Managing Severe Acute Asthma Exacerbation in Pregnancy during the COVID-19 Pandemic: A Case Report from a Resource-limited Setting

Muhammad Habiburrahman; Triya Damayanti; Mohammad Adya Firmansha Dilmy; Hariyono Winarto

doi:10.3889/oamjms.2023.11193

Authors

Muhammad Habiburrahman Faculty of Medicine, Universitas Indonesia, Dr Cipto Mangunkusumo Hospital, Central Jakarta, Indonesia; Tebet Subdistrict Public Hospital, South Jakarta, Indonesia https://orcid.org/0000-0001-6372-8240
Triya Damayanti Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia, National Respiratory Center Persahabatan Hospital, East Jakarta, Indonesia https://orcid.org/0000-0002-3779-4372
Mohammad Adya Firmansha Dilmy Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr Cipto Mangunkusumo Hospital, Central Jakarta, Indonesia https://orcid.org/0000-0003-2972-3387
Hariyono Winarto Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, Dr Cipto Mangunkusumo Hospital, Central Jakarta, Indonesia https://orcid.org/0000-0002-2081-9238

DOI:

https://doi.org/10.3889/oamjms.2023.11193

Keywords:

Severe acute asthma exacerbation, Pregnancy, Metabolic acidosis, Resource-limited settings, Indonesia, Primary care

Abstract

BACKGROUND: One-third of pregnant women will experience worsening asthma requiring emergency hospitalization. However, no report comprehensively discussed the management of asthma attacks in pregnant women in impoverished settings. We attempt to illuminate what general practitioners can do to stabilize and improve the outcome of severe acute asthma exacerbations in primary care with resource limitations.

CASE REPORT: A nulliparous 29-year-old woman in her 21^stweek of pregnancy presented severe acute asthma exacerbation in moderate persistent asthma with uncontrolled asthma status along with gestational hypertension, uncompensated metabolic acidosis with a high anion gap, anemia, respiratory infection, and asymptomatic bacteriuria, all of which influenced her exacerbations. This patient was admitted to our resource-limited subdistrict hospital in Indonesia during the COVID-19 pandemic for optimal stabilization. Crystalloid infusions, oxygen supplementation, nebulized beta-agonist with anticholinergic agents, inhaled corticosteroids, intravenous methylprednisolone, broad-spectrum antibiotics, subcutaneous terbutaline, mucolytics, magnesium sulphate, oral antihypertensives, and continuous positive airway pressure were used to treat her life-threatening asthma. After she was stabilized, we referred the patient to a higher-level hospital with more advanced pulmonary management under the supervision of a multidisciplinary team to anticipate the worst scenario of pregnancy termination.

CONCLUSION: Limitations in primary care, including the lack of sophisticated intensive care units and laboratory panels, may complicate challenges in managing severe acute asthma exacerbation during pregnancy. To enhance maternal-fetal outcomes, all multidisciplinary team members should be well-informed about key asthma management strategies during pregnancy using evidence-based guidelines regarding the drug, rationale, and safety profile.

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