Clinical Correlation: Lung Disease - PowerPoint PPT Presentation

1 / 36
About This Presentation
Title:

Clinical Correlation: Lung Disease

Description:

Distinct entities or disease progression. Chronic Bronchitis. Signs ... 'Barrel-chested', weight loss 'Pink puffers': pursing of lips, non cyanotic. pink puffer ... – PowerPoint PPT presentation

Number of Views:171
Avg rating:3.0/5.0
Slides: 37
Provided by: kristin48
Category:

less

Transcript and Presenter's Notes

Title: Clinical Correlation: Lung Disease


1
Clinical Correlation Lung Disease
Mark Bixby, M.D. October 20, 2009
2
Lung Disease
  • Chronic obstructive pulmonary disease (COPD)
  • Chronic Bronchitis
  • Emphysema
  • Asthma
  • Tuberculosis

3
Lung Disease
  • Chronic obstructive pulmonary disease (COPD)
  • Chronic Bronchitis
  • Emphysema

4
COPD Definition
  • Chronic airflow limitation not fully reversible
  • Two major diseases
  • Chronic bronchitis
  • Emphysema
  • Overlapping symptoms
  • Distinct entities or disease progression

5
Chronic Bronchitis Signs and Symptoms
  • Onset phase years
  • Chronic cough, copious sputum
  • gt3 months
  • 2 consecutive years
  • Blue bloaters sedentary, overweight, cyanotic,
    edematous, breathless
  • Severity based on spirometry

6
Interpreting Spirometry - definitions
7
Severity of COPDBased on Spirometry
8
Emphysema Signs and Symptoms
  • Severe exertional dyspnea, minimal cough
  • Prolonged expiratory phase
  • Barrel-chested, weight loss
  • Pink puffers pursing of lips, non cyanotic

9
pink puffer
blue bloater
10
COPD Lab Tests
  • Spirometry
  • ? maximum expiratory flow rate not reversible
  • Chest x-ray
  • Chronic bronchitis prominent vascular markings
  • Emphysema over distention of lungs, flattening
    of diaphragm, emphysematous bullae

11
COPD Medical Management
  • No cure, but can improve quality of life
  • Early management
  • Smoking cessation, ? exposure to pollutants
  • Regular exercise, good nutrition, prevention of
    respiratory infections, adequate hydration
  • Oxygen therapy when SpO2 88
  • Beta agonists, anticholinergics, inhaled
    corticosteroids, theophylline

12
COPD Dental Management
  • Encourage quitting smoking
  • Reschedule appointment if
  • Short of breath worse than baseline
  • Productive cough worse than baseline
  • Acute upper respiratory infection
  • Oxygen saturation lt91 (by pulse oximeter)

13
COPD Dental Management of Stable Patient
Things to do
  • Treat in upright chair position
  • Use inhalers prior to treatment
  • Use pulse oximetry
  • Use low-flow oxygen when O2 sat lt95 unless
    baseline is lower
  • May use low-dose oral diazepam
  • Supplemental steroids may be required

14
COPD Dental Management of Stable Patient
Things to avoid
  • Rubber dam use (in severe cases)
  • N2O sedation (in severe or very severe COPD)
  • Barbiturates and narcotics
  • Antihistamines and anticholinergics
  • Macrolide antibiotics and ciprofloxacin (in
    patients on theophylline)
  • Outpatient general anesthesia

15
COPD Oral Manifestations
  • Halitosis
  • Extrinsic tooth stains
  • Nicotine stomatitis
  • Periodontal disease
  • Oral cancer

16
Lung Disease
  • Chronic obstructive pulmonary disease (COPD)
  • Asthma

17
Asthma Definition
  • Chronic inflammatory respiratory disease
  • Airway hyperresponsiveness
  • Recurrent dyspnea, coughing, wheezing
  • Stimuli allergens, URI, exercise, cold air,
    medications, chemicals, smoke, anxiety

18
Airway Inflammation and Clinical Symptoms
Inflammation
19
Precipitating or Aggravating Factors
20
Asthma Signs and Symptoms
  • Predominant symptoms
  • Cough
  • Breathlessness
  • Wheezing
  • chest tightness
  • Flushing
  • Increased heart rate and prolonged expiration
  • May be self-limiting, but severe episodes may
    require medical assistance

