Asthma is a chronic condition that affects the airways in the lungs. When asthma occurs, the airways become inflamed and swollen, making them very sensitive and causing the muscles around the airways to tighten. This causes symptoms like wheezing, coughing, chest tightness, and trouble breathing. There are different levels of asthma severity ranging from mild to severe based on symptoms. Medications can help control asthma symptoms and prevent attacks. It is important for dental patients with asthma to take their medications as prescribed and for dental staff to take steps to minimize triggers.

1. Sheena ARAM Gladyz Mandeep JAY

2. What is Asthma? Causes of Asthma Signs & Symptoms Levels of Asthma Medications Cause of Emergency in the Dental Office Procedures in Clinic Prevention

3. Asthma is a chronic condition that affects the airways in the lungs which are the tubes that carry air in and out of the lungs. When Asthma occurs, the inside walls of the airways become inflamed or swollen. The inflammation makes the airways very sensitive causing the muscles around to tighten up, and airways narrower so less air flows through. This causes symptoms such as wheezing, coughing, chest tightness, and trouble breathing, especially at night or early in the morning. An asthma episode or attack is when your asthma symptoms become worse than usual. Most often extra sticky mucus is produced which also narrows the airways making it more difficult to breathe.

4. The cause of asthma is still unknown though scientists are beginning to understand what contributes to the development of asthma. There are things in the environment that bring on asthma symptoms and lead to asthma attacks. Some of the more common things include exercise, allergens, irritants, and viral infections. And for some, asthma only occurs when they exercise or have a viral infection. Asthma can be inherited Smoking during pregnancy increases the chance of a child developing asthma Second-hand smoke increases the chance of developing asthma Irritants in the workplace may lead to a person developing asthma

5. Allergens Animals or Pets Dust mites Cockroaches Pollen from trees and grass Mold (indoor and outdoor) Irritants Cigarette smoke Air pollution Cold air or changes in weather Strong odors from painting or cooking Scented products Intense Emotions Others Some medicines such as aspirin and beta-blockers Infections Sulfites in food Colds and Flu Exercise Stress Perfume

6. Asthma cannot be cured, but most people with asthma can control it so symptoms can vary from one person to another and also vary from time to time within the same person. Some people may have all the symptoms and can be life threatening, while some may only have a cough or wheeze.

7. Common asthma symptoms include: Coughing that can be worse at night or early in the morning making it hard to sleep. Wheezing is a whistling or squeaky sound when you breathe. Chest tightness can feel like a tight feeling in the chest or something sitting on your chest. Shortness of breath making it hard to speak or finish sentences. Faster breathing or noisy breathing. Pale, grey sweating Feeling tired, lethargic

8. MILD INTERMITTENT MILD PERSISTENT Is the one that comes and goes. The episodes of asthma symptoms occur twice a week or less, and symptoms at night can occur twice a month or less. During times where no symptoms occur, the lung functions normally. Is when asthma symptoms occur more than twice a week, but no more than once a single day. Symptoms at night occur more than twice a month. At times some of the asthma attacks can affect your activity. Based on symptoms, there are four levels of asthma starting from mild to severe: MODERATE PERSISTENT SEVERE PERSISTENT Is when the symptoms occur every day, and also arise at night more than once a week. Asthma attacks may affect your activity. Is when the symptoms occur throughout the day on most days, and also arise by night. In severe asthma, physical activity is likely to be limited. Anyone with asthma can have a severe attack, even people who have intermittent or mild persistent asthma.

9. QUICK- RELIEF MEDICINES LONG-TERM CONTROL MEDICINES Also known as relievers. Relievers are taken at the first signs of asthma symptoms for immediate relief. These medicines are bronchodilators. They act quickly to relax tightened muscles around your airways so the airways can open up and allow more air to flow through. Relievers are only a short-term solution for breathing problems and indicate that there is an underlying inflammation present that requires a controller medication. Also called controllers or preventers. Controllers should be taken everyday usually over long periods of time to prevent symptoms and asthma episodes or attacks. They are the most effective long-term control medicine for asthma and is an inhaled corticosteroid because this medicine reduces the airway swelling .You will feel the full effects of these medicines after taking them for a few weeks. People with persistent asthma need long term control medicines. Most people with asthma take two types of medication because each asthma medication treats only one aspect of the condition.

