Enhanced Verifiable CPD from the
University of Birmingham

Medical Emergencies
Asthma


This page discusses asthma, a fairly common condition, and one that can usually be readily managed by a prepared dental team should a patient have an attack at the dental surgery.

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If you prefer to view this page as didactic information, rather than as a self assessment, click the arrow below.
Didactic Information:

Asthma is a condition where the airways (bronchi) of the lungs are (reversibly) narrowed during an attack (or “acute exacerbation”). During an attack, the muscle cells in the bronchi constrict, with the airways becoming swollen and inflamed.

In between exacerbations, the patient may show few (if any) symptoms.

Signs & Symptoms
There is great variation in symptoms, from occasional mild attacks (brought on by a trigger) to severe cases where breathing is chronically obstructed.
Symptoms include shortness of breath, tight chest, and wheezing when breathing out. Sometimes there is repeated coughing. The neck muscles may become visible as the patient struggles to breathe.
If the attack is very severe, the patient may turn blue, or even lose consciousness.

Precautions
If the patient is known to have asthma, ensure they bring their medication with them to the surgery.
Judge the severity of their asthma: if (in the last year) they have needed oral medications as well as inhalers, and / or use a nebuliser at home, they are high risk. Similarly if they have been admitted to hospital for the condition.
Ensure the emergency drug kit contains Salbutamol aerosol inhaler (100 micrograms / actuation).
Ensure that emergency oxygen is available.

Management
Most attacks will respond quickly to a few doses of the patient’s own inhaler (e.g. Salbutamol).

If there is not a rapid response, or there are signs of a severe attack, call an ambulance urgently. For severe cases, give oxygen (15 litres / minute). Repeat doses (4 to 6 activations) of the Salbutamol inhaler should be given every ten minutes while waiting for the ambulance, preferably through a large volume spacer device.

The UK Resuscitation Council recommends that every dental practice should have a large volume spacer device as part of its emergency kit.



Self Assessment

What happens to the lungs during an asthma attack?


Does a patient with asthma show symptoms in between exacerbations?




The signs and symptoms of an asthma attack can be variable. List them.



What precautions should you take if you know a patient has asthma?



How would you manage an acute asthma exacerbation (attack)?


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