respiratory system Flashcards
asthma definition
reversible airflow obstruction, problems with expiration
asthma pathological process
caused by narrowing of airway (smooth muscle constriction) caused by mucous secretion and bronchial mucosal oedema (inflammation)
asthma monitoring / tests
peak flow test = worse in mornings
test for airway obstruction
forced expiration rate = PV1
chest x-ray = visible fluid
skin prick test to exclude allergies
asthma treatment protocols
management of triggers
medications - bronchodilators (e.g. albuterol) or inhaled corticosteroids (e.g. fluticasone) to help reduce inflammation in the airways.
asthma action plan
regular follow up
assessing severity of asthma
ask about oral steroids and if there ever been hospital admission
physical examination
breathing tests
pyramid of drugs goes
SA B2 - LD inhaled - LA B2 - Others - Oral Steroid
asthma symptoms
cough, wheeze, shortness of breath
blue inhaler
intermittent SHORT acting beta-adrenergic agonists
RELIEVER
e.g. SALBUTAMOL, TERBUTALINE
relaxes bronchial smooth muscle
○ Reduce bronchoconstriction
○ Reduce resting bronchial tone
protective against stimuli – take in anticipation of need; exercise induced asthma
quick onset
can be given inhaled, oral, IV
brown inhalers
inhaled Corticosteroids – low and high dose
ANTI-INFLAMMATORY
E.G. BECLOMETHASONE
BUDESONIDE
reduces mucous secretion and mediators that trigger contraction of bronchial smooth muscle
use if Short acting β2 agonist >3 times each week then use LOW DOSE inhaled corticosteroid every day
move to HIGH DOSE inhaled corticosteroid if symptoms dictate
spacer recommended
PREVENTION, NOT DURING ACUTE
green inhaler
intermittent LONG acting beta-adrenergic agonists
PREVENTION
E.G. SALMETEROL
relaxes bronchial smooth muscle
○ Reduce bronchoconstriction
○ Reduce resting bronchial tone
slow on set
ALWAYS USED WITH INHALED STEROID
asthma attack in the chair
make sure if pt have attack in the chair, they are monitored in the future
even though they seem to improve, give them corticosteroids in a&e (brown inhaler)
give oxygen
drugs that impair ventilation
beta-blockers - make them narrower
aspirin
respiratory depressants:
benzodiazepines (diazepam) = causes bronchial spasm
opioids (oxycodone, morphine, hydrocodone)
drug used to improve gas exchange
oxygen
inhaled respiratory drug delivery methods
meter Dose Inhaler MDI - “Puffer”
breath Activated Device
○ Spinhaler
○ Turbohaler
aids to respiratory drug delivery
nebuliser and spacer
grey inhaler
anticholinergic
inhibits muscarinic nerve transmission in autonomic nerves
HELPS TO OPEN AIRWAY
additive to B agonists
E.G IMPRATROPIUM
asthma pill drugs
mast cell stabilisers
leukotriene inhibitors
biological medicines
oxygen
standard relievers of asthma in dentistry
blue salbutamol and oxygen
copd causes
smoking, inherited, asthma, air pollutants, AAT deficiency (alpha-1 antitrypsin)
copd components
asthma component – reversible (ish)
bronchiectasis & emphysema (destruction of alveoli) component - non-reversible
copd treatment
- Smoking Cessation
- Long acting Bronchodilator (green inhaler)
- Combined with Inhaled Steroids? (<50% FEV)
- (systemic steroids)
- Oxygen Support
- Pulmonary rehabilitation therapy
copd acute episode
a sudden worsening of symptoms in a patient with COPD.
it is typically characterised by an increase in coughing, wheezing, shortness of breath, and chest tightness.
treatment : oxygen therapy, blue inhaler, corticosteroids, antibiotics, non-invasive ventilation
copd chronic type
Alveolar effects - Type 1 (hypoxia) - PINK
* reduced surface area for gas exchange
* thickening of alveolar mucosal barrier
* Often hyperventilate to compensate (pink puffer)
Poor ventilation - Type 2 (CO2 retention and hypoxia) - BLUE
* airway narrowing (reversible?)
