r flowchart lO.IJ: lypes of asthma.

Asthma
s1a11d uprigh1 w ith 1h e hack. upn g
and h ea d fixed . .
· ,~1 1 an<J tJ i t.: u,

a ll v d cv e lor" w ithin
l:'xtrinslc asthmo -c_l~ronchc!sp~s n_:-\r.~e ~c c1 n acks u su a l ly
i i 1 rnini11cc. after ex po.,un: tn alle rgen ·
become lci,c, fre quent an, 11 cs6 se ·
vere cJunn g
. micJ d l e ancJ lat f·
Intrinsic Mixed
Statu s a dol c1,cc n cc ;md rn ay dic..app ea r e ntire ly. . cu.i ll ~· n,r;r c
asthma asthma . · · • as thm a L'> u -,
as thm at1 cus fn/r/11.,icas tlzmo - i.l lta cko (rntnn l'i lC · · . h
J
T he
O f - IJ e r g 1c ast m a .
fulmi11.i111 and St'.vc• rc th an thO '-C a . c nr uall •·
,,., cJ h p a u c: nt cv ,
j0lar narrowing. As the attack progresses _, . . . lm1g: ll~r%pro g no-;l i, i<, -poore r an t e 1 b rw ec n
ro11C 11 fu th b - , 1cs1st.in c c . . . . - -cJ. - ., in int e r va e
l, air floW rnay be r er exacer ated by mucosac I ...c
" 1t•m ;1 a nd cx h1blts c lini ca l s ign s a n .. yrnp torn
1° rnatory infiltrate of mucosa. tlCUlc c phud es. . ·
, · · · ttack rE: r~1<; t c. in
inOaJll 1 Slalus asthmalicw,~ i ii. <1c u1 c ac, r h m .:1 t1 c <1 -
r - - - __ • nr'nu e for hourc..
sp ll e of drug1tle rap , :3roncho-;pac, m ny.i y VJ 1
r pes (Flowchart 30.8) -- - ~ - , -n---:-
or eve n da ys witho11t re m1 i.~ 100. r- a u c nt m()r ·
f'. c ommonl y
_
, YE"'trinsicasthma-it
,. -.--- , is developed
th . by1;--..__
allergi c fa c torsi, 11 I-S a 1SO ex hibit s cxtrcrn__0<!.tig!,!e , d e h y dr a 1i on . <,C: V e ~ h~po~ i,:.1 .
called as a_ll~rgic as ma. Pat~~nt, who i"S havin g as thmc:1 of cya no s is, pe riph e r'!!_v_ascu la r c, ho ck a nd d r ug 1niox.1catw n
allergic ongm,
. .
often has pos1t1ve family hi sto n , 01- ct ·
. h' . · J 1sease
from inte ns ive-thera p y. C h ronic p an ia l air.•,ay ob <;r rucuuo
and pos1uve atop1c 1story including hay fever, rose feve r mil y lea d 1. 0 death from res pirato ry ac id os ic,.
and eczema.
, Intrinsic asthma-it is pre~ipitated by nonallergi c fa c tors. LI
Diagnosis
is also called as ~ J h m a, idiopalhic_asthma and
infective asthma. -- Clinical diagnosis-diagnos is of bro nchi a l asthma is ba:,ec
• Mixed asthma-it is combination of allergic and non -a llergic on th e symptom s, pulmonary function 1est and phy sica l
asthma. findin g of expiratory w h eezes during th e a c ur e attack_ . _
Status asthmaticus-it is persistent exacerbati o n of Labora tory diagnosis- th e re is ra ised to ta l Jg£ a nd c:,pec111 c
asthma. lgE a ntibod y co nc e ntration .

Predisposing Factors Manage~a t .

