BRONCHIAL ASTHMA IS A DISEASE THAT LEADS TO INTRAUTERINE HYPOXIA

Аннотация

The incidence of bronchial asthma (BA) in the world is from 4 to 10% of the population [6, 14]; in the Russian Federation, the prevalence among adults it ranges from 2.2 to 5–7% [15], in the pediatric population this figure is about 10% [9]. In pregnant women, bronchial asthma is the most common disease of the pulmonary system, the frequency of diagnosis of which in the world ranges from 1 to 4% [3], in Russia – from 0.4 to 1% [8]. In recent years, standard international diagnostic criteria and methods of pharmacotherapy have been developed, which can significantly increase the effectiveness of treatment of patients with asthma and improve their quality of life (Global Initiative for the Prevention and Treatment of Asthma (GINA), 2014) [14]. However, modern pharmacotherapy and monitoring of asthma in pregnant women are more complex tasks, since they are aimed not only at maintaining the health of the mother, but also at preventing the adverse effects complications of the disease and side effects of treatment on the fetus. Keywords: bronchial asthma, hypoxia, complications, dyspnea. Pregnancy affects the course of bronchial asthma in different ways. Changes in the course of the disease vary widely: improvement in 18–69% of women, deterioration in 22–44%, and the absence of an effect of pregnancy on the course of bronchial asthma was detected in 27–43% of cases [7, 8]. This is explained, on the one hand, by the fact that on the one hand, the multidirectional dynamics in patients with varying degrees of severity of asthma (with mild and moderate severity, worsening of the course of asthma is observed in 15–22%, improvement – in 12–22%), on the other hand – insufficient diagnostics and not always correct therapy. In practice, asthma is often diagnosed only in the late stages of the disease. In addition, if its onset coincides with the gestational period, then the disease may remain unrecognized, since the respiratory disorders observed in this case are often attributed to changes caused by pregnancy. At the same time, with adequate therapy for asthma, the risk of an unfavorable outcome of pregnancy and childbirth is no higher than in healthy women [7, 10]. 367 Aprel, 2025-Yil In this regard, most authors do not consider asthma as a contraindication to pregnancy [13], and monitoring its course is recommended to be ensured using modern treatment principles [14]. The combination of pregnancy and bronchial asthma requires close attention from doctors due to the possible change in the course of bronchial asthma during pregnancy, as well as the impact of the disease on the fetus. In this regard, the management of pregnancy and childbirth in a patient suffering from bronchial asthma requires careful monitoring and joint efforts of doctors of many specialties, in particular therapists, pulmonologists, obstetricians-gynecologists and neonatologists [7]. Changes in the respiratory system in bronchial asthma during pregnancy During pregnancy, under the influence of hormonal and mechanical factors, the respiratory system undergoes significant changes: the mechanics of breathing are restructured, ventilation changes perfusion relations [2]. In the first trimester of pregnancy, hyperventilation may develop due to hyperprogesteronemia, changes in the gas composition of the blood - an increase in the content of PaCO2 [1]. The appearance of shortness of breath in the late stages of pregnancy is largely due to the development of a mechanical factor, which is a consequence of an increase in the volume of the uterus. As a result of these changes, impairment of external respiration function worsens, vital capacity of the lungs, forced vital capacity of the lungs, forced expiratory volume in 1 second (FEV1) decrease [11]. As the gestational age increases, the resistance of the vessels of the pulmonary circulation increases, which also contributes to the development of dyspnea [1]. In this regard, dyspnea causes certain difficulties in conducting differential diagnostics between physiological changes in the function of external respiration during pregnancy and manifestations of broncho-obstruction. Often, pregnant women without somatic pathology develop edema of the mucous membranes of the nasopharynx, trachea and large bronchi [7]. These manifestations in pregnant women with bronchial asthma can also aggravate the symptoms of the disease. Low compliance contributes to the worsening of the course of bronchial asthma: many patients try to refuse to take inhaled glucocorticosteroids (IGCS) due to fear of their possible side effects. In such cases, the doctor should explain to the woman the need for basic anti-inflammatory therapy due to the negative impact of uncontrolled bronchial asthma on the fetus. Asthma symptoms may first appear during pregnancy due to altered reactivity of the body and increased sensitivity to endogenous prostaglandin F2α (PGF2α) [15]. Asthma attacks that first appear during pregnancy may disappear after deliver