10. Some other long-term control medicines include: Inhaled long-acting beta-agonists – which are bronchodilators, or muscle relaxers, not anti-inflammatory drugs. They are used to help control moderate and severe asthma and to prevent night time symptoms. Long-acting beta-agonists are usually taken together with inhaled corticosteroid medicines. Leukotriene modifiers - are used either alone to treat mild persistent asthma or together with inhaled corticosteroids to treat moderate or severe asthma. Cromolyn and Nedocromil - are used to treat mild persistent asthma. Theophylline - is used either alone to treat mild persistent asthma or together with inhaled corticosteroids to treat moderate persistent asthma. People who take this should have their blood levels checked to be sure the dose is appropriate.

11. Most side effects happen in the throat: Hoarseness and Soar throat Thrush or yeast infection (looks like a whitest layer on your tongue) You can prevent thrush by rinsing your mouth, gargling, and spitting out the water after you have taken the inhaled corticosteroids by using a holding chamber. SIDE EFFECTS OF INHALED CORTICOSTEROIDS

12. CORTICOSTEROID PILLS LEUKOTRIENE Short term - prescription that last 3-7 days include: Increase Appetite, Mood Changes, Water Retention, and Hyper Activity in Children Long-term (many months) Increased Appetite, Weight gain, Stomach irritation, and Bone thinning Headache Dizziness Heartburn Upset Stomach Tiredness

13. NO Are there any contraindications to treatment for these medications? However, a person should not be treated if they are coughing or wheezing a lot. Make another appointment!

14. Anxiety is a known asthma trigger thus the dental environment is a common site for an acute asthmatic attack. Therefore, it should be ascertained that the patient has taken his or her most recent scheduled dose antiasthma medication before treatment. Additionally, substantive stress- management techniques should be used.

15. In the Dental office, some dental materials and products may worsen asthma: DENTIFRICES FISSURE SEALANTS TOOTH ENAMEL DUST METHYL METHACRYLATE COTTON ROLLS and FLUORIDE TRAYS

16. Identify patient at risk Inform appropriate healthcare professional Prioritise patients needing urgent attention Transfer to emergency care, maintaining condition

17. Record Keeping Record in Medical Alert Box Next time client visits, avoid everything that may trigger the asthma

18. Confirm that they have taken their most recent scheduled dose of medication The patients own metered-dose inhaler bronchodilator should be on hand at each visit to minimize the risk of an attack. Patients appointment should be in the late morning or the late afternoon If the asthmatic patient does not use a bronchodilator, make sure the emergency kit has both a bronchodilator and oxygen

19. How do we prevent this emergency in the future? How do we prevent this emergency in the future?

20. Schedule appointments for late morning or afternoon. Assess severity of asthmatic condition. Consider antibiotic prophylaxis for immunosuppressed patients Consider corticosteroid replacement for adrenally suppressed patients Avoid using dental materials that may elicit an asthmatic attack Have supplemental oxygen and bronchodilators available in case of acute asthmatic exacerbation To prevent asthma symptoms: Learn about your asthma and how to control it. Use medicines as directed by your doctor to prevent or stop attacks. Avoid things that make your asthma worse as much as possible. Get regular checkups from your doctor. Follow your asthma self-management plan.

21. Use vasoconstrictors judiciously Avoid eliciting a coughing reflex Avoid using local anesthetics containing sodium metabisulfite Use rubber dams cautiously Use techniques to reduce the patientʼs stress: Avoid using barbiturates Avoid using nitrous oxide in people with severe asthma

22. Be aware that some patients may have an adverse reaction to non- steroidal anti-inflammatory drugs. Use tetracycline cautiously. Avoid use of erythromycin in patients taking theophylline. Avoid use of phenobarbitals in patients taking theophylline. Analgesic of choice for these patients is acetaminophen.

24. http://junanteola.files.wordpress.com/2007/01/dental.gif http://us.st11.yimg.com/us.st.yimg.com/I/yhst-20235226328512_1961_14829220 http://www.nhlbi.nih.gov/health/dci/Diseases/Asthma/Asthma_WhatIs.html http://www.asthma.ca/adults/about/whatIsAsthma.php http://chealth.canoe.ca/channel_section_details.asp?text_id=3374&channel_id=2014&relation_id=18604 www.airpurifiers.com/products/images/asthma2.jpg www. ecoshineandwash.com/assets/images/allergens.gif www.nlm.nih.gov/.../ency/fullsize/19381.jpg http://www.cartoonstock.com/lowres/vsh0069l.jpg www.daveluptoncartoons.co.uk/.../asthma02_ix.gif http://us.st11.yimg.com/us.st.yimg.com/I/yhst-20235226328512_1961_14829220 www.gsk.co.nz/user_images/FlixInh13-6-01.jpg