Pulmonary Disease 19th March Flashcards
What diseases are classified under COPD?
Bronchitis and Emphysema
What is COPD also known as?
COAD
What is the definition of COPD?
A set of lung diseases which limit airflow that is not fully reversible, usually progressive and involves inflammatory response of lungs. Usually can be prevented by avoiding causing factors and with appropriate precautions. Symptomatic treatment is available, but there is no cure.
(In contrast to asthma, which is reversible, i.e. once a causing/precipitating factor initiates COPD, you can not cure it, whereas if asthma is triggered the airways enter a reversible state)
Note: COPD is classified as a Lower respiratory tract disorder
What is the most common precipitating factor of COPD?
-Tobacco
Other noxious chemicals such as asbestos
T/F there is a genetic component to COPD?
T (alpha-1 trypsin antiprotease deficiency)
What is the main difference between bronchitis and emphysema?
- The area affected
- Bronchitis affects bronchi/bronchioles
- Emphysema affects alveoli
What are the characterising factors of chronic bronchitis?
Chronic inflammation
Excess mucus production (goblet cells in bronchi)–>mucus plugging–>airway narrowing
Chronic productive cough (coughs up mucus)
Person appears blue–>blue bloaters
Xrays more vascular markings and shows large heart (struggling to push air through blockage)
-Frequently overweight
-Frequent respiratory infection (due to blockage)
-Elevated PCO2 (due to blockage–j>builds up in airways as body produces it)
-Heightened haematocrit (generation of RBC)
-Cor pulmonale common (failure of right side of heart)
Generic signs:
- Shortness of breath
- Wheezing
- Chest tightness
Signs:
- Tachypnea
- Active accessory muscles (more in emphysema)
- Prolonged exipration (more in emphysema–>difficulty getting rid of CO2)
- Rhonci (rattling sound, caused by mucus plugging–>more bronchitis)
- Decreased PO2
What are the characterising factors of emphysema?/
- Damage to alveoli (walls between alveoli break down leaving large air sacs–>reduced surface area)
- Chronic cough (but non-productive/no mucus coughed up)
- Person appears pink (normal colour)–>pink puffers
- Barrel chest (due to increased airway expansion)–>air bullae in x-arys with fewer vascular markings and small heart (deprived of air)
- Difficulty breathing due to being unable to constrict alveolus due to damage to peripheral/smaller airway)
- Tend to be thinner (use lots of energy to breathe)
- Few respiratory infections
- Normal PCO2
- Normal haematocrit
- Cor pulmonale rare
Generic signs:
- Shortness of breath
- Wheezing
- Chest tightness
Signs:
- Tachypnea
- Active accessory muscles
- Prolonged exipration–>difficulty getting rid of CO2
- Rhonchi
- Decreased PO2
What questions should you be able to answer when discussing COPD in relation to a pt?
How severe
How is it managed
How will that impact on TMT plan
How do you measure severity?
- Does patient get out of breath walking up stairs to surgery/unable to catch breath (high severity)
- Occasional productive cough, occasional chest infection (less severe)
How is cor pulmonale caused with COPD?
- Lungs don’t function as well, thus less oxygen coming in
- More pressure on right atrium to pump blood through lungs at faster rate to maintain oxygen
- Creates backflow (as lungs can only sustain so much bloodflow) causing expansion and decreased contraction of right atrium
How can a heart attack cause lung disease?
-Build up of fluid in lung causes pulmonary congestion
What are the main medications used in COPD?
- Bronchodilators
- Steroids (anti-inflammatory)
- Flu and pneumonia vaccination
- Antibiotics for infection
What are the treatments for COPD?
- Avoidance of allergens or pollutants
- Pulmonary hygiene (increase coughing, fluids, postural drainage)
- Breathing exercises
- Exercise (to strengthen breathing muscles)
What should you consider in the dental management of COPD?
