Harsha- Asthma

Question 1

Who has higher chances of having asthma

Answer 1

Māori

Question 2

What is bronchial asthma characterised by

Answer 2

Widespread airway obstruction
- difficulty breathing
- shortness of breath
- chest tightness
- wheezing
- coughing

Question 3

Describe aetiology of asthma

Answer 3

• uncertain, likely a combination of several factors
• hyper responsiveness (small trigger induces attack)
• Involves narrowing of airways through smooth muscle contraction, increased secretions, mucosal swelling

Question 4

What are the two types of asthma

Answer 4

Early onset (atopic) and late onset

Question 5

Describe early onset asthma

Answer 5

• onset usually in childhood
• usually an atopic parent (family history)
• IgE antibodies to common allergens

Question 6

Describe late onset asthma

Answer 6

• Can begin at any age
• usually non atopic patient (no family history)
• little evidence of external allergens playing a role

Question 7

Describe episodic asthma

Answer 7

• varying severity of attacks
• patients clinically normal between episodes
• usually atopic pts
  triggered by:
• allergens
• environment
• occupational
• infections
• drugs
• exercise
• emotion

Question 8

Describe chronic asthma

Answer 8

• spontaneous cough and wheeze, mostly at night
• wheeze and breathlessness on exercising
• usually non-atopic pts

Question 9

What can asthma lead to long-term

Answer 9

• chronic inflammation leads to structural changes to airway and lungs- pts may develop chest wall deformities (barrel chest, harrison’s sulcus)

Question 10

Describe diagnosis of asthma

Answer 10

usually by history: evidence of reversible airflow obstruction resolving spontaneously over time or with treatment
- disturbed sleep
- decreased exercise capacity
- other atopic disease
- diurnal variations in symptoms/peak flow
Signs+symptoms
Also by measuring peak flow

Question 11

Describe peak flow meter

Answer 11

• measures how fast you can blow air out of your lungs
• speed/force of air expulsion depend on degree of patency of airways

Question 12

Describe clinical assessment of an asthmatic attack

Answer 12

quickly assess severity (mild, moderate, severe, life threatening
using: breathlessness, wheeze, speech, peak flow, respiratory rate, HR

Question 13

Describe mild asthma symptoms

Answer 13

• cough
• soft wheeze- end expiratory wheeze audible with stethoscope
• minor difficulty breathing
• can speak in sentences
• oxygen saturation >92%
• PEF >70% of predicted best
• Heartrate >110
• Respiratory rate <25

Question 14

Describe moderate asthma symptoms

Answer 14

• persistent cough
• obvious difficulty breathing
• audible, pronounced wheeze
• can speak in short sentences/phrases
• oxygen saturation >92%
• Heart rate <110
• Respiratory rate <25

Question 15

Describe severe asthma symptoms

Answer 15

• shortness of breath
• evidence of accessory muscle use
• unable to remain supine
• agitated, diaphoretic
• speech limited to gasping words only
• HR- >110bpm
• RR >25/min
• oxygen saturation <90%
• peak flow <50% of predicted best

Question 17

Describe management of asthma

Answer 17

• education to avoid triggers
• lifestyle changes
• medications
• action plan to treat acute episodes

Question 17

What are some investigations for asthma

Answer 17

• pulse oximetry
• ABG; arterial blood gases
• chest xray
• ecg if pt over 40

Question 18

What are types of inhalers for asthma

Answer 18

• breath actuated inhalers
• metered dose inhalers
• soft-mist inhalers

Question 19

What are some adjuncts to facilitate inhaler therapy

Answer 19

• spacer devices
• nebulisers

Question 20

What are some classes of inhaler

Answer 20

• reliever
• preventer
• controller
• others (eg mixed)

Question 21

what are some examples of preventer inhalers

Answer 21

• fluticasone (flixotide)
• beclomethasone (beclazone)
• budesonide (pulmicort)

Question 22

What are some reliever inhalers?

Answer 22

first line:
salbutamol: respigen,salair, ventolin
terbutaline: bricanyl turbuhaler

Question 23

What are some controller inhalers

Answer 23

• salmeterol
• formoterol
  serevent

Question 24

What are some issues with children and asthma

Answer 24

- compliance - can get unwell very quickly - may become very distressed

Question 25

What are some dental considerations for asthma

Answer 25

Asthmatic attack could be triggered by: - dental anxiety - some dental materials - some drugs eg NSAIDs - allergy to penicillin - potential drug interactions

Question 26

What oral issues may asthmatics have due to inhalers

Answer 26

- dry mouth - oral thrush

Question 27

Describe accurate assessment for asthmatic patients

Answer 27

- when was it diagnosed? - triggers - medications - progress/how well controlled

Question 28

What else needs to be considered for asthmatic patients?

Answer 28

- have regular medications on hand for appointment - caution with NO2? - caution recommending NSAIDs - alert to recognise attack

Question 29

What needs to be done in the event of an asthma attack?

Answer 29

- stop dental procedure - assess severity of attack - sit patient upright - administer salbutamol inhaler-spacer/nebuliser? - administer oxygen if required - alert medical help if required - monitor closely and maintain oxygen saturation until help arrives

Question 30

What to do in an asthmatic emergency

Answer 30

- call 111 - upright position - high flow oxygen via mask - Beta 2 agonists via spacer or nebuliser - steroids if available - reassure patient - monitor closely to maintain oxygen saturation until help arrives - use adrenaline (epi pen) if symptoms are worsening