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Acute severe asthma in pregnancy — SCE Acute Medicine MCQ

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EasyRespiratory medicineAcute severe asthma in pregnancySCE Acute Medicine

A 34-year-old woman who is 28 weeks pregnant attends the AMU with wheeze and chest tightness after 2 days of coryzal symptoms. Her peak flow is 45% predicted, respiratory rate is 30/min, oxygen saturation is 91% on air and she is using accessory muscles. Chest examination reveals widespread expiratory wheeze and she can speak only in short phrases. What is the most important immediate action?

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Correct answer: C — Give high-flow oxygen and nebulised salbutamol driven by oxygen

Oxygen-driven nebulised beta-2 agonist therapy with systemic corticosteroids is first-line for acute severe asthma, including in pregnancy, with oxygen targeted to maintain adequate maternal oxygenation. CT pulmonary angiography may be needed if pulmonary embolism remains likely, but it should not delay treatment of a life-threatening asthma attack. Pregnancy should lower the threshold for senior respiratory and obstetric involvement, not reduce standard asthma therapy.

Reference: BTS/SIGN British guideline on the management of asthma; NICE NG245 asthma pathway