Applied: MT Respiratory Medication

Examples of Respiratory Diseases

• Asthma

• Chronic Obstructive Pulmonary Disorder/COPD

• Infection

  • pneumonia

  • flu

What percentage of the population is affected by asthma?

~2%

Why is acute severe asthma dangerous?

It can be fatal and requires emergency treatment

Management of acute severe asthma

• Bronchodilators

• Corticosteroids

• Oxygen

What is asthma?

chronic inflammatory airway disease causing reversible bronchial narrowing

Key pathological features of asthma

• Airway inflammation

• Oedema

• Excess mucus

• Bronchospasm

What commonly triggers asthma?

Allergens (e.g. dust, pollen)

What immune response is involved in asthma?

body overproduces IgE antibody and releases excess inflammatory mediators

Common symptoms of asthma

• Wheezing

• Coughing

• Chest tightness

• Shortness of breath

Asthma medications - inhaler types

• β₂-Agonists (Relievers)

• corticosteroids

Action of adrenoceptor-beta2 agonists

relax bronchial smooth muscle when B2 receptors are stimulated causing bronchodilation

Examples of β₂-agonists

• Salbutamol

• Terbutaline

Side effects of β₂-agonists

• Headache

• Nervousness

• Palpitations

• Tachycardia

• Tremor

Action of corticosteroids

reduce production of inflammatory mediators (prostaglandins, cytokines) and therefore airway inflammation

Examples of inhaled corticosteroids

• Beclometasone dipropionate

• Budesonide

Side effects of corticosteroids

• Adrenal suppression

• Osteoporosis

• Hypersensitivity

• Oral candidiasis

Types of inhalers

• Relievers vs preventers

• Pressurised metered-dose inhalers (pMDI)

• Dry powder inhalers (DPI)

Oral effects of inhaled corticosteroids

• Candidiasis

• Xerostomia

• Palatal inflammation

Systemic effects of long-term corticosteroids

• Weight gain

• Thin skin

• Easy bruising/bleeding

• Reduced immunity

Impact of asthma on dental treatment

• Ensure inhaler accessible; consider prophylactic puff

• Avoid fluoride varnish (colophony allergy risk)

• Use caution with Articaine (sulphites)

• Avoid/limit ultrasonics (aerosol trigger)

• Watch for oral candidiasis (esp. high-dose steroids)

• Advise spacer use + rinse after inhaler

• Avoid NSAIDs → ↑ leukotrienes → may trigger asthma attack

What is a prophylactic inhaler puff?

Using reliever inhaler before treatment to prevent attack

Why use a spacer with inhalers?

Improves delivery and reduces oral side effects

Why rinse after inhaler use?

prevent candidiasis

When are oral corticosteroids used in asthma?

Acute severe asthma

Action of oral corticosteroids

block prostaglandins that trigger the inflammatory response

Examples of oral corticosteroids

• Prednisolone

• Hydrocortisone

• Cortisone

Other conditions treated with corticosteroids

• Pemphigus vulgaris

• Crohn’s disease

• Ulcerative colitis

• Rheumatoid arthritis

• Skin diseases

What is a steroid crisis?

Inability to produce cortisol during stress due to long-term steroid use

What causes steroid crisis?

Suppressed adrenal gland function

Triggers of steroid crisis

• Illness

• Trauma

• Surgery