p.1
Pregnancy-Induced Changes in Ventilatory Physiology
What is the focus of the lecture by Lynnell Joy B. Espinosa, MD?
Pulmonary disorders in pregnancy.
p.17
Management and Treatment of Asthma
What are the potential effects of prostaglandin F2α (carboprost) on asthmatic patients?
It can cause bronchoconstriction.
p.4
Clinical Course of Asthma
When was the increase in asthma symptoms most prominent for those whose condition worsened?
Between 29-36 weeks gestation.
p.14
Management and Treatment of Asthma
How does good control of asthma during pregnancy affect perinatal outcomes?
It leads to a reduction in asthma exacerbations and fewer adverse perinatal outcomes.
p.16
Management and Treatment of Asthma
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.
p.13
Maternal and Perinatal Outcomes in Asthma
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.
p.24
Management and Treatment of Asthma
When may outpatient treatment be considered for pregnant patients with CAP?
For patients classified as LOW RISK.
p.10
Pharmacological Options for Asthma Treatment
What are the main types of pharmacological options for asthma treatment?
Controllers, relievers, and add-on therapies.
p.10
Pharmacological Options for Asthma Treatment
What is the purpose of controller medications in asthma treatment?
To reduce airway inflammation, control symptoms, and reduce future risks such as exacerbations.
p.8
Management and Treatment of Asthma
What are the components of the stepwise approach to asthma treatment?
Inhaled corticosteroids (ICS), long-acting beta-agonists (LABA), and oral corticosteroids (OCS).
p.16
Management and Treatment of Asthma
What is the recommended dose of parenteral hydrocortisone for pregnant asthmatics on oral steroids?
100 mg every 6-8 hours during labor.
p.17
Management and Treatment of Asthma
Which prostaglandin is considered a safer analog if treatment is required for asthmatic patients?
Prostaglandin E2 (dinoprostone).
p.7
Management and Treatment of Asthma
What does FEV stand for in the context of asthma?
Forced Expiratory Volume at 1 second.
p.5
Clinical Course of Asthma
What are the clinical stages of asthma characterized by?
They range from mild wheezing to severe bronchoconstriction.
p.7
Management and Treatment of Asthma
What does PEFR stand for?
Peak Expiratory Flow Rate.
p.12
Management and Treatment of Asthma
Is FENO effective in treatment planning for pregnant patients with asthma?
Yes, it is effective in treatment planning.
p.23
Classification and Management of Pneumonia
Is the pneumococcal vaccine recommended for healthy pregnant women?
No, it is not recommended.
p.21
Management and Treatment of Asthma
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).
p.23
Classification and Management of Pneumonia
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.
p.12
Management and Treatment of Asthma
What role does FENO play in antenatal asthma management?
It serves as a guide for pharmacological management to significantly reduce exacerbations.
p.20
Clinical Course of Asthma
What heart rate indicates high risk in patients with CAP?
Pulse rate (PR) > 125 bpm.
p.20
Clinical Course of Asthma
What blood pressure reading indicates high risk in patients with CAP?
Systolic blood pressure (SBP) < 90 mmHg.
p.9
Pharmacological Options for Asthma Treatment
What is the dosing frequency for most inhaled corticosteroids (ICS)?
Twice daily unless otherwise stated.
p.18
Classification and Management of Pneumonia
What is Ventilator Acquired Pneumonia?
Pneumonia acquired 48 hours or more after endotracheal intubation.
p.9
Pharmacological Options for Asthma Treatment
What is the purpose of using a SABA?
Short-acting beta agonist for quick relief of asthma symptoms.
p.11
Maternal and Perinatal Outcomes in Asthma
What is the odds ratio for gestational diabetes in asthmatic women?
1.10 (95% CI: 1.03-1.19).
p.15
Non-Pharmacologic Interventions for Asthma
What type of medications should be avoided to prevent worsening asthma?
Medications that may make asthma worse.
p.4
Clinical Course of Asthma
How was asthma severity generally characterized during the last 4 weeks of pregnancy?