Extrinsic asthma • -..2ympathomimetic amin e"-:- u se of drugs like te r butaline .
isoproterenol and m ~ o t e re n o l as fir st line therapy . fr
• Airborne allergen-house dust, feathers , animal dander
_dilates and preve11ts bron c hial s m ooth mus cle co n stricti on .
furniture stuffing, fungal spores and a wide variety of plan~
pollens. "----J!.anthinederivativ"i&xanthine deri va ti ves like a minop hyl -
line and theophylhne can be used . It inhibi ts the hydTol yi:k
• Allergenic food-it includes cow's milk, eggs, fish, chocolate,
shellfish and tomatoes. __ degrada_ti.9n-o cycUc AMP.
• Allergic drug-it includes penicillin, vaccines and aspirin . Corticosteroid corticostero id s lik e h ydr ocortisone and
pre msone can also be used . It lessens in te n si ry of antigen -
Intrinsic asthma antibody reaction .
• ~r~spiratory_ infections, u~ually viral, are well Omalizumab-it is recombinant human ize d mon o cl ona l
known m1tiatmg factor m the asthmatic patient. anti -IgE antibody, will cause reduction in wtal serum JgE
~ s o m e patients have acute asthmatic attack after and thereby decreasing the symptoms of as thm a .
~ e d exercise. • Sod_iumcromoglycate-cromol yn sodium is us.ed. It protectS
• Psychologica e ~ such as nervousness, ~SLrn~t~ ell destruction .
anxiety can cause asthmatic attack. The dental office is ~ i n h a l e d corticosteroids \vith br2._nch odilacors..
a common site for asthmatic attack. Child may develop Antzhi.stamme-antihistarr1inic usually are u seful beca use
asthmatic attack after taken into treatment room and recover ~raduce dryiT1.g and\ obstruction of air.
after moving out from treatment room. \.Emmency
. managemen{-'r-emergenc\·
. . trearm ent ts ·-m· h a 1a -
tlo~ of a s~luuon containing 0 . 1 mg isoproterenol o r 1 : 1 t)()()
Clinical Features ep'.nephrme by ne~ulizer or injection of 0 . 1 mJ of 1: l.OOO
e p m ephnn e,: Conunuous inhalacton by n asal cathete r i,;;.
• Age-it is more common in children, especiall,Qt can .,,,,.....,,........~o re teve the hypoxia . ___ _
also occur in older individuals. ~ Hydration - . ydration is necessary in the Corm ar - cr gl ":. .....,
• Symptoms-patients notice a sensation of fullness in · -W:tt-1~-n=S. • . :::, ~ "' UCO.Se '·
m cause there is dyspne a. ~-
the chest. Predominately, symptoms of acute attack are
~zing, coughing and labored breathing. There is also
~zmg and gasping saunas are heard wTiile attempting Dental Considerations
to breath. vo, mha at ion anesthe tics patient _. ,_
< u sing L1ec;1- .1.J.n>nt:>n2 · _
• !,ttack termination-termination of attack is usually 11 er s 1ould e rem 111 ed 10 brin g th o.111 1 . -,..11..
heralded by a period of intense coughing with expectoration .
d enta I o mice; the dentis t s hould ·woid · .. ' ' ~ 1t'r ,n th tht>n, t 0
.
• . ' 111 1 l ,l 1~lion 1ne,thet - -
of ~ s mucus plug which is followed by or ana Iges1c m asthmatic patil' t1l b , .. . , . · - 11..:s
f . 1 . . tcl ,lu,- t ot the p,1ss.ibil1 f\
• J~~s~1on of relief. _ o mu atmg an acut e asthmatk ;1n,1d, -~
'2:,!{(15~ severe attack, the patient is exy~mel anxious Dental wor · if attac-1...s :ire St' :t, 011 · 1 _
. ' - ,\ . ro ll l I 11 ' J ' 1
an ~ ~~~ecU Heart rate is increased to(13~ mute. )l'rlonnl'dduringtheci·i,, , h ' t.nt~
(Yano~~3/~ucous m~mb_.r<_1!)e oflips may ne visible a ong I · ' w t'l1 lr('quenc ,
0\Vt'SI. l' ;llil'lllS O il q 'r . \ .
WTifiperspiration an(flushing of f~~nd upper torso 111 additional Stl'roid tu l\' )i •' _ · t OIL ' 111 •' ~ rt' qU irt.'
" l u :St~rltlllS re· \C .
severe attack. Patient is rn<frecorrffortable if allowed to sit or dl'nlal procedun•. · ' 11011 to s t rl'ss nf
t1tm . ·-.d.t !~cks o,i dental chait•-in case of acute attack occurring on to gt'-·e b\uc -b\oate<..\ ·,_.,
denlal chair, following measures should be taken: cough .
<11 • , Ter,n ,na · t et Ji'e procedure~ terminate the dental therapy an d
C: • Later stage - in t" H:2
• p o-st~u1: the patient in any comfortable position. sputum and {eve
i d,nz nistration ofbronchodilators-0 .5 mL, 1 :1000 adrena-
Diagnosis
-ta
'-
lines can be injected subcutaneously or intramuscularly • lf
a ttack is p_rolQnged, steroids are indicated. Clinical diagnosis-c ut·(
0 • "-A erosol spray- - the onset of aerosol drug is rapid and relief blue-bloat e d a p\)e ar ar
't-
o o"'f symptoms occurs within seconds.
~ • Administer oxygen- ' it may be administered by full face
0 Manageme nt
0 -mask, nasalhood or nasal cannula.
.c
...., • Stoppage of h ab i
>< smoking.
~ Chronic Obstructive Pulmonary Disease
• Bronchodilator -
It is characterized by airway obstruction and breathlessness. in relieving b r
ipratropium b r
Types • Antibiotics-a
• Chronic bronchitis-it refers to inflammation of bronchi. lt earliest sign
is defined as a condition in which there is mucus producing amoxici\\in, tJ
cough present, for at least 3 months of the year, for more than • Oxygen thera
2 co nsecutive years. chronic basi