Discussion Question 1:
SE, a twenty-two-year-old Caucasian woman, has been diagnosed with asthma since the age of seven. Her medical records indicate that she has “mild persistent” asthma. Recently, she reports an increase in her albuterol metered-dose inhaler (MDI) usage, averaging three to four days per week over the last two months. In the past week, SE has been using albuterol once daily. She has experienced coughing episodes three nights within the last month, and shortness of breath, particularly during exercise. However, it is important to note that SE experiences shortness of breath at other times as well. SE also uses a fluticasone MDI “most days of the week.” She has been hospitalized twice in the past year due to poorly controlled asthma and visited the emergency department (ED) three times in the last six months for the same reason. SE’s lab work is within normal limits, except for a positive human chorionic gonadotropin (HCG) result.
To effectively manage asthma during pregnancy, it is essential to follow established guidelines, including those provided by the National Institutes of Health (NIH). These guidelines recommend a systematic approach to asthma management and highlight the importance of individualized care for pregnant women with asthma (Global Initiative for Asthma, 2019). SE’s case involves considerations such as asthma severity, symptom control, medication usage, and potential risks associated with her pregnancy.
Firstly, it is important to assess the severity of SE’s asthma. According to the NIH guidelines, severity can be categorized as intermittent, mild persistent, moderate persistent, or severe persistent (Global Initiative for Asthma, 2019). SE’s medical records indicate that she has “mild persistent” asthma. This classification suggests that her symptoms occur more than twice a week but less than once daily (Global Initiative for Asthma, 2019).
Next, it is important to evaluate how well her asthma symptoms are controlled. SE’s recent increase in albuterol MDI usage and her admission to the hospital and ED for poorly controlled asthma indicate a lack of effective symptom control. According to the NIH guidelines, asthma control can be classified as “well controlled,” “not well controlled,” or “very poorly controlled” (Global Initiative for Asthma, 2019). SE’s current symptom pattern suggests that her asthma is not well controlled.
Considering her medication usage, SE’s reports of using albuterol MDI three to four days per week and fluticasone MDI “most days of the week” indicate a need for adjustment. The NIH guidelines recommend an individualized management plan that includes medications appropriate for asthma severity and controlling symptoms during pregnancy (Global Initiative for Asthma, 2019). SE’s increased use of albuterol MDI suggests a need for better asthma control, and her fluticasone MDI usage may need optimization.
It is important to note that pregnant women with asthma face unique considerations due to the potential risks associated with both asthma and medication usage during pregnancy. According to the NIH guidelines, uncontrolled asthma can lead to adverse outcomes for both the mother and the fetus (Global Initiative for Asthma, 2019). Poorly controlled asthma is associated with an increased risk of preterm birth, low birth weight, and maternal complications. However, it is important to balance the risks and benefits of asthma medication usage during pregnancy to ensure appropriate management (Murphy, 2018).
To proceed with a management plan for SE, it is necessary to take into account the severity and control of her asthma, her medication usage, and the potential risks associated with her pregnancy. This plan should be individualized to address SE’s specific needs and align with the guidelines provided by the NIH. Additionally, other peer-reviewed articles can be utilized to support specific aspects of the plan. Proper management of SE’s asthma during pregnancy is crucial for her well-being and the health of her unborn child.