What is the focus of the lecture by Lynnell Joy B. Espinosa, MD?
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Pulmonary disorders in pregnancy.
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What is the focus of the lecture by Lynnell Joy B. Espinosa, MD?
Pulmonary disorders in pregnancy.
What is a key non-pharmacologic intervention for asthma management?
Patient education.
What is the drug of choice for inducing labor among asthmatic pregnant patients?
Oxytocin.
Does intravenous hydrocortisone reduce maternal morbidity during labor and delivery in asthmatic pregnant patients?
Yes, it is indicated for reducing maternal morbidity.
What intervention can help reduce asthma symptoms related to smoking?
Smoking cessation.
Does the use of prostaglandins significantly increase asthma exacerbations during labor induction?
No, there is no significant increase in asthma exacerbation among women given prostaglandin for induction of labor.
What is the recommended dose of parenteral hydrocortisone for pregnant asthmatics on oral steroids?
100 mg every 6-8 hours during labor.
What are the potential effects of prostaglandin F2α (carboprost) on asthmatic patients?
It can cause bronchoconstriction.
What trend was observed in patients who improved during pregnancy?
Improvement was gradual as pregnancy progressed.
What should be controlled to help manage asthma effectively?
Environmental triggers.
What is the main question regarding treatment for pregnant women with confirmed CAP?
Will hospitalization compared to outpatient treatment reduce adverse maternal and fetal outcomes?
What is the maternal mortality rate during pregnancy?
0.8%.
What does FEV1/FVC ratio indicate in asthma?
It measures the proportion of forced expiratory volume in one second to forced vital capacity.
When should pregnant asthmatics receive parenteral hydrocortisone?
If they are on oral steroids exceeding prednisolone 7.5 mg per day for more than two weeks prior to delivery.
Which prostaglandin is considered a safer analog if treatment is required for asthmatic patients?
Prostaglandin E2 (dinoprostone).
When was the increase in asthma symptoms most prominent for those whose condition worsened?
Between 29-36 weeks gestation.
What is the risk of pregnancies in women with asthma compared to non-asthmatic women?
Increased risk of preterm birth, low birth weight, and small for gestational age infants.
What type of medications should be avoided to prevent worsening asthma?
Medications that may make asthma worse.
How should pregnant patients with confirmed CAP be stratified?
According to disease severity.
What are some complications associated with maternal mortality?
Acute lung infection, prematurely ruptured membranes, and preterm delivery.
What is the significance of a FEV1 of 65-80%?
It indicates a mild to moderate obstruction in airflow.
Does the use of prolonged corticosteroids increase the risk of developing gestational diabetes mellitus (GDM) among asthmatic pregnant patients?
Yes, prolonged corticosteroids may increase the risk.
What does FEV stand for in the context of asthma?
Forced Expiratory Volume at 1 second.
What type of exercises can benefit asthma patients?
Breathing exercises.
How does good control of asthma during pregnancy affect perinatal outcomes?
It leads to a reduction in asthma exacerbations and fewer adverse perinatal outcomes.
How was asthma severity generally characterized during the last 4 weeks of pregnancy?
Asthma was generally less severe.
What is the best treatment option for Moderate to High Risk CAP in pregnant patients?
Hospital admission.
What is the increase in low birth weight neonates during pregnancy?
2-fold increase.
What are the clinical stages of asthma characterized by?
They range from mild wheezing to severe bronchoconstriction.
What is asthma classified as?
A chronic inflammatory airway syndrome with major hereditary components.
How does the use of exhaled nitric oxide fraction (FENO) affect asthma exacerbations in pregnant patients?
It helps in reducing exacerbations.
How does good control of asthma affect the risk of gestational diabetes in pregnant asthmatics?
The risk of gestational diabetes is decreased among pregnant asthmatics with good control.
What is recommended to achieve control of asthma during pregnancy?
The use of pharmacologic therapy.
When may outpatient treatment be considered for pregnant patients with CAP?
For patients classified as LOW RISK.
What does PEFR stand for?
Peak Expiratory Flow Rate.
What was noted about asthma symptoms during labor and delivery?
Substantial asthma symptoms were uncommon.
What is the incidence of preterm and growth-restricted newborns during pregnancy?
Increased incidence.
What is the effectiveness of the PPSV23 pneumococcal vaccine?
60 to 70% protective.
