Asthma in Pregnancy Spirometry MCQ — NEET PG Practice Question | NEETPGAI
Asthma in Pregnancy Spirometry
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baby OBG
A 28-year-old primigravida at 26 weeks gestation presents for routine antenatal care. She has a history of mild asthma diagnosed 5 years ago, previously well-controlled on albuterol as needed. Spirometry today shows an obstructive pattern with FEV1 at 75% of predicted (marked as **B** in the diagram), with FEV1/FVC ratio of 0.68. She reports increased use of albuterol over the past 4 weeks. Which of the following is the most appropriate next step in management?
A. Initiate budesonide inhaled corticosteroid and continue albuterol as needed
B. Refer for urgent pulmonology evaluation and consider hospitalization
C. Prescribe oral prednisone 40 mg daily for 7 days followed by taper
D. Reassure the patient and continue albuterol monotherapy with monthly spirometry
Explanation
Why Initiate budesonide inhaled corticosteroid and continue albuterol as needed is right
The spirometry pattern marked B shows an obstructive pattern with FEV1 <80% predicted, which indicates inadequate asthma control during pregnancy. According to NAEPP 2020 guidelines and ACOG Practice Bulletin, FEV1 <80% predicted mandates therapy escalation. The patient's increased albuterol use and objective decline in FEV1 confirm worsening control in the second trimester—the period of peak risk for asthma deterioration (24–36 weeks). NAEPP stepwise therapy recommends stepping up from intermittent SABA monotherapy to Step 2 (mild persistent asthma): low-dose inhaled corticosteroid. Budesonide is the preferred ICS in pregnancy because it is the only Category B inhaled corticosteroid with the most extensive safety data; other ICS agents (fluticasone, beclomethasone) are Category C. Albuterol (Category C) remains safe and should be continued for rescue use. The cardinal principle of asthma management in pregnancy is that the risks of uncontrolled asthma—including preeclampsia, gestational diabetes, preterm labor, IUGR, and perinatal mortality—substantially exceed the risks of asthma medications.
Why each distractor is wrong
Reassure the patient and continue albuterol monotherapy with monthly spirometry: This is inadequate management. An FEV1 <80% predicted is the threshold for therapy escalation, not observation. Continued SABA monotherapy without ICS in a patient with worsening control risks further deterioration, maternal complications (preeclampsia, preterm labor), and fetal compromise (IUGR, low birth weight). Monthly spirometry is too infrequent; ACOG recommends assessment at each prenatal visit.
Prescribe oral prednisone 40 mg daily for 7 days followed by taper: This dose and duration are appropriate for acute exacerbation management, not for chronic control in a stable patient without signs of status asthmaticus (normal oxygen saturation, no respiratory distress). Systemic corticosteroids should be minimized in the first trimester (small cleft lip/palate risk) and reserved for acute episodes or severe persistent asthma requiring Step 4–6 therapy. This patient requires ICS escalation first.
Refer for urgent pulmonology evaluation and consider hospitalization: While specialist input may be appropriate for severe or refractory asthma, this patient's presentation does not warrant urgent referral or hospitalization. She is hemodynamically stable, not in acute distress, and has a clear stepwise management pathway (ICS initiation) that should be implemented immediately in primary obstetric care. Unnecessary hospitalization delays appropriate outpatient therapy.
High-YieldNEET PG
FEV1 <80% predicted in a pregnant asthmatic = step up therapy with budesonide (preferred ICS, Category B); uncontrolled asthma risks exceed medication risks.
ACOG Practice Bulletin — Asthma in Pregnancy 2008; NAEPP 2020 Guidelines
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