Asthma and COPD

Asthma
Asthma is a chronic inflammatory pulmonary disorder that is characterized by reversible obstruction of the airways

COPD
Chronic obstructive pulmonary disease is a slowly progressive disease that is characterized by a gradual loss of lung function COPD includes chronic bronchitis, chronic obstructive bronchitis, or emphysema, or combinations of these conditions

Chronic Bronchitis
Inflammation of the main airway passages (bronchi) to the lungs, which results in the production of excess mucous, a reduction in the amount of airflow in and out of the lungs, and shortness of breath

Emphysema
A respiratory disease characterized by breathlessness brought on by the enlargement, or over-inflation of, the air sacs (alveoli) in the lungs

Etiology
Cause of asthma is unknown but many factors play a part: Genetic factors: Asthma tends to run in the family Environmental factors: pollen, dust, mold, tobacco smoke Occupational exposure: chemicals and gases Smoking is the leading cause of COPD followed by occupational exposures

Clinical Features of Asthmatic Patients
General: intermittent wheezing, coughing, and breathlessness During an attack: decreased peak flow, tachypnea, use of accessory muscles to breathe, hyperinflation or barrel chest, and prolonged inspiration

Clinical Features of COPD Patients
Mild COPD: no abnormal signs, smokers cough, little or no breathlessness Moderate COPD: breathlessness with/without wheezing, cough with/without sputum Severe COPD: breathlessness on any exertion/at rest, wheeze and cough prominent, lung inflation usual, cyanosis, peripheral edema, and polycythemia in advanced disease

Diagnosis
Spirometry
Breathing test which measures the amount and rate at which air can pass through the airways

Bronchodilator Reversibility Testing
Relaxing tightened muscles around the airways and opening up airways quickly to ease breathing

Other pulmonary function testing
Diffusion capacity

Chest X-ray Arterial Blood Gas
Shows oxygen level in blood

Medical Management of Asthmatic Patient
Limit exposure triggering agents Medications such as: inhaled corticosteroids, inhaled beta2 adrenergic agonist, and cromolyn sodium

Medical Management of COPD Patient
Smoking cessation and elimination of environmental pollutants Palliative measure such as regular exercise, good nutrition, flu and pneumonia vaccines Bronchodilators, corticosteroids, anticholinergics, and NSAIDs

Dental Management of Asthmatic Patient
Identify and assess status Avoid precipitating factors Bring inhaler for each appointment Drug considerations: Avoid ASA, NSAIDs, barbiturates, and narcotics Drug interactions with asthmatic medications (ex. Theophylline vs. Antibiotics, Cimetidine) Chronic corticosteroid users may require steroid supplementation For sedation, nitrous oxide/oxygen and/or small doses of oral diazepam is recommended

Dental Management of COPD Patient
Review history for concurrent heart disease Avoid treatment if upper respiratory tract infection is present Treat in upright position Avoid rubber dam in severe cases Use pulse oximetry (if pulse ox <91%, use low flow 2-3L/min) Avoid Nitrous oxide/oxygen in severe cases Avoid barbiturates, narcotics, antihistamines, and anticholinergics If patient is on steroid regimen, supplement as needed Drug interactions with COPD medication

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