Asthma and COPD

For dentist
Asthma
Asthma is a
chronic
inflammatory
pulmonary disorder
that is
characterized by
reversible
obstruction of the
airways
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
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
Emphysema
A respiratory
disease
characterized by
breathlessness
brought on by the
enlargement, or
over-inflation of,
the air sacs
(alveoli) in the
lungs
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.
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
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
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
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
Medical Management of Asthmatic
Patient
Limit exposure triggering agents
Medications such as: inhaled
corticosteroids, inhaled beta2
adrenergic agonist, and cromolyn
sodium
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
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
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 <91%, use low 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