The document discusses respiratory diseases chronic obstructive pulmonary disease (COPD) and asthma. It defines COPD as a chronic, progressive lung disease characterized by breathlessness and airflow limitation. The two main components of COPD are chronic bronchitis and emphysema. Smoking is the primary cause of COPD. Symptoms include dyspnea, cough, and sputum production. Diagnosis involves spirometry and blood gas tests. Treatment focuses on smoking cessation, bronchodilators, antibiotics, and oxygen therapy. The document also defines asthma as a condition of bronchial hyperresponsiveness causing wheezing, coughing, and dyspnea. It discusses the extrinsic and intrinsic types and their triggers. Sympt

1. Respiratory disease
Asthma and COPD

2. Chronic obstructive pulmonary
disease
 Definition:
COPD is a chronic,slowly progressive,irreversible
disease,charecterized by breathlessness and
wheeze,cough and sputum production .
 Is usually a combination of chronic
bronchitis,emphysema.

3.  Chronic bronchitis:
Definition:
 excessive production of mucus and persistent cough
with sputum production ,daily for 3 months in a year
for more than 2 consecutive years.
 Sputum stagnates and becomes infected with
S.pneumonae,M.catarrahlis,H.influenzae.

4.  Emphysema
Definition:
 Dilatation of air spaces distal to the terminal
bronchioles with destruction of the alveoli reducing
the area for air exchange.

5.  Causes of COPD:
 SMOKING
 Environmental pollution
 Dust
 Occupational exposures to chemicals
 Deficiency of the aniproteolytic enzyme alpha 1-
antirypsin (rare)

6.  Clinical features:
 Progressive dyspnea and low oxygen saturation
 accumulation of carbon dioxide(hypercapnia)
 Acidosis
 eventual respiratory failure or Rt.sided heart failure.
 Early morning mucoid cough .

7.  COPD is complicated by chronic hypoxemia with
dyspnea on effort.
 Mild at first ,then deteriorates to leave respiratory
cripples ,dyspneic at rest
 Some pts with emphysema maintain normal blood
gases by Hyperventilation “pink panter”,”pink puffer”
who is severely breathless and pink from vasodilation
caused by co2 retention .

8.  Those with chronic bronchitis, fail to maintain
hyperventilation ,lose the co2 drive ,become
hypercapnic and hypoxic, but less breathless.
 Chronic hypoxemia leads to central cyanosis and ankle
edema and raised jugular venous pressure gives rise to
“blue bloated “ appearance ,for whom the respiratory
drive is from low po2 and thus o2 administration is
contraindicated.

9. diagnosis
 Chest radiographs
 Respiratory function tests(Spirometry ).
 Arterial blood gas estimation .
 FEV1 is typically reduced, and is used to grade COPD.
 FEV1 and if less than 40% severe COPD.
 FEV1:FVC if the ratio was less than 70% confirms
airways obstruction.

10. management
 Stop smoking
 Antibiotics amoxicillin,trimethoprim,tetracyclin.
 Immunization against influenza.
 Mucolytics carbocisteine
 Bronchodilators ipratropimbromide,antimuscarinics
oxitropium or beta agonist or occasionally lowe dose
inhaled or systemic corticosteroids or theophylline.
 Long term oxygen therapy
 Surgery
 Lung transplantation

11. Dental aspects
 Upright position
 Difficult to use rubber dam
 Pt on corticosteroids should be treated with precautions.
 Theophylline interactions with
:epinephrine,clindamycin,clarithromycin,azithromycin,ery
thromycin,ciprofloxacin may result in dangerously high
levels of theophylline.
 L.A preferred, but bilateral mandibular and palatal
injections should be avoided.
 Analgesia only if necessary and after preoperative
assessment.

12.  Diazepam and midazolam are mild respiratory
depressants should not be used.
 G.A only if necessary.
 I.V barbiturates are totally contraindicated.
 Pt may cough and contaminate other areas of the lung
if slightly anesthetized.
 Spirometry and carbon monoxide perfusion are
essential to assess respiratory function.

13.  Preoperatively: cessation of smoking for at least 1 week
 Respiratory infection must be eradicated, sputum
should first be sent for culture and sensivity, but
antimicrobials such as amoxicillin should be started
without awaiting results.
 Ipratropium can cause dry mouth

14. Asthma
 Common 2-5% of the population .
 Males
 Childhood or early adulthood.
 About half of patients developed it before the age of 10
years.

