Manajemen Asma dalam Kehamilan: Apa yang Harus Dipahami oleh Dokter Umum

Penulis

  • Muhammad Habiburrahman Fakultas Kedokteran Universitas Indonesia, Jakarta Pusat, Indonesia, RSUPN Dr. Cipto Mangunkusumo, Jakarta Pusat, Indonesia, RSUD Tebet, Jakarta Selatan, Indonesia
  • Muhammad Ilham D Rakasiwi Fakultas Kedokteran Universitas Indonesia, Jakarta Pusat, Indonesia

DOI:

https://doi.org/10.55175/cdk.v50i3.657

Kata Kunci:

Asma, dokter umum, kehamilan, manajemen, pelayanan primer

Abstrak

Eksaserbasi asma dalam kehamilan dapat mempersulit proses persalinan dan berisiko bayi lahir dengan berat badan lahir rendah dan ibu berisiko mengalami persalinan preterm, preeklampsia, dan sectio caessaria. Penyebab eksaserbasi asma dalam kehamilan dapat akibat terapi kurang optimal selama kehamilan akibat kekhawatiran personal pasien dan dokter yang kurang didukung bukti terkait keamanan agen farmakologis asma dalam kehamilan, dan rendahnya kepatuhan pasien untuk kontrol rutin, terutama selama masa pandemi COVID-19. Hingga kini, manajemen asma antenatal menjadi tugas besar dokter umum di layanan primer, dan dokter spesialis obstetrik dan ginekologi, serta dokter spesialis paru di layanan sekunder, sedangkan panduan khusus komprehensif asma dalam kehamilan di Indonesia masih terbatas. Telaah literatur ini bertujuan untuk memberikan pemahaman esensial perubahan klinis dan mekanisme yang berkontribusi terhadap tidak terkontrolnya asma selama kehamilan, pendekatan diagnosis komprehensif asma dalam kehamilan, dan menyediakan informasi obat-obatan yang aman untuk manajemen asma dalam kehamilan.

Asthma exacerbations in pregnancy can complicate the delivery process and risk low birth weight in the baby, as well as preterm labor, preeclampsia, and a cesarean section in mothers. Asthma exacerbations during pregnancy can be caused by ineffective treatment due to patient and physician concerns about the safety of asthma medications during pregnancy that are not supported by reliable data, as well as poor patient compliance for routine control, particularly during the COVID-19 pandemic. Asthma management during antenatal care falls primarily on general practitioners in primary care, and obstetricians and gynecologists, and pulmonologists in secondary-level services. While specific guidelines in Indonesia are still limited, this review aims to present a fundamental understanding of clinical changes and mechanisms that contribute to the uncontrolled status of asthma during pregnancy, a comprehensive diagnostic approach to asthma in pregnancy, and provide a safety drug profile during pregnancy

Unduhan

Data unduhan belum tersedia.

Referensi

Odedra KM. Treatment of asthma in pregnancy: A case study. Nurse Prescr. 2014;12(4):185–8.

Murphy VE, Gibson PG, Smith R, Clifton VL. Asthma during pregnancy: Mechanisms and treatment implications. Eur Respir J. 2005;25(4):731–50.

Murphy VE, Clifton VL, Gibson PG. Asthma exacerbations during pregnancy: Incidence and association with adverse pregnancy outcomes. Thorax. 2006;61(2):169–76.

Clifton VL, Busuttil MD. A case study of stillbirth in a pregnancy complicated by asthma. Obstet Gynecol cases Rev. 2015;2:2.

Kwon HL, Belanger K, Bracken MB. Effect of pregnancy and stage of pregnancy on asthma severity: A systematic review. Am J Obstet Gynecol. 2004;190(5):1201–10.

Munn MB, Groome LJ, Atterbury JL, Baker SL, Hoff C. Pneumonia as a complication of pregnancy . J Matern Fetal Med. 1999;8(4):151–4.

Goodnight WH, Soper DE. Pneumonia in pregnancy. Crit Care Med. 2005;33(10 Suppl).

Brabin L, Brabin BJ, Gies S. Influence of iron status on risk of maternal or neonatal infection and on neonatal mortality with an emphasis on developing countries. Nutr Rev. 2013;71(8):528–40.

Sutherland ER, Brandorff JM, Martin RJ. Atypical bacterial pneumonia and asthma risk. J Asthma. 2004;41(8):863–8.

Hsu YL, Lin CL, Wei CC. Association between vesicoureteral reflux, urinary tract infection and antibiotics exposure in infancy and risk of childhood asthma. PLoS One 2021;16(9):e0257531.

