ASTHMA

By::Areej Salim Dawood

SUPERVISION BY::Dr.Emad Hamodey Abdulla

WHAT IS ASTHMA?

Asthma is a chronic inflammatory disorder of the airways, causes recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night or in the early morning

WHAT HAPPENS IN ASTHMA?

Narrowing of bronchial Airways Muscle Spasm Mucosal swelling Thick bronchial secretion Inflammatory Reaction Reversible

TYPES OF ASTHMA Intrinsic Asthma: Non-Atopic/Non-Allergic Bronchial reaction due to: cold air

Extrinsic ASTHMA Atopic/Allergic Asthma

Allergic Rhinitis Urticaria

Eczema

Signs &Symptoms

Feeling of chest tightness Dyspnea Tachypnea Cough Use of Accessory/Respiratory Muscles

Agitations

WHEEZING

GOLDEN RULE

Differential Diagnosis: Pulmonary Edema Pulmonary Embolism Anaphylactic Rxn COPD Pneumonia Foreign Body Aspiration Cystic fibrosis

ALL THAT WHEEZES IS NOT ASTHMA

DIAGNOSIS OF ASTHMA

History & Clinical Chest X- Ray (CXR) Pulmonary Function Test (PFT)

Arterial Blood Gases (ABGs)

RISK OF ASTHMA::Dental treatment may lead to

anxiety of patient this lead to bronchi construction..

And if not treated immediately it may lead to a condition called status asthmaticus,, it consider as sever form of paroxysmal asthma and consider as live threat

::REMEMBER Asymptomatic patients:

Elective dentistry

  Symptomatic patients

Reappointment

DON’T USE THE FALLOWING Dentifrices Sulfites Cotton rolls Fluoride trays Fissure sealants Tooth Enamel dust Methyl methacrylate

UPDATING PATIENTS HISTORY AT EVERY VISIT ABOUT THESE FACTORS

Frequency of asthmatic attacks Precipitating agents Types of pharmacotherapy used  Length of time since an emergency

visit owing to acute asthma 

BEFORE DENTAL TREATMENT

1.Patients appointment should be late morning or afternoon.

2.Assess severity of ASTHAMATIC condition.

3.Consider antibiotic prophylaxis for immuno-suppressed patients

4.Consider corticosteriod replacement for adrenally suppressed patients.

AT EACH VISIT MAKE SURE Confirm that they have taken their most

recent scheduled dose of medication.

The patient’s own metered-dose inhaler bronchodilator should be on hand at each visit to minimize the risk of an attack.

Procedure should be done Late morning / afternoon.

Emergency kit with a bronchodilator and oxygen.

Avoid using dental materials that may elicit an ASTHMATIC ATTACK ie ,DENTIFRICES ,FISSURE SEALANTS ,METHYL METHA ACRYLATE ,FLOURIDE TRAYS & COTTON ROLLS can trigger asthmatic events.

If asthmatic patients does not use a broncodilator ,make sure the emergency kits has both a bronchodilator & oxygen.

DURING TREATMENT::1.Rubber dams should be used cautiously.

2.Use technique to reduce patient stress: Avoid prolonged supine positioning Avoid nitrous oxide in people with sever

ASTHMA. Avoid using BARBITURATES.

3.Avoid using LA containing SODIUM METABISULFIDE.4.Use vasoconstrictor judiciously

AFTER TREATMENT1.TETRACYCLINE should be used cautiously.

2.Avoid use of ERTHROMYCIN in patients taking THEOPHYLLINE.

3.Avoid use of PHENOBARBITALS in patients taking THEOPHYLLINE.

4.Analgesic of choice for these patients is ACETAMINOPHEN.

THE MOST LIKELY TIMES FOR AN ACUTE EXACERBATION ARE: During and immediately after

local anesthetic administration. 

With stimulating procedures such as extraction, surgery,pulp extirpation

WHEN YOU ARE IN TROUBLE !You gave local anesthesia to your

patient & all of a sudden patient:

Has difficulty in breathing

Talking in phrases

You could hear loud wheezes

Using accessory muscles

Slightly Agitated

THE DENTAL PROCEDURE

DON’T BE

AFRAID

MANAGING AN ACUTE ASTHMATIC ATTACK::

Discontinue the dental procedure and allow the patient to assume a comfortable position.

Establish and maintain a patent airway and administer b2 agonists via inhaler or nebulizer.

Administer oxygen  6-10 liters via face mask, nasal hood or cannula. If no improvement is observed and symptoms are worsening, administer epinephrine subcutaneously (1:1,000 solution, 0.01 milligram/ kilogram of body weight to a maximum dose of 0.3 mg).

Document in time form the beginning of the event.

Alert emergency medical services.

Maintain a good oxygen level until the patient stops wheezing and/or medical assistance arrives.

Begin diligent basic life support.

Escort patient to hospital as needed.

UPRIGHT POSITION

IS PREFERED