Respiratory Flashcards
Components of respiratory system
ventilation and gas exchange
V/Q mismatch
ratio of oxygen to blood is not properly matched, leading to ventilation/perfusion misamtch or dead space ventilation
investigations for respiratory conditions
sputum examination, chest radiograph, CT scan, pulmonary function spirometry, bronchoscopy, VQ scan
drugs which improve airway patency [ability to breath]
bronchodilators [B2 agonist, anticholinergic]
anti-inflammatory [corticosteroid]
durgs which impair ventilation
beta blockers - make airway narrower, increase effect of smooth muscle constriction
respiratory depressants - benzodiazepine, opoids
drugs used to imrpove gas exchange
oxygen
inhaled drug delivery methods
meter dose inhaler (MDI) = puffer
breath activated device
methods to improve respiratory drug delivery
neubuliser = liquid drug in chamber, increased delivery, good in attack
spacer = using MDI, into chamber, get adequate drug volume
Beta-2 agonists short acting + examples
relieves symptoms and bronchoconstriction
onset of 2-3mins, lasts 4-6hours
treats and in anticipation
sulbutamol, terbutaline [BLUE INHALER]
Beta-2 agonists long acting + examples
relieves symptoms and bronchoconstriction
onset of 1-2hours, lasts 12-15hours
used to prevent, not in anticipation
always used with inhaled steroid
salmeterol [green inhaler]
anticholinergics
inhibits nerve transmission, helps in bronchial dilation with beta-agonists and effective in reducing mucus secretion
ipratropium [GREY INHALER]
corticosteroids
reduce inflammation in bronchial walls, mucus secretion
most effective
brown inhalers, orange inhaler, pink inhaler
asthma
common, reversible airwflow obstruction
bronchial hyperactivty, overreaction of the airway, causes bronchial change in the wall which narrows and restricts air in and out
asthma cellular response
allergen triggering of IgE production, B and T cell interaction, degranulation of mast cells = narrowing airway, oedema and mucus secretion
airways narrow due to;
- bronchial smooth muscle constriction
- bronchial mucosal oedema
- excessive mucous secretion into airway lumen
symptoms of asthma
cough, wheezing, shortness of breath, worse and night/early morning, difficulty breathing out
diagnosis of asthma
PEFR [tracks airway resistance, peak expiratory flow rate]
skin prick tests, biphasic response, spirometry
triggers of asthma
unknown, infections, environmental stimuli, cold air
risk assessment of treatment done by assessment of medication. what is the order
SA B2 agonist -> LD inhaled steroid -> LA B2 agonist -> others ->oral steroid/ever hospitalised
dental aspects of asthma
know px has asthma, know severity, know triggers, know how to assess and treat acute asthma attack
- blue inhaler, subsequent oxygen if needed
COPD
chronic obstructive pulmonary disease
lung conditions which cause breathing difficulties
can be chronic bronchitis and emphysema
causes damage to airways and alveoli, meaning less ability to ventilate and have gas exchange
chronic bronchitis/bronchiectasis
disease of airways with recurring damage
damage to wall, increased mucus, less diameter for gas exchange
productive cough in winter
emphysema
destruction of alveoli sacs and dilation of others
less air, more inflammatory changes, increased cardiac size
symptoms of COPD
cough, mucus, fatigue, shortness of breath, dyspnoea, chest discomfort
diagnosis of COPD
spirometry
management of COPD
smoking cessation is key, long-acting bronchodilator combined with inhaled steroids, oxygen support, po=ulmonary rehabilitation therapy
consequences of COPD
can lead to respiratory failure
type 1 respiratory failure
hypoxia, hypoxaemia, thickening of alveolar barrier
reduced area for gas exchange, often hyperventilate to compensate
type 2 respiratory failure
CO2 retention and hypoxia
hypercapnia, ventilation failure, airway anrrowing, restrictive lung effects
oxygen use in COPD
used in acute stage until medical help arrives
at home - only effective if 24/7, intermittent use not good, increased cardiovascular risk of death
airflow obstructions and dentistry
ability to attend treatment - supplemental oxygen
use of inhaled steroids - candida risk, use spacer device for MDI puffers, rinse mouth after use to remove powder deposition and local immunusuppression which leads to candida
often smokers/ex-smokers - enhanced oral cancer risk
cystic fibrosis
genetic disease where the lungs and digestive system can be clogged with thick, sticky mucus
inherited defect in cell chloride channels, producing excess mucus
aetiology of cystic fibrosis
CFTR gene on chromosome 7
affects the way ion channels open, recessive gene so both parents needed
diagnosis of cystic fibrosis
prenatal screening, perinatal screening, sweat test [salt content higher in CF], CFTR gene testing
symptoms of cystic fibrosis
troublesome cough, repeated chest infections, prolonged diarrhoea, poor weight gain
consequences of cystic fibrosis
liver dysfunctions, prone to osteoporosis, diabetes symptoms [prolonged pancreas disease], reduced fertility
treatment of cystic fibrosis
physiotherapy, medications, exercise, transplantation
medications for cystic fibrosis
lungs - bronchodilators
digestive - pancreatic enzyme replacement, supplemments
CFTR modulators - change chloride channel regulation, allows for more normal secretion
stem cell treatment - replace old
lung tumours causes
mainly smoking but, radon, workplace chemicals, air pollution, genetics, radiation therapy, lung diease
type of lung tumours
small cell
non small cell - squamous cell carcinoma, adenocarcinoma
symptoms of lung tumours
cough, harmoptysis, pneumonia, metastasis, dysphagia, SVC obstruction
diagnosis of lung tumours
delayed as metastasis occurs before detactable and symptoms occur.
outcome and prognosis poor
role of dentist with lung tumours
smoking cessation advice, reduced chance of lung tumours in the first place
offered to every px, recorded in notes
obstructive sleep apnoea
airway obstruction, airwy muscle tone drops, allows tongue to fall back and block airway during sleep
symptoms of sleep apnoea
snoring, drowsiness, poor sleep, irritable
consequences of sleep apnoea
periods of hypoxia, less alert, impacts daily life, increased risk of road traffic accidents, increased risk of MI as low oxygen
treatment of sleep apnoea
CPAP mask, mandibular advancement device, postional therapy
