Respiratory disorders Asthma a chronic disorder of the respiratory system an inflammatory hyper- responsiveness of the airways to certain triggers narrowing, resulting in obstruction of the airways and mucous production Asthma is characterized by : intermifent episodes of wheezing and shortness of breath as the individual afempts to inhale and exhale. These symptoms are variable and can be worse at night . The condition is under-diagnosed in female adolescents

Tr ig g e r s f o r a st hm a Pollen and house dust mite allergens Chronic nasal rhinitis Smoking: primary and passive Infection Occupational exposure Pollution Cold air and physical exercise Food Drugs, e.g. aspirin Premenstrual conditions and pregnancy

Investigations include: peak expiratory flow measurements using a small hand-held device (peak flow meter) to assess the speed by which air is exhaled spirometry via a spirometer to measure the volume and speed of air exhaled allergy testing chest X-ray to exclude other conditions steroid trial: 2 weeks of oral prednisolone or 6 weeks of an inhaled corticosteroid.

Treatment : salbutamol corticosteroid inhaler (e.g. betclometasone dipropionate), twice a day: usually colour-coded brown or orange and described as a preventer inhaler bronchodilator inhaler/beta-2 agonist (e.g. salbutamol), when required: colour-coded blue and described as a reliever inhaler. -long acting beta-2 agonists, theophyllines, leukotriene antagonists and, in extreme cases, oral corticosteroids

-In pregnancy, women are at increased risk of : delivering low birth weight preterm babies have a greater tendency to other medical complications such as pre-eclampsia medication used to control asthmatic symptoms is generally safe in pregnancy These include:

short- and long-acting beta-2 agonists inhaled steroids oral theophyllines leukotriene antagonists: if they are already being used, these should continue, but should not be commenced as a new therapy steroid tablets: indicated for severe asthma and exacerbation -pregnant women should be encouraged to cease smoking - avoid passive cigarette smoke.

Severe acute asthma, also termed status asthmaticus or asthma attack, occurs when there is spasm of the smooth muscle in the walls of the smaller bronchi and bronchioles leading to partial or complete obstruction of the airways, known as bronchoconstriction. This manifests with periods of coughing, wheezing and difficulty with exhalation. Air may become trapped in the alveoli during exhalation. Excessive secretion of mucous may obstruct the bronchioles and worsen the afack. This is a medical emergency and pregnant women should be treated in hospital.

High flow oxygen should be administered immediately to maintain saturations between 94 and 98%, a systemic corticosteroid given and inhaled short-acting beta-2 agonists administered via a large volume spacer or nebulizer -If the response is poor, inhaled ipratropium bromide may be given and arrangements made to transfer the woman to the ICU/HDCU for ventilatory support

The labour of a woman whose asthma is well controlled may progress physiologically, supported by the midwife. -Those women who have been receiving oral steroids may require hydrocortisone during labour. -If anaesthesia is required, epidural is preferable to general anaesthesia. - If ergometrine and syntometrine are used to control blood loss following the birth of the placenta, extreme caution should be taken to reduce the risk of inducing bronchoconstriction -Breastfeeding should be encouraged and the woman should continue to take all prescribed medication for her asthma during lactation