Approximately five percent of adults and ten percent of children in the United States suffer from asthma.1 Asthma is a chronic lung inflammatory condition that causes constriction of the airway and excessive mucus, making it difficult to breath (Thomas, Parolia, Kundabala & Vikram, 2010). Precautions should be taken when dealing with an asthma patient in your chair as a dental professional. Being aware of the precautions of an asthma patient will help to decrease and manage the risk of an asthma attack from happening in the first place. Throughout my Case Study, I will be discussing a specific patient who has personally dealt with asthma most of her life. Patient Brieana was diagnosed with asthma in the fourth grade after she experienced a very traumatizing asthma attack while playing in a softball tournament in Bloomington, Minnesota. Asthma does not run in her family so, when she had the attack, she and her family were unaware of what was happening. After some test had been run, she was officially diagnosed with asthma. Twelve years later, Brieana is now a 22-year-old college student and has well-controlled exercise induced and seasonal asthma. Throughout her teenage years, she stayed very active by participating in sports and programs throughout the student body. To this day, she still enjoys having an active lifestyle whether it is traveling or experiencing new things with friends or family. She has never let her asthma affect her day to day life or hold her back from doing the things she loves. Growing up, Brieana was not exposed to being outdoors which is where most of her allergies are. Being allergic to pollen, a seasonal allergy, worked to her advantage to not enjoy the outdoors. Her lifestyle has been impacted by asthma starting at a young age, she has had to make numerous lifestyle changes. The lifestyle changes that Brieana has had to make include; taking medications daily, carrying around her inhalers at all times, being aware of her surroundings, and taking precautions when necessary. Now that Brieana is in college, she has realized that it is harder for her to manage her asthma away from her parents. She knows to take her medication religiously, or her asthma will get worse. With her being away at college, she doesn’t have someone to remind her when to take her medications or when it is the appropriate time to get a refill. She has had to grow up and become more responsible and independent throughout the last few years while she has been in college.
Asthma is a chronic lung disease of the airway that makes it harder to move air in and out of the lungs, making it difficult for someone with asthma to breathe. With asthma, there is swelling or inflammation in the air passage of your lungs and causes excess mucus.1 This results in a temporary narrowing of their airways that carry oxygen to the lungs.2 This results in asthma symptoms including, coughing, wheezing, shortness of breath, and chest pain.3 Asthma affects people of all ages, but it most often starts during childhood. In the United States, more than 25 million people are known to have asthma (Thomas, Parolia, Kundabala, Vikram, 2010). Nearly seven million of these people are children (Thomas, Parolia, Kundabala, Vikram, 2010). Asthma has no cure. Even when you feel fine, you still have the disease, and it can flare up at any time. Ever since Brieana has been diagnosed in fourth grade, she has spent many years adjusting her lifestyle. Luckily, she can manage this disease with today’s understanding and treatment for this disease. She experiences very few symptoms in her day to day life. She can live a normal, active life and sleep through the night without interruption from asthma. This is because Brieana has chosen to take an active role in managing her asthma. Brieana uses effective medications and two inhalers to manage her asthma. The medication she takes once a day; every day is Cetirizine. Cetirizine is an antihistamine used to temporarily relieve symptoms of upper respiratory allergies (Wynn, Meiller, & Crossley, 2018). It also is used to relieve itching due to urticaria (hives).
