29

Pulmonary Function Tests and Sedation with Pulmonary Diseases: Assessment, Analysis, and Associated Dental Management Guidelines

Pulmonary disease can involve the upper airway or the lower airway. Rhinitis, sinusitis, and pharyngitis are common upper airway diseases. Asthma, bronchitis, emphysema, and chronic obstructive pulmonary disease (COPD) are conditions that affect the lower airways.

The dentist should not only be familiar with disease states but should also be knowledgeable about the diagnostic tools used to detect and assess the control statuses of pulmonary diseases. This becomes particularly important with the conditions causing significant changes in the patient’s ASA status.

THE DIAGNOSTIC TOOLS TO DETECT PULMONARY DISEASE

The diagnostic tools used to detect pulmonary disease are presented in the following sections.

< ?enlrg -24pt?>

History and Physical Examination

History can reveal the presence of symptoms and/or etiological factors such as smoking, specific allergens, or genetic predisposition, which are responsible for the pulmonary disease(s). Sinus congestion, headaches, cough, dyspnea, wheezing, hemoptysis (coughing up blood), sleepiness, snoring, and morning headaches are some of the more common symptoms experienced with pulmonary disease. Physical examination can reveal nasal congestion, nasal inflammation, and cobblestoning of the pharynx from constant postnasal dripping, macroglossia, nasal polyps, and cervical lymphadenopathy, in addition to findings detected through the classic inspection, palpation, percussion, and auscultation findings in the lungs.

Laboratory Tests

Pulmonary Function Tests (PFTs)

Pulmonary function is measured by spirometry. The tests detect how efficiently the oxygen from the lungs is transferred into the blood and how well the carbon dioxide is removed from the blood. The following list details terminologies and facts associated with spirometry.

Common Spirometry Associated Terminologies, Definitions, and Disease Types

• Forced vital capacity (FVC): FVC measures the amount of air exhaled forcefully after deep inspiration.
• Forced expiratory volume (FEV): FEV measures the amount of air exhaled forcefully in one breath. FEV1 is the amount of exhaled air measured at 1 second. FEV1/FVC can then be determined.
• Forced expiratory flow 25–75%: This measures the air flow halfway through an exhale.
• Peak expiratory flow (PEF): PEF measures how quickly one can exhale. It is usually measured at the same time as forced vital capacity (FVC).
• Total lung capacity (TLC): TLC measures the amount of air in the lungs following deep inspiration.
• Residual volume (RV): RV measures the amount of air in the lungs after complete expiration.

It is important to note that staging of COPD is generally done by spirometry. This is discussed in detail in Chapter 34.

Lung Disease Types

There are two main types of lung disease that can be found with lung function tests: obstructive lung disease and restrictive lung disease.

Obstructive lung disease is associated with narrowed airways and it takes a long time for the patient to empty the lungs. Asthma, chronic bronchitis, emphysema, bronchiectasis, bronchiolitis, and chronic obstructive pulmonary disease (COPD) />