INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com
Airway hyper-responsiveness to any stimulus leading to broncho-spasm, mucosal edema and mucous plugging of airways manifesting as episodic breathlessness with wheezing, spasmodic cough.
Types of asthma ď Ź
Extrinsic asthma (allergic asthma)- onset at young age, family history +, allergic to certain substances, increased eosinophil count, increased IgE levels and positive skin sensitivity test. Intrinsic asthma- onset in middle age, no family history, aggravated by emotional stress, responds to steroids. www.indiandentalacademy.com
Types of asthma
Exercise-induced asthma- more on exposure to cold and dry air. Aspirin-induced asthma- due to NSAIDs.
Pathogenesis Entry of allergen ↓ IgE formation ↓ allergen + IgE get attached to mast cell ↓ degranulation of mast cell ↓ release of mediators (histamine, bradykinin, ECF, leukotrienes, prostaglandins) ↓ increased vascular permeability, mucosal edema & increased mucus secretion leading to clinical features.
Sneezing Tightness in the chest Wheezing Trapping of air in the lungs Signs of hyper-inflation Rhonchi on auscultation
Acute severe asthma
Gasping for breath SBC less than 20 Cyanosis Altered consciousness Pulsus paradoxus Silent chest
Emergency care- indications
PEFR < 50% of predicted normal Failure to respond to beta agonists Severe wheeze/ cough Gasping/ sweating Rapid deterioration over a few hrs. Severe retraction with nasal flaring Hunching forward www.indiandentalacademy.com
Alertness and color of pt Vital signs Use of acc ms Chest auscultation PEFR, FEV1 Pulse oximetry CXR, CBC, ECG, ABG, Electrolyte levels www.indiandentalacademy.com
Diagnosis & Management
Spirometry a must Inhaled steroids can be used Pt education- written instructions, selfmonitoring with peak flow meter, proper use of inhaler. Regular follow up based on severity. Consultation with pulmonologist/ allergy specialist. www.indiandentalacademy.com
AEC Lung function tests- FEV1, FVC, FEV1/ FVC ratio, PEFR, RV, etc.
FEV1/FVC before and after inhaler; increase in 12% or 200 ml after inhaler suggests reversibility IgE levels CXR, X ray PNS Skin tests Bronchial challenge tests. www.indiandentalacademy.com
Beta-2 agonists Steroids Ipratropium bromide Methyl xanthenes- aminophyllin, theophyllin. Sodium cromoglycate Leukotrienes modifiers- Monteleukast 10 mg tab o.d. www.indiandentalacademy.com
Treatment of acute severe asthma
Inhaled terbutaline 2.5-5 mg every 20 min for 3 doses Adrenaline 0.3-0.5 mg every 20 min 3 doses Prednisone to be started/ increased
Avoid allergens Desensitization Sodium cromoglycate Immunoglobins
Dental considerations in Asthma-1
Patients on steroid inhalers prone to oropharyngeal candidiasis. Patients on ipratropium may have dry mouth. Anxiety can precipitate asthma. Relative analgesia with Nitrous oxide and Oxygen preferable to sedation with Diazepam ( chances of Respiratory failure)
Dental considerations in Asthma-2
Patients asked to bring their regular medications. Aspirin and NSAIDs avoided. Morphine & other opioids known to cause direct histamine release. Systemic steroids have their own complications.
www.indiandentalacademy.com Leader in continuing dental education