Bronchial asthma (NXPowerLite)

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INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com

Bronchial asthma:

Bronchial asthma www.indiandentalacademy.com

Definition-:

Definition- Airway hyper-responsiveness to any stimulus leading to broncho-spasm, mucosal edema and mucous plugging of airways manifesting as episodic breathlessness with wheezing, spasmodic cough. www.indiandentalacademy.com

Types of asthma:

Types of asthma Extrinsic asthma (allergic asthma)- onset at young age, family history +, allergic to certain substances, increased eosinophil count, increased IgE levels and positive skin sensitivity test. Intrinsic asthma- onset in middle age, no family history, aggravated by emotional stress, responds to steroids. www.indiandentalacademy.com

Types of asthma:

Types of asthma Exercise-induced asthma- more on exposure to cold and dry air. Aspirin-induced asthma- due to NSAIDs. www.indiandentalacademy.com

Pathogenesis :

Pathogenesis Entry of allergen ↓ IgE formation ↓ allergen + IgE get attached to mast cell ↓ degranulation of mast cell ↓ release of mediators (histamine, bradykinin, ECF, leukotrienes, prostaglandins) ↓ increased vascular permeability, mucosal edema & increased mucus secretion leading to clinical features. www.indiandentalacademy.com

Clinical features:

Clinical features Sneezing Tightness in the chest Wheezing Trapping of air in the lungs Signs of hyper-inflation Rhonchi on auscultation www.indiandentalacademy.com

Acute severe asthma:

Acute severe asthma Gasping for breath SBC less than 20 Cyanosis Altered consciousness Pulsus paradoxus Silent chest www.indiandentalacademy.com

Emergency care- indications:

Emergency care- indications PEFR < 50% of predicted normal Failure to respond to beta agonists Severe wheeze/ cough Gasping/ sweating Rapid deterioration over a few hrs. Severe retraction with nasal flaring Hunching forward www.indiandentalacademy.com

Evaluation:

Evaluation Alertness and color of pt Vital signs Use of acc ms Chest auscultation PEFR, FEV1 Pulse oximetry CXR, CBC, ECG, ABG, Electrolyte levels www.indiandentalacademy.com

Diagnosis & Management:

Diagnosis & Management Spirometry a must Inhaled steroids can be used Pt education- written instructions, self-monitoring with peak flow meter, proper use of inhaler. Regular follow up based on severity. Consultation with pulmonologist/ allergy specialist. www.indiandentalacademy.com

Investigations:

Investigations AEC Lung function tests- FEV 1 , FVC, FEV 1 / FVC ratio, PEFR, RV, etc. FEV1/FVC before and after inhaler; increase in 12% or 200 ml after inhaler suggests reversibility IgE levels CXR, X ray PNS Skin tests Bronchial challenge tests. www.indiandentalacademy.com

Treatment :

Treatment Beta-2 agonists Steroids Ipratropium bromide Methyl xanthenes- aminophyllin, theophyllin. Sodium cromoglycate Leukotrienes modifiers- Monteleukast 10 mg tab o.d. www.indiandentalacademy.com

Treatment of acute severe asthma:

Treatment of acute severe asthma Inhaled terbutaline 2.5-5 mg every 20 min for 3 doses Adrenaline 0.3-0.5 mg every 20 min 3 doses Prednisone to be started/ increased www.indiandentalacademy.com

Prevention:

Prevention Avoid allergens Desensitization Sodium cromoglycate Immunoglobins www.indiandentalacademy.com

Dental considerations in Asthma-1:

Dental considerations in Asthma-1 Patients on steroid inhalers prone to oro-pharyngeal candidiasis. Patients on ipratropium may have dry mouth. Anxiety can precipitate asthma. Relative analgesia with Nitrous oxide and Oxygen preferable to sedation with Diazepam ( chances of Respiratory failure) www.indiandentalacademy.com

Dental considerations in Asthma-2:

Dental considerations in Asthma-2 Patients asked to bring their regular medications. Aspirin and NSAIDs avoided. Morphine & other opioids known to cause direct histamine release. Systemic steroids have their own complications. www.indiandentalacademy.com

PowerPoint Presentation:

Thank You www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com

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