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Asthma

This document defines asthma as a long-term inflammatory disease of the lungs' airways. It is characterized by variable and recurring symptoms, reversible airflow obstruction, and easily triggered bronchospasms. The document discusses the etiology, clinical presentation, diagnosis, treatment including pharmacologic and non-pharmacologic approaches, and dental considerations for patients with asthma.

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khaled alahmad
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14 views11 pages

Asthma

This document defines asthma as a long-term inflammatory disease of the lungs' airways. It is characterized by variable and recurring symptoms, reversible airflow obstruction, and easily triggered bronchospasms. The document discusses the etiology, clinical presentation, diagnosis, treatment including pharmacologic and non-pharmacologic approaches, and dental considerations for patients with asthma.

Uploaded by

khaled alahmad
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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Bronchial asthma

Sara Taha Ibrahim


Assistant professor of internal medicine
Definition

Asthma is a long-term inflammatory disease of the airways of the lungs. It is


characterized by variable and recurring symptoms, reversible airflow obstruction,
and easily triggered bronchospasms.
These may occur a few times a day or a few times per week. Depending on the
person, asthma symptoms may become worse at night or with exercise.
Etiology
Factors that can contribute to asthma or airway hyperreactivity may include any of the
following:
• Environmental allergens (eg, house dust mites; animal allergens, especially cat and dog;
cockroach allergens; and fungi)
• Viral respiratory tract infections
• Exercise, hyperventilation
• Gastroesophageal reflux disease
• Chronic sinusitis or rhinitis
• Aspirin or nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity
• Use of beta-adrenergic receptor blockers.
• Environmental pollutants, tobacco smoke
• Occupational exposure
• Irritants (eg, household sprays, paint fumes)
• Emotional factors or stress
Clinical presentation

Signs and symptoms of asthma include the following:


• Wheezing
• Coughing
• Shortness of breath
• Chest tightness/pain
• May be accompanied by other allergies as allergic rhinitis or skin atopic dermatitis
or eczema.
Diagnosis

• Laboratory assessments and studies are not routinely indicated for the
diagnosis of asthma, but they may be used to exclude other diagnoses.
Eosinophilia and elevated serum IgE levels may help guide therapy in
some cases.
• Arterial blood gases and pulse oximetry are valuable for assessing
severity of exacerbations and following response to treatment.
• Spirometry with post bronchodilator response should be obtained as the
primary test to establish the asthma diagnosis.
• The chest radiograph remains the initial imaging evaluation in most
individuals with symptoms of asthma, but in most patients with asthma,
chest radiography findings are normal or may indicate hyperinflation.
Treatment

Pharmacologic treatment
• Pharmacologic management includes the use of relief and control
agents. Control agents include inhaled corticosteroids, long-acting
bronchodilators (beta-agonists and anticholinergics), theophylline
(Theo-24, Theochron, Uniphyl), leukotriene modifiers, anti-IgE
antibodies, anti-interleukin (IL)–5 antibodies, and anti–IL-4/IL-13
antibodies. Relief medications include short-acting bronchodilators,
systemic corticosteroids, and ipratropium (Atrovent).
• The pharmacologic treatment of asthma is based on stepwise therapy.
Asthma medications should be added or deleted as the frequency and
severity of the patient's symptoms change.
Allergen avoidance
• Environmental exposures and irritants can play a strong role in
symptom exacerbations. The use of skin testing or in vitro testing to
assess sensitivity to perennial indoor allergens is important. Once the
offending allergens are identified, counsel patients on how to avoid
them. Efforts should focus on the home, where specific triggers
include dust mites, animals, cockroaches, mold, and pollen.

Patient education in bronchial asthma is to provide the patient and the


patient's family with suitable information and training so that the patient
can keep well and adjust according to a planned medication.
Dental aspects:
• Elective dental care should be deferred in severe asthmatics until they are in a better
phase.
• Asthmatic patients should be asked to bring their usual medication with them when
coming for dental treatment.
• Acute asthmatic attacks may be precipitated by anxiety. It is important to lessen fear of
dental treatment by gentle handling and reassurance.
• Acute asthmatic attacks are usually self-limiting & respond to the patient’s usual
medication, such as a beta-agonist inhaler, but status asthmaticus is a potentially fatal
emergency so refer to hospital immediately.
• LA is best used: Adrenaline (epinephrine) is contraindicated in patients using
theophylline, as it may precipitate arrhythmias.
• Sedatives in general are better avoided as, in an acute asthmatic attack, even
benzodiazepines can precipitate respiratory failure.
• General A is best to be avoided, as it may be complicated by hypoxia and hypercapnia,
which can cause pulmonary oedema even if cardiac function is normal. The risk of
• Allergy to penicillin may be more frequent in asthmatics.
• Drugs to be avoided, since they may precipitate an asthmatic attack:
Acrylic monomer (Dental acrylic resin)
Aspirin and other NSAIDs.
Barbiturates
Beta-blockers
Colophony (tooth paste)
Cyanoacrylates (adhesives)
Opioids
Pancuronium, Suxamethonium, Tubocurarine (muscle relaxant)
Asthma drugs with oral complications:
Thank you

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