Pulmonary Disease Flashcards
what are the types of pulmonary disease
- asthma
- chronic obstructive pulmonary disease: bronchitis and emphysema
- tuberculosis
what is asthma
- chronic inflammatory airway disorder
- airway hyper responsiveness to stimuli
- bronchial edema
- narrowing of the ariways- obstruction
what are the signs and symptoms of asthma
- recurrent and reversible episodes of:
- dyspnea
- wheezing
- coughing
-tightness of chest
which is a true asthma symptom
tightness of chest
what are the aggravating/complicating factors of asthma
- smoking
- air pollutants: urban and industrial
what are the stages of asthma
- controlled
- partially controlled
- uncontrolled
how frequent are the daytime symptoms and need for rescue meds in controlled asthma
- twice or less per week
how frequent are the daytime symptoms and need for rescue meds in partially controlled asthma
- more than twice a week
how frequent are the daytime symptoms and need for rescue meds in uncontrolled asthma
three or more features of partiallly controleld asthma present in any week
what are the types of asthma
- extrinsic
- exercise induced
- intrinsic
- drug induced
describe extrinsic asthma and another name for it
- allergic or atopic
- most common
- children and young adults
- typical fam hx
- triggered by allergesn-pollen, dust, house mites, animal dander, mold
- exaggerated inflammatory responsew
what is the mechanism of extrinsic asthma
allergen -> T helper lymphocyte type 2 (Th2) -> antibody production of high levels of IgE -> activation of mast cells, basophils, and eosinophils -> bradykinin, histamine, leukotrienes -> bronchoconstriction
describe exercise induced asthma
- unknown pathogenesis
- children and young adults
- triggered by exercise and thermal changes
-cold air irritates mucosa resulting in airway hyperactivity
describe instrinsic asthma and another name for it
- idiosyncratic, nonallergic, non atopic
- second most common
- middle aged individuals
- triggered by respiratory irritants (tobacco, air pollution, emotional stress, gastroesophageal reflux disease)
- infrequently associated with fam hx
- normal IgE levels
what is the mechanism in instrinsic asthma
- allergen -> activation of mast cells, basophils and eosinophils -> bradykinin, histamine, interleukines, leukotrienes -> bronchoconstriction
describe drug induced asthma
- subset of intrinsic
- affects children, young adults, and middle aged adults
- common antigens
what common antigens cause drug induced astham
- NSAIDs, ASA
- beta blockers
- ACEi
- anticholinergic drugs
- food dye
- metabisulfites in food and in local anesthetics with epinephrine
what are the types of treatments for asthma
- inhaled beta 2 agonists
- short acting beta 2 agonists
- long acting beta 2 agonists
what do the inhaled beta 2 agonists do for asthma tx
- bind to beta2 receptors in lungs smooth muscle relaxation
- bronchodilation
what are the short acting beta 2 agonists used for
single use (rescue) meds used alone
what do the long acting beta 2 agonists do for asthma
- used in combination with steroids on a scheduled protocol
- used alone leads to CVD complications
what are the side effects of asthma treatments
- tremors, tachcyardia
- increases blood sugar
- cough
- K+ decrease
what is an example of a short acting beta 2 agonist
albuterol
what is an example of an anticholinergic med used to treat asthma
- atrovent
- spiriva
what is an example of a methylxanthine used to tx asthma
theophylline
wwhat is an example of a mast cell stabilizer used to treat asthma
cromolyn
what is an example of a corticosteroid used to tx asthma
- dexamethasone
- fludrocortisone
- methylprednisone
- prednisone
what is an example of leukotriene receptor antagonists used to treat asthma
singulair
what is an example of combination inhalers used to tx asthma
- advair diskus
- symbicort
what are the oral signs of asthma
- mouth breather: high palatal vault, overjet, crossbite, greater facial height
- dry mouth
- candida
- enamel defects and caries
- gingivitis/periodontitis
- enamel erosion possible with GERD
what are the dental tx considerations with unstable asthma
- dental treatment should be limited to urgent care only
- treatment of acute pain, bleeding or infection
what are the dental tx considerations with stable asthma
- any indicated dental tx may be provided if management protocols are considerd
- consult with physician for severe persistent asthma
what are the drug interactions with asthma and what do they do
- aspirin can trigger asthma
- NSAIDs can trigger asthma
- opiods and barbituates: respiratory depression
- sulfites in epinephrine preparation of local anesthetics
- theophylline and macrolides or ciprofloxacin: potent inhibitor of CYP3A4. increases levels of theophylline. toxicity causing arrythmia and seizures)
- cholinergic agonists: effect of cholinergic agents promotes bronchoconstriction. sialogogues are contraindicated in pts with uncontrolled asthma
what is status asthmaticus
severe prolonged asthma attack that is more than 24 hours and life threatening
what are the overall dental treatment considerations for asthma
- avoid known precipitating factors
- reduce risk of attack
- have pt bring medication inhaler to each apppointment
- recommend prophylaxis with inhaler before appointments for those with moderate to severe asthma