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Asthma and Pregnancy (part 1)

Asthma and Pregnancy (part 1)
By Qanta Ahmed, MD

As a doctor who specializes in asthma, it is not often that I see pregnant women in my office, but I do see them from time to time. While I worry about all my patients, pregnant woman have special needs that makes caring for them both challenging and gratifying. Remember, we are not just looking after you, but also your awaited baby.

You must go see your doctor when you are pregnant. This is probably the most important thing you can do for your new child. If you have asthma, your doctor visits become even more important.

Asthma's Changing Patterns

Pregnant women with asthma are not necessarily 'high risk' patients. In fact, asthma can follow a curious pattern in pregnant patients. One third of women experience no change in their asthma during pregnancy, one third actually notice an improvement when they are pregnant, and one third may experience a flare-up of their asthma during this time. Since there is no index to predict which way a patient will react, it is necessary to closely follow every pregnant asthma patient.

Most people are well aware of the myriad changes a body goes through during pregnancy -- even the lungs go through interesting and intelligent alterations to adapt to the developing baby. In fact, one of the most confounding aspects of taking care of a pregnant patient is that it is normal for her to be short of breath. This makes it difficult to discern a "normal" breathlessness from a problem that requires medication.

The Pregnant Body

A woman's body adjusts gradually as the pregnancy develops. Since a pregnant patient is carrying more weight, the lungs need to accommodate to the additional work of breathing caused by the weight gain. A pregnant woman breathes a little faster than normal, which is perfectly healthy. The body is raising what is called the minute ventilation (the amount of breathing you do in a minute).

As the belly grows, it alters the shape of the bottom part of the chest. The chest is separated from the belly by a swathe of muscle called the diaphragm, which is a vital muscle that helps you to breathe. As the belly gains in girth, it pushes upwards against the diaphragm, preventing deep breaths and consequently increasing the respiratory rate. To make the chest a little bigger, the ribs splay outwards like bucket handles, letting the patient breathe a little deeper.

How To Tell If Your Asthma Is Out Of Control

It is important to monitor your asthma while you are pregnant, so that you can make sure it is always under control. Asthma warning symptoms are the same when you are pregnant as when you are not. If you notice any of the following, visit your doctor immediately:
  • You are finding your usual tasks increasingly difficult because of your breathing
  • You find yourself reaching for your inhaler more than you are used to
  • You are awakened by coughing at night
  • You hear yourself wheeze on the telephone
The main message here is -- do not ignore symptoms, and talk with your doctor about any changes in your breathing. Your doctor may recommend a peak flow meter. This simple device measures airflow when you blow into it, and can be an important tool for monitoring asthma. Talk to your doctor about whether it is right for you.

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