Information Sourced May 2020
Patients with asthma may have an attack while at the dental surgery. Most attacks will respond to 2 puffs of the patient’s short-acting beta2 agonist inhaler such as salbutamol 100 micrograms/puff; further puffs are required if the patient does not respond rapidly. If the patient is unable to use the inhaler effectively, further puffs should be given through a large-volume spacer device (or, if not available, through a plastic or paper cup with a hole in the bottom for the inhaler mouthpiece). If the response remains unsatisfactory, or if further deterioration occurs, then the patient should be transferred urgently to hospital. Whilst awaiting transfer, oxygen should be given with salbutamol 5 mg or terbutaline sulfate 10 mg by nebuliser; if a nebuliser is unavailable, then 2–10 puffs of salbutamol 100 micrograms/metered inhalation should be given (preferably by a large-volume spacer), and repeated every 10–20 minutes if necessary. If asthma is part of a more generalised anaphylactic reaction, an intramuscular injection of adrenaline/epinephrine (as detailed under Anaphylaxis) should be given.
Patients with severe chronic asthma or whose asthma has deteriorated previously during a dental procedure may require an increase in their prophylactic medication before a dental procedure. This should be discussed with the patient’s medical practitioner and may include increasing the dose of inhaled or oral corticosteroid.