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Management of Patients with Chronic Diseases

Course Number: 567

Chronic Obstructive Pulmonary Disease (COPD) / Asthma

A group of diseases that cause airflow blockage and breathing-related problems, including emphysema, chronic bronchitis, and asthma.38 These diseases have different etiologies; however, the signs and symptoms often overlap. Clinical signs and symptoms are summarized in Figure 6.

Figure 6. Clinical Signs and Symptoms of COPD.

  • Coughing that produces large amounts of mucus - COPD
  • Night or early morning cough – asthma39
  • Wheezing
  • Chest tightness38,40
  • Shortness of breath,38 particularly with physical activity40
  • Frequent respiratory infections
  • Severe COPD can cause lower extremity edema, weight loss, decreased muscle endurance, blue lips or fingernails, tachycardia, and decreased alertness40

Epidemiology and Etiology

At the present time 14 million Americans have been diagnosed with COPD40and 22 million Americans have been diagnosed with asthma.40 Many people are unaware they have decreased lower pulmonary function so these numbers are likely an underestimate.38 COPD is typically caused by long-term exposure to lung irritants such as air pollution, chemical fumes and dust from the workplace, and secondhand smoke.40 It is estimated that 75% of people who have COHP smoke or used to smoke.40 Additional risk factors include genetic factors,38 alpha-1 antitrypsin deficiency,40 smoking (particularly in the US),38,40 air pollutants,38 chemical fumes, dusts,40 and respiratory infections.38,39 The social determinants of health are also a COPD risk factor. Individuals who are unemployed, retired, unable to work, divorced, widowed, or separated, and people who had less than a high school education are more likely to report COPD.38 Figure 7 provides additional statistics about this disease.

Figure 7. COPD Statistics and Risk Factors.

  • COPD (not including asthma) is the 4th leading cause of death in the United States40
  • COPD is more common in people greater than 40 years old40
  • COPD is more common in American Indian/Alaska Native and multiracial non-Hispanic38
  • COPD is more common in women38
  • COPD is more common in people who have a history of asthma38
  • 1 in 13 Americans have asthma41
  • Allergies are a risk factor for triggering asthma.39,42

Patient Management and Oral Health Considerations for COPD

The majority of patients diagnosed with COPD or asthma can be safely treated in the dental office with few modifications to how care is delivered. Oral health providers should assess the severity of disease when patients have these diagnoses. Patients with severe disease may need to have dental care provided while sitting in an upright position in the dental chair. COPD and asthma medications reduce the quantity and quality of saliva (xerostomia) and increase the risk of mouth breathing, dental caries, dental erosion, periodontal disease and oral candidiasis.43 Gastroesophageal acid reflex is more common in patients diagnosed with asthma and can cause enamel erosion. It is important to provide oral hygiene instructions which include preventive interventions and ways to reduce modifiable and non-modifiable risk factors. Patients that are chronic cigarette smokers may present with leukoplakia, erythroplakia or frank carcinoma.42 Oral health providers should make sure patients are aware that cigarette smoking is a risk factor for COPD and asthma, advise patients to quit smoking, and offer patients information about tobacco cessation. COPD has been known to increase the risk of arthritis and depression.38 The oral conditions associated with these diseases could also affect people diagnosed with COPD.