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A presentation made for BDS 3 regarding Medical Emergencies and Asthma

Harpreet Chowlia

on 19 September 2013

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Transcript of Asthma

ASTHMA Definition DEFINITION AND AETIOLOGY "An inflammatory disease of the lungs characterized by (in most cases) reversible airway obstruction. Originally, a term used to mean “difficult breathing”; now used to denote bronchial asthma." "An acute or chronic disorder characterized by widespread and largely reversible reduction in the caliber of bronchi and bronchioles, due in varying degrees to smooth muscle spasm, mucosal oedema, and excessive mucus in the lumens of airways." Bronchial Asthma (2) Aetiolgy (3) Which lumen is most likely to produce an asthma attack? A B (4) Type I hypersensitivity reaction

First exposure
Eosinphils phagocytose the allergen
Allergen presented to T Cell
Plasma cells and memory cells

Second exposure
Mast cell is sensitised by IgE and allergen binds
Localised accumulation of inflammatory cells
Mucous secretion, vasodilation and bronchoconstriction
a family history of asthma
developing another atopic condition, such as a food allergy
having bronchiolitis as a child
being exposed to tobacco smoke as a child
being born prematurely
a low birth weight What increases the risk of having asthma? HARPREET CHOWLIA (5) SIGNS AND

Upper respiratory infections
Allergens e.g. pollen, animal fur
Airborne irritants e.g.cigarettee smoke
Medicines e.g. NSAIDs
Exercise What triggers asthma? (5) •feeling breathless/gasping

•a tight chest

•wheezing, which makes a whistling sound when the patient breathe

•coughing, particularly at night and early morning Severe Asthma Attack •the reliever inhaler, which is usually blue, does not help symptoms at all

•the symptoms of wheezing, coughing and tight chest are severe and constant

•patient is too breathless to speak

•patient's pulse is racing

•patient feels agitated or restless

•patient's lips or fingernails look blue (6) TREATMENT AND SIDE EFFECTS There are two types of medications used to treat asthma... Reliever
Inhalers Preventer
Inhalers Quick-relief medications used to treat acute symptom Provide long-term control to prevent further exacerbation (7) (8) Side Effects Relievers Preventers Safe and effective
Few side effects
Mild shaking of hand
Muscle Cramps
Only at high doses Very safe at usual doses
Side effects at high doses over long-term use
Oral Candidiasis
Hoarse voice CONTRAINDICATIONS Beta-blockers - acute hypertension

NSAIDs/Aspirin - inhibition of COX-1 DENTAL IMPACT DENTAL ADVICE/PREVENTION Salivary Output
Sympathomimetic agents
potential side effect of a reduction in salivary output


Limited evidence to support this statement:
A study found that salivary flow was not changed after the use of a beta2-receptor agonist inhaler.

Another found no increase in the rate of dental caries that would have been expected if their salivary function had been affected by these inhalers. Oral Canidiasis (11-14) Glucocorticoids increases susceptibility to oral Candida infections (thrush).

Steroid aerosols interfere with the normal balance of microflora and favour the proliferation of candida albicans. (15) Other Oral Impacts Increased risk of caries and enamel defects.

Increased risk of gingivitis and periodontal disease, as more calculus build up.

Higher than average rates of malocclusion.

An increased overjet, overbite and posterior crossbite.

High palatal vault. (16) Before Treatment When an asthmatic dental patient seeks care, the dental professional must:

Update the patients medical health history at every visit

Be aware of the potential for dental materials and products that exacerbate asthma

Assess the patient's risk level by taking an oral history of the illness

Enquire about the frequency and severity of acute episodes

Review the patient’s medications thoroughly

Determine the patient’s specific triggering agents During Treatment (17) The most likely times for an acute exacerbation are:

During and immediately after local anesthetic administration

With stimulating procedures such as extraction and surgery
Patient has taken their most recent scheduled dose of medication

The patient has their own inhaler on hand

The emergency kit has both a bronchodilator and oxygen

You have obtained a medical consultation before administering N2O to such patients. At each visit ensure... For improper positioning of suction tips

If fluoride trays or cotton rolls could trigger a hyper-reactive airway response in the patient

You are using rubber dams cautiously

You are avoiding prolonged supine positioning Always check... (17) After Treatment Instruct patients to rinse their mouths after using an inhaler

Reinforce OHI to help minimize gingivitis

Be aware of possible need to prescribe antifungal agents

Assess orthodontic needs for malocclusion

Recommend xylitol mints and/or gum to stimulate saliva production and caries resistance. In Conclusion... (9) (10) Asthma can be triggered by a variety of sources including allergens, stress and medicines, all of which are important in a dental setting.