21
Severity Control
22
Classifying Asthma Severity (age 12)
23
Asthma Classification
  • Mild symptoms last less than an hour and do not
    occur daily
  • Moderate Daily symptoms affecting sleep and
    activity level
  • Severe Ongoing symptoms that limit normal
    activity and result in emergency hospitalizations

24
Asthma Lab Tests
  • No one diagnostic test
  • Chest xray, skin testing, sputum smears and blood
    counts (for eosinophilia), arterial blood gases
  • Spirometry (peak expiratory flow meter) before
    and after bronchodilator

25
Stepwise Therapy for Asthmafor people 12 years
of age and above
Persistent Asthma
Therapy Preferred Alternative
Step 6 High Dose ICS LABA OCS AND Consider
omalizumab for patients with allergies
Step 5 High Dose ICS LABA AND Consider
omalizumab for patients with allergies
26
Asthma Medical Management
  • Plan for avoiding triggers
  • Inhaled drugs
  • Corticosteroids
  • Leukotriene inhibitors
  • Beta-adrenergic agonists
  • Anticholinergics

27
Asthma Dental Management
Things to do
  • Schedule late-morning appointments
  • Use rescue inhaler before procedures
  • Use pulse oximeter during procedures
  • Provide stress-free environment
  • good rapport and openness
  • may use N2O or oral benzodiazepine

28
Asthma Dental Management
Things to avoid
  • Precipitating factors
  • Barbiturates and narcotics
  • Aspirin, NSAIDs
  • Antihistamines (or use cautiously)
  • Macrolide antibiotics and ciprofloxacin (in
    patients on theophylline)

29
Asthma Managing an attack
  • Warning signs
  • Frequent cough
  • Inability to finish sentence in one breath
  • Bronchodilator ineffective
  • Tachypnea
  • Tachycardia (gt110)
  • Diaphoresis
  • What to do
  • Use short-acting beta-adrenergic agonist inhaler
  • Positive-flow oxygenation
  • If severe subcutaneous epinephrine, call EMS

30
Asthma Oral Complications
  • Mouth breathing complications
  • Increased gingivitis and caries secondary to beta
    agonist inhaler use
  • Oral candidiasis secondary to steroid inhaler use

31
Lung Disease
  • Chronic obstructive pulmonary disease (COPD)
  • Asthma
  • Tuberculosis

32
TB Definition
  • Pulmonary and systemic disease
  • Most common cause M. tuberculosis
  • Spread by respiratory droplet

33
TB Signs and symptoms
  • Most patients with 1 infection no symptoms
  • Cough (scanty, mucoid sputum later purulent)
  • Systemic symptoms malaise, unexplained weight
    loss, night sweats, fever
  • Extrapulmonary manifestations lymphadenopathy,
    back pain, GI or renal disturbances, heart
    failure, neurologic deficits

34
TB Lab Tests
  • Positive tuberculin (Mantoux) skin test (does not
    mean infection is clinically active)
  • Xray findings
  • progressive primary TB patchy infiltrates,
    cavitation, hilar lymphadenopathy
  • healed primary TB calcified peripheral nodule,
    calcified lymph node (Ghon complex)
  • Sputum smear positive for acid fast organisms
  • Confirm with culture and/or molecular tests

35
TB chest xray
36
TB Medical Management
  • Drugs chosen based on health of patient,
    likelihood of resistant strain
  • Patients become non-infectious in 3-6 months
  • Prophylactic drug treatment for certain close
    contacts (young, HIV infected, diabetic)

37
TB Dental Management
  • New, active TB treat only urgently and in a
    hospital isolation room
  • After 2-3 weeks of treatment treat normally
  • History of TB treat normally if no active
    disease
  • Positive TB test treat normally if no active
    disease
  • Clinical signs suggestive of TB do not treat

38
TB Oral Complications
  • Painful, deep tongue ulcers (infrequent)
  • Cervical, submandibular lymphadenitis (scrofula)

39
Lung Disease
  • Chronic obstructive pulmonary disease (COPD)
  • Asthma
  • Tuberculosis
Write a Comment
User Comments (0)
About PowerShow.com