What was the first coronoviral infection in China and when did it occur?
The first coronoviral infection was SARS-CoV, which occurred in 2002.
What is the ultimate goal of asthma therapy during pregnancy?
To protect both the mother and the fetus by achieving good asthma control, thus decreasing the risk for adverse outcomes.
What does PEFR stand for?
Peak Expiratory Flow Rate.
What are the main types of pharmacological options for asthma treatment?
Controllers, relievers, and add-on therapies.
Is FENO effective in treatment planning for pregnant patients with asthma?
Yes, it is effective in treatment planning.
What is the hallmark of asthma?
Reversible airway obstruction from bronchial smooth muscle contraction, vascular congestion, tenacious mucus, and mucosal edema.
Is the use of intranasal corticosteroids associated with the development of gestational diabetes mellitus among pregnant asthmatics?
No, intranasal corticosteroids are not associated with the development of GDM.
What is the significance of FEV and PEFR in managing acute asthma attacks?
They are used to assess lung function and guide treatment.
What adverse perinatal outcomes can pharmacologic therapy help prevent in asthmatic pregnant patients?
Preterm delivery, congenital fetal anomalies, and fetal growth restriction.
How does the course of asthma in successive pregnancies tend to be for an individual patient?
It tends to be similar.
What conditions have increased incidence during pregnancy?
Pre-eclampsia and cesarean delivery.
Is the pneumococcal vaccine recommended for healthy pregnant women?
No, it is not recommended.
What syndrome did SARS-CoV cause?
Severe acute respiratory syndrome (SARS).
What defines asthma control?
Minimal or no chronic symptoms day or night, minimal or no exacerbations, no limitations on activities, maintenance of (near) normal pulmonary function, minimal use of short-acting inhaled beta2-agonist, and minimal or no adverse effects from medications.
What does a normal FEV1/FVC ratio suggest?
It suggests normal lung function without significant obstruction.
What is the purpose of controller medications in asthma treatment?
To reduce airway inflammation, control symptoms, and reduce future risks such as exacerbations.
What is a non-invasive method used during pregnancy to assess airway inflammation?
Measurement of exhaled nitric oxide (FENO).
What percentage of pregnancies are complicated by asthma?
4-8%.
What is recommended for pregnant asthmatics regarding intranasal corticosteroids?
The use of intranasal corticosteroids as controller medication is recommended.
Where is the protocol for managing acute asthma attacks implemented?
At Parkland Hospital.
Does sustained versus interrupted pharmacologic therapy affect the incidence of congenital fetal anomalies?
The text does not provide a definitive answer to this question.
Who is recommended to receive one lifetime dose of PPSV23?
Gravidas with diabetes mellitus or chronic heart, lung, or liver disease.
What are the components of the stepwise approach to asthma treatment?
Inhaled corticosteroids (ICS), long-acting beta-agonists (LABA), and oral corticosteroids (OCS).
What is the case fatality rate of SARS?
Approximately 10%.
What are reliever medications used for in asthma management?
For as-needed relief of breakthrough symptoms during worsening asthma or exacerbations.
Why is asthma more dangerous for pregnant women?
Due to diminished functional residual capacity and greater pulmonary shunting, making it susceptible to hypoxia and hypoxemia.
What can FENO measurement help diagnose during pregnancy?
Asthma.
Do intranasal corticosteroids increase the risk for the development of gestational diabetes among women with asthma?
No, they do not increase the risk.
What is the purpose of the management protocol for acute asthma?
To provide structured care for patients experiencing asthma attacks.
What is the recommended schedule for PCV13 and PPSV23 doses?
One lifetime dose of PCV13 followed by one PPSV23 dose at least 8 weeks later, and then again 5 years later if not previously provided.
What is the frequency of symptoms for intermittent asthma?
Less than 2 days per week.
What is the recommended treatment for uncomplicated community-acquired pneumonia in pregnancy?
Macrolides such as clarithromycin (500 mg twice daily) or azithromycin (500 mg daily), plus Oseltamivir (75 mg orally twice daily for 5 days for suspected influenza A).
What was the case fatality rate of SARS in pregnancy?
Up to 40%.
What are the two scoring systems used to guide admission for pneumonia?
Pneumonia Severity Index (PSI) and CURB-65 scoring system.
What is considered mild intermittent asthma?
