respiratory system

Question 1

asthma definition

Answer 1

reversible airflow obstruction, problems with expiration

Question 2

asthma pathological process

Answer 2

caused by narrowing of airway (smooth muscle constriction) caused by mucous secretion and bronchial mucosal oedema (inflammation)

Question 3

asthma monitoring / tests

Answer 3

peak flow test = worse in mornings
test for airway obstruction
forced expiration rate = PV1
chest x-ray = visible fluid
skin prick test to exclude allergies

Question 4

asthma treatment protocols

Answer 4

management of triggers
medications - bronchodilators (e.g. albuterol) or inhaled corticosteroids (e.g. fluticasone) to help reduce inflammation in the airways.
asthma action plan
regular follow up

Question 5

assessing severity of asthma

Answer 5

ask about oral steroids and if there ever been hospital admission
physical examination
breathing tests

pyramid of drugs goes
SA B2 - LD inhaled - LA B2 - Others - Oral Steroid

Question 6

asthma symptoms

Answer 6

cough, wheeze, shortness of breath

Question 7

blue inhaler

Answer 7

intermittent SHORT acting beta-adrenergic agonists
RELIEVER
e.g. SALBUTAMOL, TERBUTALINE

relaxes bronchial smooth muscle
○ Reduce bronchoconstriction
○ Reduce resting bronchial tone

protective against stimuli – take in anticipation of need; exercise induced asthma

quick onset
can be given inhaled, oral, IV

Question 8

brown inhalers

Answer 8

inhaled Corticosteroids – low and high dose
ANTI-INFLAMMATORY

E.G. BECLOMETHASONE
BUDESONIDE

reduces mucous secretion and mediators that trigger contraction of bronchial smooth muscle

use if Short acting β2 agonist >3 times each week then use LOW DOSE inhaled corticosteroid every day
move to HIGH DOSE inhaled corticosteroid if symptoms dictate

spacer recommended
PREVENTION, NOT DURING ACUTE

Question 9

green inhaler

Answer 9

intermittent LONG acting beta-adrenergic agonists
PREVENTION

E.G. SALMETEROL

relaxes bronchial smooth muscle
○ Reduce bronchoconstriction
○ Reduce resting bronchial tone

slow on set
ALWAYS USED WITH INHALED STEROID

Question 10

asthma attack in the chair

Answer 10

make sure if pt have attack in the chair, they are monitored in the future
even though they seem to improve, give them corticosteroids in a&e (brown inhaler)
give oxygen

Question 11

drugs that impair ventilation

Answer 11

beta-blockers - make them narrower
aspirin

respiratory depressants:
benzodiazepines (diazepam) = causes bronchial spasm
opioids (oxycodone, morphine, hydrocodone)

Question 12

drug used to improve gas exchange

Answer 12

oxygen

Question 13

inhaled respiratory drug delivery methods

Answer 13

meter Dose Inhaler MDI - “Puffer”

breath Activated Device
○ Spinhaler
○ Turbohaler

Question 14

aids to respiratory drug delivery

Answer 14

nebuliser and spacer

Question 15

grey inhaler

Answer 15

anticholinergic
inhibits muscarinic nerve transmission in autonomic nerves
HELPS TO OPEN AIRWAY
additive to B agonists

E.G IMPRATROPIUM

Question 16

asthma pill drugs

Answer 16

mast cell stabilisers
leukotriene inhibitors
biological medicines
oxygen

Question 17

standard relievers of asthma in dentistry

Answer 17

blue salbutamol and oxygen

Question 18

copd causes

Answer 18

smoking, inherited, asthma, air pollutants, AAT deficiency (alpha-1 antitrypsin)

Question 19

copd components

Answer 19

asthma component – reversible (ish)
bronchiectasis & emphysema (destruction of alveoli) component - non-reversible

Question 20

copd treatment

Answer 20

• Smoking Cessation
• Long acting Bronchodilator (green inhaler)
• Combined with Inhaled Steroids? (<50% FEV)
• (systemic steroids)
• Oxygen Support
• Pulmonary rehabilitation therapy

Question 21

copd acute episode

Answer 21

a sudden worsening of symptoms in a patient with COPD.
it is typically characterised by an increase in coughing, wheezing, shortness of breath, and chest tightness.

treatment : oxygen therapy, blue inhaler, corticosteroids, antibiotics, non-invasive ventilation

Question 22

copd chronic type

Answer 22

Alveolar effects - Type 1 (hypoxia) - PINK
* reduced surface area for gas exchange
* thickening of alveolar mucosal barrier
* Often hyperventilate to compensate (pink puffer)

Poor ventilation - Type 2 (CO2 retention and hypoxia) - BLUE
* airway narrowing (reversible?)
* restrictive lung defects
* No good gas control

Question 23

what is copd

Answer 23

MIXED airway reversible obstruction and destructive lung disease
It separates from asthma that is reversible

Question 24

type 1 copd

Answer 24

enough O2 but can’t diffuse it

Question 25

type 2 copd

Answer 25

can’t get enough o2 in lungs

Question 26

oral issues with inhaled steroid use

Answer 26

thrush: Inhaled steroids can increase the risk of developing thrush, a fungal infection in the mouth that appears as white patches on the tongue and inner cheeks.

hoarseness: Inhaled steroids can irritate the throat, leading to hoarseness and voice changes.

dry mouth: Inhaled steroids can reduce saliva production, leading to dry mouth, which can increase the risk of tooth decay and gum disease.

difficulty swallowing: In some cases, inhaled steroids can cause difficulty swallowing due to irritation of the throat and esophagus.

