asma-1-uht-2013 (1)

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http://slidepdf.com/reader/full/asma-1-uht-2013-1 1/113

dr Ediyono Sp P

Sub dep Paru RSAL Dr Ramelan

FK UHT. 2013

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NONO Kelompok PenyakitKelompok Penyakit PenyakitPenyakit

11 InfeksiInfeksi 1. TBC1. TBC2. Bukan TBC ( Bronkitis,2. Bukan TBC ( Bronkitis, Pneumonia, AbsesPneumonia, Abses ParuParu ))

22 Alleri Alleri A!ma "ron#iale A!ma "ron#iale

33 PPOK ( Penyakit ParuPPOK ( Penyakit Paru

Obstruksi kronis )Obstruksi kronis )Bronkitis Kronis, EmfisemaBronkitis Kronis, Emfisema..

44 Peny. PleuraPeny. Pleura Pleuritis, Efusi Pleura,Pleuritis, Efusi Pleura, S!"arte,S!"arte,

Pneumotoraks, mesot!eliomaPneumotoraks, mesot!elioma

Tumor, #llTumor, #ll

1. Asal :1. Asal : ParuParu PRIMER, SEKUNDERPRIMER, SEKUNDER, Mediastinum, Mediastinum

. Pertum!u"an : #INAK, $ANAS. Pertum!u"an : #INAK, $ANAS

66 $a"at %arurat Paru$a"at %arurat Paru Batuk #ara! ( &emo'toe ), Pneumotoraks,Batuk #ara! ( &emo'toe ), Pneumotoraks, Emboli ParuEmboli Paru

PPOK Akut, Status Asmatikus, Oe#em Paru,PPOK Akut, Status Asmatikus, Oe#em Paru, A%SA%S

aal *afasaal *afas

77 Penyakit Paru Ker+aPenyakit Paru Ker+a PneumokoniosisPneumokoniosis

Penyakit 'enyakit Pernafasan

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GINA = Global Initatve For Asthma Per!im'unan %okter Paru -n#onesia

www.ginasthma.org

Updated 2011

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Pokok bahasan Asma BronkialePokok bahasan Asma Bronkiale

1.1. Pen#a!uluan.Pen#a!uluan.

2.2. %efinisi Asma Bronkiale.%efinisi Asma Bronkiale.

0.0. PatoenesisPatoenesis

/./. aktor isikoaktor isiko

.. %ianosis #an Klasifikasi%ianosis #an Klasifikasi

3.3. Penatalaksanaan AsmaPenatalaksanaan Asma4.4. Obat AsmaObat Asma

5.5. Kon#isi K!ususKon#isi K!usus

6.6. Penea!anPenea!an

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EPIDEMIOLOGI ASMA

300 juta penderita asma di seluruh dunia5 – 10 % asma erat

!ara hidup m"dern pre#alensi menin$at 50 % per 10 tahun

Salah satu pen&ea asen se"lah'er

Diperiraan (0(5

ertamah 100 juta penderita asma

M"rtalitas (50)000 pertahun

diarenaan tanpa "at "ntr"ler

GINA 2006

Di Indonesia prevalensi asma sekitar : 5,4%

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ercentage Distribution

of Current Asthmaf Current Asthma

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0.0. PatoenesisPatoenesis7'at!ofisioloi7'at!ofisioloi

3.3. PenatalaksanaanPenatalaksanaan78anaemen78anaemen AsmaAsma4.4. Obat AsmaObat Asma

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Asma Asma %% PDPI &&' (

adala" )en*akitadala" )en*akit

*an+ meli!atkan !er!a+ai sel inflamasi den+an*an+ meli!atkan !er!a+ai sel inflamasi den+an

aki!ataki!at, ditandai den+an, ditandai den+an $%ee&in$%ee&in

meni meni , sesak nafas, rasa !erat di dada,, sesak nafas, rasa !erat di dada, ba'u#ba'u#

'eru'ama pada malam ( pai dini %ari 'eru'ama pada malam ( pai dini %ari ..

Pen*em)itan dan +e-ala asma terse!ut da)atPen*em)itan dan +e-ala asma terse!ut da)at

!ersifat!ersifat

inflamasi kronik saluran nafas

)en*em)itan saluran nafas *an+!erariasi

reersi!el !aik se/ara s)ontan mau)un

den+an )en+o!atan.

DefnisiDefnisi

Pe#oman %ianosis 9 Penatalaksanaan Asma. P%P- 2/

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Definition “ Asthma “

Asthma is a chronic inflammatory disorder of the airways

in which many cells and cellular elements play a role.

The chronic inflammation is associated with airway

hyperresponsiveness that leads to recurrent episodes of

wheezing, breathlessness, chest tightness, and coughing,

particularly at night or in the early morning.These episodes are usually associated with widespread, but

variable, airflow obstruction within the lung that is often

reversible either spontaneously or with treatment.

