Respiratory illness complicating pregnancy presents a diagnostic challenge, as it can be difficult to distinguish normal physiologic changes of pregnancy from medical conditions such as asthma, pulmonary embolism, pulmonary edema, infections such as influenza or Covid 19 or even anxiety. Asthma represents one of the most common chronic illnesses coexisting in pregnancy, affecting an estimated 3% to 8% of pregnant women. When poorly controlled in pregnant women, asthma is not only associated with increased prematurity, need for cesarean delivery, preeclampsia, growth restriction, and other perinatal complications, but it also confers an increased risk of maternal pneumonia.[1] While the incidence of community-acquired pneumonia in pregnancy approximates that of the nonpregnant population, pregnancy-associated physiologic changes make misdiagnosis more likely and increase the risk of morbidity and mortality.[2] Pregnant women are more likely to experience severe illness from influenza and Covid 19 infection with higher rates of hospitalization, intensive care unit admission, and death relative to the general population.[3],[4] OB/GYN hospitalists are ideally positioned to provide protocol-driven assessment and management of patients presenting with respiratory complaints in pregnancy.