15.  It’s a state of bronchial hyper-reactivity causing:
 Paroxysmal expiratory wheezing
 Dyspnea
 Cough

16.  Generalized reversible bronchial narrowing is caused
by:
excessive bronchial s.m tone ,edema and congestion,
mucus hypersecretion and diminished ciliary
clearance.

17. Types of asthma
 Extrinsic
 intrinsic

18. extrinsic
 Allergic asthma
 Typical in children
 Precipitated by:
dust, animals, molds,antibiotics,NSAIDs, milk, eggs,fish,
Fruit, nuts and some antibiotics.
 Asymptomatic between attacks.
 Usually patient develop other allergic diseases like
eczema,hay fever ,drug sensitivities.
 Tends to resolve in adult life.

19. Extrinsic
 Associated with overproduction of IgE on exposure to
allergens and release of mast cell products that cause
bronchospasm and oedema.
 Mediators: histamine,leukotrines
prostaglandins,bradykinins and PAF(platelet
activating factor).

20. Intrinsic
 Not allergic.
 Mast cells instability and hyperresponsive airways.
 Triggered by :
Emotional stress-gastro-oesophageal reflux-vagally
mediated responses.

21.  Both extrinsic and intrinsic could be initiated by the
following:
 Infections(viral,mycoplasmal or fungal)
 Exercise
 Emotional stress
 Food types(nuts, shellfish,strawberriesor milk)
 Food additives(tartrazine)
 Drugs(NSAIDs,beta blockers,ACE inhibitors,aspirin)
 Fumes including cigarette smoke.

22. Clinical features
 Dyspnea
 Cough
 Wheezing
 Laboured expiration.

23.  Children present with repeated colds with cough,
malaise and fever at night.
 Nasal polyps specially in aspirin sensitive asthmatics.
 Rarely, a prolonged and often life-threatening attack
refractory to treatment starts and if this persist for
more than 24 h, its termed status asthmaticus and
potentially lethal.

24. General management
 Chest radiographs
 Spirometry(important)
 skin tests , which may help to identify any allergens.
 Blood examination(usually raised total IgE and
specific IgE antibody concentrations).
 Avoidance of identifiable irritants and allergens, use of
drugs
 Home use of peak flow meters allows patients to
monitor progress and detect any deterioration.

25. Drugs
 Beta 2 agonists (sulbutamol)
 Corticostroids, if there are daily symptoms.
 Leukotriene receptor antagonists(Zafirlukast)
 Omalizumab(a recombinant humanized monoclonal
anti IgE antibody ) decrease the symptoms.
 Systemic steroids,oxygen and hospitalization in
recalcitrant disease .

27. Dental aspects
 Ask pt to bring their medications.
 In severe asthmatics..defer elective ttt.
 Allergy to penicillin maybe more frequent .
 Theophylline interactions
 Patients On leuokotriene modifying drugs may have
prolonged INR and bleeding tendency .
 Systemic steroids treatment brings with it the risks
from steroid complication, and operation are
dangerous on such patient without adequate
preparation.

28.  Avoid the following drugs :
 Aspirin increases zafirlukast levels.
 NSAIDs
 Sulphites in L.A
 If epinephrine containing local analgesics are indicated,
thy should be given with an aspirating syringe, but
contraindicated with pt on theophyline causes
dyrhythmias
 Conscious sedation :
 Relative analgesia with NO and oxygen is preferable over IV
sedation .

29.  Sedatives are better to be avoided .
 G.A is best avoided
 Opioids avoided

30. Dental aspects
 Oral manifestations :
-The use of corticosteroid inhalers causes oral and
pharyngeal thrush and rarely angina,bullosa
haemorrhagica.
-Beta 2 agonists and ipratropium bromide causes dry mouth .
-Anti-asthmatic drugs may Lower the salivary pH
-Periodontal inflammation is more in asthmatic patients .
-Gastro-oesophageal reflux is common with tooth erosion

31. Acute asthmatic attack
 Asthmatic attacks may be precipitated by
-Anxiety:gentle handling and reassurance..
-drugs which include:
 Asprin ,NSAIDs
 Barbiturates
 Beta blockers
 Mefanamic acid
 Pentazocine
 Acrylic monomer
 Colophony and cyanocrylates .

32.  Usually self-limiting or responds to the ptn usual
drugs,..beta agonist inhaler
 Status asthmaticus is potentially lethal emergency.

33. Thank you