Rescue readiness: Keep the prescribed rescue inhaler and spacer available; follow the medical asthma action plan for pretreatment medication
Anxiety and nitrous: Reduce anxiety; consider nitrous oxide for well-controlled asthma after airway assessment; defer during active wheezing
Triggering drugs: Avoid NSAIDs in aspirin-sensitive asthma; avoid narcotics that release histamine (morphine, meperidine)
Local anesthesia: Ask about documented sulfite sensitivity: vasoconstrictor-containing local anesthetics contain sulfite preservatives.
Diagnostic limit: Asthma alone does not establish sulfite allergy
Steroid history: Patients on chronic systemic steroids may need stress dosing (see adrenal insufficiency)
After inhaled steroids: Rinse and spit after inhaled steroids and use a spacer to prevent candidiasis
Acute attack: stop, sit upright, give prescribed inhaled albuterol with a spacer and oxygen as indicated; activate EMS for severe symptoms or poor response. IM epinephrine is indicated if anaphylaxis is suspected
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Active wheezing or suspected anaphylaxis stops elective dental care. Severe symptoms or poor response require EMS; suspected anaphylaxis requires IM epinephrine and emergency care.
Active wheezing or suspected anaphylaxis stops elective dental care. Severe symptoms or poor response require EMS; suspected anaphylaxis requires IM epinephrine and emergency care.