Asthma/COPD

Question 1

COPD

Answer 1

Irreversible chronic airflow obstruction for which no cure exists
Chronic bronchitis
Emphysema

Differentiation of these is difficult, so they get lumped together.

Question 2

Epidemiology/Incidence
—- leading cause of death in US
24 million Americans
130/2000 patients in dental practice

Answer 2

3rd

Question 3

Etiology of COPD

Answer 3

Smoking, genetics, occupational exposure to stuff

Question 4

COPD genetic susceptibility

Answer 4

Production of inflammatory mediators in response to smoke exposure

Question 5

Chronic bronchitis - Changes in large airways

Answer 5

thickened bronchial walls

enlargement of mucous glands

Question 6

Chronic Bronchitis - Changes in small airways

Answer 6

narrowing, scarring, increased sputum production, mucous plugging, collapse of peripheral airways

Question 7

Smoke injures

Answer 7

lung parenchyma

Question 8

Lung parenchyma damage -
—— is damaged
—- migrate to the damage site
cells release enzymes that destroy ——-

Answer 8

alveolar epithelium

inflammatory cells

alveolar walls

Question 9

In COPD —— is lost, —— enlarge

Answer 9

Elastic recoil

air spaces

Question 10

IN copd, Obstruction on ——- occurs

Answer 10

expiration

Question 11

Complications of COPD

Answer 11

Progressive deterioration with periodic exacerbations Progressive dyspnea
Recurrent pulmonary infections
Pulmonary hypertension —right-sided heart failure Thoracic bullae & pneumothorax

Question 12

COPD Pharmacologic Management
Scheduled --------- bronchodilators 
Anticholinergics
Inhaled steroids for refractory cases -------- for severe cases
Antibiotics prn

Answer 12

short & long-acting

Theophylline

Question 13

If SOB at rest, productive cough, upper respiratory infection

Answer 13

Reschedule elective treatment

Question 14

Dental Modifications for Patients with Stable COPD
Chair positioning: —–
Local Anesthesia: ———-
Nitrous oxide/oxygen: ——-

Answer 14

upright or semi-supine

bilateral IAN or palatal blocks can be uncomfortable

ok in mild-moderate COPD; avoid in severe cases

Question 15

Why rotate tylenol and ibuprofen.

Answer 15

They do not work by the same mech. Gets relief by another drug. Alternate every 6 pills.

Question 16

COPD _ Avoid drugs that will —— (anticholinergics or antihistamines)
Avoid drugs that will further decrease —– (narcotics)

Answer 16

dry out secretions

respiratory drive

Question 17

Asthma may progress to

Answer 17

COPD

Question 18

Secondary to a variety of stimuli
Characterized by reversible episodes of hyper- responsiveness…difficulty breating, coughing, and wheezing

Answer 18

Inflammatory airway disease with an exaggerated contractile response

Question 19

Airflow Obstruction
Contraction of ———
Thickening of airway wall secondary to ——-
Plugging of airway with ——

Answer 19

airway smooth muscle

inflammatory response

mucous

Question 20

Unavoidable ASTHMA triggers

Answer 20

• Respiratory tract illnesses
• Physical exertion
• Hormonal fluctuations
• Extreme emotion

Question 21

Triggers that can be addressed/treated - asthma

Answer 21

• Inhaled allergens
• Respiratory irritants
• Comorbid conditions
• Medications
• Influenza
• Pneumococcal infection
• Dietary sulfites

Question 22

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.

Answer 22

spirometry

Question 23

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.

Answer 23

exhalation

Question 24

Goals of med management - asthma

Reduce impairment

Answer 24

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

Question 25

Goals of med management - asthma

Reduce risk

Answer 25

Prevent recurrent exacerbations & ED care

Optimization of pharmacotherapy with minimal or no adverse effects

Question 26

Intermittent Asthma - tx

Answer 26

Inhaled quick-acting beta-2 agonists prn

Question 27

Persistent Asthma: tx

Answer 27

Inhaled quick-acting beta-2 agonists prn

Inhaled glucocorticoids scheduled

Question 28

PRN =

Answer 28

as needed for symptoms.

Question 29

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

Answer 29

2x

2x

SABAs

1x

Question 30

Steroids for asthma

Answer 30

Steroids when other stuff won’t work. This is a bit of a heavier hammer and will clear things up.

Question 31

Character of Severe Disease asthma

Answer 31

Frequent exacerbations Exercise intolerance

Multiple scheduled medications ED visits

Question 32

No elective care - asthma

Current Symptoms: ——–

+/- poor compliance with drug therapy
ED visit within last —-months

Answer 32

SOB
Wheezing
Increased RR

3

Question 33

When treating, ——- doesn’t depress airway. Will not be viewed as an irritant.

Avoid triggers
——– may trigger attack - do you tolerate these drugs:?

Answer 33

NItrous

Aspirin/NSAIDS

Question 34

Asthma attack -

Answer 34

Sudden onset with peak Typically self-limiting
•
symptoms after 10-15 minutes

Question 35

Treatment of Asthma Attack
Inhaled --------
2-4 puffs, repeat Q20 minutes Supportive
O2
Vitals
Activate EMS prn

Answer 35

short-acting beta-2 agonist

Question 36

Albuterol has —– adverse effects than other options

Answer 36

less CV

Question 37

Status Asthmaticus

Answer 37

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