WORLD ASTHMA DAY IS OBSERVED ON FIRST TUESDAY OF EVERY MAY.
THEME OF THIS YEAR IS
NEVER TOO EARLY NEVER TOO LATE
WORLD ASTHMA DAY IS OBSERVED ON FIRST TUESDAY OF EVERY MAY.
THEME OF THIS YEAR IS
NEVER TOO EARLY NEVER TOO LATE
Asthma is the most common chronic disease in children.
Its incidence is increasing even in the era of advanced investigation facilities and treatment modalities’.
Most school days of children are lost due to asthma morbidities.
Interaction between host and environment is necessary for the manifestations of disease in genetically susceptibles.
Stress is one of the aggravating factor for asthma flare ups.
It has long been assumed that the stress has a causative role in asthma and now a definite link has been found.
The exact mechanism for the causation of asthma by stress is still unclear.
There is more concerns by Researchers and clinicians about the developments during intrauterine life and during the first 2 years of life.
Stress during pregnancy affects the immune system,neuroendocrine system and antioxidant system.
The result is recurrent respiratory tract infections and recurrent wheezing and asthma in children born to such mothers having depression and anxiety during pregnancy.
Smejda and colleagues studied on 370 pairs of mother and child to know the correlation between maternal stress ,atopic dermatitis,asthma and recurrent respiratory infections.Those mothers were included who experienced stress for at least 1 month during pregnancy. The study was a part of Polish mother and child cohort,a large multicentre prospective cohort study established in 2007..The lead researcher was Katarzyna Smejda MD from the department of Pediatrics and Allergy ,Medical university of Lodz in Poland.The whole cohort comprises 1700 pairs of mother and child followed from pregnancy upto 2 years of age of the child. The ongoing cohort study is focussed on the child at the age of 7 years.
Thakur and colleagues studied the effect of social discrimination on development of asthma in children aged 8-21 years.African American children who were discriminated socially had 78% more chance of developing asthma as compared to nondiscriminated(OR, 1.78; 95% CI,1.33-2.39). Children who felt discriminated socially also had poor asthma control even after good adherence to correct technique of asthma controller medication as compared to nondiscriminated choldren.(OR, 1.97; 95% CI, 1.42-2.76)
In conclusion,stress free environment during pregnancy and childhood is essential for a good respiratory health of children.
REFERENCES:
It has been observed that, there happens no chanage in FEV1,no admissible change in FEV1/FVC and a slight increase in FVC ,during normal pregnancy.There should be a cause of concern in case of any deviation seen in these observed parameters.
In normal pregnancy,there happens a change in cardiac output,stroke volume and heart rate.Women already diagnosed asthma may experience exacerbation due to these changes.Some women especially those who are genetically predisposed to develop asthma may experience the symptoms of asthma first time due to these changes during pregnancy.The enlarged gravid uterus my compress the inferior vena cava during third trimester of pregnancy,thereby decreasing cardiac output.This mechanical change along with some hormonal changes may exacerbate asthma and nonallergic rhinitis.
There is a strong correlation of asthma with obstetric and non obstetric comorbidities.Among obstetric ,the important ones are,preeclamsia,placenta previa,abruptio placenta eand obstetrical hemorrhage. There is higher rates of caesarean delivery in women with asthma.Among non obstetric comorbidities are increased rates of gestational Diabetes,increased rates of pulmonary embolism and increased frequency of respiratory infections including influenza.
Asthma exacerbation causes adverse effects on fetuses which includes,prematurity,low birth weight,fetal deaths(still birth) and some congenital anomalies in the form of cleft lip and cleft palate.Low birth weight has been seen more commonly in female while prematurity and still births have been seen more commonly in male fetuses.Children born to mothers having asthma have more chance of developing asthma.
Variuos research studies show that a good control of asthma symptoms and reducing or avoiding asthma exacerbation results in better outcome for mother and babies. There is a growing evidence in literatures that suggest that, inhalational corticosteroids(ICS) and beta-2 agonists(SABA), both are safe to be used during pregnancy for asthma management.Among ICS, the most studied is budesonide.ICS use during pregnancy improves FEV1 and reduces exacerbations.
The safety of biologicals in the form of IgE inhibitor(omalizumab) and anti IL-5(meplozumab and reslizumab),have not been established.However ,the woman already on these medications before becoming pregnant has not been seen to experience any adverse outcome.
Treating comorbidities is an important part to control asthma. If there is coexisting allergic or nonallergic rhinitis,it should be treated with intranasal sterioids.Coexisting GER should be treated with PPI . If there is coexisting anxiety and depression ,these should be addressed properly.
We should not forget to avoid allergen exposure in the form of house dust mite,animal danders,cockroaches,pollen and indoor molds. According to NAEP ,allergen impermeable bed coverings should be used,bed sheets should be washed weekly with water at or above 130 degree F,and humidity should be kept below 50%.
Good control of asthma by non pharmacologic and whenever needed pharmcologic measures gives better outcome for mothers and babies
REFERENCES:
1.Bonham CA, Patterson KC, Strek ME. Asthma outcomes and management during pregnancy [published online September 1, 2017]. Chest.pii: S0012-3692(17)31485-X. doi:10.1016/j.chest.2017.08.029
2.Meakin AS, Saif Z, Jones AR, Aviles PFV, Clifton VL. Review: placental adaptations to the presence of maternal asthma during pregnancy. Placenta. 2017;54:17-23.
3.Global Initiative for Asthma. Global strategy for asthma management and prevention, 2017. www.ginasthma.org Accessed October 3, 2017.
4.Liu X, Agerbo E, Schlünssen V, Wright RJ, Li J, Munk-Olsen T. Maternal asthma severity and control during pregnancy and risk of offspring asthma [published online June 28, 2017]. J Allergy Clin Immunol. 2017. pii: S0091-6749(17)30854-0. doi:10.1016/j.jaci.2017.05.016
5.National Heart, Lung, and Blood Institute; National Asthma Education and Prevention Program Asthma and Pregnancy Working Group. NAEPP expert panel report. Managing asthma during pregnancy: recommendations for pharmacologic treatment-2004 update. J Allergy Clin Immunol. 2005;115(1):34-46.
6.Bain E, Pierides KL, Clifton VL, et al. Interventions for managing asthma in pregnancy. Cochrane Database Syst Rev. 2014;10:CD010660. doi:10.1002/14651858.CD010660.pub2