age and over. Emphasis is placed on the similarities and differences between pediatric and adult asthma management approaches to achieve asthma control.

scholarly journals Asthma death

Pneumologia ◽  
2020 ◽  
Vol 68 (4) ◽  
pp. 162-168
Author(s):  
Hana Khairina Putri Faisal ◽  
Faisal Yunus
Keyword(s):  
Mortality Rate ◽  
Inhaled Corticosteroids ◽  
Action Plan ◽  
Asthma Management ◽  
Psychosocial Problems ◽  
Poor Adherence ◽  
Psychiatric Disease ◽  
High Dose ◽  
History Of ◽  
Asthma Mortality

AbstractThe prevalence of asthma is still high in many countries. However, the asthma mortality rate has been significantly decreased after the epidemic of asthma death in the 1970s. The epidemic was occurred in New Zealand and was associated with the use of high-dose inhaled fenoterol at that time. The increased use of inhaled corticosteroids (ICS) in asthma management is proposed as the key factor in the declining trend of asthma mortality rate. The risk factors of asthma-related deaths included history of near-fatal asthma requiring intubation and mechanical ventilation, hospitalisation or emergency care visit for asthma in the past year, currently using or having recently stopped using oral corticosteroids, not currently using ICS, overuse of short-acting b2-agonists, history of psychiatric disease or psychosocial problems, poor adherence with asthma medications and/or poor adherence with (or lack of) a written asthma action plan, food allergy in a patient with asthma, and air pollution.

Screening Instrument for Adolescents of Parents With Chronic Medical Condition

2013 ◽  
Author(s):  
Dominik S. Sieh ◽  
Frans J. Oort ◽  
Johanna M. A. Visser-Meily ◽  
Anne Marie Meijer
Keyword(s):  
Medical Condition ◽  
Screening Instrument ◽  
Chronic Medical Condition

scholarly journals Higher Omega-3 Index Is Associated with Better Asthma Control and Lower Medication Dose: A Cross-Sectional Study

Nutrients ◽  
2019 ◽  
Vol 12 (1) ◽  
pp. 74 ◽  
Author(s):  
Isobel Stoodley ◽  
Manohar Garg ◽  
Hayley Scott ◽  
Lesley Macdonald-Wicks ◽  
Bronwyn Berthon ◽  
...  
Keyword(s):  
Fatty Acids ◽  
Asthma Control ◽  
Inhaled Corticosteroids ◽  
Asthma Management ◽  
Airway Disease ◽  
Cross Sectional Study ◽  
Erythrocyte Membranes ◽  
Omega 3 ◽  
Asthma Control Questionnaire ◽  
Cross Sectional

Asthma is a chronic inflammatory airway disease, associated with systemic inflammation. Omega-3 polyunsaturated fatty acids (n-3 PUFA) have established anti-inflammatory effects, thus having potential as an adjunct therapy in asthma. This study aimed to compare erythrocyte n-3 PUFA in adults with (n = 255) and without (n = 137) asthma and determine the relationship between erythrocyte n-3 PUFA and clinical asthma outcomes. Subjects had blood collected, lung function measured and Juniper Asthma Control Questionnaire (ACQ) score calculated. Fatty acids were measured in erythrocyte membranes by gas chromatography, and the omega-3 index (O3I) was calculated (% eicosapentaenoic acid + % docosahexaenoic acid). O3I was similar in subjects with and without asthma (p = 0.089). A higher O3I was observed in subjects with controlled or partially controlled asthma (ACQ < 1.5) compared to subjects with uncontrolled asthma (ACQ ≥ 1.5) (6.0% (5.4–7.2) versus 5.6% (4.6–6.4) p = 0.033). Subjects with a high O3I (≥8%) had a lower maintenance dose of inhaled corticosteroids (ICS) compared to those with a low O3I (<8%) (1000 μg (400–1000) versus 1000 μg (500–2000) p = 0.019). This study demonstrates that a higher O3I is associated with better asthma control and with lower ICS dose, suggesting that a higher erythrocyte n-3 PUFA level may have a role in asthma management.

