Author 丨 Li Yong Suzhou City Hospital Breathing Department
This article is published by the author’s authorization of the doctor. Do not reprint without authorization.
Introduction
A 31 -year -old woman from the clinic one day, 20 weeks of pregnancy, complained that chest tightness was half a month.
I went to a second -level hospital three days ago to diagnose asthma. I gave the QD to Sammetro /Flutakaton (50 μg /250 μg) 1. There was no significant improvement after treatment, and there was still chest tightness at night.
The patient had the original history of asthma for more than 20 years. Before pregnancy, it was irregular to use Samero/Fluenta Song on demand. After pregnancy, the patient thought that inhaled drugs were not good for the fetus and were basically short of chest tightness every night during pregnancy.After taking the medicine for a clinic of the front and outer hospitals, I am now worried that I am very worried about whether the drug has adverse effects on the fetus, so I will consult for consultation.
Examination: Breathing is smooth and intact, no purple magpie, SAO2 98%, no pestle -like finger, the lung breathing sound is slightly lower, no sound sound, no wet Luo sound, heart rate 90 times/cubicNo swelling.
Let the patient demonstrate the use of the inhalation device of Saimetro/Fluta pine, and there is no problem with the inhalation technology.
Differential diagnosis: It is mainly inadequate heart function, chronic obstructive pulmonary diseases, upper airway obstructive lesions, and perverted reactive bronchial mildewy, etc. (limited to the length of this article).
Pregnant women belong to the relative contraindications of lung function test [1], so they do not consider it for the time being.
This article will be discussed in question and answer to the patient’s condition evaluation and step -type adjustment treatment, as well as the problem of safe medication during pregnancy.
Q1 asthma staging and grading?
The long -term treatment goal of asthma is to achieve the best symptom control and minimize future risks, including asthma -related mortality, acute seizures, continuous airflow restrictions and treatment.
Chronic duration refers to symptoms such as asthma, shortness of breath, chest tightness, cough, etc. [2], so it is determined as a chronic duration.
The principle of chronic sustaining asthma is based on the severity of the patient’s condition and the level of control, and the corresponding treatment plan is selected.
According to Gina 2021’s long -term step -type treatment scheme (Figure 1), this patient has symptoms every day. After level 3 (low -dose ICS) treatment, it has not reached fully control. It should belong to the fourth asthma and belong to severe asthma.
Figure 1 Long -term (stepped) treatment plan for asthma patients [3]
The current low -dose ICS/LABA treatment, according to FIG. 1 is equivalent to the fourth level of asthma and receive the third treatment.
Q2 Current asthma control situation
Asthma symptoms can use asthma control test (ACT) questionnaire (Table 1):
Table 1 CAT questionnaire and its scoring standard
The patient scored 14 points, which means that asthma control is poor.
At present, it is the fourth level of asthma and severe asthma, but it is used in the third level of treatment. The asthma control is poor. Obviously, the treatment plan should be upgraded.
Q3 How to adjust the treatment plan for asthma control is very poor, so it is necessary to upgrade the treatment. Refer to Gina’s stepped treatment plan (Figure 1). It is recommended to upgrade to the level 4 treatment plan and give the mid -dose ICS/Fumatlo maintenance+on -demand ICS on demand ICS/Fumatlo, Prescription Bu Di Neid/Fomatlo (320 μg/9.0 μg) 1 suck BID+PRN.
Patient’s original Saimetro/Flutakaton (50 μg/250 μg) 1 suck QD, propionate fluinicate is 250 μg/day, which is a low -dose inhalation hormone (ICS). It belongs to the third level of treatment., Planning Pharmaceutical Pidane/Fermatlo (320 μg/9.0 μg) 1 suction BID, Buddined 640 μg/day, belongs to the mid -dose ICS, upgraded to level 4 of the treatment, and can be according to the patient’s asthma symptoms as needed as needed as needed as needed as needed as needed as needed as needed as needed as needed as needed as needed as needed as needed as required as requiredInhale Bu Di Neid/Fomatlo, no more than 4 suction every day.(Note: Laba Fumatlo has a long -term and fast effect, so GINA recommends ICS/Fomatlo as a long -term maintenance medicine, which can also be used to alleviate first aid drugs, two medicines.)
Q4 Anti -Points of Asthma treatment during pregnancy
Surgee during pregnancy refers to asthma that occurs during pregnancy.About 4%~ 8%of pregnant women suffer from asthma, and patients with 1/3 asthma are aggravated due to pregnancy. They mostly occur on the 24th to 36th weeks of pregnancy. Pregnancy asthma not only affects pregnant women, but also affects the fetus. Unsus -controlled pregnancy asthma will cause pregnant women to have children.Epilepsy or stood hypertrophy cannot increase the mortality rate, premature yield rate and low body signs of peripheral dysfunction [2].GINA 2021 Although there are concerns about asthma medication during pregnancy, the active benefits of the active treatment of asthma during pregnancy are far more than the potential risks of commonly used control and relieving medication [4] (grade evidence);It can cause bad endings to pregnant women and babies (Class A); conventional dose ICS/LABA is safe evidence (grade evidence); relegation treatment should not be considered before childbirth;ICS (C -Class Evidence) should be discontinued.