Asthma that has minimal or no chronic symptoms and minimal or no exacerbations.
What vital sign indicates moderate risk in patients with CAP?
Respiratory rate (RR) < 30 per minute.
When are add-on therapies considered for asthma patients?
When patients have persistent symptoms or exacerbations despite optimized treatment with high-dose controlled medications.
How can asthma exacerbations during pregnancy be reduced?
Using a validated FENO-based treatment algorithm.
What is the 'rule of thirds' in asthma during pregnancy?
1/3 will improve, 1/3 will remain unchanged, and 1/3 will deteriorate.
Who should receive the pneumococcal vaccines among women?
Women with chronic immunocompromise, generalized malignancy, chronic renal disease, cochlear implant, or asplenia such as sickle-cell disease.
How often do moderate persistent asthma symptoms occur?
More than 2 days per week, but not daily.
What antibiotics are used for severe pneumonia in pregnant patients?
Respiratory fluoroquinolones like moxifloxacin (400 mg daily) or levofloxacin (750 mg daily), or B-lactams such as ampicillin/sulbactam, ceftriaxone, ceftaroline, or cefotaxime, coupled with a macrolide.
What is the significance of minimal use of short-acting inhaled beta2-agonists?
It indicates better asthma control and fewer symptoms.
What was the second worldwide outbreak of coronavirus and when did it occur?
COVID-19, which occurred in 2019-2020.
What does a CURB-65 score of 4 or 5 indicate?
Consider inpatient admission and possibly ICU care.
What is the preferred inhaled corticosteroid (ICS) for use in pregnant patients?
Budesonide.
What vital sign indicates high risk in patients with CAP?
Respiratory rate (RR) > 30 per minute.
What role does FENO play in antenatal asthma management?
It serves as a guide for pharmacological management to significantly reduce exacerbations.
What percentage of pregnant asthmatic patients experience exacerbation?
20-36%.
What characterizes severe persistent asthma symptoms?
Symptoms occur throughout the day.
How long should antibiotics be administered for pneumonia in pregnancy?
Antibiotics are typically discontinued after 5 to 7 days in patients who are afebrile for 48 to 72 hours.
What is pneumonia's rank as a leading cause of death in the US during pregnancy?
7%.
Are mRNA COVID-19 vaccines safe during pregnancy?
Yes, they are safe during pregnancy and among breastfeeding women.
What is the mortality rate for outpatient care according to CURB-65?
15%.
What are the rescue medications of choice for pregnant asthmatic patients?
Inhaled SABA (Short-Acting Beta Agonists).
What heart rate indicates high risk in patients with CAP?
Pulse rate (PR) > 125 bpm.
What is the brand name for Albuterol?
Proventil HFA, Ventolin HFA, ProAir HFA, Xopenex HFA.
When do most asthma exacerbations occur during pregnancy?
In the second half of pregnancy.
What is the maximum frequency of nocturnal awakenings for moderate persistent asthma?
3-4 times per month.
By late pregnancy, how much does vital capacity and inspiratory capacity increase?
By approximately 20%.
What is the expected clinical improvement timeline for pneumonia treatment in pregnancy?
Clinical improvement is usually evident in 48 to 72 hours, with resolution of fever in 2 to 4 days.
What percentage of common morbidity does pneumonia represent in pregnancy?
3%.
What is the significance of a respiratory rate greater than 30/min in CURB-65?
It is a risk factor for early deterioration in pneumonia.
What blood pressure reading indicates high risk in patients with CAP?
Systolic blood pressure (SBP) < 90 mmHg.
What are the available doses for Beclomethasone HFA?
80-240 mcg.
What is the lung function (FEV1) in moderate persistent asthma?
More than 80% predicted.
What happens to expiratory reserve volume during pregnancy?
It declines from 1300 ml to approximately 1100 ml.
What is the most common form of pneumonia?
Community-acquired pneumonia.
How long may radiographic abnormalities take to resolve in pneumonia patients?
Radiographic abnormalities may take up to 6 weeks to completely resolve.
What is considered hypothermia in the context of pneumonia management?
Core temperature <36°C.
What temperature range indicates high risk in patients with CAP?
Temperature < 36 or > 40 degrees Celsius.
What is the dosing frequency for most inhaled corticosteroids (ICS)?
Twice daily unless otherwise stated.