- Avoid treating if Upper respiratory tract infection is present
- Treat in upright chair position
- Avoid use of rubber dam in severe disease
- Use supplementary oxygen
- Avoid nitrous sedation
- Avoid barbiturates, narcotics, antihistamines and anticholenergic, codeine (respiratory depression due to central decrease in respiratory drive)
- Supplemental steroids may be needed for invasive procedure (as adrenal gland is being suppresed by negative feedback and can’t produce extra)
- Avoid erythromycin, macrolide, ciprofloxacin for peole taking theophylline
- Do not use sedation in outpatient setting (out of hospital)
-LA can be used normally
What is the difference between COPD and asthma?
-Narrowing of airways in asthma is reversible, whereas it isn’t in COPD
What is treatment of asthma based on?
- Reducing inflammation and opening up airways
- Salbutamol (beta 2 agonist)
- Salmetaral
What is asthma?
Inflammation of airways which causes constriction of airways
What is the best way to assess asthma severity?
Patient’s medication
What should you take into consideration in dental management of asthmatic patient?
Assess severity + level of control
- Avoid triggers
- Ask pt to bring meds to appts
- Avoid aspirin (affects airways), NSAIDS, barbiturates/narcotics (histamine releasing), erythromycin and macrolides if pt taking theophyline
- If taking steroids may need supplements for invasive procedures
- If sedation required, use nitrous and/or small dose diazepam
- Recognise signs and symptoms of worsening asthma attack
What are the general signs and symptoms of asthma?
What are the signs and symptoms of severe or worsening asthma attack?
General symptoms: -Coughing -Tightness in chest -Wheezing -Shortness of breath -Struggling to breathe\ (Often worse at night, early morning or during exercise)
- Inability to finish senetence in one breath
- Ineffectiveness of meds to relieve
- Tachypnea >25 breaths per minute
- Tachycardia >100 BPM
- Accessory muscle usage
- Paradoxical pulse (drop in pulse following inspiration)
- Diaphoresis (sweating)
- Pallour (oxygen)
How would you manage asthma in emergency?
- REst
- Remove everything from mouth
- Ventolin (1 puff, 4 breaths, repeat 4 times, wait 4 minutes)
- Make sure suction available
- Make sure emergency kit available
- Call ambulance
Define: Tidal volume: Inspiratory reserve volume Expiratory reserve volume: Residual Volume Inspiratory Capacity Functional residual Capacity Vital Capacity Total Lung capacity
Tidal volume: Amount of air expired/inspired during normal breath
Inspiratory reserve volume: Additional amount of air that can be inhaled after a normal inhalation
Expiratory reserve volume: Additional amount of air that can be exhaled after a normal exhalation
Residual Volume: Amount left after expiratory reserve volume is exhaled (always a small amount of air remaining in lung to prevent tissues sticking together)
Inspiratory Capacity: Maximum amount of air that can be inhaled (TV + IRV)
Functional residual Capacity: Amount of air left in lungs after a normal exhalation (RV + ERV)
Vital Capacity: Maximum amount of air that can be exhaled/inhaled during each cycle (IRV+TV+ERV)
Total Lung capacity: Total amount of air held by lung (IRV + TV + ERV + RV)
What are the medications available for asthma?
Relievers (shorter acting):
- Ventolin (salbutamol): Beta 2 agonist, promotes bronchodilation
- Bricanyl (Terbutaline injection): Beta 2 agonist, promotes bronchodilation
PReventers:
- Flixotide (fluticasone inhaler): glucocorticoid, anti-inflammatory effect on airways
- Pulmicort (budesonide): Corticosteroid inhaler, anti-inflammatory effect on airways
- Alvesco (ciclesonide inhaler): glucocorticosteroids, anti-inflammatory effect on airways
- Qvar (beclomethasone): glucocorticoid, anti-inflammatory effect on airways
Symptom controlelrs (longer acting):
- Oxis (formoterol): Beta-2 agonist, bronchodilator
- Serevent (Salmeterol): Beta-2 agonist, bronchodilator
Combination:
Seretide: Salmeterol + Fluticasone
Symbicort: Formoterol + Budesonide