Q5 Is the current medicine for pregnant women safely?
The patient was worried and repeatedly asked whether the current medication has adverse effects on pregnancy on pregnancy.
Review instructions [Drug for pregnant women and breastfeeding women] chapter: Buddine/Fomatlo is used in pregnancy, this product is only used to benefit greater than potential danger.Budiid, which should be appropriately controlled to control asthma appropriately.
The research data of Sammetero/Takatong in pregnancy women are limited.Only in the case of possible benefits to the mother’s expectations than the possible risk of the fetus, this product can be used during pregnancy.
Check Drug.com’s above -mentioned two ICS/LABA pregnancy and lactation warnings: Buddine/Fumatlo should use this medicine during the benefit of benefits greater than potential risks.Classification of US FDA during pregnancy: Unbelled, Australian Prescription Classification System B3 [5].Sammetro/Takatong is not used in pregnant women unless the medication benefits are greater than the risk of fetal fetuses.Classification of US FDA Drugs during pregnancy: Unbelled, Australian Prescription Classification System B3 [6].(Note: The FDA believes that the use of ABCDX five letters classification during pregnancy is too simple to guide the guidance of safe medication during pregnancy. One letter cannot cover all information of safe medicine during pregnancy, so the five -letter classification method has been abolished; Australia’s B3 level represents the safety of this drug during pregnancy.Sexual data is limited. Observation research has not found that there is an increase in deformed or other harmful effects on human fetuses. Animal test shows that medication is increased to the fetus, but this feature is uncertain to humans [7].)
Interpretation: Both ICS/LABAs are not disabled in pregnant women, but they are just used with caution. It is recommended to use it under the weighing pros and cons.
Many patients and even grass -roots clinicians have taken medication during pregnancy as floods. Poor asthma control or acute seizures would rather carry it hard, and they were unwilling or dare not take medicine. Patients were often worried about the potential damage to the fetus for the treatment of the drug and ignored the asthma but not the asthma failure.It is very reasonable to control the damage to the mother and fetus.
Through detailed conditional evaluation, carefully review the drug manual, comprehensively evaluate the risk of benefits, seek the best balance of benefits and risks, discuss treatment decisions with patients, scientifically and reasonably standardize medication, and strive to achieve effective asthma control, thereby reducing asthma to reduce asthmaThe adverse effects of the treatment of drugs on the mother and fetus.
practice
So explained in detail the risk of current condition, asthma uncontrollable, and the benefits and potential risks of the treatment of medication. After negotiating with pregnant women and their families, the treatment plan was adjusted to Buddine/Fumatlo (320 μg/9.0 μg) 1 1Bid+PRN does not exceed 4 suction every day, and instructed to return to the clinic after a week.
One week later, the patient’s retransmit was obviously improved. The chest tightness improved significantly.
Summarize
The long -term treatment goal of asthma is to achieve the best symptom control and minimize future risks;
案 The adjustment strategy of asthma treatment scheme is mainly based on the level of symptoms and risk factors, and the lifting level adjustment is performed according to the asthma stepped treatment scheme;
制 The uncontrolled asthma during pregnancy can bring serious adverse effects on pregnant women and fetuses. Actively controlling asthma can reduce the risk of mother and fetus;
喘 The principle of asthma treatment during pregnancy is the same as typical asthma. Based on pregnancy safety considerations, the choice of drugs should be cautious and weigh the advantages and disadvantages;
应Ste asthma pregnant women should reasonably select the treatment medication with high safety under the guidance of a specialist, and should not be considered before childbirth.
1. Chinese Medical Association. Conventional lung function test (2018). China National Physician Magazine 2019; 18: 511–8.2.China Tuberculosis and Breathing Magazine 2020: 1023–48.3.3.3.global Initiative for Asthma. Global StrategyFor Asthma Management and PREVENTION: Update 2021 [EB/OL]. [2021-04-26] .http://wwww w.ginaasthma.org/.4. Murphy Ve, Gibson Pg. Asthma in Pregnancy.clin Chest Med 2011; 32: 93–110. Doi: 10.1016 / J.CCM.2010.10.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5.5. ding warnings.https: //www.drugs.com/Pregnancy/Budesonide- Formoterol.html.6.fluticAsone/Salmeterol Pregnancy andBreastFeeding Warnings. -salmeterol.html.7.Australian categorisation system forprescripImed Medicines in Pregnancy. https:///www.tga.gov.au/australian-categorisation-System-Presden-Medicines-Pregnation.