What is the level of interference with normal activity in intermittent asthma?
None.
How much does tidal volume increase due to progesterone-driven respiratory stimulation?
Approximately 40%.
What does a BUN level greater than 19 mg/dL indicate in the CURB-65 scoring?
It scores 1 point in the CURB-65 assessment.
What alternative antibiotic may be given postpartum for pneumonia?
Doxycycline may be given instead if postpartum.
What is nosocomial pneumonia?
An acute infection of the pulmonary parenchyma acquired in a hospital setting.
What mental state change indicates high risk in patients with CAP?
Altered mental state of acute onset.
What is the combination of Budesonide and Formoterol classified as?
LABA/ICS Inhaler.
What defines the lung function in severe persistent asthma?
Less than 60% predicted.
What is the increase in minute ventilation during pregnancy?
30 to 40 percent.
What are the implications of leukopenia in pneumonia patients?
Leukopenia (<4000/µL) is a risk factor for early deterioration.
What defines Hospital Acquired Pneumonia?
Pneumonia acquired 48 hours or more after hospital admission.
What chest X-ray finding indicates high risk in patients with CAP?
Pleural effusion or abscess.
What is the high dose range for Fluticasone propionate?
500 mcg.
What is the use of short-acting beta-agonists in intermittent asthma?
Less than 2 days per week.
What is the change in arterial partial pressure of oxygen (PaO2) during pregnancy?
It rises from 100 to 105 mmHg.
What does confusion or disorientation indicate in pneumonia management?
It is a risk factor for early deterioration.
What is Ventilator Acquired Pneumonia?
Pneumonia acquired 48 hours or more after endotracheal intubation.
What is the prognosis for patients with low risk CAP?
Associated with low morbidity and mortality.
What does HFA stand for in inhalers?
Hydrofluoroalkane.
What is the FEV1/FVC ratio in moderate persistent asthma?
Normal.
How much does carbon dioxide (CO2) production increase due to expanded metabolic demands?
By 30%.
What is the mortality rate for inpatient admission according to CURB-65?
22%.
What type of pneumonia is obtained in health care facilities?
Health Care acquired pneumonia.
What is the mortality rate associated with moderate risk CAP?
Mortality rate of 21%.
What is the purpose of using a SABA?
Short-acting beta agonist for quick relief of asthma symptoms.
What happens to PaCO2 levels during pregnancy?
It is reduced from 40 to 32 mmHg.
What is the most common pathologic agent causing pneumonia?
Bacteria.
What is the mortality rate associated with high risk CAP?
Mortality rate of 36%.
What is the low dose range for Mometasone?
100-200 mcg.
By how much does residual volume diminish during pregnancy?
Approximately 20%, from 1500 ml to 1200 ml.
Name two common bacterial pathogens associated with pneumonia.
Streptococcus pneumoniae and Haemophilus influenzae.
What is the significance of 'NA' in the dosing table?
Not applicable.
How does the expanding uterus affect chest wall compliance?
It lowers chest wall compliance by one third.
Which atypical bacteria can cause pneumonia?
Legionella spp and Mycoplasma pneumoniae.
What is the reduction in functional residual capacity during pregnancy?
10 to 25%.
Which viruses are associated with pneumonia?
Influenza A and Varicella.
What is the odds ratio for hemorrhage in women with asthma?
1.09 (95% CI: 1.03-1.16).
What is the odds ratio for gestational diabetes in asthmatic women?
1.10 (95% CI: 1.03-1.19).
What is the odds ratio for chorioamnionitis in women with asthma?
1.12 (95% CI: 1.09-1.15).
What is the odds ratio for preeclampsia in asthmatic women?
1.14 (95% CI: 1.06-1.22).
What is the odds ratio for placental abruption in women with asthma?
1.22 (95% CI: 1.09-1.36).
What is the odds ratio for ICU admission in asthmatic women?
1.34 (95% CI: 1.04-1.72).
What is the odds ratio for pulmonary embolism in women with asthma?
1.71 (95% CI: 1.05-2.79).
What is the odds ratio for SGA neonates in asthmatic women?
1.10 (95% CI: 1.05-1.16).
What is the odds ratio for preterm delivery in women with asthma?
1.47 (95% CI: 1.12-1.23).
What is the odds ratio for anomalies in asthmatic women?
1.48 (95% CI: 1.04-2.09).
