Respiratory Disorders

• Respiratory disorders, presentation date: 24th January 2025
• Presenters: Hannah Barrow, Khadeeja Saeed, and Georgina Prosser

Learning Objectives

• Explain the components of the respiratory system
• Describe pulmonary ventilation and perfusion
• Define respiratory disorders
• State the different types of lung diseases
• Explain the pathophysiology of common respiratory illnesses like asthma
• Know medical emergencies and how to manage a respiratory related medical emergency
• Explain how dental treatments could be affected by respiratory conditions
• Know what medications these patients could be on, and their relevance to dentistry

Importance of Respiratory Disorders in Dentistry

• Respiratory disease affects approximately 1 in 5 individuals
• Respiratory disease represents the third leading cause of mortality in England
• About 25% of dental patients may suffer from some form of respiratory disorder
• Lung cancer, COPD, and pneumonia are the biggest causes of death (NHS England)
• Smoking significantly elevates the risk
• Dental understanding the impact on oral health is essential

GDC Practice Preparation

• Dental hygienists and therapists must be able to describe physiology and management
• Registrants must be able to properties of medicines and therapeutic agents
• Recognize psychological and sociological factors affecting treatment
• Explain the impact of medical and psychological conditions
• Know how to recognize and manage medical emergencies

Lecture Structure

• How the respiratory system works, covering anatomy and physiology
• Pathophysiology covering what respiratory disease is, and classifications
• Common diseases; signs, symptoms and treatments
• Asthma and COPD pathophysiology, signs, symptoms, and treatments
• Managing patients with respiratory diseases, clinical considerations, emergencies

Respiratory System Components

• Airway for air intake and output
• Lungs.
• Muscles of respiration facilitate breathing
• Blood vessels transport oxygen to cells

Ventilation

• Ventilation is defines as the flow of air in and out of the lungs
• Breathing in requires:
  • Ribs moving up and out
  • The diaphragm flattens
  • The change cause an increase in the volume of the chest
  • Which results in a decrease in pressure means
• Breathing out requires:
  • Ribs to fall
  • The diaphragm moves up
  • The change cause an decrease in the volume of the chest
  • Which results in an increase in pressure

Perfusion

• Perfusion is defined as movement of oxygen from the air into blood vessels
• Facilitate removal of carbon dioxide from the blood vessels, which we then expire
• Gas exchange occurs in the lungs between alveoli and pulmonary capillaries

Common Respiratory Diseases

• Asthma
• COPD
  • Chronic Bronchitis
  • Emphysema
• Lung Cancer
• Pneumonia
• Pleural Effusion (buildup if fluid between lung and chest cavity"
• A respiratory disorder affects the body's ability to carry out pulmonary ventilation and perfusion

Airway Diseases

• Airway diseases affect the ability to move air in and out of the lungs
• Compromise the body's ability to exchange oxygen and carbon dioxide
• Narrowing or blockage of Airways leads to:
• Asthma
  • COPD

Lung Tissue Disease

• Lung tissue diseases affect the lungs and their structure
• Scarring or inflammation of the lung tissue affects their ability to expand and take air in and out
• Examples include:
  • Tuberculosis
  • Covid-19

Lung Circulation Disease

• Lung circulation diseases affect the pulmonary blood vessels
• Caused by clotting, scarring, or inflammation
• Affect the ability of the lungs to take up oxygen and release carbon dioxide (gas exchange)
• These diseases may also affect heart function, like in pulmonary hypertension

Lung Cancer in Detail

• Lung cancer is a serious form of cancer
• Around 47,000 people are diagnosed with lung cancer every year in the UK
• The majority of lung cancer cases, 4 out of 10, impact people over 75
• Symptoms:
  • Persistent cough
  • Pain
  • Coughing up blood - haemoptysis
  • Breathlessness
  • Weight loss, fatigue
• Types:
  • Different forms of lung cancer include primary/secondary, non-small/ small cell lung cancer
  • Non-small cell is the most common form: SCC, adenocarcinoma, large cell carcinoma
  • A major risk factor is smoking
• Treatments involve:
  • Surgery
  • Radiotherapy/chemotherapy

Pneumonia in Detail

• Pneumonia is inflammation and swelling of the tissue in the lungs
• Mostly seen in children, elderly, smokers, immunocompromised
• Symptoms:
  • Cough, difficulty breathing, tachycardia, fever, sweating and shivering, loss of appetite and chest pain
• Causes can be various:

  • Bacterial infection, viral infection (e.g. COVID19), aspiration pneumonia
  • Inhaling a harmful agent, or hospital acquired pneumonia
• Treatments include:
  • Rest, fluids, antibiotics, and hospital admission for severe cases

Pleural Effusion in Detail

• Pleural effusion means there is fluid in the pleural cavity (surrounding the lungs)
• This build up affects the ability of the lungs to expand and work
• Symptoms are:
  • Difficulty breathing, fever, cough, and SOB
• Aetiology from other organs, cancer, infections, autoimmune conditions, pulmonary embolism can be the cause
• Treatments involve:
  • Methods to drain the fluid and treat original cause

