Asthma
- Chronic Lung Disease
- Airways-inflamed and narrowed
- Unknown Cause
What causes Asthma?
- Unknown:
- Theories:
- Genetic and environmental factors
- Hygiene Hypothesis
Environmental and Genetic Factor Theory
- Genetic and environmental factors interact to cause asthma
- early in life
- Factors include:
- Atopy
- inherited tendency to develop allergies
- Parents w/asthma
- Respiratory infections during childhood
- Airborne allergens or viral infections in infancy/early childhood
- immune system still developing
- Atopy
Hygiene Hypothesis
- Emphasize hygiene and sanitation
- Western lifestyle caused changed in:
- living conditions
- Less infections in early childhood
- Children dont have the same type of environmental factors and infections as in the past
- affects immune system development
- increase risk for atopy and asthma
What are the common signs and symptoms of asthma?
- Coughing
- worse at night or early in morning
- hard to sleep
- Wheezing
- Chest tightness
- Shortness of Breath
What are some triggers of asthma?
- Allergens
- Dust, animal fur, mold, pollen, grass, flowers
- Irritants
- cig smoke, air pollution, chemical or dusts in workplace, compounds in home products, sprays (hair spray)
- Meds
- aspirin or other NSAIDs
- Nonselective beta blockers
- Sulfites
- in food and drinks
- Viral upper respiratory infection
- colds
- Physical activity
- exercise
What is the best way to diagnose asthma?
- Lung function test
- Medical history
- type and frequency of symptoms
- physical exam
Asthma: Dx tests
- Allergy testing
- find out what allergens
- Bronchoprovocation test
- how sensitive airways are
- Spirometry
- lung function during
- physical activty
- after receiving increases doses of :
- cold air
- chemical to breathe in
- lung function during
- Chest X-ray or EKG
- if another condition caused symptoms
- reflux disease
- vocal cord dysfunction
- sleep apnea
- if another condition caused symptoms
at what age do most children develop their first symptoms?
Before 5
A young child who has frequent wheezing w/colds or respiratory infections is more likely to have asthma if:
- parents have asthma (1 or both)
- signs of allergies
- eczema- allergic skin condition
- allergic reactions to airborne allergens
- ex: pollen
- Wheeze with no cold or other infection
What is the goal of asthma treatment?
Control the disease
What does good asthma control consist of?
- Prevent:
- chronic and troublesome symptoms
- coughing & SOB
- Asthma attacks→ER/hospital
- chronic and troublesome symptoms
- Maintain:
- good lung fuction
- normal activity and sleep
- Reduce need for quick-relief meds
Quick relief medicines for Asthma
- All patients need
- relieve asthma flare up
- Inhaled short acting beta-2 agonists:
- Albuterol
- Levalbuterol
- Metaproternol
Long term meds for Asthma Control
- Inhaled Corticosteroids=most effective
- Advair, Dulera, Symbicort
- combo of:
- long-acting beta-agonists bronchodilator
- inhaled steroid
- combo of:
- Erevent
- Foradil
- Perforomist
Meds to Avoid in asthma patients
- Aspirin
- trigger asthma attack
- Barbiturates & Narcotics
- especially meperidine
- release histamine
- trigger asthma attack
- cause respiratory depression
- Post Treatment Drug Interactions→AVOID
- Macrolid Antibiotics w/theophylline
- elevate theophylline serum level
- Macrolid Antibiotics w/theophylline
Dental Management: Before Treatment
- Discuss how stable the asthma is
- how many attacks/week
- triggers?
- how is it relieved
- Make sure patient has SHORT ACTING inhaler
Dental Management: During Tx
- Recognize signs and symptoms of severe or worsening asthma attack
What are the signs and symptoms of a severe or worsening asthma attack?
- Can’t finish sentences w/1 breath
- bronchodilators do not relieve dyspnea
- Tachypnea >25 breaths/min
- Tachycardia> 110 beats/min
What to do in the case of an asthma attack?
- Act immediately
- Stop procedure→remove rubber dam
- give Short Acting Bronchodilator & O2
- IF NO RELIEF:
- give pt’s oral inhaler
- Repeat short acting bronchodilator inhaler
- give subcutaneous epi 0.3-0.5mL
- repeat SA inhaler Q5 if needed
- Activate EMS
- provide O2 mask
Asthma: Oral Manifestations
- Reduce salivary flow
- All=25%
- Parotid=35%
- Increase In:
- lactobacillis
- Strep mutans
- Higher caries rates
- anti asthma meds