Asthma was generally less severe.
p.12
Management and Treatment of Asthma
How does the use of exhaled nitric oxide fraction (FENO) affect asthma exacerbations in pregnant patients?
It helps in reducing exacerbations.
p.7
Management and Treatment of Asthma
What is the significance of FEV and PEFR in managing acute asthma attacks?
They are used to assess lung function and guide treatment.
p.25
COVID-19 and Pregnancy
What syndrome did SARS-CoV cause?
Severe acute respiratory syndrome (SARS).
p.13
Management and Treatment of Asthma
What is recommended for pregnant asthmatics regarding intranasal corticosteroids?
The use of intranasal corticosteroids as controller medication is recommended.
p.8
Management and Treatment of Asthma
What is considered mild intermittent asthma?
Asthma that has minimal or no chronic symptoms and minimal or no exacerbations.
p.8
Management and Treatment of Asthma
What is the significance of minimal use of short-acting inhaled beta2-agonists?
It indicates better asthma control and fewer symptoms.
p.21
Management and Treatment of Asthma
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.
p.2
Pregnancy-Induced Changes in Ventilatory Physiology
What happens to expiratory reserve volume during pregnancy?
It declines from 1300 ml to approximately 1100 ml.
p.20
Clinical Course of Asthma
What mental state change indicates high risk in patients with CAP?
Altered mental state of acute onset.
p.19
Classification and Management of Pneumonia
What are the implications of leukopenia in pneumonia patients?
Leukopenia (<4000/µL) is a risk factor for early deterioration.
p.19
Classification and Management of Pneumonia
What does confusion or disorientation indicate in pneumonia management?
It is a risk factor for early deterioration.
p.11
Maternal and Perinatal Outcomes in Asthma
What is the odds ratio for preeclampsia in asthmatic women?
1.14 (95% CI: 1.06-1.22).
p.11
Maternal and Perinatal Outcomes in Asthma
What is the odds ratio for pulmonary embolism in women with asthma?
1.71 (95% CI: 1.05-2.79).
p.11
Maternal and Perinatal Outcomes in Asthma
What is the odds ratio for anomalies in asthmatic women?
1.48 (95% CI: 1.04-2.09).
p.17
Management and Treatment of Asthma
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.
p.5
Clinical Course of Asthma
What does FEV1/FVC ratio indicate in asthma?
It measures the proportion of forced expiratory volume in one second to forced vital capacity.
p.5
Clinical Course of Asthma
What is the significance of a FEV1 of 65-80%?
It indicates a mild to moderate obstruction in airflow.
p.14
Pharmacological Options for Asthma Treatment
What is recommended to achieve control of asthma during pregnancy?
The use of pharmacologic therapy.
p.5
Clinical Course of Asthma
What does PEFR stand for?
Peak Expiratory Flow Rate.
p.22
Maternal and Perinatal Outcomes in Asthma
What conditions have increased incidence during pregnancy?
Pre-eclampsia and cesarean delivery.
p.5
Clinical Course of Asthma
What does a normal FEV1/FVC ratio suggest?
It suggests normal lung function without significant obstruction.
p.23
Classification and Management of Pneumonia
Who is recommended to receive one lifetime dose of PPSV23?
Gravidas with diabetes mellitus or chronic heart, lung, or liver disease.
p.23
Classification and Management of Pneumonia
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.
p.12
Management and Treatment of Asthma
How can asthma exacerbations during pregnancy be reduced?
Using a validated FENO-based treatment algorithm.
p.21
Management and Treatment of Asthma
What alternative antibiotic may be given postpartum for pneumonia?
Doxycycline may be given instead if postpartum.
p.20
Clinical Course of Asthma
What chest X-ray finding indicates high risk in patients with CAP?
Pleural effusion or abscess.
p.2
Pregnancy-Induced Changes in Ventilatory Physiology
By how much does residual volume diminish during pregnancy?
Approximately 20%, from 1500 ml to 1200 ml.
p.18
Classification and Management of Pneumonia
Which atypical bacteria can cause pneumonia?
