Bronchial Asthma Dental 2012

7/29/2019 Bronchial Asthma Dental 2012

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Bronchial Asthma

Basheer Khassawneh, MD, FCCP

Associate Professor, Faculty of Medicine

Pulmonary and Critical Care and Sleep MedicineCMO, King Abdullah University Hospital

Jordan University of Science and Technology


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Definition and Characteristics

A chronic inflammatory disorder of theairways

Causing recurrent/intermittent episodes of:Wheezing

Breathlessness

Chest tightness

Cough particularly at night

Symptoms are worse at night and/or in theearly morning


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Definition and Characteristics

Variable airflow limitation that is

at least partly reversible eitherspontaneously or with treatment

Airway hyper-responsiveness to a

variety of stimuli


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The Scope of the Problem -USA

Affects 14 -15 million people

6% of children under 18 years of age

Inner city children have highest rates

Rates higher among females

Rates higher among blacks


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Base: All respondents (unweighted N=1000).

How Asthma Affects the General

Population

Family Members

With Asthma

35.1%

Friends/Coworkers

With Asthma

29.4%

None23.0%

CurrentlyExperiencing Asthma

6.7%

Past History of

Asthma

5.8%

Experience With Asthma: Public Survey


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Risk Factors for Asthma

Allergy/Atopy

Family history of asthma/allergy

Perinatal exposure to tobacco smokeEarly viral respiratory tract infections

Low birth weight

Environmental pollutionLow socio-economic status

Passive smoking


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Atopy and Asthma

Atopy is associated with elevated total IgE

Specific IgE against common aero-allergens

Positive skin test to common aero-allergensAsthmatics are more atopic than non-

asthmatics

Atopy is more common in childhood asthma

House dust mite is the most common aer-

allergen worldwide


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Indoor Air Triggers

Environmental tobacco smoke

Cockroaches

House dust mites - commonAnimal dander - cats

Mold


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Outdoor Air Triggers

Particulate matter (air pollution)

Combustion products

Industrial emissionsVehicle exhaust

Outdoor pollens

Olive


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Additional TriggersViral upper respiratory infections

Exercise and hyperventilation

GERDSinusitis and rhinitis

Diet

Cold air

Drugs

Aspirin, NSAID, beta blockers


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Asthma Diagnosis

History and patterns of symptoms

Physical examination

Measurements of lung function

Measurements of allergic status to identifyrisk factors


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Symptoms and Signs

Variety of symptomswheeze

shortness of breath

chest tightness

cough

Asthma symptoms tend to be:Variable and intermittent

Worse at night

Provoked by triggers


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Additional Elements in History

Personal or family history of

Asthma

Atopic condition: eczema, allergic

rhinitis

Worsening of symptoms after

Exposure to recognized triggers

Taking aspirin, NSAID, b-blockers

Exercise


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Physical Signs of Asthma

During exacerbations

Wheeze, silent chest, hyper-resonant

Wheeze: are diffuse, polyphonic,

bilateral and particularly expiratory

Chronic asthma may have signs ofhyperinflation with/without wheeze


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Differential Diagnoses

COPDGastro-esophageal reflux disease (GERD)Post nasal drip (allergic rhinitis, sinusitis)

Cystic fibrosisTumor: Laryngeal, tracheal, lungBronchiectasisForeign body

Vocal cord dysfunctionHyperventilation


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Diagnostic Tools

Peak flow monitoring by patients

Pulmonary function testing (spirometry)

Bronchoprovocative challenge


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Pulmonary Function Test

Obstructive pattern

Forced Vital Capacity (FVC)

Forced Expiratory Volume in 1 second (FEV1)

FEV1/FVC < 70%

Reversible airflow limitation

FEV1 increases by 15% after inhalation of a rapid-acting

beta-2-agonist


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Clinical Control of Asthma

No (or minimal)* daytime symptoms

No limitations of activity

No nocturnal symptoms

No (or minimal) need for rescue medication

Normal lung function No exacerbations

_________

* Minimal = twice or less per week


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Levels of Asthma Control

Characteristic Controlled(All of the following)

Partly controlled(Any present in any week)

Uncontrolled

Daytime symptoms None ( 2/ week) > 2 / week

3 or morefeatures of

partly

controlled

asthma

present in

any week

Limitations of

activities None Any

Nocturnal

symptoms /

awakening

None Any

Need for rescue /

reliever treatment None ( 2 / week) > 2 / week

Lung function

(PEF or FEV1)Normal

< 80% predicted or

personal best (if

known) on any day

Exacerbation None 1 / year 1 in any week


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Asthma Management

Although there is no cure for asthma

Appropriate managementmost often results in

the achievement of control


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Controller Medications

Inhaled glucocorticosteroids

Leukotriene modifiers

Anti-IgE

Theophylline

Systemic glucocorticosteroids

Long-acting inhaled 2-agonists


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Reliever Medications

Rapid-acting inhaled 2-agonists

Salbutamol


Anticholinergics

Ipratropium

Theophylline

Short-acting oral 2

-agonists


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Episodes of progressive increase in

shortness of breath, cough, wheezing, or

chest tightness

Characterized by decreases in expiratory

airflow

Potentially life-threatening and treatment

requires close supervision

Asthma Exacerbations


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Primary therapies for exacerbations

Repetitive administration of rapid-acting inhaled

2-agonist


Oxygen supplementation

Closely monitor response to treatment with serialmeasures of lung function

Manage Asthma Exacerbations


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Acute AsthmaEmergency Department Management

Good Response

Observe for atleast 1 hour

If Stable,Discharge to

Home

Initial AssessmentHistory, Physical Examination, PEF or FEV1

Initial TherapyBronchodilators; O2 if needed

Incomplete/Poor Response

Add Systemic Glucocorticosteroids

Good Response

Discharge

Poor Response

Admit to Hospital

Respiratory Failure

Admit to ICU


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ORAL HEALTH CHANGES

IN PATIENTS WITH ASTHMA

Increased rate of caries development

Reduced salivary flow

Oral mucosal changes

GingivitisOrofacial abnormalities Increased upper anterior and total anterior facial

height

Higher palatal vaults

Greater overjets

Higher prevalence of posterior crossbites


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Thank You

Documents

Bronchial Asthma Dental 2012