SE is a twenty-two-year-old Caucasian woman who was diagnosed with asthma at age seven. According to her medical record, she has "mild persistent" asthma. Today, she reports that she has been using her albuterol metered-dose inhaler (MDI) approximately three to four days per week over the last two months. Over the past week, she admits to using albuterol once daily. She has been awakened by a cough three nights during the last month. She states she especially becomes short of breath when she exercises. However, she also admits that the shortness of breath is not always brought on by exercise. She also has a fluticasone MDI, which she uses "most days of the week." She has been hospitalized twice in the last year for poorly controlled asthma and has been to the emergency department (ED) three times in the last six months for the same problem. Her lab work is all within normal limits, with the exception of a positive human chorionic gonadotropin (HCG). Answer the following questions:

What information in the case study suggests that her asthma is not well controlled?

What factors could possibly lead to this?

How would you classify the symptoms based upon the National Institutes of Health (NIH) guidelines?

With the recognition that she is pregnant, how would you alter her treatment for asthma?

Support your responses with guidelines, including the NIH guidelines, for management of asthma during pregnancy. Use other peer-reviewed articles as needed to support specific aspects of your plan.