Legionella spp and Mycoplasma pneumoniae.
p.11
Maternal and Perinatal Outcomes in Asthma
What is the odds ratio for ICU admission in asthmatic women?
1.34 (95% CI: 1.04-1.72).
p.4
Clinical Course of Asthma
What trend was observed in patients who improved during pregnancy?
Improvement was gradual as pregnancy progressed.
p.14
Maternal and Perinatal Outcomes in Asthma
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.
p.4
Maternal and Perinatal Outcomes in Asthma
What was noted about asthma symptoms during labor and delivery?
Substantial asthma symptoms were uncommon.
p.3
Clinical Course of Asthma
What is the hallmark of asthma?
Reversible airway obstruction from bronchial smooth muscle contraction, vascular congestion, tenacious mucus, and mucosal edema.
p.12
Management and Treatment of Asthma
What is a non-invasive method used during pregnancy to assess airway inflammation?
Measurement of exhaled nitric oxide (FENO).
p.10
Pharmacological Options for Asthma Treatment
What are reliever medications used for in asthma management?
For as-needed relief of breakthrough symptoms during worsening asthma or exacerbations.
p.6
Classification and Management of Pneumonia
How often do moderate persistent asthma symptoms occur?
More than 2 days per week, but not daily.
p.9
Pharmacological Options for Asthma Treatment
What is the brand name for Albuterol?
Proventil HFA, Ventolin HFA, ProAir HFA, Xopenex HFA.
p.6
Classification and Management of Pneumonia
What is the use of short-acting beta-agonists in intermittent asthma?
Less than 2 days per week.
p.18
Classification and Management of Pneumonia
Name two common bacterial pathogens associated with pneumonia.
Streptococcus pneumoniae and Haemophilus influenzae.
p.18
Classification and Management of Pneumonia
Which viruses are associated with pneumonia?
Influenza A and Varicella.
p.16
Management and Treatment of Asthma
Does intravenous hydrocortisone reduce maternal morbidity during labor and delivery in asthmatic pregnant patients?
Yes, it is indicated for reducing maternal morbidity.
p.24
Maternal and Perinatal Outcomes in Asthma
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?
p.24
Clinical Course of Asthma
How should pregnant patients with confirmed CAP be stratified?
According to disease severity.
p.25
COVID-19 and Pregnancy
What was the first coronoviral infection in China and when did it occur?
The first coronoviral infection was SARS-CoV, which occurred in 2002.
p.14
Maternal and Perinatal Outcomes in Asthma
What adverse perinatal outcomes can pharmacologic therapy help prevent in asthmatic pregnant patients?
Preterm delivery, congenital fetal anomalies, and fetal growth restriction.
p.8
Management and Treatment of Asthma
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.
p.13
Maternal and Perinatal Outcomes in Asthma
Do intranasal corticosteroids increase the risk for the development of gestational diabetes among women with asthma?
No, they do not increase the risk.
p.10
Pharmacological Options for Asthma Treatment
When are add-on therapies considered for asthma patients?
When patients have persistent symptoms or exacerbations despite optimized treatment with high-dose controlled medications.
p.19
Classification and Management of Pneumonia
What does a CURB-65 score of 4 or 5 indicate?
Consider inpatient admission and possibly ICU care.
p.25
COVID-19 and Pregnancy
Are mRNA COVID-19 vaccines safe during pregnancy?
Yes, they are safe during pregnancy and among breastfeeding women.
p.21
Management and Treatment of Asthma
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.
p.21
Management and Treatment of Asthma
How long may radiographic abnormalities take to resolve in pneumonia patients?
Radiographic abnormalities may take up to 6 weeks to completely resolve.
p.19
Classification and Management of Pneumonia
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.
p.18
Classification and Management of Pneumonia
What defines Hospital Acquired Pneumonia?
Pneumonia acquired 48 hours or more after hospital admission.
p.20
Clinical Course of Asthma
What is the prognosis for patients with low risk CAP?
Associated with low morbidity and mortality.
p.2
Pregnancy-Induced Changes in Ventilatory Physiology
What happens to PaCO2 levels during pregnancy?
