Respiratory Diseases (PDF)

Respiratory disorders 24th January 2025 Hannah Barrow Georgina Prosser Academic Clinical Fellow in Specialty Registrar in Special Special Care Dentistry Care Dentistry...

Respiratory disorders 24th January 2025 Hannah Barrow Georgina Prosser Academic Clinical Fellow in Specialty Registrar in Special Special Care Dentistry Care Dentistry Khadeeja Saeed Academic Clinical Fellow in Special Care Dentistry Aims & Learning objectives By the end of the session, you should be able to: o Explain the different parts of the respiratory system o Describe pulmonary ventilation and perfusion o Define what is meant by the term respiratory disorders o State the different types of lung diseases o Explain the pathophysiology of common respiratory disorders e.g. Asthma o Describe how to manage a respiratory related medical emergency o Explain how dental treatments could be affected by these conditions o Describe what medications these patients could be on and their relevance to dentistry Why do I need to know about respiratory disorders? o Respiratory disease affects 1 in 5 people o 3rd largest cause of death in England o 25% of your patients may suffer from a respiratory disorder o Lung cancer, COPD (chronic obstructive pulmonary disorder) and pneumonia are the biggest causes of death (NHS England) o Smoking is a huge risk factor in these cases with conditions seen more in low socioeconomic groups o Dental professionals need to understand how these disorders can impact oral health GDC preparing for practice: Dental hygienists and therapists The registrant will be able to… o Describe relevant and appropriate physiology and its application to patient management o Describe the properties of relevant medicines and therapeutic agents and discuss their application to patient management o Recognise psychological and sociological factors that contribute to poor oral health, the course of diseases and the success of treatment o Explain the impact of medical and psychological conditions in the patient o Recognise and manage medical emergencies Structure of lecture 1. How does the respiratory system work (revision) Anatomy, physiology, ventilation and perfusion 2. How does respiratory disease occur Explain what respiratory disease is, classifications, common lung conditions, signs and symptoms, treatments 3. Asthma and COPD Pathophysiology, signs and symptoms, treatments 4. Management of dental patients with respiratory disease Patient management, clinical considerations, smoking and prevention, medical emergencies involved with lung disorders Group discussion – reflective learning MCQs Part 1: How does the respiratory system work? Anatomy and physiology Four main parts of the respiratory system 1. Airway How do we breathe air in and out? What do we use? 2. Lungs What is the role of the lungs? 3. Muscles of respiration Which muscles do we use to breathe in and out? 4. Blood vessels How we get oxygen to the cells Ventilation: flow of air in and out of lungs The role of a ventilator Perfusion: o Process of moving oxygen from the air into our blood vessels o And removing carbon dioxide from the blood vessels which we then expire o This is the gas exchange process o It occurs in the lungs between the alveoli and pulmonary capillaries Part 2: How does respiratory disease occur? What are some common respiratory diseases? Common lung diseases – how do they occur? o Asthma o Chronic Obstructive Pulmonary Disease (COPD) ▪ Chronic Bronchitis ▪ Emphysema o Lung Cancer o Pneumonia o Pleural Effusion A respiratory disorder is anything which affects the body's ability to carry out pulmonary ventilation and perfusion. Types of respiratory disease Can be classified in to: 1. Airway disease 2. Lung tissue disease 3. Lung circulation disease Types of respiratory disease 1. Airway disease: o The ability to move air in and out of the lungs is affected o This compromises the body’s ability to exchange oxygen and carbon dioxide o It is caused by narrowing or blockage of the airways o Examples: Asthma, COPD. Types of respiratory disease 2. Lung tissue disease o Affects the lungs and their structure o Scarring or inflammation of the lung tissue affects their ability to expand and take air in and out o Examples: Tuberculosis, Covid-19 Types of respiratory disease 3. Lung circulation disease o Affects the pulmonary blood vessels o Caused by clotting, scarring, or inflammation. o They affect the ability of the lungs to take up oxygen and release carbon dioxide into the vessels (gas exchange) o These diseases may also affect heart function. As seen in pulmonary hypertension. Common lung diseases – how do they occur? o Asthma o Chronic Obstructive Pulmonary Disease (COPD) ▪ Chronic Bronchitis ▪ Emphysema o Lung Cancer o Pneumonia o Pleural Effusion A respiratory disorder is anything which affects the body's ability to carry out pulmonary ventilation and perfusion. Lung Cancer o One of the most common and a serious form of cancer o In the UK, around 47,000 people are diagnosed with it every year o 4 out of 10 people = over 75 years of age Symptoms: o Persistent cough, pain, coughing up blood (haemoptysis), breathlessness, weight loss, fatigue Types: o Different