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Transcript of Respiratory: COPD
What is COPD?
COPD stands for Chronic Obstructive Pulmonary Disorder
a lung disease involving
chronic obstruction of airflow
which interferes with normal breathing and is not fully reversible
It includes chronic bronchitis and emphysema
Oral therapy (medication)
Lung surgery and transplantation
- 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'.
Producing sputum (phlegm) regularly
Frequent winter ‘bronchitis’ (due to viral influenza or bacterial infection in the upper respiratory tract)
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
Acid erosion on tooth surface :
Occlusal mouth guard
Liaise with GP to alter medication
Use a spacer when inhaling corticosteroids
Rinse mouth with water after inhaling
Good oral hygiene
Thorough smoking history
Advice and support on smoking cessation
Normal lung tissue
COPD lung tissue
Alveoli in emphysema with loss of surface area
Main cause of COPD
86% of COPD deaths are due to smoking
Past exposure to fumes, dust and chemicals including grains, cadmium and coal dust, welding fumes and silica
15% of COPD is work-related (UK)
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
waking at night
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.
Bronchodilators can be short lasting or long lasting.
There are 3 main types:
Acts on smooth muscle to dilate the airways and reduces mucus production
Irregular heart beat
Phosphodiesterase type-4 inhibitor
Acts as an anti-inflammatory
Avoid using in patients that are immunocompromise, have cancer and heart failure
Inhaled forms include:
Acts as an anti inflammatory reducing swelling in the lungs
Lower respiratory tract infections
Use with caution in patients with hyperthyroidism, heart disease and diabetes.
Not to be used in patients with glaucoma, hyperthyroidism, tachyarrhythmias.
Reduces sputum viscosity
(Mucolytic therapy should be stopped after 4 weeks if there is no benefit).
Use with caution in patients with stomach ulcers
Patient with known allergies
Periodontal issues due to smoking
Dental Advice, Prevention and Prophylaxis
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
Corticosteroids can lead to fungal infections
Possible burning, painful sensation on tongue
Unpleasant taste in mouth
Cracks in corners of the mouth (angular cheilitis)
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
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