You must be aware of how to manage patients with such a condition, and what warning signals to look out for. Classical Symptoms (1) (3) NOTE: HYPOKALAEMIA (16) (17) References (1) Stedman’s Medical Dictionary. Lippincott Williams & Wilkins (2006). Cited on 26/01/13. Available from http://www.medilexicon.com/medicaldictionary.php?t=8055
(2)Stedman’s Medical Dictionary. Lippincott Williams & Wilkins (2006). Cited on 26/01/13. Available from http://www.medilexicon.com/medicaldictionary.php?t=8057
(3)Asthma. Cited on 26/01/13. Available from http://www.patient.co.uk/health/asthma
(4)Asthma UK. Asthma Basics. Last Updated on 12/10/12. Cited on 26/01/13. Available from http://www.asthma.org.uk/about-asthma/asthma-basics
(5)NHS. Causes of Asthma. Last Updated on 23/07/12. Cited on 26/01/13. Available from http://www.nhs.uk/Conditions/Asthma/Pages/Causes.aspx
(6)NHS. Symptoms of Asthma. Last Updated on 23/07/12. Cited on 26/01/13. Available from http://www.nhs.uk/Conditions/Asthma/Pages/Symptoms.aspx
(7)NHLBI Guideline 2007, p. 213. Cited on 26/01/13. Available from http://www.nhlbi.nih.gov/guidelines/asthma/07_sec3_comp4.pdf
(8)NHS. Treating Asthma. Last Updated on 23/07/12. Cited on 26/01/13. Available from http://www.nhs.uk/Conditions/Asthma/Pages/Treatment.aspx
(9)Booker, R. Which drugs are contraindicated for asthma patients? The British Journal Of Primary Care Nursing; 1 (3) (2007).
(10)BNF Android App. British National Formulary. Salbutamol.
(11)Moore PA, Guggenheimer J. Medication-induced hyposalivation; etiology, diagnosis, and treatment.Compend Contin Educ Dent. 2008;29(1):50-55.
(12)del-Río-Navarro BE, Corona-Hernández L, Fragoso-Ríos R, et al. Effect of salmeterol and salmeterol plus beclomethasone on saliva flow and IgA in patients with moderate-persistent chronic asthma. Ann Allergy Asthma Immunol. 2001;87(5):420-423.
(13)Meldrum AM, Thomson WM, Drummond BK, et al. Is asthma a risk factor for dental caries? Finding from a cohort study. Caries Res. 2001;35(4):235-239.
(14)Schulman JD, Taylor SE, Nunn ME. The association between asthma and dental caries in children and adolescents: a population-based case-control study. Caries Res. 2001;35(4):240-246.
(15)Guggenheimer J, Moore PA. Xerostomia: Aetiology, recognition and treatment. J Am Dent Assoc.2003;134(1):61-69.
(16)University of Washington School of Dentistry. Adults with Respiratory Disorders: Asthma and Allergies. Cited on 26/01/13. Available from http://dental.washington.edu/sites/default/files/departments/spec_need_pdfs/Asthma-Adult.pdf
(17)MANAGEMENT IN DENTAL CARE OF THE ASTHMA PATIENT FOR THE DENTAL HEALTH PROFESSIONAL. Cited on 26/01/13. Available from http://www.dentalgentlecare.com/asthma_management_in_dental_treatment.htm
(18) Sooriakumarum P, Jayasena C & Scully C Key Topics in Human Diseases for Dental Students. London: Taylor & Francis Group; 2005
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