Asthma Flashcards
What percentage of children have asthma
5-10%
What percentage of adults have asthma
2-5%
What is asthma
Reversible airflow obstruction due to bronchial hyper reactivity
Describe the cellular response to asthma
Allergen triggers IgE production which triggers a B cell - T cell interaction causing degranulation of mast cells which eventually leads to narrowing of the airway, oedema and mucous secretion
What can cause narrowing of the airways
Bronchial smooth muscle contraction
Bronchial mucosal oedema
Excessive mucous secretion into the airway lumen
Describe the names of biologic drugs
Usually end in -mab or -ib
What are the symptoms of asthma
Cough
Wheeze
Shortness of breath
Diurnal variation - worse overnight and early morning
Difficulty breathing out and lungs fill with air
What causes an asthma cough
The high levels of mucous being produced in the airway causing irritation
What is used to track airway resistance and how should it be checked
PEFR - peak expiratory flow rate
Only check morning against morning and evening against evening
What are common triggers of asthma
Unknown Infections Environmental stimuli - dust, smoke, chemicals Cold air - chilling of the airways Atopy
What can be carried out to help treat asthma caused by atopy
A skin prick test
Describe the asthma biphasic response
After a patient recovers from an acute asthma attack they are not back to normal
Hours later they may develop a more significant response
How should an asthma biphasic response be treated
In acute attack, B agonists are important to try and open the airways quickly but a corticosteroid must also be given to prevent the later response
Give examples of common asthma drugs
Intermittent short acting beta-adrenergic agonists Inhaled corticosteroids - low dose Inhaled corticosteroids - high dose Regular long acting B agonists Adjuvant therapy
Give examples of adjuvant therapy for treating asthma
Regular montelucast - a leukotriene inhibitor
Pulsed oral steroid - prednisolone
Biologic therapy
How should B agonists be taken to be most effective
Nebulised just as effective as IV
What is the most effective asthma treatment
Corticosteroids
How should corticosteroids be used alongside B agonists
If short acting B agonist >3 times each week then use low dose corticosteroid every day
Move to high dose corticosteroid if symptoms dictate
What should the daily dose of corticosteroids be under
<1500ug in adults
<800ug in children
Which patients are at the top of the asthma risk assessment pyramid
Those who have been permitted to hospital with asthma or those who have had to use an oral steroid in the past year
Which patients are at the bottom of the asthma risk assessment pyramid
Those with a blue or brown inhaler
What does an asthma self assessment look for
Changes which suggests the asthma is getting more severe and what actions they need to take with certain levels of breathing and speaking so an ambulance is called appropriately and the patient doesn’t leave it too late
What aspects of asthma should a dentist know in relation to their patient
Know that the patient has asthma - history
Know the severity of the patients asthma - risk assess
Know the triggers for the patients asthma - avoid these
Know how to assess and treat a patient during an acute asthma attack
