COPD

Question 1

chronic obstructive pulmonary disease

Answer 1

IRREVERSIBLE chronic airflow obstruction for which no cure exists

Question 2

COPD is a combo of what 2 disease processes?

Answer 2

• chronic bronchitis

- emphysema

Question 3

chronic bronchitis

Answer 3

excessive bronchial mucous production

Question 4

how long do pts have to cough for to be diagnosed with chronic bronchitits?

Answer 4

pt has to have chronic cough for 3 consecutive months within the last two years

Question 5

how many Americans have COPD?

Answer 5

24 million

Question 6

T/F: COPD is the 3rd leading cause of death in US

Answer 6

true

Question 7

etiology of COPD

Answer 7

• smoking
• genetic susceptibility
• long-term exposure to occupational and environmental pollutants

Question 8

genetic susceptibility of COPD

Answer 8

production of inflammatory mediators in response to smoke exposure

Question 9

what changes in large airways are seen in pts with chronic bronchitis?

Answer 9

• thickened bronchial walls

- enlargement of mucous glands

Question 10

what changes in small airways are seen in pts with chronic bronchitis?

Answer 10

narrowing, scarring, increased sputum production, mucous plugging, collapse of peripheral airways

Question 11

T/F: chronic bronchitis obstructs inspiration

Answer 11

false

obstruction on inspiration AND expiration

Question 12

pathophysiology of emphysema

Answer 12

• smoke injures lung parenchyma

- air spaces enlarge and lose elastic recoil

Question 13

how does smoke injure lung parenchyma?

Answer 13

• alveolar epithelium is damaged
• inflammatory cells migrate to damage site
• cells release enzymes that destroy alveolar walls

Question 14

T/F: emphysema obstructs expiration

Answer 14

true

Question 15

complications of COPD

Answer 15

• progressive deterioration with periodic exacerbations
• progressive dyspnea
• recurrent pulmonary infections
• pulmonary hypertension
• thoracic bullae & pneumothorax

Question 16

pulmonary hypertension is a complication of COPD seen in pts with what?

Answer 16

right-sided heart failure

Question 17

medical management

Answer 17

• smoking cessation
• annual influenza & pneumoccal vaccinations
• pharmacologic management
• supplemental O2

Question 18

what drugs are COPD pts on?

Answer 18

• scheduled short & long-acting bronchodilators
• anticholinergics
• antibiotics prn

Question 19

why are anticholinergics given to COPD pts?

Answer 19

decreases mucous production

*don’t prescribe, leave it to treating physician

Question 20

what is given to refractory COPD pts?

Answer 20

inhaled steroids

*for pts who aren’t responding to short or long bronchodilators

Question 21

for severe COPD cases, what is given?

Answer 21

Theophylline

Question 22

should you provide dental care to COPD pts with SOB at rest, productive cough, upper resp infection?

Answer 22

no, reschedule elective txtment

Question 23

dental mods for pts with stable COPD

Answer 23

• upright or semi-supine chair positioning
• bilateral IAN or palatal blocks can be uncomfortable
• nitrous oxide/oxygen for pts in mild-moderate COPD

Question 24

should you give pts with severe COPD nitrous oxide?

Answer 24

no, nitrous can get trapped

Question 25

heavy smoker is more on the chronic bronchitis or emphysema side?

Answer 25

emphysema

Question 26

what drugs should pts with stable COPD avoid because it'll dry out secretions?

Answer 26

anticholinergics or antihistamines

Question 27

what drugs should pts with stable COPD avoid because it'll further decrease respiratory drive?

Answer 27

narcotics like fentanyl