3BDS: Resp medicine 2

what is asthma

Reversible small airways obstruction.
Small airways of spongy lungs get narrowed and obstructed with spasm + mucous.
Inflammatory and allergic condition

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what are the symptoms for asthma?

Chronic and acute
• Wheeze
• Breathlessness (Not always directly related to exercise, Trigger by cold, Emotion )
• Cough (Nocturnal, Exercise induced, Cold induced)

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what is the asthma assessment called? what is it plotted by?

Peak expiratory flow rate (plotted by sex, age and height).
How much air you can expel from your lungs at your peak of your expiratory flow. How hard you can blow air out of your lungs.

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what to ask the patient when it comes to the peak expiratory flow rate?

Ask what their usual peak flow is. Best peak flow. What is it today?

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what can trigger asthma? what are the precipitants ?

- Allergens- house dust mite, pet dander, pollen
- Irritants- dust, smoke
- Exertion
- NSAIDs
- Emotion

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what are the indications that someone has chronic asthma (indicators of increased severity )

 Restrictions of activities (house work, can go to work etc)
 Worsening symptoms
 Frequent inhaler use, particularly ‘relievers’ i.e. SABA (4 or 5 a day bad)
 Use of LAMA, Montelukast, theophylline, oral corticosteroids, monoclonal antibody Rx (omali

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what are the peak flow recordings for moderate acute asthma, acute severe asthma and life threatening asthma?

- Moderate acute asthma= PEFR 50-75% of best or predicted
- Acute severe asthma= PEFR 33-50%
- Life threatening asthma= PEFR <33%
(of best or predicted)

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what are other symptoms would show that someone has acute severe asthma (apart from the peak flow reading )

- respiratory rate >25/min
heart rate >110
inability to complete sentences in one breath

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what would you do to manage each type of asthma (moderate, acute and life threatening )

moderate: give salbutamol and reassess
acute: phone 999, give salbutamol, give oxygen
life threatening: phone 999, give salbutamol, give oxygen

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how would you treat acute asthma in your surgery?

ABCDE approach,
phone 999- if they don't get better after the 2 puffs of sulbutamol with spacer and get someone to get AED
high flow oxygen
salbutamol 5mg nebuliser or 2-10 puffs via spacer
repeat salbutamol every 10 mins
write handover for hospital

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what would be some indications of unstable asthma

• Recent infections (coughs, colds)
• Poor compliance

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what are some symptoms of unstable asthma?

- Using SABA inhaler more frequently (blue inhaler)
- Reduced exercise limit

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what are the dental aspect regarding someone with unstable asthma?

Recognition of unstable symptoms
- Delay treatment and refer to GP or hospital

Assess current symptoms
- Exercise tolerance
- Worsening symptoms?
- Recent medication changes
- PEFR

Manage an acute attack

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what impacts do NSAIDSS on someone with asthma?

NSAIDS- can induce bronchospasm

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what are the oral side effects from:
salbutamol
inhaled corticosteroids
leukotriene receptor antagonists
LAMA
oral corticosteroids

salbutamol: may cause oral and throat irritation
inhaled corticosteroids: oral candidiasis, altered taste, altered voice
Leukotriene receptor antagonists: dry mouth
LAMA: dry mouth, dysphonia, altered taste
oral corticosteroids: oral candidiasis

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so, overall main oral side effects of inhaled therapy?

candidiasis, altered taste, dry mouth

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3BDS: Resp medicine 2

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