Philip KEJ, Buttery S, Williams P, Vijayakumar B, Tonkin J, Cumella A, et al. Impact of COVID-19 on people with asthma: A mixed methods analysis from a UK wide survey. BMJ Open Respir Res. 2022;9(1):e001056.

Duki MIZ, Sudarmadi S, Suzuki S, Kawada T, Tri-Tugaswati A. Effect of air pollution on respiratory health in Indonesia and its economic cost. Arch Environ Health. 2003;58(3):135–43.

Firoozi F, Ducharme FM, Lemière C, Beauchesne MF, Perreault S, Forget A, et al. Effect of fetal gender on maternal asthma exacerbations in pregnant asthmatic women. Respir Med. 2009;103(1):144–51.

Murphy VE, Schatz M. Asthma in pregnancy: A hit for two. Eur Respir Rev. 2014;23(131):64–8.

Ekström S, Mogensen I, Georgelis A, Westman M, Almqvist C, Melén E, et al. General stress among young adults with asthma during the COVID-19 pandemic. J Allergy Clin Immunol Pract. 2022;10(1):108–15.

Eldeirawi KM, Nyenhuis SM, Huntington-Moskos L, Polivka BJ. Coronavirus disease 2019–related anxiety is associated with uncontrolled asthma in adults. Ann Allergy, Asthma Immunol. 2022;129(1):109.

Robbins T, Shennan A, Sandall J. Modified early obstetric warning scores: A promising tool but more evidence and standardization is required. Acta Obstet Gynecol Scand. 2019;98(1):7–10.

Singh S, McGlennan A, England A, Simons R. A validation study of the CEMACH recommended modified early obstetric warning system (MEOWS). Anaesthesia 2012;67(1):12–8.

Ryan HM, Jones MA, Payne BA, Sharma S, Hutfield AM, Lee T, et al. Validating the performance of the modified early obstetric warning system multivariable model to predict maternal intensive care unit admission. J Obstet Gynaecol Canada 2017;39(9):728-733.e3.

Shields LE, Wiesner S, Klein C, Pelletreau B, Hedriana HL. Use of maternal early warning trigger tool reduces maternal morbidity. Am J Obstet Gynecol. 2016;214(4):527.e1-527.e6.

Carle C, Alexander P, Columb M, Johal J. Design and internal validation of an obstetric early warning score: Secondary analysis of the Intensive Care National Audit and Research Centre Case Mix Programme database. Anaesthesia 2013;68(4):354–67.

GINA. Global strategy for asthma management and prevention [Internet]. 2022 [cited 2022 Jul 3]. Available from: https://ginasthma.org/wp-content/uploads/2022/07/GINA-Main-Report-2022-FINAL-22-06-30-WMS.pdf

Ramasamy MN, Minassian AM, Ewer KJ, Flaxman AL, Folegatti PM, Owens DR, et al. Safety and immunogenicity of ChAdOx1 nCoV-19 vaccine administered in a prime-boost regimen in young and old adults (COV002): A single-blind, randomised, controlled, phase 2/3 trial. Lancet. 2021;396(10267):1979–93.

Lalloo UG, Ainslie GM, Abdool-Gaffar MS, Awotedu AA, Feldman C, Greenblatt M, et al. Guideline for the management of acute asthma in adults: 2013 update. S Afr Med J. 2012;103(3 Pt 2):189–98.

British Thoracic Society. QRG 153 • British guideline on the management of asthma quick reference guide. London: British Thoracic Society; 2016.

Lapinsky SE. Acute respiratory failure in pregnancy. Obstet Med. 2015;8(3):126.

Cochrane C, Marsden J. Asthma exacerbation in adults – Treatment [Internet]. 2022 [cited 2022 Jul 3]. Available from: https://www.bcemergencynetwork.ca/clinical_resource/asthma-exacerbation-in-adults-treatment/

Kokturk N, Turktas H, Kara P, Mullaoglu S, Yilmaz F, Karamercan A. A randomized clinical trial of magnesium sulphate as a vehicle for nebulized salbutamol in the treatment of moderate to severe asthma attacks. Pulm Pharmacol Ther. 2005;18(6):416–21.

Pollart SM, Compton RM, Elward KS. Management of acute asthma exacerbations . Am Fam Physician. 2011;84(1):40–7.

Soubra SH, Guntupalli KK. Acute respiratory failure in asthma. Indian J Crit Care. 2003;7:225-32.

Cheng C, Shyur S, Huang L, Kao Y. Factors for high-risk asthma in Taiwanese children. Asian Pacific J allergy Immunol. 2010;28(4):250–5.