forms of lung cancer – primary/secondary, non-small/ small cell lung cancer o Non-small cell = most common form: SCC, adenocarcinoma, large cell carcinoma o Risk factors: Smoking is major one Treatments o Surgery / radiotherapy / chemotherapy Pneumonia o Inflammation and swelling of the tissue in the lungs o Seen in the very young or elderly, smokers, immunocompromised Symptoms: (can be chronic or acute) o Cough, difficulty breathing, tachycardia, fever, sweating and shivering, loss of appetite, chest pain Causes: o Bacterial infection, viral infection (e.g. COVID19), aspiration pneumonia, inhaling a harmful agent, hospital acquired pneumonia Treatments: o Rest, fluids, antibiotics, hospital admission (severe cases) Pleural effusion o Fluid in the pleural cavity (which surrounds the lungs) o Affects ability of lungs to expand and work efficiently Symptoms: o May be none, difficulty breathing, fever, cough, SOB Aetiology: o Fluid from other organs, cancer, infections, autoimmune conditions, pulmonary embolism Treatments: o Methods to drain the fluid, treat the cause of the fluid build up Part 3: Asthma and COPD Asthma: Key points o A common chronic inflammatory disorder of the airways o Affects people of all ages o 12% of people in the UK have asthma o 4% of asthmatics have severe asthma o Causes inflammation and narrowing of the airways in response to a stimuli o Symptoms ▪ Wheezing, coughing, tight chest, shortness of breath ▪ If symptoms become worse = an acute asthma attack o Currently no cure o Medications can help treat the symptoms and prevent/relieve symptoms of an asthmatic attack Asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role: in particular, mast cells, eosinophils, T lymphocytes, macrophages, neutrophils, and epithelial cells. In susceptible individuals, this inflammation causes recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night or in the early morning. These episodes are usually associated with widespread but variable airflow obstruction that is often reversible either spontaneously or with treatment. The inflammation also causes an associated increase in the existing bronchial hyperresponsiveness to a variety of stimuli. Pathophysiology o Patients with asthma show airway changes in response to a stimulus o Stimuli include; ▪ Allergens, stress, occupational exposure, viruses, cold air, exercise and others o Changes in the airway occur in a complex manner involving many different types of cells which cause inflammation and narrowing of the airway and airway hyper- responsiveness. Pathophysiology of asthma (stages often occur simultaneously) 1. Bronchoconstriction When a stimulus is encountered, bronchial smooth muscle contraction occurs quickly to narrow the airway (protective mechanism) o Allergen induced acute bronchoconstriction results from cells being activated by mast cells; histamine, tryptase, leukotrienes and prostaglandins are released, and these directly contract airway smooth muscle o NSAIDs (eg Aspirin) cause this same bronchoconstriction affect 2. Airway oedema (swelling) As the stimulus produces more reaction from the airways, other factors occur which cause further airway difficulty: o Oedema, inflammation, mucus hypersecretion and structural changes including hypertrophy and hyperplasia of the airway smooth muscle o These latter changes may not respond to usual treatment o A positive feedback cycle is produced which produces further inflammation and narrowing of their airways and more sensitivity of the airways (hypersensitivity) Medications for asthma o Medications for asthma aim to prevent or relieve the symptoms which occur during an attack (narrowing of airways, oedema, inflammation) o The type and dose of medication depends on; - Patient’s age - Symptoms - Severity of asthma - Any other medical conditions/ medication side effects Category Purpose Types Long-term asthma control medications Quick-relief medications (rescue medications) Medications for allergy-induced asthma Biologics (for severe asthma) Category Purpose Types Long-term asthma Taken regularly to control Inhaled corticosteroids control medications chronic symptoms and prevent Leukotriene modifiers attacks Long-acting beta agonists Quick-relief medications (rescue medications) Medications for allergy-induced asthma Biologics (for severe asthma) Category Purpose Types Long-term asthma Taken regularly to control Inhaled corticosteroids control medications chronic symptoms and prevent Leukotriene modifiers attacks Long-acting beta agonists Quick-relief Taken as needed for rapid, Short-acting beta agonists such as medications short-term relief of symptoms salbutamol (rescue medications) Oral and intravenous corticosteroids (for serious asthma) Medications for allergy-induced asthma Biologics (for severe asthma) Category Purpose Types Long-term asthma Taken regularly to control Inhaled corticosteroids control medications chronic symptoms and prevent Leukotriene modifiers attacks Long-acting beta agonists Quick-relief Taken as needed for rapid, Short-acting beta agonists such as medications short-term relief of symptoms albuterol, salbutamol (rescue medications) Oral and intravenous corticosteroids (for serious asthma) Medications