[Allergy & Asthma Corner]

Good asthma control during pregancy may result in: (see the pic below)

Asthma is a very treatable disorder which has been addressed in a multitude of publications and seminars in recent years. Death rates have decreased over the past few years but hospital admissions and emergency department visits have remained high. Under-treatment is a major reason for asthma attacks and poor control.

Pregnancy has unpredictable influences on asthma control. Some women have better lung function with pregnancy while others have a worse experience.

It is very important to maintain good asthma control throughout pregnancy. Some women and their family and friends are fearful about medications taken while pregnant. Asthma medications should be reviewed by your doctor. The risk of harm from asthma medications are far outweighed by the risk of uncontrolled asthma.

Remember:

1) Most inhalers have very little systemic absorption. This means very little amounts of the drug get past the lung when inhaled. Preferred asthma and nasal medications tend to be inhalants. Steroidal inhalants are cornerstone to controlling asthma. There is an available category B inhalant for the lungs as well as the nose. (See the link on defining drug categories in pregnancy below)

2) There is more of a risk of impaired pregnancy and labor from under-treatment of asthma Vs over treatment. Under-treatment may result in less oxygen getting to the developing baby. During crucial times of tissue development, less oxygen may be harmful. The embryo or fetus must get oxygen left over from blood that the mother’s tissues have already begun to extract.

Recent revisions of asthma management guidelines emphasize the importance of controlling inflammation and measuring lung function as well as the level of asthma control.

Any women with a history of moderate to severe asthma should be followed by an asthma specialist (allergist or pulmonologist). A pulmonary function test should be done early on and periodically through the pregnancy if warranted. Rhinitis should also be addressed and adequately managed. Mouth breathing, because of nasal blockage may be followed by throat irritation, cough and worsening asthma.

An asthma action plan should be established. Peak flow monitoring at home may assist in managing your asthma. Scheduled follow-up visits are very important.

Well controlled asthma during pregnancy reduces risk of complications for both the mother and child.

www.acaai.org/public/advice/pregn.htm

and

www.en.wikipedia.org/wiki/Pregnancy_category

"A beautiful baby girl" To mom: Thanks for letting me show off Shandra

Are you surviving the cold and flu season so far? The worse has yet to come unfortunately. The Christmas and New Year’s holidays usually provide further exposures to germs, allergens and irritants. The intermingling of relatives and friends as they visit each other increases the sharing of viruses, and other infections. The allergen and irritant exposure may occur when visiting households that have few or no environmental controls. Wood burning, scented candles, dusty ornaments and artificial trees and plants, cats, dogs, birds and other pets are just a few potential factors.

This time of the year one may more frequently encounter the friend or relative that smokes cigarettes, cigars or pipe tobacco. The outdoor weather keeps more of these polluters of indoor air inside.

How can you prepare for some of these potential exposures?

If you will be visiting another home for the holiday season anytime soon:

-1. Dress warmly making sure to cover your extremities well (head, face, hands and feet)

-2. Ask your allergist or doctor if certain allergy medications may be taken before leaving your home, in order to prevent allergy symptoms form occurring.

-3. Inform your host of specific triggers important for you to avoid (such as tobacco, wood burning smoke, fragrances and fumes and food allergies).

-4. If the host or hostess have pets that you are allergic to, ask that they be put up early in the day. Try to stay in rooms that are least frequented by the pets. Minimize the time you spend in homes where you have previously had problems. Leave early if you develop symptoms, especially chest symptoms.

-5. Make certain you take some of your allergy medications with you, especially inhalers.

-6. If there will be an overnight stay (not recommended in homes where problems have previously arisen) take your pillow or at least, your dust mite proof encasement with you. Have your host restrict pets from the guest bedroom area. The bedroom should be vacuumed and damp dusted hours before your arrival. Any stuffed animals or other dust catching items should be removed from the bedroom.

-7. For asthma patients: Have your asthma action plan available as well as medications required to follow the plan (see my section on Asthma Checklist and Asthma Action Plan). Parents should provide relatives and friends with phone numbers that may be needed in case there are serious problems.

The holidays are such joyful occasions yet allergic and infectious problems tend to frequently taint the experience for many patients and families. Frequent hand washing and limited kissing and hugs (harder not to hug…I know) might give you an edge in dodging the feared cold and flu virus. A dust or surgical mask over the face of a sick adult or older child may also help, especially if they are coughing or sneezing (of course staying home in bed would be better but…).

Hopefully you have had your flu shot, if not, it’s not too late.

I hope my tips and suggestions are helpful.

To my patients: Let me know you read this email and I’ll give you an extra sample, if available.