Ichinose M, Sugiura H, Nagase H, Yamaguchi M, Inoue H, Sagara H, et al. Japanese guidelines for adult asthma 2017. Allergol Int. 2017;66(2):163–89.

Rai SP, Patil AP, Vardhan V, Marwah V, Pethe M, Pandey IM. Best treatment guidelines for bronchial asthma. Med J Armed Forces India 2007;63(3):264–8.

Stout JW, Visness CM, Enright P, Lamm C, Shapiro G, Gan VN, et al. Classification of asthma severity in children: The contribution of pulmonary function testing. Arch Pediatr Adolesc Med. 2006;160(8):844–50.

Reddel HK, Bacharier LB, Bateman ED, Brightling CE, Brusselle GG, Buhl R, et al. Global initiative for asthma strategy 2021: Executive summary and rationale for key changes. Eur Respir J. 2022;59(1):2102730. DOI: 10.1183/13993003.02730-2021.

Asthma Australia. Asthma control test - Asthma Australia [Internet]. [cited 2022 Jul 3]. Available from: https://asthma.org.au/about-asthma/understanding-asthma/asthma-control-test/

Lim AS, Stewart K, Abramson MJ, George J. Management of asthma in pregnant women by general practitioners: A cross sectional survey. BMC Fam Pract. 2011;12:121. doi: 10.1186/1471-2296-12-121.

Ayres-De-Campos D, Spong CY, Chandraharan E. FIGO consensus guidelines on intrapartum fetal monitoring: Cardiotocography. Int J Gynaecol Obstet. 2015;131(1):13–24.

Grivell RM, Alfirevic Z, Gyte GML, Devane D. Antenatal cardiotocography for fetal assessment. Cochrane database Syst Rev. 2015;2015(9):1–39.

Janga D, Yoong W. Electronic fetal monitoring. Royal College of Obstetrician and Gynaecologists [Internet]. 2015 [cited 2022 Jul 3]. Available from: https://elearning.rcog.org.uk//obstetrics/electronic-fetal-monitoring

Abubaker J, Syed F, Arsalan A, Akram M. Asthma management during pregnancy: Case report & literature review. PJCM. 2015.

Pernia S, Demaagd G. The new pregnancy and lactation labeling rule. Pharm Ther. 2016;41(11):713.

Gaga M, Oikonomidou E, Zervas1 E, Papageorgiou-Georgatou N. Asthma and pregnancy: Interactions and management. Breathe 2007;3(3.):267–76.

Namazy JA, Schatz M. The safety of asthma medications during pregnancy: An update for clinicians. Ther Adv Respir Dis. 2014;8(4):103–10.

Moore LE, Martin JNJ. When betamethasone and dexamethasone are unavailable: hydrocortisone. J Perinatol. 2001;21(7):456–8.

Roberts D, Brown J, Medley N, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane. 2017;3(3):CD004454.

Anderson GG, Rotchell Y, Kaiser DG. Placental transfer of methylprednisolone following maternal intravenous administration. Am J Obstet Gynecol. 1981;140(6):699–701.

Boehringer Ingelheim. Combivent UDVs. Datapharm. 2020.

Gluck PA, Gluck JC. A review of pregnancy outcomes after exposure to orally inhaled or intranasal budesonide. Curr Med Res Opin. 2005;21(7):1075–84.

Boehringer Ingelheim. Pulmicort Respules 0.5mg. Datapharm. 2017.

Boehringer Ingelheim. Combivent. FDA. 2012.

Boehringer Ingelheim. Salbutamol Tablets BP 2mg. Datapharm. 2021.

Truscott JE. Asthma drugs in pregnancy and lactation. Aust Prescr. 2014;37(1):6.

Boehringer Ingelheim. Bricanyl Injection, 0.5 mg/ml, solution for injection or infusion. Datapharm. 2021.

Shaker MS, Oppenheimer J, Grayson M, Stukus D, Hartog N, Hsieh EWY, et al. Reply to “subcutaneous terbutaline as an alternative to aerosolized albuterol.” J allergy Clin Immunol Pract. 2020/04/22. 2020;8(7):2450–2.

Simons FE, Gillies JD. Dose response of subcutaneous terbutaline and epinephrine in children with acute asthma. Am J Dis Child. 1981;135(3):214–7.

Kane BG. Alternative treatments for acute asthma during COVID. American College of Emergency Physicians [Internet]. 2021. Avaiable from: https://www.acep.org/corona/covid-19-field-guide/treatment/alternative-treatments/.

Kelly HW. Magnesium sulfate for severe acute asthma in children. J Pediatr Pharmacol Ther. 2003;8(1):40–5.

