Respiratory disease in pregnancy

• Asthma treatment is largely similar to the nonpregnant population and is safe for use in pregnancy.
• Shortness of breath is a common complaint in pregnancy, but in a tachypneic patient further investigation may be warranted.
• High-risk pregnant patients should be screened and treated for tuberculosis (TB).
• Nicotine replacement therapy is preferable to continued smoking in pregnancy.

Many physiological and anatomical changes of pregnancy affect the respiratory system. These changes often affect the presentation and management of the various respiratory illnesses in pregnancy. This article focuses on several important respiratory issues in pregnancy. The management of asthma, one of the most common chronic illnesses in pregnancy, remains largely unchanged compared to the nonpregnant state. Infectious respiratory illness, including pneumonia and tuberculosis, are similarly managed in pregnancy with antibiotics, although special attention may be needed for antibiotic choices with more pregnancy safety data. When mechanical ventilation is necessary, consideration should be given to the maternal hemodynamics of pregnancy and fetal oxygenation. Maintaining maternal oxygen saturation above 95% is recommended to sustain optimal fetal oxygenation. Cigarette smoking has known risks in pregnancy, and current practice guidelines recommend offering cognitive and pharmacologic interventions to pregnant women to assist in smoking cessation.