Overview
This lecture covers key concepts, diagnosis, management, and dental considerations for COPD and asthma, including medications and oral manifestations relevant to dental care.
COPD: Definition, Causes, and Types
- COPD (Chronic Obstructive Pulmonary Disease) is a preventable, irreversible respiratory disorder restricting airflow.
- Cigarette smoking is the main cause of COPD.
- Two primary clinical presentations: chronic bronchitis ("blue bloater") and emphysema ("pink puffer").
Chronic Bronchitis
- Characterized by chronic airway inflammation, increased mucus production, and narrowed airways.
- Symptoms: chronic productive cough, noisy chest (ronchi, wheezing), cyanosis, peripheral edema, and overweight appearance.
Emphysema
- Affects alveoli, causing destruction of lung tissue and air trapping.
- Symptoms: minimal cough, barrel-shaped chest, thin body type, severe dyspnea, flattened diaphragm, and smaller heart.
COPD Diagnosis and Staging
- Diagnosed by spirometry: FEV1/FVC ratio <70% confirms COPD.
- Additional tests: pulse oximetry, arterial blood gas, and chest radiographs.
- Staged from mild (Stage 1) to very severe (Stage 4).
COPD Medications and Management
- Inhaled anticholinergics (e.g., ipratropium) and beta-adrenergic agonists (bronchodilators) relax airway muscles.
- Corticosteroids reduce inflammation (e.g., fluticasone, prednisone).
- Phosphodiesterase inhibitors (e.g., theophylline) as last resort.
- Drug therapy generally escalates with disease severity: anticholinergics → bronchodilators → corticosteroids → theophylline.
Dental Considerations for COPD
- Encourage smoking cessation; provide nicotine replacement or bupropion if needed.
- Use semi-supine/upright chair position; avoid rubber dams and bilateral mandibular blocks in severe cases.
- Avoid narcotics, barbiturates, certain antibiotics with theophylline, and nitrous oxide in severe COPD.
- Monitor oxygen saturation; low-flow oxygen if SaO2 <95%.
- General anesthesia is not recommended.
- Reschedule and refer unstable patients (symptomatic, low oxygen).
Oral Manifestations of COPD
- Common: halitosis, tooth staining, nicotine stomatitis, periodontal disease, oral cancer, aspiration pneumonia, dry mouth (from anticholinergics).
Asthma: Definition, Pathophysiology, and Triggers
- Asthma causes reversible airway obstruction with episodes of wheezing, coughing, and difficulty breathing.
- Triggered by allergens, infections, exercise, cold, NSAIDs, chemicals, smoke, and stress.
- Pathophysiology: smooth muscle spasm, mucosal inflammation, and excess mucus.
Asthma Diagnosis and Management
- Diagnosed via spirometry, allergy testing, and sputum smears.
- Medications: inhaled corticosteroids (first-line for long-term control), short-acting beta-agonists (albuterol) for acute attacks, antihistamines, decongestants, leukotriene receptor antagonists.
- Combination inhalers may include corticosteroids and long-acting beta-agonists.
Dental Considerations for Asthma
- Prevent acute attacks by reducing stress, confirming medication compliance, and having inhaler/EpiPen available.
- Avoid NSAIDs, narcotics, and barbiturates; nitrous oxide may be used if no active symptoms.
- Monitor oxygen, provide low-flow oxygen if necessary, reschedule uncontrolled patients.
Oral Manifestations of Asthma
- Dry mouth (from inhalers), increased caries risk, GERD, oral candidiasis, enamel defects, periodontitis, and malocclusions (from mouth breathing).
Nitrous Oxide and Oxygen Use
- Nitrous oxide is generally safe for asthma (if controlled) but contraindicated in severe COPD, pregnancy, psychiatric disorders, MS, communication barriers, otitis media, and sickle cell disease.
- Oxygen is safe for COPD and asthma, but caution with bleomycin users or paraquat poisoning.
Key Terms & Definitions
- COPD — Chronic obstructive pulmonary disease; irreversible airflow limitation.
- Chronic Bronchitis — Long-term inflammation of bronchi with excessive mucus.
- Emphysema — Alveolar wall destruction and air trapping in lungs.
- Spirometry — Test measuring lung function (FEV1/FVC).
- Pulse Oximetry — Test to measure blood oxygen saturation.
- Bronchodilators — Drugs that relax airway muscles (e.g., beta-agonists).
- Corticosteroids — Drugs reducing inflammation.
- Theophylline — Phosphodiesterase inhibitor; last-resort COPD drug.
- Asthma — Chronic, reversible airway obstruction.
- Leukotriene Antagonists — Block inflammation triggered by allergens.
Action Items / Next Steps
- Review COPD and asthma medication classes and their dental implications.
- Know criteria to reschedule or refer unstable COPD/asthma patients.
- Read about oral manifestations and management strategies for pulmonary diseases in dental settings.