A key adverse event for Cetirizine related to dental treatment is Xerostomia, increased blood pressure, and decrease salivation (Wynn, Meiller, & Crossley, 2018). The two inhalers that she uses are Breo Ellipta and Ventolin HFA. Breo Ellipta is a fluticasone furoate 200 mcg and vilanterol 25 mcg inhalation powder. Ventolin HFA is an albuterol sulfate inhalation aerosol, one puff is equal to 90 mcg per actuation. Brieana only uses her inhalers before she exercises or if needed, during. Since her asthma is seasonal, under certain circumstances she will need it throughout the night or when her allergies are bad. In addition, Brieana takes a Krill Oil and Ultimate CoQ10 Ubiquinol, ultimate absorption. Krill Oil is taken as a supplement to lower blood lipids and Ultimate CoQ10 Ubiquinol- ultimate absorption is a premier heart supplement, it promotes cardiovascular health, normal blood pressure and improved circulation. Brieana is a patient with moderate to severe systemic disease that limits activity but is not incapacitating. Since Brieana has exercise-induced asthma, she is classified as an ASA 3. With an ASA 3, there are some dental considerations relating to her asthma. Some impacts on her dental appointments include, considering shorter appointments, stress reduction therapy, and monitoring the patient closely (Gurenlian & Pickett, 2015). Oral manifestations can be induced by some systemic diseases and can show up in the dental setting. Several medications that are used to treat asthma have been linked to some oral disorders including, Xerostomia, oral candidiasis, acid reflex, and an increasing rate of caries and gingivitis. With all of these oral manifestation Brieana does not experience any difficulty while she brushes her teeth. Since it is recommended that Brieana has shorter or reduced appointment times, she normally needs more frequent recalls. However, frequent recalls are more likely to happen when her seasonal allergies are at their worse.
When the patient’s seasonal allergies are at their worst, patient positioning is a major concern. When the patient is in a normal supine position for too long, a coughing reflex is triggered. When a coughing reflex is triggered, it makes the dental appointment more complex for both the patient and for the dental health providers. Positioning the patient in a semi-supine position will help the patient with any excessive mucus that they may experience. Also, considering when is an appropriate time for the patient to come in for an appointment is important. Dental professionals need to consider appropriate appointment time to help minimize the risk of a medical emergency from occurring (Gurenlian & Pickett, 2015). To minimize the risk of an asthma attack happening to your patient while at their appointment, consider scheduling late mornings or late afternoon appointments. In the early morning or late at night is when people who suffer from asthma experience their worst symptoms. Wheezing and excessive mucus is more likely to happen during these times. Also, when patients with asthma are scheduled in the late morning or late afternoon, it allows more time for their medications to start working the way they are supposed to. Asthma attacks in the dental office are emergency situations that are more apt to occur during an appointment with an asthma patient. Some signs and symptoms to identify are if your patient is experiencing an asthma attack include; inability to finish their sentence with one breath, patient becoming agitated and anxious, coughing, chest tightness, and wheezing. When an asthma attack occurs, there are steps that need to be taken to manage an acute asthmatic episode. Step one is to discontinue treatment as soon as the dental professional identifies that their patient is having an asthma attack.1 Step two is to sit the patient upright or in a comfortable position that the patient prefers.2 Step three is to administer the patients’ inhaler three times that they have brought to their appointment or one from the emergency drug kit.3 Step four is if after three doses of the inhaler and there is no improvement, additional measures need to be taken.
These additional measures include; administer oxygen to the patient, call 911 and EMS, and administer epinephrine intramuscularly.4 It is important to stay with that patient at all times during their attack. If the attack is resolved quickly, the patient can be discharged on their own. If medical assistance or the administration of epinephrine is necessary, the patient should be discharged to EMS and taken to the hospital (Schwartz, S., 2018). After one dose of epinephrine, the patient should be monitored for a biphasic anaphylaxis reaction, which is a reaction that happens hours later after an initial reaction. An asthma attack can be prevented before it leads to an emergency situation by taking action before it begins to occur. Some approaches that should be taken to prevent an asthma attack include making sure the patient brings their inhaler to every appointment, making sure the patient uses their inhaler before each appointment or when needed throughout the appointment, taking medication when scheduled, making sure the patient is in an appropriate and comfortable position for them, shortening appointment times, monitoring the patient closely during appointments, and trying to reduce as much stress as possible on the patient. In conclusion, asthma impacts five percent of adults and ten percent of children in the United States. Asthma shows a correlation between oral and systemic health. As a dental professional, it is important to be aware of any conditions that a patient may have and how to properly handle any situation that could affect their treatment. Precautions should be taken when dealing with an asthma patient in your chair as a dental professional. By completing health histories prior to an appointment, you are aware and have the ability to manage any medical emergency that can and may occur. Dental professionals have the ability to not only impact oral health but to also impact systemic health.
Our editors will help you fix any mistakes and get an A+!Get started
Please check your inbox