|
Asthma and COPD |
Asthma
¨ Bronchial asthma is a generalised airways obstruction which in the early stages is paroxysmal and reversible. The obstruction, leading to wheezing, is due to bronchial muscle contraction, mucosal swelling and increased mucus production. ¨ Exposure to allergens and/or stress can induce an attack. It is now accepted that inflammation is an important aetiological factor in asthma and this has resulted in the use of anti-inflammatory medication in the management of the condition. ¨ In terms of management, infrequent attacks can be managed by salbutamol (ventolin) inhalers as needed or prophylactically if an attack might be predicted e.g. before exercise or prior to a stressful event such as dental treatment. ¨ If the attacks are more frequent, the salbutamol should be used regularly. ¨ If this is insufficient, inhaled steroids (or cromoglycate in the young) should be used. ¨ In severe cases systemic steroids may be prescribed. Enquiry should be directed toward the efficacy of medication, use of steroids and whether there have been episodes of hospitalisation.
Chronic Obstructive Airways Disease
¨ COAD comprises chronic bronchitis and emphysema. ¨ Chronic bronchitis is said to exist when there is sputum production on most days for 3 months of the year in two successive years. ¨ Emphysema is dilatation of airspaces distal to the terminal bronchioles by destruction of their walls. The two co-exist in varying proportions in COAD and smoking is a common predisposing factor. ¨ Some COAD patients are breathless but not cyanosed ('pink puffers') some are cyanotic and if heart failure supervenes become oedematous or bloated ('blue bloaters'). In these patients the respiratory centres are relatively insensitive to carbon dioxide and they rely on 'hypoxic drive' to maintain respiratory effort. It is dangerous to give high levels of supplemental oxygen for longer than brief periods to these patients as breathing may stop or the patient may begin to hypoventilate.
Treatment of acute exacerbations of COAD involves broad spectrum antibiotics, bronchodilators (inhaled or nebulised) and possibly physiotherapy. Steroids may also be used. Dental treatment should be avoided during an exacerbation and in any event if possible should be carried out under LA.
Ref: British Dental Journal 14 June 2003; Volume 194, No. 11
|