Question 27

position of patient in respiratory failure for dental treatment

Answer 27

in general, patients with respiratory failure may benefit from sitting upright or in a semi-upright position during dental treatment. This position can help improve oxygenation and facilitate breathing.

Question 28

protecting the airway during dental treatment

Answer 28

pre-op assessment
supplemental oxygen
position of the patient
suction available
use of sedation

Question 29

what advice should be given to a patient with high dose inhaled steroid therapy delivered via a MDI?

Answer 29

spacer and rinse the mouth

Question 30

is there cross reactivity with other allergies important for dental care of patients with asthma?

Answer 30

f-varnish

Question 31

how should a history of COPD influence the need for a patient to attend for regular dental check-ups?

Answer 31

poor O2 flow in the morning so big treatment should be done in afternoon

Question 32

how would you assess the severity of patients asthma?

Answer 32

what inhalers and have they been admitted to the hospital recently

Question 33

why might she have developed a candida infection in her mouth?

Answer 33

steroid inhalers = immunosuppressant
adhere to tissues = increased candida chance

Question 34

how could candida be treated? Suggest topical and systemic options.

Answer 34

Topical options include:

Nystatin: A topical antifungal medication that is available as an oral suspension or lozenge.
Clotrimazole: An antifungal medication available as a topical cream, lozenge, or oral troche.
Miconazole: An antifungal medication available as a topical cream or oral gel.
Amphotericin B: An antifungal medication available as an oral rinse.

Systemic options include:

Fluconazole: A systemic antifungal medication that is available in tablet or liquid form.
Itraconazole: A systemic antifungal medication available in capsule or oral solution form.
Ketoconazole: A systemic antifungal medication available in tablet or cream form.

Question 35

how could candida be prevented from returning in the future?

Answer 35

rinse mouth after using inhaler
use spacer
use mouthwash

Question 36

how would you assess the severity of COPD condition?

Answer 36

speak to patients, listen to breathing
chest rising??
quality of air
count breaths/min - 16-20

Question 37

what would be the best way to manage the acute COPD breathlessness just now.

Answer 37

take into empty room
supine position
give oxygen

Question 38

what complication of COPD might he experience if he is given oxygen? How can this be minimised?

Answer 38

one complication of COPD that may occur if a patient is given oxygen is hypercapnia, or an increase in carbon dioxide levels in the blood.
leads to HYPERCAPNIA

symptoms of hypercapnia can include shortness of breath, headache, confusion, lethargy,

mechanical ventilation, bronchodilator medications, or other interventions to improve respiratory function.

check how much oxygen they had

Question 39

should his dental care be abandoned today?

Answer 39

depends how severe
call an ambulance
contact GP if required

Question 40

cystic fibrosis - how does it affect the body?

Answer 40

• Inherited defect in cell Cl- channels
• Produces excess sticky mucus
• Lungs are congested
• Pancreas: Malabsorption of nutrients

Question 41

how cystic fibrosis is passed?

Answer 41

inherited disorders

Question 42

cystic fibrosis genetics

Answer 42

• CFTR gene-chromosome 7
• Recessive gene
• Both parents must have gene

Question 43

cystic fibrosis treatment

Answer 43

Airway clearance techniques. eg. chest physiotherapy, high-frequency chest wall oscillation, and positive expiratory pressure masks.
Bronchodilators: These are medications that help to open the airways and improve breathing. Examples include albuterol, levalbuterol, and ipratropium.
Inhaled corticosteroids: These are medications that help to reduce inflammation in the airways, improving lung function and reducing the risk of exacerbations. Examples include fluticasone and budesonide.
Enzyme replacement therapy: This is a treatment for pancreatic insufficiency, which is common in people with cystic fibrosis. Enzyme replacement therapy involves taking capsules with pancreatic enzymes before meals to aid in digestion and nutrient absorption.
Nutritional support: People with cystic fibrosis may require extra calories and nutrients to maintain their weight and support growth. This may involve a high-calorie diet, supplements, and/or feeding tubes.
Antibiotics: People with cystic fibrosis are at high risk of lung infections, which can cause serious complications. Antibiotics may be used to treat and prevent infections.
Lung transplantation: In severe cases of cystic fibrosis where lung function is severely compromised, a lung transplant may be necessary.