* restrictive lung defects
* No good gas control
what is copd
MIXED airway reversible obstruction and destructive lung disease
It separates from asthma that is reversible
type 1 copd
enough O2 but can’t diffuse it
type 2 copd
can’t get enough o2 in lungs
oral issues with inhaled steroid use
thrush: Inhaled steroids can increase the risk of developing thrush, a fungal infection in the mouth that appears as white patches on the tongue and inner cheeks.
hoarseness: Inhaled steroids can irritate the throat, leading to hoarseness and voice changes.
dry mouth: Inhaled steroids can reduce saliva production, leading to dry mouth, which can increase the risk of tooth decay and gum disease.
difficulty swallowing: In some cases, inhaled steroids can cause difficulty swallowing due to irritation of the throat and esophagus.
position of patient in respiratory failure for dental treatment
in general, patients with respiratory failure may benefit from sitting upright or in a semi-upright position during dental treatment. This position can help improve oxygenation and facilitate breathing.
protecting the airway during dental treatment
pre-op assessment
supplemental oxygen
position of the patient
suction available
use of sedation
what advice should be given to a patient with high dose inhaled steroid therapy delivered via a MDI?
spacer and rinse the mouth
is there cross reactivity with other allergies important for dental care of patients with asthma?
f-varnish
how should a history of COPD influence the need for a patient to attend for regular dental check-ups?
poor O2 flow in the morning so big treatment should be done in afternoon
how would you assess the severity of patients asthma?
what inhalers and have they been admitted to the hospital recently
why might she have developed a candida infection in her mouth?
steroid inhalers = immunosuppressant
adhere to tissues = increased candida chance
how could candida be treated? Suggest topical and systemic options.
Topical options include:
Nystatin: A topical antifungal medication that is available as an oral suspension or lozenge.
Clotrimazole: An antifungal medication available as a topical cream, lozenge, or oral troche.
Miconazole: An antifungal medication available as a topical cream or oral gel.
Amphotericin B: An antifungal medication available as an oral rinse.
Systemic options include:
Fluconazole: A systemic antifungal medication that is available in tablet or liquid form.
Itraconazole: A systemic antifungal medication available in capsule or oral solution form.
Ketoconazole: A systemic antifungal medication available in tablet or cream form.
how could candida be prevented from returning in the future?
rinse mouth after using inhaler
use spacer
use mouthwash
how would you assess the severity of COPD condition?
speak to patients, listen to breathing
chest rising??
quality of air
count breaths/min - 16-20
what would be the best way to manage the acute COPD breathlessness just now.
take into empty room
supine position
give oxygen
what complication of COPD might he experience if he is given oxygen? How can this be minimised?
one complication of COPD that may occur if a patient is given oxygen is hypercapnia, or an increase in carbon dioxide levels in the blood.
leads to HYPERCAPNIA
symptoms of hypercapnia can include shortness of breath, headache, confusion, lethargy,
mechanical ventilation, bronchodilator medications, or other interventions to improve respiratory function.
check how much oxygen they had
should his dental care be abandoned today?
depends how severe
call an ambulance
contact GP if required
cystic fibrosis - how does it affect the body?
- Inherited defect in cell Cl- channels
- Produces excess sticky mucus
- Lungs are congested
- Pancreas: Malabsorption of nutrients
how cystic fibrosis is passed?
inherited disorders
cystic fibrosis genetics
- CFTR gene-chromosome 7
- Recessive gene
- Both parents must have gene
cystic fibrosis treatment
Airway clearance techniques. eg. chest physiotherapy, high-frequency chest wall oscillation, and positive expiratory pressure masks.
Bronchodilators: These are medications that help to open the airways and improve breathing. Examples include albuterol, levalbuterol, and ipratropium.
Inhaled corticosteroids: These are medications that help to reduce inflammation in the airways, improving lung function and reducing the risk of exacerbations. Examples include fluticasone and budesonide.
Enzyme replacement therapy: This is a treatment for pancreatic insufficiency, which is common in people with cystic fibrosis. Enzyme replacement therapy involves taking capsules with pancreatic enzymes before meals to aid in digestion and nutrient absorption.
Nutritional support: People with cystic fibrosis may require extra calories and nutrients to maintain their weight and support growth. This may involve a high-calorie diet, supplements, and/or feeding tubes.
Antibiotics: People with cystic fibrosis are at high risk of lung infections, which can cause serious complications. Antibiotics may be used to treat and prevent infections.
Lung transplantation: In severe cases of cystic fibrosis where lung function is severely compromised, a lung transplant may be necessary.