Kokotajlo S, Degnan L, Meyers R, Siu A, Robinson C. Use of intravenous magnesium sulfate for the treatment of an acute asthma exacerbation in pediatric patients. J Pediatr Pharmacol Ther. 2014;19(2):91–7.

FDA. FDA recommends against prolonged use of magnesium sulfate to stop pre-term labor due to bone changes in exposed babies. 2013.

Rahman Z, Helali AM. Facts about magnesium sulfate: Time to revise the safety concern in obstetric use. J Enam Med Coll. 2014;4(3):177–83.

Munn MB, Groome LJ, Atterbury JL, Baker SL, Hoff C. Pneumonia as a complication of pregnancy. J Matern Fetal Med. 1999;8(4):151–4.

Goodnight WH, Soper DE. Pneumonia in pregnancy. Crit Care Med. 2005;33(10 SUPPL.):390-7.

Stefan MS, Shieh MS, Spitzer KA, Pekow PS, Krishnan JA, Au DH, et al. Association of antibiotic treatment with outcomes in patients hospitalized for an asthma exacerbation treated with systemic corticosteroids. JAMA Intern Med. 2019;179(3):333–9.

Little BB. Drugs and pregnancy: A handbook. Great Britain: Oxford University Press Inc; 2006. 1–385 p.

Schaefer C, Peters P, Miller RK. Drugs during pregnancy and lactation: Treatment options and risk assessment. 2nd ed. Great Britain: Academic Press Elsevier; 2007.1–907 p.

Briggs GG, Freeman RK, Towers CV, Forinash AB. Drugs in pregnancy and lactation: A reference guide to fetal and neonatal risk. 11th ed. Philadelphia: Wolters Kluwer; 2017. 1–5614 p.

Al-Zidan RN. Drugs in pregnancy: A handbook for pharmacists and physicians. Burlington, Canada: Apple Academic Press Inc., Taylor & Francis Group; 2021. 1–465 p.

Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):45–67.

Roemer H, Roemer B, Katz VL, Dewan D, Bentley C. Acute respiratory infection in pregnancy [Internet]. 2013. Available from: https://www.acepnow.com/article/acute-respiratory-infection-pregnancy/.

Sandrock CE, Norris A. Infection in severe asthma exacerbations and critical asthma syndrome. Clin Rev Allergy Immunol. 2015;48(1):104–13.

Beloosesky R, Ginsberg Y, Khatib N, Maravi N, Ross MG, Itskovitz-Eldor J, et al. Prophylactic maternal N-acetylcysteine in rats prevents maternal inflammation-induced offspring cerebral injury shown on magnetic resonance imaging. Am J Obstet Gynecol. 2013;208(3):213.e1-213.e6.

Al-Jedai AH, Balhareth SS, Algain RA. Assessment of foetal risk associated with 93 non-US-FDA approved medications during pregnancy. Saudi Pharm J. 2012;20(4):287–99.

Wigle PR, McNeal SM, Tibbs K. Pregnancy and OTC cough, cold, and analgesic preparations. US Pharm; 2006. pp. 33–47.

Gupta R, Wadhwa R. Mucolytic medications. StatPearls [Internet]. 2021. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559163/#:~:text=Mucolytics%20are%20drugs%20used%20to,of%20agents%20called%20mucoactive%20agents.

Mokhtari V, Afsharian P, Shahhoseini M, Kalantar SM, Moini A. A review on various uses of N-acetyl cysteine. Cell J. 2017;19(1):11–7.

Macchi A, Terranova P, Castelnuovo P. Recurrent acute rhinosinusitis: A single blind clinical study of N-acetylcysteine vs ambroxol associated to corticosteroid therapy. Int J Immunopathol Pharmacol. 2012;25(1):207–17.

Shimaa MM, Hossam EG, Adel ME-M. Effect of N-acetyl cysteine supplementation on blood lead levels in pregnant women suffering from pre-eclampsia. Obstet Gynaecol Cases - Rev. 2018;5(3):1–8.

Amin AF, Shaaban OM, Bediawy MA. N-acetyl cysteine for treatment of recurrent unexplained pregnancy loss. Reprod Biomed Online. 2008;17(5):722–6.

Diterbitkan

2023-03-01

Cara Mengutip

Habiburrahman, M., & Rakasiwi, M. I. D. (2023). Manajemen Asma dalam Kehamilan: Apa yang Harus Dipahami oleh Dokter Umum. Cermin Dunia Kedokteran, 50(3), 138–150. https://doi.org/10.55175/cdk.v50i3.657

Terbitan

Bagian

Articles