A snapshot of general practitioner attitudes, levels of confidence and self-reported paediatric asthma management practice

2011 ◽  
Vol 17 (3) ◽  
pp. 288 ◽  
Author(s):  
Jessica A. Roydhouse ◽  
Smita Shah ◽  
Brett G. Toelle ◽  
Susan M. Sawyer ◽  
Craig M. Mellis ◽  
...  
Keyword(s):  
General Practitioners ◽  
Management Practices ◽  
Inhaled Corticosteroids ◽  
Management Practice ◽  
Controlled Trial ◽  
Asthma Management ◽  
Convenience Sample ◽  
Paediatric Asthma ◽  
Baseline Questionnaire ◽  
Practitioner Attitudes

The prevalence of asthma in Australia is high. Previous findings have suggested that asthma management, particularly in primary care, remains suboptimal and recent government initiatives to improve asthma management and encourage the use of written asthma action plans (WAAPs) in general practice have been implemented. We aimed to assess the attitudes, confidence and self-reported paediatric asthma management practices of a convenience sample of Australian general practitioners (GPs). A baseline questionnaire was administered to GPs as part of a randomised controlled trial. General practitioners (GPs) were recruited from two areas of greater metropolitan Sydney, NSW between 2006 and 2008. Invitations were sent to an estimated 1200 potentially eligible GPs. Of 150 (12.5%) GPs that enrolled, 122 (10.2%) completed the baseline questionnaire. Though 89% were aware of the Australian National Asthma Guidelines, less than 40% were familiar with guideline recommendations. While 85.2% had positive attitudes towards WAAPs, only 45.1% reported providing them frequently. For children with frequent symptoms, 90% agreed they should prescribe daily, inhaled corticosteroids (ICS), and 83% reported currently prescribing ICS to such patients. These findings indicate gaps between GP attitudes and behaviours and highlights opportunities for interventions to improve paediatric asthma management.

The School Nurse Role in Asthma Management: Can the Action Plan Help?

2005 ◽  
Vol 21 (1) ◽  
pp. 23-30 ◽  
Author(s):  
Anne Borgmeyer ◽  
Patricia Jamerson ◽  
Patricia Gyr ◽  
Nina Westhus ◽  
Emily Glynn
Keyword(s):  
Action Plan ◽  
Asthma Management ◽  
School Nurse ◽  
School Nurses ◽  
Direct Care ◽  
Continued Education ◽  
Nurse Role ◽  
Chronic Disorder ◽  
Asthma Action Plans ◽  
Valuable Role

Asthma is the most common chronic disorder in American schoolchildren, and school nurses play a valuable role in its management. A study was conducted in which school nurses were asked to describe their role in caring for students with asthma and their use of Asthma Action Plans (AAPs). The nurses indicated that they frequently provided direct care and education. They were comfortable with providing care to students with asthma and familiar with AAPs. Having an AAP increased their confidence in managing students with asthma. This emphasizes the need for continued education regarding the AAP and the development of policies that direct care and encourage use of an AAP at school.

scholarly journals Psychosocial Outcomes in Adult Survivors of Retinoblastoma

2015 ◽  
Vol 33 (31) ◽  
pp. 3608-3614 ◽  
Author(s):  
Jennifer S. Ford ◽  
Joanne F. Chou ◽  
Charles A. Sklar ◽  
Kevin C. Oeffinger ◽  
Danielle Novetsky Friedman ◽  
...  
Keyword(s):  
Traumatic Stress ◽  
Medical Condition ◽  
Cancer Recurrence ◽  
Psychosocial Outcomes ◽  
The United States ◽  
Fear Of Cancer Recurrence ◽  
Chronic Medical Condition ◽  
Post Traumatic Stress ◽  
Stress Symptoms ◽  
Post Traumatic

Purpose Survival rates for individuals diagnosed with retinoblastoma (RB) exceed 95% in the United States; however, little is known about the long-term psychosocial outcomes of these survivors. Patients and Methods Adult RB survivors, diagnosed from 1932 to 1994 and treated in New York, completed a comprehensive questionnaire adapted from the Childhood Cancer Survivor Study (CCSS), by mail or telephone. Psychosocial outcomes included psychological distress, anxiety, depression, somatization, fear of cancer recurrence, satisfaction with facial appearance, post-traumatic growth, and post-traumatic stress symptoms; noncancer CCSS siblings served as a comparison group. Results A total of 470 RB survivors (53.6% with bilateral RB; 52.1% female) and 2,820 CCSS siblings were 43.3 (standard deviation [SD], 11) years and 33.2 (SD, 8.4) years old at the time of study, respectively. After adjusting for sociodemographic factors, RB survivors did not have significantly higher rates of depression, somatization, distress, or anxiety compared with CCSS siblings. Although RB survivors were more likely to report post-traumatic stress symptoms of avoidance and/or hyperarousal (both P < .01), only five (1.1%) of 470 met criteria for post-traumatic stress disorder. Among survivors, having a chronic medical condition did not increase the likelihood of psychological problems. Bilateral RB survivors were more likely than unilateral RB survivors to experience fears of cancer recurrence (P < .01) and worry about their children being diagnosed with RB (P < .01). However, bilateral RB survivors were no more likely to report depression, anxiety, or somatic complaints than unilateral survivors. Conclusion Most RB survivors do not have poorer psychosocial functioning compared with a noncancer sample. In addition, bilateral and unilateral RB survivors seem similar with respect to their psychological symptoms.

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