BRONCHIAL ASTHMA PATIENT AND DENTAL TREATMENT PROTOCOL

Bronchial asthma is a generalized airway obstruction which in the early stages is paroxysmal and reversible.

• The obstruction, leading to wheezing, is due to bronchial muscle contraction, mucosa swelling and increased mucus production.

symptoms of Asthma

• Exposure to allergens and/or stress can induce an attack.

• It is now accepted fact that inflammation is an important etiological factor in asthma and this has resulted in the use of anti-inflammatory medication in the management of the condition.

TRIGGERS OF BRONCHIAL ASTHMA

• Infections of the upper airways, for example, colds and flu.

• Allergens such as dust mites, pollens, animal fur molds or feathers.

• Airborne irritants such as including fumes, pollution and cigarette smoke.

• Certain medicines like painkillers such as non-steroidal anti-inflammatory drugs (NSAIDs).

• Emotions – Laugher or stress

• Food additives like sulfites and tartrazine.

• Weather conditions : sudden changes in temperature, exposure to cold air,thunderstorms and humid hot for days.

• Indoor conditions – like mold, carpet cleaning chemicals and flooring materials.

• Exercise

• Gastroesophageal reflux disease (GERD)

• Food allergies

• smoking

• Alcohol

Asthmatic attack

symptoms of an asthma attack can include:

Severe wheezing when breathing both in and out.
Coughing that won't stop.
Very rapid breathing.
Chest tightness or pressure.
Tightened neck and chest muscles, called retractions.
Difficulty talking.
Feelings of anxiety or panic.
Pale, sweaty face.

MANAGEMENT OF ASTHMATIC ATTACK

• Although there is no cure for Asthma (chronic disease) , the proper treatment will make an enormous difference in preventing long-term as well as short-term complications caused by Asthma.

• If asthmatic attack occurs in dental chair, stop the

procedure.

• Administer antiasthamatic drug normally used by the

patient followed immediately by hydrocortisone 200 mg

intravenously along with oxygen.

• If there is no response within 2 to 3 minutes, give salbutamol or terbutaline by slow intravenous injection or Adrenaline 1:1,000 solution intramuscularly (0.01 milligram/kg of body weight to a maximum dose of 0.3mg)

• A proper case history must be taken of an asthmatic patient and all dental counsel must take precaution to do safe procedures and must avoid treatments which may trigger an attack.

Avoid anxiety which may precipitate an asthmatic

attack.

• Patients are advised to bring their regular medication

with them.

• Elective dental care should be deferred in severe

asthmatics until they are in a better phase.

• Patient should not be treated during sickness e.g.

flu-like symptoms.

• Allergy to penicillin may bemore frequent.

• Epinephrine, erythromycin,clindamycin and azithromycin are contraindicated for patients on theophylline.

• Infrequent attacks of asthma can be managed by salbutamol (asthalin) inhalers or can be used prophylactically if an attack is predicted. e.g. before exercise or prior to a stressful event such as dental treatment.

• If the attacks are more frequent, the salbutamol should be used regularly.

• If this is insufficient, inhaled steroids (or cromoglycate in the young patients)should be used.

• In severe cases systemic steroids may be prescribed.

* Avoid the use of Local anesthesia containing vasoconstrictor due to reaction with sulphites present as preservatives in it.

• Aspirin and NSAIDs should be avoided as they are considered asthma precipitating drugs.

• Patients on steroid inhalers are prone to oral and pharyngeal thrush and those on ipratropium bromide may have dry mouth.

• Avoid antihistamines such as promethazine and diphenhydramine because of their drying effect that can exacerbate the formation of tenacious mucus in acute attack.

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