Session to discuss the management of pulmonary disease during pregnancy

Physiological changes that occur during pregnancy can lead to respiratory symptoms and cardiovascular changes. This can make it challenging for clinicians to decipher whether their pregnant patients’ symptoms are consistent or evidence of new or worsening respiratory conditions.

A panel of experts will discuss how physiology during pregnancy alters the clinical presentation and management of pulmonary disorders during the CHEST 2025 session Pulmonary Disease in Pregnancy: Management From Conception to Birth at 4 pm CT on Tuesday, October 21, in McCormick Place, South Building, Room 502. Stephanie Levine, MD, FCCP, Professor of Medicine at the University of Texas Health San Antonio, will chair the session.

“The management of pulmonary and pulmonary vascular disease in pregnancy requires careful adaptation of standard approaches to ensure maternal and fetal safety,” Dr. Levine said. “This session will provide expert guidance on physiologic changes in pregnancy and review evidence-based strategies for managing asthma, venous thromboembolism, and pulmonary hypertension in this unique patient population.”

The panel chose to focus on asthma because of its prevalence in pregnant patients and how it can fluctuate during pregnancy. Historically, a third of patients experience symptom improvement, a third see no change, and a third see their symptoms worsen during pregnancy. Sandhya Khurana, MD, FCCP, Professor of Pulmonary and Critical Care Medicine at the University of Rochester Medical Center, will cover how to manage asthma during pregnancy to lower the risk of harm to the fetus from a severe asthma attack.

The session will also include a presentation on the diagnosis of venous thromboembolism in pregnancy by Lisa K. Moores, MD, FCCP, Associate Dean for Assessment and Professional Development and Professor of Medicine at the Uniformed Services University of the Health Sciences.

Pregnant patients are at an increased risk of developing deep vein thrombosis (DVT) and pulmonary embolism, and they are also at an increased risk of bleeding, particularly during and after delivery. So an important factor to understand is how to balance the risk of clotting vs the risk of overbleeding during pregnancy and birth. The presentation of DVT and pulmonary embolism is often missed due to nonspecific symptoms that are normally present during pregnancy, such as shortness of breath and lower extremity swelling.

“The standard noninvasive diagnostic algorithms we use to diagnose pulmonary embolism really weren’t developed for patients who are pregnant. [Pregnant patients] were excluded from those trials, so we didn’t really know whether [the diagnostic algorithms] worked,” Dr. Moores said. “It wasn’t until the last five years that we had some prospective data to tell us how we can manage the approach to diagnosis in patients who are pregnant. I plan to focus on those studies and how those have impacted the current guidelines and go through a stepwise approach for diagnosing within that.”

Deborah Levine, MS, MD, FCCP, Clinical Professor of Pulmonary, Allergy, and Critical Care Medicine at Stanford University, will end with a presentation on pulmonary hypertension, which can be a life-threatening condition in pregnant patients. Managing pulmonary hypertension during pregnancy is difficult because these patients cannot receive certain medications that would normally be used. Therefore, a multidisciplinary team of specialists is essential to ensure the safety of both mother and child.