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Respiratory: COPD

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Niruba Patkunan

on 7 March 2014

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Transcript of Respiratory: COPD

Respiratory: COPD
What is COPD?
COPD stands for Chronic Obstructive Pulmonary Disorder

WHO definition:
a lung disease involving
chronic obstruction of airflow
which interferes with normal breathing and is not fully reversible

It includes chronic bronchitis and emphysema
Managing COPD

Inhaled therapy
- inhalers
-nebulisers

Oral therapy (medication)

Oxygen therapy

Lung surgery and transplantation

Pulmonary Rehabilitation
- physical exercise program designed for the individual
- advice on coping with breathlessness

Signs and Symptoms
Symptoms are often slow to develop and are often ignored by patients as 'smoker's cough'.

Chronic cough
Producing sputum (phlegm) regularly
Frequent winter ‘bronchitis’ (due to viral influenza or bacterial infection in the upper respiratory tract)
Wheezing
Dyspnea (shortness of breath) especially during physical activity

Dental Impact of COPD and it's drugs
Dry mouth (xerostomia):
Keeping well hydrated
Sucking on sugar free lozenges and ice cubes
Chewing sugar free gum
Saliva substitutes

Acid erosion on tooth surface :
Occlusal mouth guard
Liaise with GP to alter medication

Oral Infections:
Use a spacer when inhaling corticosteroids
Rinse mouth with water after inhaling
Good oral hygiene

Smoking:
Thorough smoking history
Advice and support on smoking cessation





Krisha Vekaria
Normal lung tissue
COPD lung tissue
Histology
Small bronchiole
Normal Alveoli
Alveoli in emphysema with loss of surface area
Aetiology
Smoking
Main cause of COPD
86% of COPD deaths are due to smoking
Passive smoking

Occupation
Past exposure to fumes, dust and chemicals including grains, cadmium and coal dust, welding fumes and silica
15% of COPD is work-related (UK)

Air Pollution
Less common
Pollution is high in urban areas
Studies have shown strong correlations between nitrogen dioxide and particulates in the air and COPD
Previously burning of fossil fuels produced high levels of smoke and sulphur dioxide. This was reduced due to the Clean Air Act in 1956
Genetics

Less Common:
weight loss
effort intolerance
waking at night
ankle swelling
fatigue

Chest pain and haemoptysis (coughing blood) are not very common symptoms of COPD but may indicate other underlying diseases such as angina, heart attack and lung cancer. However blood streaked sputum may be seen in COPD.

Hereditary COPD is due to a deficiency in the protein alpha-1-antitrypsin.
Results in natural enzymes damaging the lungs.
Found in 1% of people with COPD.
Usually develops in people under the age of 35.

Medication
Bronchodilator
Bronchodilators can be short lasting or long lasting.

There are 3 main types:
Beta-2-agonists
Anticholinergics
Methylxanthines

Acts on smooth muscle to dilate the airways and reduces mucus production
General S/E:
Nervousness
Restlessness
Trembling
Dry mouth
Irregular heart beat
Nausea
Phosphodiesterase type-4 inhibitor
Example:
Roflumilast

Acts as an anti-inflammatory

S/E:
Nausea,
Abdominal pain,
Weight loss,
Decreased appetite,
Insomnia
Vomitting
Gastro-oesophageal reflux

C/I:
Avoid using in patients that are immunocompromise, have cancer and heart failure





Corticosteroids
Tablet form:
Prednisolone


Inhaled forms include:
Beclomethsone
Budesonide
Flunisolide
Fluticasone


Mucolytics
Acts as an anti inflammatory reducing swelling in the lungs

S/E:
Adrenal suppression
Lower respiratory tract infections
Cataracts
Oral candidiasis
Sore throat
Hoarse voice
Osteoporosis
Increase diabetes

General C/I:
Use with caution in patients with hyperthyroidism, heart disease and diabetes.
C/I:
Not to be used in patients with glaucoma, hyperthyroidism, tachyarrhythmias.
Examples:
Acetylcysteine

Guiafenesin

Reduces sputum viscosity

S/E:
Nausea
Diarrhoea
(Mucolytic therapy should be stopped after 4 weeks if there is no benefit).

C/I:
Use with caution in patients with stomach ulcers

Vaccination
NICE Recommendation:
Influenza vaccination
Pneumococcal vaccination

S/E:
Mild fever
Anaphylaxsis

C/I:
Patient with known allergies

Periodontal issues due to smoking
Oral cancer
Dental Advice, Prevention and Prophylaxis
Dry mouth:
Bronchodilators in particular anti-cholinergic
Increased susceptiblity to dental caries

Acid erosion on tooth surface :
Phosphodiesterase type-4 inhibitors
Vomiting and GORD
Loss of enamel >> increased sensitivity
Irritation of oral mucosa and burning sensation

Oral Infections:
Corticosteroids can lead to fungal infections
Possible burning, painful sensation on tongue
Unpleasant taste in mouth
Cracks in corners of the mouth (angular cheilitis)

Smoking:
increased risk of periodontitis
increased risk of oral cancer
Afternoon appointments: COPD worse in morning due to mucus production
Keep patient in the upright position when possible
Assist patient with travel
Regular visits to monitor oral hygiene and oral cancer
Do not use nitrous oxide or high flow rate oxygen as it can result in respiratory depression
Dental Modifications
References
1. The National Archives. Department of Health. Facts about COPD [online]2010[cited 17 Feb 2014] Available from URL: http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Healthcare/Longtermconditions/COPD/DH_113006
2. Health and Safety Executive. Chronic Obstructive Pulmonary Disease (COPD). [online]2012[cited 17 Feb 2014] Available from URL: http://www.hse.gov.uk/statistics/causdis/copd/
3. NICE. Chronic Obstructive Pulmonary Disease. June 2010 Available from URL: http://www.nice.org.uk/nicemedia/live/13029/49399/49399.pdf
4. British Thoracic Society. COPD. [online] [cited 17 Feb 2014] Available from URL: http://www.brit-thoracic.org.uk/clinical-information/copd/
5. NHS. Symptoms of COPD. [online]2012[cited 17 Feb 2014]Available from URL: http://www.nhs.uk/Conditions/Chronic-obstructive-pulmonary-disease/Pages/Symptoms.aspx
6. Lozano AC, Perez GS, Esteve CG. Dental considerations in patients with respiratory problems. J Clin Exp Dent 2011;3(3):e222-7.
7. BNF. Corticosteroids.[online] 2013[cited 17 Feb 2014] Available from URL:http://www.medicinescomplete.com/mc/bnf/current/PHP1843-corticosteroids.htm
8. BNF. Bronchodilators.[online] 2013[cited 17 Feb 2014] Available from URL: http://www.medicinescomplete.com/mc/bnf/current/PHP1724-chronic-obstructive-pulmonary-disease.htm
9. Rahman SS, Faruque M, Khan MHA, Hossain SA. Dental management of COPD patient. Bang Med J (Khulna) 2011; 44 : 21-24
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