for Taken regularly/ PRN to reduce Allergy shots (immunotherapy) allergy-induced body's sensitivity to a particular Allergy medications asthma allergy-causing substance (allergen) Biologics (for severe asthma) Category Purpose Types Long-term asthma Taken regularly to control Inhaled corticosteroids control medications chronic symptoms and prevent Leukotriene modifiers attacks Long-acting beta agonists Quick-relief Taken as needed for rapid, Short-acting beta agonists such as medications short-term relief of symptoms albuterol, salbutamol (rescue medications) Oral and intravenous corticosteroids (for serious asthma) Medications for Taken regularly/ PRN to reduce Allergy shots (immunotherapy) allergy-induced body's sensitivity to a particular Allergy medications asthma allergy-causing substance (allergen) Biologics Taken with control medications Omalizumab (Xolair) (for severe asthma) to stop underlying biological Mepolizumab (Nucala) responses causing lung inflammation Risk factors for death from asthma COPD: Key points o Chronic Obstructive Pulmonary Disease o A group of lung conditions where the airways are narrowed/damaged o Two of these lung conditions are chronic bronchitis and emphysema o People with these conditions find it difficult to empty air out of the lungs o In the UK there is approximately 3 million people with COPD (2 million = undiagnosed) o Prevalence increases with age o People are usually diagnosed at age of 50 + o Smoking is the greatest risk factor for this disease Bronchitis o Means the airways are inflamed and narrowed. o Excessive mucus can be produced in patients with this disease. Emphysema o Affects the alveoli air sacs. o The air sacs are damaged and break down. o This prevents air to be breathed in and out effectively. These conditions narrow the airways. This makes it harder to move air in and out during respiration. This ultimately affects gas exchange and can be life threatening if not managed. o Asthma and COPD are both chronic lung diseases o COPD is a progressive lung disease seen in adults. It’s irreversible o Mainly due to damage caused by smoking, while asthma is due to an inflammatory reaction o COPD is a progressive disease, while allergic reactions of asthma can be reversible Management of COPD Prevention is better than a cure o Stop smoking services o Vaccinations (flu) o Exercise programmes o Tailored management plan o Managing other health problems (overall health and comorbidities) o Medications to improve breathlessness and prevent acute exacerbations o Further care = oxygen therapy Part 4: Management of dental patients with respiratory disorders Dental management of patients with asthma: o When were you diagnosed? / how long have you had it? o Do you take any medications – which ones and how often? o Have you ever been to hospital for your asthma? How many times? What happened? o What triggers your asthma? o Do you have any other allergies? o Get a detailed social history as well e.g. smoking o These questions allow you understand how severe a person’s asthma is Q - What dental materials you could use and what triggers can be avoided? Patient management: COPD in the dental setting Get a full accurate medical history; o Medications, triggers, severity of disease, any oxygen use? Hospital admissions? o Smoker? – give cessation advice and document o For invasive dental treatments – good practice to check patient SATS before, during and after procedure o May need to give oxygen if levels are low – speak to a senior member of your team if working with patients in hospital Medical emergencies The General Dental Council (GDC) states: 'a patient could collapse on any premises at any time, whether they have received treatment or not. It is therefore essential that all registrants must be trained in dealing with medical emergencies, including resuscitation, and possess up to date evidence of capability’ Medical emergencies o Risk management – how can we avoid one? ▪ Take a full accurate detailed patient history o Planning ahead – two dental/ health care professionals in the clinical environment trained in medical emergencies o Ensure you are aware of the management of medical emergencies ▪ CPD up to date with regular revision and training within your team Anaphylaxis Signs and symptoms: Management: o Sudden onset ✓ ABCDE. ✓ Call 999 (emergency o Flushing and pallor services) o Respiratory distress (stridor, wheeze and/or ✓ Lie flat, elevate legs (if hoarseness) breathing not impaired) o Hypotension and tachycardia ✓ Oxygen 15L/min o Rapid progression of symptoms ✓ Give Adrenaline IM o Life threatening o Skin and/or mucosal changes o Sense of impending doom Adrenaline – doses o Give 500 micrograms of adrenaline IM (0.5ml of 1:1000) (adult dose) o Repeat adrenaline at 5 min intervals until adequate response Paediatric doses of adrenaline: o Under 6 years of age – 150micrograms (0.15ml of 1.1000) o 6 – 12 years of age – 300 micrograms (0.3ml of 1:1000) o Over 12 years (adult dose = 500 micrograms) Asthma – medical emergency Signs and symptoms o Breathlessness and expiratory wheeze SEVERE = inability to complete sentences in one breath o RR > 25/min Pulse >110/min LIFE THREATENING = cyanosis or RR