Asthma/COPD Flashcards
COPD
Irreversible chronic airflow obstruction for which no cure exists
Chronic bronchitis
Emphysema
Differentiation of these is difficult, so they get lumped together.
Epidemiology/Incidence
—- leading cause of death in US
24 million Americans
130/2000 patients in dental practice
3rd
Etiology of COPD
Smoking, genetics, occupational exposure to stuff
COPD genetic susceptibility
Production of inflammatory mediators in response to smoke exposure
Chronic bronchitis - Changes in large airways
thickened bronchial walls
enlargement of mucous glands
Chronic Bronchitis - Changes in small airways
narrowing, scarring, increased sputum production, mucous plugging, collapse of peripheral airways
Smoke injures
lung parenchyma
Lung parenchyma damage -
—— is damaged
—- migrate to the damage site
cells release enzymes that destroy ——-
alveolar epithelium
inflammatory cells
alveolar walls
In COPD —— is lost, —— enlarge
Elastic recoil
air spaces
IN copd, Obstruction on ——- occurs
expiration
Complications of COPD
Progressive deterioration with periodic exacerbations Progressive dyspnea
Recurrent pulmonary infections
Pulmonary hypertension —right-sided heart failure Thoracic bullae & pneumothorax
COPD Pharmacologic Management Scheduled --------- bronchodilators Anticholinergics Inhaled steroids for refractory cases -------- for severe cases Antibiotics prn
short & long-acting
Theophylline
If SOB at rest, productive cough, upper respiratory infection
Reschedule elective treatment
Dental Modifications for Patients with Stable COPD
Chair positioning: —–
Local Anesthesia: ———-
Nitrous oxide/oxygen: ——-
upright or semi-supine
bilateral IAN or palatal blocks can be uncomfortable
ok in mild-moderate COPD; avoid in severe cases
Why rotate tylenol and ibuprofen.
They do not work by the same mech. Gets relief by another drug. Alternate every 6 pills.
COPD _ Avoid drugs that will —— (anticholinergics or antihistamines)
Avoid drugs that will further decrease —– (narcotics)
dry out secretions
respiratory drive
Asthma may progress to
COPD
Secondary to a variety of stimuli
Characterized by reversible episodes of hyper- responsiveness…difficulty breating, coughing, and wheezing
Inflammatory airway disease with an exaggerated contractile response
Airflow Obstruction
Contraction of ———
Thickening of airway wall secondary to ——-
Plugging of airway with ——
airway smooth muscle
inflammatory response
mucous
Unavoidable ASTHMA triggers
- Respiratory tract illnesses
- Physical exertion
- Hormonal fluctuations
- Extreme emotion
Triggers that can be addressed/treated - asthma
- Inhaled allergens
- Respiratory irritants
- Comorbid conditions
- Medications
- Influenza
- Pneumococcal infection
- Dietary sulfites
Lung function - ——– is how you check this (how much pt can forcibly exhale in 1s). When they are doing well, they can hit a good number.
spirometry
Asthma is a problem with ——-. Even baseline without active symptoms, their airways are more narrow than patient without asthma.
Too many triggers to prescribe for.
exhalation
Goals of med management - asthma
Reduce impairment
Freedom from frequent symptoms Minimal need (≤2d/week) of inhaled short-acting beta agonists to relieve symptoms Maintenance of normal daily activities, including athletics and exercise
Goals of med management - asthma
Reduce risk
Prevent recurrent exacerbations & ED care
Optimization of pharmacotherapy with minimal or no adverse effects
Intermittent Asthma - tx
Inhaled quick-acting beta-2 agonists prn
Persistent Asthma: tx
Inhaled quick-acting beta-2 agonists prn
Inhaled glucocorticoids scheduled
PRN =
as needed for symptoms.
Character of Well-Controlled Asthma
Daytime symptoms no more than —-/month
Nighttime symptoms no more than —-/month
—– for relief of asthma symptoms needed <3d/week No interference with normal activity
Oral steroids courses and/or urgent care visits no more than—-/year
2x
2x
SABAs
1x
Steroids for asthma
Steroids when other stuff won’t work. This is a bit of a heavier hammer and will clear things up.
Character of Severe Disease asthma
Frequent exacerbations Exercise intolerance
Multiple scheduled medications ED visits
No elective care - asthma
Current Symptoms: ——–
+/- poor compliance with drug therapy
ED visit within last —-months
SOB
Wheezing
Increased RR
3
When treating, ——- doesn’t depress airway. Will not be viewed as an irritant.
Avoid triggers
——– may trigger attack - do you tolerate these drugs:?
NItrous
Aspirin/NSAIDS
Asthma attack -
Sudden onset with peak Typically self-limiting
•
symptoms after 10-15 minutes
Treatment of Asthma Attack Inhaled -------- 2-4 puffs, repeat Q20 minutes Supportive O2 Vitals Activate EMS prn
short-acting beta-2 agonist
Albuterol has —– adverse effects than other options
less CV
Status Asthmaticus
Severe, prolonged asthma attack (>24h) Refractory to normal therapy Associated with respiratory infection Can lead to exhaustion, dehydration, peripheral vascular collapse, death True medical emergency