Asthma in Detail

• Chronic inflammatory disorder of the airways
• Happens to all ages
• Affects 12% of people in the UK
• 4% of asthmatics have severe asthma
• Symptoms:
• Wheezing, coughing, tight chest, shortness of breath
• If symptoms worsen = an acute asthma attack
• Currently has no cure
• Medications can treat and/or prevent
• Pathophysiology caused by allergens, stress, occupational factors
• Viruses/cold air and exercise
• Occurs due to different types of cells which cause inflammation and narrowing of the airway and airway hyper-responsiveness

Pathophysiology of Asthma - Bronchoconstriction

• Bronchoconstriction happens from an encountered stimulus
• Rapid contraction of bronchial smooth muscle causes airway narrowing (protective)
• Allergen induced acute bronchoconstriction occurs
• Cells activated by mast cells and cause histamine, tryptase, leukotrienes and prostaglandins to to release Which contracts the airway smooth muscle
• NSAIDs cause this bronchoconstriction

Pathophysiology of Asthma - Airway Oedema

• Reaction from the airways is due to other factors
• Other factors lead to further airway difficulty
  • Oedema, inflammation, mucus hypersecretion and structural changes include muscle changes
• Positive feedback reinforces inflammation, sensitivity, and airway narrowing
• Oedema and those structural changes may not respond to usual treatment

Asthma Medications

• Medications aim to prevent or relieve to narrowing of airways, oedema, and inflammation
• Medication type & dosage is dependent on:
  • Patient age
  • Symptoms
  • Asthma severity
  • Other medical conditions/medication side effects
• Long term asthma control medicines are taken to control attacks
• Short term “rescue” medicines act as a relief of symptoms
• Some allergy induced asthma medicines reduce bodies sensitivity to the allergen

Risk Factors for Death from Asthma

• Previous severe exacerbation (intubation or ICU for asthma)
• Hospitalizations for asthma in the past year
• ED: visit because of history
• Current drug use or withdrawal
• Low socioeconomic status and illicit drug use as well

COPD in Detail

• The airways are narrowed or damaged from Pulmonary disease
• Bronchitis and emphysema are the lung conditions are the results
• People with COPD and the related conditions find it difficult to empty air out of the lungs
• Approximately 3 million people in the UK have the disease and 2 million are not diagnosed
• Prevalence up with age
• People are usually diagnosed at age of 50
• Smoking is the greatest risk factor

COPD - Bronchitis vs Emphysema

• Bronchitis: Airways become inflamed and narrowed from airways
• Excessive mucus can produce the symptoms
• Emphysema: alveoli air sacs are affected or damage
• Air sacs damage and air cant be effectively breathed
• This makes it harder to move air in and out during respiration
• Which can affect gas exchange
• Life threatening if not managed

COPD Facts

• Asthma and COPD are both chronic lung diseases
• COPD is progressive and irreversible
• Asthma’s allergic reactions can be reversible
• Management: stop smoking to prevent as it’s better than a cure

COPD Management

• Stop smoking
• Vaccinations (flu)
• Exercise programmes
• Tailored management plan
• Managing overall health and comorbidities
• Medications to improve breathlessness and prevent acute exacerbations
• Further care = oxygen therapy

Managing Dental Asthma Patients

• Questions to help dental patients and treatment:
  • When were you diagnosed?
  • take any medications?
  • ever been to hospital?
  • What triggers you?
• Get detailed social history and understand severe
• Take note of what materials to avoid

Managing Dental COPD Patients

• Get a full accurate medical history
  • Medications to treat
• triggers for a flares up
• severity of disease
• whether oxygen is required
• and any hospital admissions
• Smoker?
  • Give cessation advice and document given
• For treatments
  • Good practice to SATS before, during and after
• Need to give oxygen?
• Speak to member on your team, usually a senior member

Medical Emergencies and the GDC

• The General Dental Council (GDC) states: 'a patient could collapse on any premises at any time
• Registrants trained and have evidence for resuscitation
• Risk and avoid emergencies by a detailed patient medical history
• Plan, work with other people to prevent emergencies.

Anaphylaxis

• Symptoms include:
  • Sudden onset
  • Flushing and pallor
  • Respiratory distress: stridor, wheeze and/or hoarseness Hypotension and tachycardia
• Rapid progression of symptoms to life threatening
• Skin and/or mucosal changes and a Sense of impending doom
• Treatment involves:
  • ABCDE
  • Call 999 (emergency services) with a Lie flat, elevate legs (if breathing not impaired)
• Provide Oxygen 15L/min and Give Adrenaline IM
• Dosages:
  • Give 500 micrograms of adrenaline IM (0.5ml of 1:1000) (adult dose)
  • Can Repeat at 5min intervals
  • Under 6 years of age - 150micrograms (0.15ml of 1.1000)
  • 12 years of age – 300 micrograms (0.3ml of 1:1000)
  • Over 12 years (adult dose = 500 micrograms)

Asthma - Medical Emergency

• Breathlessness and expiratory wheeze
• Severe = inability to complete sentences in one breath and RR >25/min Pulse >110/min
• Life threatening = cyanosis or RR <8/min Pulse
  • exhaustion, or decreased LOC
• treatment includes:
  • ABCDE
  • Sit upright Give
  • asthma medication with 100mcg
  • call emergency
  • spacers
• do not allow patient to have more than 10 in total