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Chronic obstructive pulmonary disease

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Definition

Chronic obstructive pulmonary disease is due to pulmonary emphysema or chronic bronchitis. There is either complete irreversible airway obstruction or minimally reversible obstruction.
Obstruction in the strictest sense means occlusion of a hollow structure. Pneumology defines the term "obstruction" as a narrowing of bronchi with subsequent increased airway resistance.

Synonyms:
COLD =chronic obstructive lung disease
COPD =chronic obstructive pulmonary disease
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Causes

The most important aetiological factor of chronic obstructive pulmonary disease is cigarette smoking, followed by occupational and environmental exposure to hazardous substances.

Chronic bronchitis:
There is destruction of the ciliated epithelium of the bronchial system. The bronchial mucosa atrophies and collapses and increasing obstruction develops.

Pulmonary emphysema:
This is an irreversible dilatation of airways distal to the terminal bronchioles due to destruction of the walls of the pulmonary alveoli which become overextended or destroyed due to recurrent inflammation. During exhalation, obstruction develops because the lung loses its elasticity.
This is due to significant alteration of the pulmonary tissue surface, the individual alveoli having coalesced to form a smooth balloon-like structure.

Symptoms and signs

The passage of air is impeded during exhalation. This results in:
  • Respiratory distress
  • Cough
  • Excessive production of mucus, expectoration
  • Sensation of "overexpansion"
COPD patients are characterised by breathing difficulties even at rest.

Risk reduction during treatment

  • Any further oxygen reduction should be avoided.
    • The patient should be kept in an upright position.
    • Do not administer barbiturates or narcotics as they depress respiration (Foley NM 2000).
  • Give the patient the subjective feeling that they are able to breathe freely and that sufficient air is available:
    • Do not use dental dam, if possible.
    • Open a window.
    • Normal local anaesthetics may be used but avoid bilateral nerve blocks in the mandibular foramen or greater palatine foramen.
  • The patient should bring their usual inhalers (bronchospasmolytic agent) and be able to feel or see it during treatment.
  • Facilities to administer oxygen via a nasal tube should be available.


sources

  • Day MB (2000)   Managing the patient with severe respiratory problems   J Calif Dent Assoc 28:585-9, 591-3, 595-8
  • Foley NM (2000)   Chronic obstructive pulmonary disease   SAAD Dig 17:3-12