Asthma

Question 1

Asthma

Answer 1

• Chronic Lung Disease
• Airways-inflamed and narrowed
• Unknown Cause

Question 2

What causes Asthma?

Answer 2

• Unknown:
• Theories:
  
  • Genetic and environmental factors
  • Hygiene Hypothesis

Question 3

Environmental and Genetic Factor Theory

Answer 3

• 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

Question 4

Hygiene Hypothesis

Answer 4

• 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

Question 5

What are the common signs and symptoms of asthma?

Answer 5

• Coughing
  
  • worse at night or early in morning
  • hard to sleep
• Wheezing
• Chest tightness
• Shortness of Breath

Question 6

What are some triggers of asthma?

Answer 6

• 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

Question 7

What is the best way to diagnose asthma?

Answer 7

• Lung function test
• Medical history
  
  • type and frequency of symptoms
• physical exam

Question 8

Asthma: Dx tests

Answer 8

• 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
• Chest X-ray or EKG
  
  • if another condition caused symptoms
    
    • reflux disease
    • vocal cord dysfunction
    • sleep apnea

Question 9

at what age do most children develop their first symptoms?

Answer 9

Before 5

Question 10

A young child who has frequent wheezing w/colds or respiratory infections is more likely to have asthma if:

Answer 10

• 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

Question 11

What is the goal of asthma treatment?

Answer 11

Control the disease

Question 12

What does good asthma control consist of?

Answer 12

• Prevent:
  
  • chronic and troublesome symptoms
    
    • coughing & SOB
  • Asthma attacks→ER/hospital
• Maintain:
  
  • good lung fuction
  • normal activity and sleep
• Reduce need for quick-relief meds

Question 13

Quick relief medicines for Asthma

Answer 13

• All patients need
  
  • relieve asthma flare up
• Inhaled short acting beta-2 agonists:
  
  • Albuterol
  • Levalbuterol
  • Metaproternol

Question 14

Long term meds for Asthma Control

Answer 14

• Inhaled Corticosteroids=most effective
• Advair, Dulera, Symbicort
  
  • combo of:
    
    • long-acting beta-agonists bronchodilator
    • inhaled steroid
• Erevent
• Foradil
• Perforomist

Question 15

Meds to Avoid in asthma patients

Answer 15

• 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

Question 16

Dental Management: Before Treatment

Answer 16

• Discuss how stable the asthma is
  
  • how many attacks/week
  • triggers?
  • how is it relieved
• Make sure patient has SHORT ACTING inhaler

Question 17

Dental Management: During Tx

Answer 17

• Recognize signs and symptoms of severe or worsening asthma attack

Question 18

What are the signs and symptoms of a severe or worsening asthma attack?

Answer 18

• Can’t finish sentences w/1 breath
• bronchodilators do not relieve dyspnea
• Tachypnea >25 breaths/min
• Tachycardia> 110 beats/min

Question 19

What to do in the case of an asthma attack?

Answer 19

• 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

Question 20

Asthma: Oral Manifestations

Answer 20

• Reduce salivary flow
  
  • All=25%
  • Parotid=35%
• Increase In:
  
  • lactobacillis
  • Strep mutans
• Higher caries rates
  
  • anti asthma meds