Asthma

Question 1

How is asthma best described?

Answer 1

Reversible airflow obstruction

Question 2

How common is athsma?

Answer 2

5-10% of children

2-5% of adults

Question 3

What are the 3 things responsible for narrowing the airway in asthma?

Answer 3

1. Bronchial smooth muscle constriction
2. Bronchial mucosal oedema
3. Excessive mucous secretion into airway lumen

Question 4

What are the symptoms of asthma?

Answer 4

1. Cough (most common)
2. wheeze - expiratory phase noise
3. Shortness of breath
4. Diurnal variation
   - worse overnight and early morning
5. Difficulty breathing OUT and lungs fill with air
   - measured by falling peak expiratory flow rate

Question 5

What are the main triggers for asthma?

Answer 5

1. Most are unkown
2. Infections
3. Environmental stimuli
   - dust
   - smoke
   - chemicals are work
4. Cold air
5. Atopy

Question 6

Describe how asthma is biphasic

Answer 6

1. Allergen inhalation
2. Early asthmatic response (15 mins)
3. Recovery
4. Late asthmatic response with increased bronchial hyper-responsiveness (e.g. increased diurnal rhythm)(24 hours)

Question 7

What are the 5 core asthma drugs?

Answer 7

1. Intermittent short acting beta-adrenergic agonists
2. Inhaled corticosteroids - low dose
3. Inhaled corticosteroid - high dose
4. Regular long acting beta - adrenergic
   agonist
   (1-4 Standard treatment^)
5. Adjuvant therapy
   - regular montelucast
   - pulsed oral steroid - prednisolone
   - biologic therapy
   (High end treatment)

Question 8

What are the main functions of beta-adrenergic agonists?

Answer 8

. Nebulised as effective as IV in an emergency
. Relax bronchial smooth muscle
- reducing bronchoconstriction
- reducing resting bronchial tone
. Protective against stimuli - take in anticipation of need
. Short and long acting
- short = ‘reliever’ drug
- long = ‘preventer’ drug - must use with inhaled steroid

Question 9

Describe pros of corticosteroid use in asthma patients and when and how they should be used

Answer 9

1. Most effective asthma treatment
2. Immune cell and epithelial cell actions
3. Use if short acting beta agonists > 3 times then use low dose inhaled corticosteroid every day
4. Move to High dose inhaled corticosteroid if symptoms dictate

Question 10

What are the risks of corticosteroid use?

Answer 10

1. Potentially adrenal suppression, osteoporosis
   - no evidence of daily dose < 1500micrograms
   - children < 800micrograms

Note: spacer recommended if daily dose exceeds 800 micro grams in the adult

Question 11

Describe the asthma risk assessment by treatment pyramid

Answer 11

1. SA B2 agonist - mild
2. Low dose inhaled steroid - mild
3. Long acting B2 agonist - moderate
4. Other medications (montelucaste, pulse prednisolone etc) - more severe
5. Oral steroid in last year, hospitalised EVER due to asthma - severe, highest risk

Question 12

What are the dental aspects of asthma?

Answer 12

1. Know that the patient has asthma - history
2. Know the severity of patients asthma - risk assess
3. Know the triggers for the patients asthma - avoid these
4. Know how to assess and treat a patient during an acute asthma attack