Asthma and COPD

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Asthma and COPD

• Lisa Tran, DDS

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Asthma

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

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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

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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

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Emphysema

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

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Epidemiology

• 20.3 million Americans report having asthma
• 5,000 deaths annually from asthma
• 12.1 million Americans reported being diagnosed
  with COPD
• 119,000 deaths annually from COPD
• COPD is the 4th leading cause of death in the U.S.

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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

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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

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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

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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

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Medical Management of Asthmatic Patient

• Limit exposure triggering agents
• Medications such as inhaled corticosteroids,
  inhaled beta2 adrenergic agonist, and cromolyn
  sodium

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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

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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

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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 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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