Asthma and Breathing Emergencies

Breathing problems in dental settings may arise from asthma, panic, anaphylaxis, aspiration, choking, sedation complications, infection, or cardiac causes. Although asthma is common, do not assume every breathless patient has asthma. Assess the whole presentation and escalate promptly if there are severe features.

Signs of severe or life-threatening asthma

• Unable to complete sentences in one breath.
• Exhaustion, confusion, reduced consciousness, or cyanosis.
• Very fast or very slow breathing.
• Worsening wheeze or a silent chest.
• Not improving after initial salbutamol.

SDCEP advises sitting the patient upright, giving oxygen, and delivering salbutamol via a large-volume spacer in repeated puffs according to the emergency protocol. If a severe asthma episode does not respond within 5 minutes, arrange emergency transfer to hospital. Dental nurses can assist by fetching the spacer, timing puffs, recording the patient's response, reassuring the patient, and calling 999 when needed.

Choking and aspiration are different

Assess breathing; do not guess. Bring the spacer, oxygen and emergency kit early, and call 999 if severe features or a poor response are present.