Emma Hammett1 provides an up to date guide on managing patients who have an asthma attack in the dental practice.
Asthma is an extremely common chronic condition that can be triggered and exacerbated by the stress of visiting the dentist.
When someone is having an asthma attack, their airways go into spasm which causes tightness of the chest; the linings of the airways become inflamed and phlegm is produced further obstructing the airways and leading to severe difficulty in breathing (Fig. 1). Asthma does lead to fatalities and should always be taken seriously.
Anyone who has been prescribed an inhaler should have it with them at all times.
Common asthma triggers
There are many different triggers for asthma attacks and many asthmatics are well aware of their individual triggers, although they may not always be able to avoid them (Fig. 2).
Inflammatory factors that might trigger an asthma attack include allergens, work and respiratory infections. Irritants that might trigger an attack include strong smells, cold air and temperature change, exercise or stressful and emotional environments.
Other triggers for a potential asthma attack include pollutants, food additives, gastric reflux, tobacco and medications.
Symptoms of asthma
Symptoms of asthma include:
A persistent cough (when at rest)
A wheezing sound coming from the chest (when at rest)
Difficulty breathing (breathing fast and with effort, using all accessory muscles in the upper body)
Unable to talk or complete sentences and possibly going very quiet
An asthmatic patient may try to tell you that their chest ‘feels tight’ (young children may express this as tummy ache).
You must call an ambulance immediately and commence the asthma attack procedure without delay if someone:
Has a blue/white tinge around lips
Is going blue
Not everyone will get all of these symptoms.
Encouraging someone to sit upright is generally helpful when dealing with breathing problems (Fig. 3). Sitting the wrong way round on a chair may be a good position for them, as demonstrated in Figure 4.
Do not take a patient experiencing an asthma attack outside for fresh air if it is cold – as cold air can make symptoms worse.
Using a spacer or volumiser device has been shown to deliver medication more effectively and increases the amount of the medication reaching the airways rather than hitting the back of the throat. The use of a spacer device can help sufferers achieve better control of their asthma (Fig. 5).
Spacers come in a variety of shapes and sizes, but not all spacers fit all types of inhalers – use the spacer prescribed with the inhaler. Spacers for small children are usually fitted with a face mask. There is considerable co-ordination required to use an inhaler without a spacer and this can lead to increased stress and worsening of symptoms.
Patients should always keep the spacer with the inhaler and have both available at all times.
How to help in an asthma attack
The following guidelines are suitable for both children and adults (Fig. 6).
Calm the situation and reassure the casualty as this can help them to control their symptoms; conversely, panic can increase the severity of an attack. Assist them to take one to two puffs of the reliever inhaler (usually blue) – using a spacer device if available.
Sit them down, loosen any tight clothing and encourage them to take slow, steady breaths
If they do not start to feel better, they should take more puffs of their reliever inhaler (up to ten at roughly two minute intervals)
If there is no improvement after taking their inhaler as above, or if you are worried at any time, call 999/112
The patient should keep taking the reliever inhaler two puffs every two minutes, whilst waiting for the paramedics to arrive.
Please note that if the patient has taken more than ten puffs at a time it won't have done them any harm. Salbutamol is a well-tested medication and the main side effects from overdosing are lightheadedness and a slight tremor of the hands – both of which will resolve without treatment.
After an asthma attack
Within 48 hours of an attack, the patient should make an appointment with their doctor or asthma nurse for an asthma review.
People often have a variety of different asthma inhalers and medication to control their asthma – if they are having an asthma attack it is the reliever inhaler that they need. Reliever inhalers are usually blue and the other inhalers are often steroid based to reduce their sensitivity to asthma inducing agents.
Visit www.firstaidforlife.org.uk, email email@example.com or telephone 0208 675 4036 for more information about the first aid training we provide for dental practices throughout the UK. We also have a great range on online first aid courses through www.onlinefirstaid.com that are ideal for first aid refreshers and for completion of your verifiable CPD. First Aid for Life provides this information for guidance and it is not in any way a substitute for medical advice. First Aid for Life is not responsible or liable for any diagnosis made, or actions taken based on this information.
This article has four CPD questions attached to it which will earn you one hour of verifiable CPD. To access the free BDA CPD hub, go to http://bit.ly/2e3G0sv