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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 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 16 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

Asthma medications reduce the quantity and quality of saliva 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. This can result in enamel erosion. In patients that are chronic smokers, dental providers may observe leukoplakia, erythroplakia or frank carcinoma.42 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.