Topic 4 - Respiratory Disease

Question 1

What is the difference between asthma and COPD?

Answer 1

Asthma - occurs commonly in childhood, diurnal symptom change, can be worse at night, variable breathlessness

COPD - progressive and persistent breathlessness, productive cough, nearly always smoker

Question 2

What happens to bronchioles in asthma?

Answer 2

Wall thickens.

During attack, smooth muscle becomes tight and air is trapped in alveolus

Question 3

What is involved in asthma diagnosis?

Answer 3

PEF

Signs, symptoms and triggers

Triggers: NSAIDs, beta-blockers, viral infections, latex
Signs: wheeze which is bilateral, diffuse, expiratory
Symptoms: wheeze, breathlessness, cough, tight chest

Question 4

Define asthma

Answer 4

Chronic inflammatory disease defined by airway obstruction and bronchial hypersensitivity to stimuli

Question 5

What dictates asthma management and what kind of approach is it?

Answer 5

Severity of asthma dictates management - can change over time.

Step-wise management that aims to have no limitations on physical activity, normal lung function, no exacerbation, minimal symptoms and minimal need for beta-antagonists.

Question 6

Stepwise asthma approach pg 76

Question 7

What are the two types of asthma drugs?

Answer 7

Preventors:
Inhaled corticosteroids
Systemic corticosteroids like prednisolone
Tablet
Two others

Relievers:
Beta-agonists like salbutamol and salmetarol, anti-muscarinic agents, tablets

Question 8

What oral health management will you need to give for those with asthma?

Answer 8

• Check ASA score
• Denture hygiene advice
• Wash mouth out after corticosteroids as can get fungal infection
• Avoid advising NSAIDs
• Avoid macrolide antibiotics erythromycin etc. in those who take tablet.

Question 9

Define COPD

Answer 9

Chronic inflammatory disease of the airways

Is not fully reversible and progressively worsens

Question 10

When would you diagnose COPD?

Answer 10

Anyone over 35 with a risk factor and:

• Wheeze
• Winter bronchitis
• Persistent cough
• Sputum production
• Breathlessness

Question 11

What are the signs and symptoms of COPD?

Answer 11

Symptoms:

• Cough that’s persistent
• Sputum production
• Breathlessness

Signs:

• Damaged airways
• Damaged lung parenchyma

Question 12

How can you manage COPD?

Answer 12

Want to limit the complications, control symptoms, and limit progressino.

Short acting beta-antagonists, long acting beta antagonists, tablet, surgery

Question 13

What are the signs of exacerbation of COPD? How can you treat it?

Answer 13

• Acute confusion
• Dyspnoea
• Tachypnoea
• Pursed lip breathing
• Acute cyanosis
• Acute peripheral oedema

Treat:

• Increasing dosage of vasodilator
• Nebulisors
• Oral corticosteroid short course
• Antibiotic if infective flare

Question 14

What oral healthcare considerations should you have in COPD?

Answer 14

Downstairs surgery used
Smoking cessation advice
Check any exacerbation

Question 15

What are URTIs? Are they harmful? What should you do?

Answer 15

URTIs include sinusitis, epiglottis, pharyngitis, common cold, tonsillitis

Are benign but can develop into LRTIs.

Epiglottis and strep sore throat can be harmful.

Take flu jab.

Question 16

What is strep sore throat caused by and how is it spread?

How long does it last and what are the symptoms and oral signs?

What treatment is there?

Answer 16

Strep. bacteria causes it.

Lasts 7 days, spread by close contact. Symptoms include fever, fatigue, cervical lymphandenopathy, painful swallowing, sore throat.

Oral signs - strawberry tongue, inflamed tonsils, macropapula rash, petechial rash of soft palate and pharynx

Treatment - penicillins

Question 17

What is pneumonia caused by and how is it characterised?

Answer 17

Pneumonia is an inflammation of the alveoli due to bacteria. Inflammatory cells and fluid enter the alveoli which reduces site for gaseous exchange.

Bacteria can be S. Pneumoniae, viral like influenza, other bactria liek s. aureus etc.

Can be consequence of URTI viral.

Symptoms include breathlessness, chest pain when breathing, fever, cough, sputum colour change, and sputum foul-smell.

Question 18

What are the types of lung cancer you can get?

What are the risk factors?

Symptoms?

What is the treatment and how does this affect oral health?

Answer 18

Can be primary tumour or secondary metastasis.

Risk factors - smoking, asbestos, obesity

Symptoms - hoarse voice, cough, chest pain, coughing up sputum and blood, finger clubbing

Small cell (aggressive and spread rapidly) or large cell (adenocarcinoma, SCC, large cell carcinoma)

Treatment - radiotherapy can cause oral presentations as close to head and neck

Question 19

What is laryngeal cancer symptoms, risk factors and treatment?

What should you do in case of medical emergency?
Affect on oral health?

Answer 19

Risk factors - alcohol, smoking, HPV

Symptoms - change in voice, difficulty swallowing or globus, bad breath, cough

Treatment: chemo, radiotherapy, laryngectomy

Don’t cover with face mask during med emergency.

Radiation can affect the mouth - caries and xerostomia

Question 20

What is pulmonary embolism caused by and what are the risk factors?

What are the symptoms?

Can it cause death?

Answer 20

Pulmonary embolism - an embolus goes through venous circulation through RHS of heart out through the pulmonary artery

Causes sudden death.

Symptoms - dyspnoea, coughing up blood and sputum, and chest pain.

Question 21

What are the risk factors for pulmonary embolism

Answer 21

Hypercoagulability (factor V, cancer, pregnancy, OCP) and stasis (long haul flights, surgery, bed bound)