COPD

Question 1

COPD

Bronchitis

• Excessive mucous production in trachea and bronchi causing airway constriction.
• Chronic cough with sputum production for 3+ months in 2 consecutive years.

Emphysema:

• Permanent damage of alveoli due to inflammation causing enlarged air spaces and lost of elastic recoil (difficult to breathe out)
• Linked to deficiency of alpha1 antitrypsin (neutralizes neutrophil elastase)

Answer 1

Causes

• Smoking
• Occupational/air pollution
• Emphysema: antitrypsin deficiency (neutralizes neutrophil elastase)

Cor Pulmonale: right sided heart failure due to pulmonary hypertention (emphysema)

Question 2

Medical Management

First line: Anticholinergics + beta2 agonist _{(both bronchodilators)}

​Supplemental: Inhaled corticosteroids

Theophylline _{<em>limited role due to narrow therapeutic index</em>}

Antibiotics, low-flow supplemental O2

Smoking cessation

Influenza and Pneumococcal vaccination

Answer 2

Anticholinergic bronchodilators Ipratropium, Tiotropium

B-agonist inhaler Epinephrine (acute), Albuterol (acute)

^{<span>Isoproterenol, Salmeterol, Formoterol</span>}

Inhaled corticosteroid Beclomethasone, Fluticasone ^{Dexamethasone, Triamcinolone}

Systemic corticosteroid

Antileukotrienes Montelukast (singulair)

Phoshodiesterasee Inhibitors Theophylline

Question 3

Dental Management

Defer Tx: unstable, SOB/rest, productive cough, URI, O2 < 91%

Antibiotics - macrolide/cipro interact Theophylline

Drugs - avoid sedation / narcotics, barbiturates (depress respir)

General anesthesia - contraindicated

N2O: avoid in emphysema and severe chronic bronchitis

Anxiety: Consider low-dose BNZ

Blood Pressure - CV comorbidity (eval BP)

Pulse Ox - monitor

Additional O2: Low-flow (2-3 L/min) needed if O2 < 91%, consider if < 95%

Supplemental Steroid may be needed

Devices - rubber dam avoid if severe

Chair position - semi supiine or upright

Answer 3

Theophylline and Abx Interaction:

Ciprofloxacin, Macrolides _{(erythro, azithromycin)}

anorexia, N/V, headache, cardiac arrhythias, convulsions