Decision Tree - Asthma in Pregnancy

    Goldman's Cecil Medicine, Twenty-Fourth Edition

    247 - Common Medical Problems in Pregnancy - E-FIGURE 247-1

    Stepwise approach for management of asthma during pregnancy and lactation. The stepwise approach is meant to assist, not replace, the clinical decision making required to meet individual patient needs. Recommendations are as follows. Gain control as quickly as possible, considering a short course of systemic corticosteroid and then stepping down to the least medication necessary to maintain control. Minimize the use of short-acting inhaled β2-agonist‡. Provide self-education on self-management and controlling environmental factors that make asthma worse (e.g., allergens, irritants). Refer to an asthma specialist if there are difficulties controlling asthma or if step 4 care is required. Referral may be considered if step 3 care is required. *There are more data on using budesonide during pregnancy than on using other inhaled corticosteroids. †There are minimal data on using leukotriene receptor antagonists in humans during pregnancy, although there are reassuring animal data. ‡There are more data on using albuterol during pregnancy than on using other short-acting inhaled β2-agonists. FEV1 = forced expiratory volume in 1 second; PEF = peak expiratory flow.


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