PG 2025: Pulmonary Literature Review and Interactive Complex Case Presentations (PG)-Levine- Pulmonary Literature Review Complex Cases FinalPG 2025

Levine- Pulmonary Literature Review Complex Cases FinalPG 2025

Pdf Summary

This literature review by Dr. Stephanie M. Levine updates on pulmonary medicine in pregnancy, focusing on the diagnosis and management of venous thromboembolism (VTE) and asthma in pregnant women.<br /><br />Dyspnea affects two-thirds of pregnant women due to physiological changes like progesterone-driven hyperventilation and estrogen-related airway edema. Diagnosing pulmonary embolism (PE) in pregnancy is challenging because anemia and pregnancy symptoms may mask PE signs.<br /><br />For suspected PE, the Pregnancy-Adapted YEARS algorithm combines clinical criteria and D-dimer levels to reduce imaging, shown safe across trimesters and avoiding many CT pulmonary angiographies. The Pregnancy-Adapted Geneva (PAG) score further refines risk stratification with better predictive power than standard Geneva scores. European guidelines recommend low-molecular-weight heparin (LMWH) or unfractionated heparin during pregnancy and postpartum, avoiding warfarin and DOACs.<br /><br />Asthma affects 5-8% of U.S. pregnant women and is linked to increased maternal and fetal complications. Severity often mirrors pre-pregnancy status. Standard diagnosis applies, but bronchial challenges are contraindicated. Monitoring via questionnaires, FeNO, and patient education is essential. Guidelines emphasize continuing inhaled corticosteroids (ICS), especially budesonide (Category B), and advise against stepping down ICS during pregnancy, although emerging evidence suggests step-down may be safe if eosinophilic inflammation or symptoms are low.<br /><br />Biologics like omalizumab and mepolizumab show no major safety signals but are generally continued rather than initiated during pregnancy. Recent expert consensus supports biologic use before conception and continuation during pregnancy and breastfeeding if indicated.<br /><br />Obesity increases asthma prevalence and worsens control in pregnancy, compounding risks of hypertensive disorders, gestational diabetes, preterm birth, and cesarean delivery.<br /><br />Large cohort data indicate asthma exacerbations rise during the 2nd and 3rd trimesters, with many modifiable risk factors including reduced ICS use.<br /><br />In summary, recent advances refine VTE diagnosis algorithms and reinforce established asthma management principles during pregnancy, with cautious but growing support for biologic therapies. Careful risk stratification and adherence to treatment optimize maternal and fetal outcomes.

Keywords

pulmonary medicine pregnancy

venous thromboembolism VTE

pulmonary embolism PE diagnosis

Pregnancy-Adapted YEARS algorithm

Pregnancy-Adapted Geneva score

low-molecular-weight heparin LMWH

asthma in pregnancy

inhaled corticosteroids ICS

biologics omalizumab mepolizumab

obesity asthma pregnancy