Clinical Case

A 10 year old girl was schedules

for a tooth extraction in your clinic.
When she came in she was coughing
and has a peculiar breathing sound.
Her mother said that she was suffering
from bronchial asthma.

What is a Bronchial Asthma?

It is a common disorder and it is characterized by airway
inflammation and hyper responsiveness to stimuli that
produce bronchoconstriction. Over 5% to 10% of persons
of all ages suffer from this chronic airway disorder.
Extrinsic Asthma: It is mostly episodic, less prone to status
asthmaticus.
Intrinsic Asthma: It tends to be perennial, status
asthmaticus is more common.

What are the medications for

bronchial asthma?
Methylxanthines- Theophylline
Pharmacokinetics:
Absorbed orally; rectal absorption form suppositories is
erratic.
All tissues; crosses placenta and is secreted in milk; 50% in
plasma protein bound.
Metabolized in liver by demethylation and oxidation.
Excreted in urine; 10% of total administration excreted
unchanged form.

*Children elimination is much faster.

 Pharmacodynamics
Theophylline has two distinct actions in the airways of patients with
reversible obstruction; smooth muscle relaxation and suppression of
the response of the airways to stimuli.

Indications
- Primarily used to treat chronic obstructive lung disorders and
asthma.
- Also used to treat apnea.

Adverse Effects:
- Narrow Margin Safety
- CVS and CNS stimulant; ADRs to dose; not dependent to dose; GIT
Distress
- Children are more reliable to developed CNS Toxicity
- Rapid I.V. injection cause precordial pain, syncope and sudden
death.

Controllers and Relievers

Long-Term Control Medications
-

Long-acting beta-agonists. A beta-agonist, is a type of drug called a

bronchodilator, which opens your airways.

Leukotriene modifiers block chemicals that cause inflammation.

Mast cell stabilizers curb the release of chemicals that cause

inflammation.

Theophylline is a bronchodilator used to prevent nighttime symptoms.

-

An immunomodulator is an injection given if you have moderate to

severe asthma related to allergies that doesnt respond to inhaled
certain drugs.

 Quick-Relief Asthma Drugs

- Short-acting beta-agonists (bronchodilators)
- Anticholinergics. These are bronchodilators that can be
paired with, or used instead of, short-acting betaagonists.
- Systemic corticosteroids are anti-inflammatory drugs
that get symptoms under control quickly.

MANAGEMENT IN DENTAL CARE OF THE

ASTHMA PATIENT
For patients with asthma, the practitioner should
consider the following:
1) the frequency of asthmatic attacks.
2) the type of medications used chronically and during
acute attacks.
3) the length of time since the child was last seen
emergently with acute asthma.
Also, We should consider Physical examination that may
include auscultation of the lungs, observation of the rate
and depth of respiration, use of accessory muscles for
respiration, shortness of breath, and coughing.

 Dental procedures may be

accomplished in the clinic setting for
the well-controlled asthmatic. A
wheezing or poorly controlled patient
should be reappointed. If a patient
has been or is currently using a
metered dose inhaler bronchodilator,
it should be brought to each dental
appointment. Anxiety is a trigger in
children with asthma.
*Dental environment is a common site
for an acute asthmatic attack.

A Dentist should consider all these for

a safer practice.

THANK YOU!