Asthma attack in the practice

An asthma attack is one of the most common clinical emergencies in the general population and, for that reason, one of the most likely to show up in an orofacial harmonization (HOF) practice. Asthmatic patients usually arrive well controlled. Anxiety, pain, the smell of a product, a new medication or a recent respiratory infection can change that picture within minutes.

This page covers recognition and initial management, at the level of practice organization. It does not recommend drugs or doses: medical management is defined by a qualified professional according to current protocols, and emergency services take over the case when necessary.

Why does asthma matter in HOF?

Three practical reasons:

1. Triggers in the environment: anxiety, pain, odors from products and antiseptics, and exertion can set off an attack.
2. Commonly used medications: certain anti-inflammatories can worsen asthma in sensitive people, and this enters the post-procedure instructions.
3. Confusion with an allergic emergency: wheezing and shortness of breath also occur in anaphylaxis, which requires a different approach.

For the question as the patient asks it, see asthma and harmonization procedures.

How do you prevent it starting at the medical history?

Prevention is the most efficient part. An HOF medical history that asks about asthma in detail changes the day of the appointment.

If the patient has active symptoms, postponing is usually the most prudent choice. Always ask them to bring the rescue medication and keep it in view, within arm's reach, throughout the appointment. Record the answers and the decision in the patient record.

How do you recognize an attack?

Signs vary in intensity. Watch for:

• shortness of breath or a feeling of "not getting enough air";
• wheezing when breathing (not always present in the most severe attacks);
• persistent dry cough;
• chest tightness;
• broken speech, in short sentences;
• visible use of the neck and chest muscles to breathe;
• anxiety and agitation, which make things worse.

In severe attacks, the wheezing may decrease because hardly any air is moving, and that does not mean improvement. Signs of severity are cyanosis (bluish lips or fingertips), drowsiness, confusion, inability to speak and exhaustion.

What should you do in the first minutes?

If the practice has monitoring, such as a pulse oximeter, it helps track progress. If oxygen is available and the team is trained, the decision to use it follows the clinic's protocol and medical guidance (see oxygen in the practice).

When is it anaphylaxis and not asthma?

Telling them apart is essential, because the treatment changes. Clues that suggest anaphylaxis:

When in doubt, treat it as a serious situation: call emergency services and follow the anaphylaxis protocol. Read more in anaphylaxis in the HOF practice, syncope or anaphylaxis and angioedema after a procedure.

When should you call SAMU?

Call SAMU 192 when there is:

• shortness of breath that does not improve quickly after the patient's rescue medication;
• progressive worsening, inability to speak or very broken speech;
• bluish lips or fingertips;
• drowsiness, confusion or exhaustion;
• suspected anaphylaxis;
• doubt about the severity.

Agree in advance who makes the call and who provides the address, age, history and time. See when to call SAMU and hospital transfer of the patient.

How do you document it and how do you resume?

After stabilizing the patient, record the start time, the signs observed, the actions taken, the medication used by the patient, the time emergency services were called and the outcome. Details in emergency documentation in the practice.

The procedure should only be resumed after an appropriate clinical assessment and with the patient's agreement. In general, it is better to reschedule. Rescheduling is also an opportunity to talk about asthma control with the treating physician. For an honest conversation, see communicating a complication to the patient.

How do you train the team?

Include the asthma attack in the exercises of the team emergency drill and check that the HOF practice emergency kit and the clinic's plan are consistent with what the responsible professional defines. A simple starting point: everyone knows their role, the SAMU number is visible and the asthmatic patient always brings their rescue medication.

Harmy is not part of the emergency response. In routine care, it supports the planning conversation with an illustrative projection made from a frontal photo, always as a simulation.

What should you not forget after the attack?

Once breathing stabilizes, the patient is usually tired, frightened and eager to leave. Resist releasing them too quickly. Keep them under observation for a reasonable time, and confirm that they breathe comfortably at rest, can speak in full sentences and have someone to take them home. If SAMU was called, the service decides on transport.

Also record what triggered the episode, when identifiable: product, odor, pain, anxiety, exertion. This information goes into the medical history for future visits and may change the environment, the schedule and the pace of care. In future appointments, it is worth discussing asthma control with the treating physician before booking a new procedure, and reminding the patient to always bring their rescue medication.