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The Case
A 22-year-old pregnant woman with a diagnosis of asthma is experiencing a change in the severity of asthma symptoms. She uses both an albuterol MDI and fluticasone MDI with increased regularity. Shortness of breath is present, and she was hospitalized twice last year for poorly controlled asthma. She also went to the emergency department three times during the last month. The situation is affecting her sleep and physical activity.
Increased coughing is the clearest sign of her asthma not being in control. Shortness of breath during exercise suggests the presence of exercise-induced bronchospasm that can accompany uncontrolled cases of asthma (National Heart, Lung, and Blood Institute, 2017). The case mentions the decreased effectiveness of the fluticasone MDI that she uses which can also be a clue to her condition (Zanforlin, Corsico, DI Marco, Patella, & Scichilone, 2016).
Her pregnancy might be the leading factor for her condition. Commonly, pregnancy leads to the presence of a positive human chorionic gonadotropin, as well as hormonal imbalance. These factors are likely affecting the effectiveness of her fluticasone MDI, which makes her lose control of the condition (Baldacara & Silva, 2017).
NIS guidelines suggest that her condition falls under “moderate severity asthma.” The frequency of her SABA use is increased, asthma is limiting her activity and night awakenings have increased pointing to this classification. Her patterns of MDI use in the last two months and the bronchospasm suggest that her asthma is poorly controlled (National Heart, Lung, and Blood Institute, 2017).
The NIS guidelines recommend monthly visits to the physician to monitor and assist in treatment. The use of albuterol is appropriate for pregnant women and should continue. However, fluticasone MDIs have shown to be ineffective and should not be utilized (National Heart, Lung, and Blood Institute, 2017). For long-term care, budesonide can be used, as it has no evident negative effect on pregnant women their children (Goldie & Brightling, 2013).
References
Baldacara, R., & Silva, I. (2017). Association between asthma and female sex hormones. Sao Paulo Medical Journal, 135(7), 46-59. Web.
Goldie, M., & Brightling, C. (2013). Asthma in pregnancy. The Obstetrician & Gynaecologist, 15(4), 241-245. Web.
National Heart, Lung, and Blood Institute. (2017). Guidelines for the Diagnosis and Management of Asthma (EPR-3) – NHLBI, NIH. Web.
Zanforlin, A., Corsico, A. G., DI Marco, F., Patella, V., & Scichilone, N. (2016). Asthma in pregnancy: one more piece of the puzzle. Minerva Medica, 107(1), 1-4. Web.
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