ASTHMA: A Comprehensive Review


  • Mary Mays MS, CNM, FNP,

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    • Mary Mays, MS, cnm, fnp completed her midwifery and family nurse practitioner training in 1985 at the Frontier School of Midwifery and Family Nursing in Hyden, Kentucky, and received her master's degree from the University of California, San Francisco. She is currently a nurse practitioner with Health Care for the Homeless in San Francisco and provides prenatal care in the midwifery service at San Francisco General Hospital.

  • Steven Leiner MS, FNP, PA

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    • Steven Leiner, MS, fnp, pa completed his master's degree and nurse practitioner training at Pace University, Pleasantville, New York, in 1980. He currently works at Mission Neighborhood Health Center in San Francisco.

    • Both authors serve as Assistant Clinical Professors in the Department of Family Health Care Nursing at the University of California, San Francisco.

Address correspondence to Mary Mays, 815-A 26th Ave., San Francisco, CA 94121.


Asthma is common among women of childbearing and childrearing age. As a primary health care provider, the certified nurse-midwife is often called upon to play a direct role in diagnosis and collaborative co-management. This article reviews the pathogenesis of asthma and its natural history during pregnancy. Patient symptoms and findings on physical examination are described in depth, enabling clinicians to detect subtle presentations and avoid common pitfalls. A section on pulmonary function tests and other laboratory tools provides a foundation for objective monitoring of pulmonary function. Environmental control measures and pharmacologic therapies are described in detail. An algorithm for treatment strategies allows certified nurse-midwives to play an active role in co-management of their asthmatic patients, while a section on patient education highlights the essential teaching points her clients will require. Specific issues regarding antenatal fetal well-being and intrapartal management are discussed. With a sound knowledge base, and through their expertise in client education and counseling, the certified nurse-midwife is in a special position to optimize care for women with asthma.