It is reduced from 40 to 32 mmHg.
p.11
Maternal and Perinatal Outcomes in Asthma
What is the odds ratio for chorioamnionitis in women with asthma?
1.12 (95% CI: 1.09-1.15).
p.22
Maternal and Perinatal Outcomes in Asthma
What are some complications associated with maternal mortality?
Acute lung infection, prematurely ruptured membranes, and preterm delivery.
p.13
Maternal and Perinatal Outcomes in Asthma
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.
p.8
Management and Treatment of Asthma
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.
p.14
Clinical Course of Asthma
Does sustained versus interrupted pharmacologic therapy affect the incidence of congenital fetal anomalies?
The text does not provide a definitive answer to this question.
p.7
Management and Treatment of Asthma
What is the purpose of the management protocol for acute asthma?
To provide structured care for patients experiencing asthma attacks.
p.20
Clinical Course of Asthma
What vital sign indicates moderate risk in patients with CAP?
Respiratory rate (RR) < 30 per minute.
p.25
COVID-19 and Pregnancy
What was the second worldwide outbreak of coronavirus and when did it occur?
COVID-19, which occurred in 2019-2020.
p.18
Classification and Management of Pneumonia
What is the most common form of pneumonia?
Community-acquired pneumonia.
p.2
Pregnancy-Induced Changes in Ventilatory Physiology
How does the expanding uterus affect chest wall compliance?
It lowers chest wall compliance by one third.
p.11
Maternal and Perinatal Outcomes in Asthma
What is the odds ratio for placental abruption in women with asthma?
1.22 (95% CI: 1.09-1.36).
p.11
Maternal and Perinatal Outcomes in Asthma
What is the odds ratio for SGA neonates in asthmatic women?
1.10 (95% CI: 1.05-1.16).
What is asthma classified as?
A chronic inflammatory airway syndrome with major hereditary components.
p.13
Management and Treatment of Asthma
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.
p.3
Maternal and Perinatal Outcomes in Asthma
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.
p.19
Classification and Management of Pneumonia
What are the two scoring systems used to guide admission for pneumonia?
Pneumonia Severity Index (PSI) and CURB-65 scoring system.
p.21
Management and Treatment of Asthma
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.
p.6
Classification and Management of Pneumonia
What characterizes severe persistent asthma symptoms?
Symptoms occur throughout the day.
When do most asthma exacerbations occur during pregnancy?
In the second half of pregnancy.
p.2
Pregnancy-Induced Changes in Ventilatory Physiology
What is the change in arterial partial pressure of oxygen (PaO2) during pregnancy?
It rises from 100 to 105 mmHg.
p.18
Classification and Management of Pneumonia
What type of pneumonia is obtained in health care facilities?
Health Care acquired pneumonia.
p.11
Maternal and Perinatal Outcomes in Asthma
What is the odds ratio for hemorrhage in women with asthma?
1.09 (95% CI: 1.03-1.16).
p.6
Classification and Management of Pneumonia
What is the frequency of symptoms for intermittent asthma?
Less than 2 days per week.
p.3
Clinical Course of Asthma
What is the 'rule of thirds' in asthma during pregnancy?
1/3 will improve, 1/3 will remain unchanged, and 1/3 will deteriorate.
p.20
Clinical Course of Asthma
What vital sign indicates high risk in patients with CAP?
Respiratory rate (RR) > 30 per minute.
p.10
Pharmacological Options for Asthma Treatment
What are the rescue medications of choice for pregnant asthmatic patients?
Inhaled SABA (Short-Acting Beta Agonists).
p.19
Classification and Management of Pneumonia
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.
p.20
Clinical Course of Asthma
What temperature range indicates high risk in patients with CAP?
Temperature < 36 or > 40 degrees Celsius.
p.18
Classification and Management of Pneumonia
What is nosocomial pneumonia?
An acute infection of the pulmonary parenchyma acquired in a hospital setting.
p.11
Maternal and Perinatal Outcomes in Asthma
What is the odds ratio for preterm delivery in women with asthma?
1.47 (95% CI: 1.12-1.23).
