pulmonary dx pts/ vaping Flashcards
congential vs acquired pul dx
industrial acquired pul dx
- Black Lung (coal miners)
- Asbestosis (miners)
- Bronchitis (Steel mills,smog)
- COPD
recreational pul dx
- Tobacco: Cigarettes, cigars, pipes
- Vaping
- Chew (Snus, chaw, dip, etc.)_
- Cannabis (Marie Juana)
- Cigarettes (joint)
- Cannabidol
- Topical (oils, creams)
Focal Problems aggravated by
Smoke and Smoking
- Periodontal Disease
- Asthma
relation of smoking to perio dx
cumulative/dependent?
result?
a
smoking increases tooth loss odds by?
70%
smoking effects on perio mechanism?
smoking effects on perio possible effects?
vascular?
pmn?
Ig?
lymphocytes?
pathogens?
fibroblasts?
difficulty with?
cytokines/GFs?
refactory periodontitis with smokers?
asthma
Chronic inflammatory airway disorder
* Airway hyper-responsiveness to stimuli
* Bronchial edema
* Narrowing of the airways i.e., obstruction
signs and symptoms of asthm,a
Recurrent, reversible episodes of:
*Dyspnea (shortness of breath)
*Wheezing
*Coughing
*Tightness of chest
Which of the following is a “true”
asthma symptom?
*Dyspnea (shortness of breath)
*Wheezing
*Coughing
*Tightness of chest
tightness of chest
Aggravating/Complicating Factors of asthma
● Smoking
● Air pollutants (quality)
- urban
- industrial
asthma stages
- Controlled
- Partially Controlled
- Uncontrolled
controlled asthma
partially controlled asthma
uncontrolled asthma
Types of Asthma
- Extrinsic (Allergic)
- Exercise Induced
- Intrinsic
- Drug Induced
Intrinsic (idiosyncratic, nonallergic, nonatopic)
* common?
* demo?
* Triggered by?
* Infrequently associated with?
* IgE levels?
- Second most common
- Middle-aged individuals
- Triggered by respiratory irritants (tobacco, air pollution, emotional stress, gastroesophageal reflux
disease (GERD) - Infrequently associated with family history
- Normal IgE levels
intrinsic asthma pathway
patient considerations for asthma
status asthmaticus
Severe prolonged asthma attack (more than 24 hours)
→ life threatening
drugs to avoid with asthma
➢Aspirin, NSAIDs, Narcotics, Macrolide antibiotics
➢Sulfite containing local anesthetics may need to be avoided
drug of choice for asthma attack
Short-acting Beta2-adrenergic agonist (inhaler) is the drug of choice for an acute attack
sedation for asthma pts
➢Nitrous (better)
➢Short-acting benzodiazepine
severe persistent asthma
med consult
asthma emergency pt presentation
res. rate?
HR?
appearance?
- Respiratory rate >25 breaths/min, labored breathing
- Tachycardia >110 beats/min
- Flushed appearance
what to do at school with asthma attack
- Stop treatment, inform supervising faculty, administer O2, and call 4444
➢ Remove all items from patient’s mouth
➢ Record the time attack began
➢ Raise the dental chair
➢ Give short-acting β2-adrenergic agonist inhaler
➢ Administer oxygen
o Administer 0.3-0.5 ml of 1:1000 epinephrine –small doses are SM dilators
o Call an ambulance
o Re-administer short-acting β2-adrenergic agonist inhaler every 20
minutes until EMS arrive
o The emergency team will continue treating the patient with bronchodilators and oral systemic corticosteroids
Focal Problems from Smoke and Smoking
- COPD
- Bronchitis
- Emphysema
- CAD (coronary artery disease)
types of COPD
bronchcitis and emphysema
Bronchiolitis
(chronic obstruction - small airways)
* Excessive tracheobronchial mucus production to cause coughing and sputum production for >3 months for >2 consecutive years in the absence of infection or other causes of chronic cough
emphysema
- Longterm Chronic obstructive bronchiolitis leads to destruction of lung parenchyma and alveolar walls
- Decreased elastic recoil
- Difficulty in maintaining airway opening during expiration
progression COPD
Type II (emphysema) is a progression of Type I leading many to just use these as descriptive terms for COPD.
3rd leading cause of death in USA
COPD
Chronic Obstructive Pulmonary Disease (COPD) Aggravating/Complicating Factors
● Smoking
● Air pollutants (quality)
- urban
- industrial
● CVD
- comorbidity
Chronic Obstructive Pulmonary Disease (COPD)
Signs and Symptom
- Dyspnea
- Cough
- Sputum
COPD tx
- Inhaled long-acting bronchodilators
- Corticosteroids if asthma also present and/or more reversible obstruction
- Smoking cessation is only intervention that actually lessens disease progression
important COPD meds
COPD oral manifestations
- Dry mouth
- Steven-Johnson syndrome with theophylline
COPD can exacerbate the smoking effects of?
* breath?
* Tooth?
nicotine ?
* Periodontal?
* malignancies?
* plaques?
* what cancer?
- Halitosis
- Tooth staining
- Nicotine stomatitis
- Periodontal disease
- Oral potentially malignant disorders
- Leukoplakia
- Erythroplakia
- Oral squamous cell carcinoma
Chronic Obstructive Pulmonary Disease (COPD) dental tx considerations
Determine?
➢ Medical consultation for?
➢ If COPD Stage III or higher?
Determine stage and severity of COPD
➢ Medical consultation for mild to moderate COPD to determine the presence of respiratory failure right-sided heart failure
➢ If COPD Stage III or higher or who have respiratory and heart failure
o Consider dental treatment in a hospital setting
tx if <stage 3 copd:
➢ Place the patient in what position?
➢ Avoid using a?
➢ Avoid treating if?
➢ Local anesthetic with epi?
o May need to limit epi if?
➢ Place the patient in a semi-supine position to avoid respiratory distress
➢ Avoid using a rubber dam
➢ Avoid treating if upper respiratory infection is present
➢ Local anesthetic with epi is acceptable
o May need to limit epi if concomitant CVD
what meds should be avoided in copd?
when should macrolides and ciprofloxacin be avoided?
- Avoid medications that cause respiratory depression
➢Barbiturates
➢Narcotics
➢Nitrous oxide is contraindicated
➢Benzodiazepines (low dose may be acceptable in certain situations)
o Consult physician - macrolide antibiotics and ciprofloxacin should not be prescribed to COPD patients already taking theophylline
vaping
vaping components
e liquid ingredients
are e liquids safe?
vaping aerosol
why is vaping popular
EVALI
other health concerns of vaping
hr?
bp?
bronchitis?
lung dx?
blood sugar?
vaping effects on oral health?