GINA !"AT# $%&&

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Inflamasi

nflamasi

Definisi inflamasi :Definisi inflamasi :

Reaksi lokal -arin+an ter"ada)Reaksi lokal -arin+an ter"ada)

infeksi/idera dan meli!atkan le!i" !an*akinfeksi/idera dan meli!atkan le!i" !an*ak

mediator di!andin+ res)on imum dida)atmediator di!andin+ res)on imum dida)at

"ara'a$i)aya K.*+ Renani! ,. ,munoloi Da!ar edi!i #e-10. FKU,. 2012

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Inlammasi

InfeksiInfeksi

0rauma0rauma

Aler+i Aler+i

/alor %"eat(,/alor %"eat(,

ru!or %redness(,ru!or %redness(,

tumor %sellin+ (tumor %sellin+ (

dolor %)ain(.dolor %)ain(.

% Asma (

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Pen+ertian Aler+iPen+ertian Aler+i

Alergi ' (dari )ata “Allos*+

: 'enyim'anan 7 'eruba!an #ari ara semula.

Alergen '

: Ben#a asin ( Antigen ) yan #a'at menin#uksi

ter+a#inya reaksi !i'ersensitifitas 7 aleri.

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Pen+ertian Aler+iPen+ertian Aler+i

Antigen '

: ;at yan #a'at bereaksi #enan 'ro#uk res'on

imun s'esifik, terutama antibo#i.

Imunogen '

: ;at yan #a'at meransan res'on imun s'esifik

baik !umoral, selular 7 ke#uanya.

< -munoen terutama : 'rotein 9 'olisakari#a.

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-mmune System %isor#ers-mmune System %isor#ers

&y'ersensiti=ity (Allery): An abnormal res'onse&y'ersensiti=ity (Allery): An abnormal res'onseto antiens.to antiens.

our Types of -ypersensitivity eactionsour T ypes of -ypersensitivity eactions::

Ty'e -Ty'e - (( Anaphylactic Anaphylactic) eations) eations

Ty'e --Ty'e -- ((/ytoto0ic/ytoto0ic) eations) eations

Ty'e ---Ty'e --- ((Immune /omple0 Immune /omple0 ) eations) eations

Ty'e ->Ty'e -> ((/ell12ediated /ell12ediated ) eations) eations

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Reaksi Imun Klinis Mekanisme Waktu

Reaksi

Ty'e -Ty'e - ((-mme#iate-mme#iate

!y'ersensiti==ity7!y'ersensiti==ity7 Anap Anap

hylactichylactic))

?rtikaria,asma,#iare,anafilaksis

%eranulasi sel 8ast 'ele'asan !istamin

8enit < +am

TTy'e --y'e -- ((Antibo#y<Antibo#y<

me#iate#me#iate#

!y'ersensiti=ity7!y'ersensiti=ity7/ytoto/ytoto

0ic 0ic))

Anemia !emolitik*eutro'eniaTrombosito'enia

-nteraksi Ab #enan'ermukaan A

=ariasi

Ty'e ---Ty'e --- ((ImmuneImmune/omple0 /omple0 ))

Serum SiknessArytralia@imfa#eno'ati>asulitis

Terbentuknya Kom'lek-mun 1<0 minu

Ty'e ->Ty'e -> ((/ell1/ell1

2ediated 2ediated ))

%ermatitis kontak aleri8antou Tes

Pele'asan sitokin<akti=asimakrofa<luka +arinan

2<4 !ari

eaksi &i'ersensitifitaseaksi &i'ersensitifitas

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!eaksi "ipersensitivitas!eaksi "ipersensitivitas

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"elayed hypersensitivity reaction

Ty'e ->Ty'e -> ((/ell12ediated /ell12ediated ) eations) eations

#$ber$lin reation & 'anto$( #est )

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eaksi &i'ersensiti=itas Ti'e -eaksi &i'ersensiti=itas Ti'e -a* +ensitiation-I./ Prod$tion b* +$bse0$ent /(pos$re to Aller.en

Plasma ell

'ast 1ell

I. / I. /

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http://slidepdf.com/reader/full/asma-1-uht-2013-1 22/113N #ngl 3 2ed, 4ol. 566, No. 7 ebruary &, $%%& www.ne8m.org

-nterations : C%/ T Cells an# B Cells < -E Synt!esis-nterations : C%/ T Cells an# B Cells < -E Synt!esis

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!espon inlammasi dari 'ast ell

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HistamineHistamine

other mediatorsother mediators

Early phase reactionEarly phase reaction

(within the first hour)(within the first hour)

sneezingsneezing

rhinorrhearhinorrhea nasal pruritusnasal pruritus

ocular pruritusocular pruritus

Late phase reactionLate phase reaction

(after several hours)(after several hours)

nasal obstructionnasal obstruction

swollen eyesswollen eyes tiredness, irritabilitytiredness, irritability

sleep disturbancesleep disturbance

Attract EosinophilsAttract Eosinophils

and other immune cellsand other immune cells

Mast cellMast cell

AllergensAllergens Adcock I. Clin Exp Allerg Rev 2002; 2: 85-8.Adcock I. Clin Exp Allerg Rev 2002; 2: 85-8.

Aller.i !eationAller.i !eation

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!eaksi Inlammasi!eaksi Inlammasi

-nflamasi Akut-nflamasi Akut -nflamasi Kronis-nflamasi Kronis

eaksi asma

Ti'e e'at( menit )

eaksi asma

Ti'e e'at( menit )

eaksi asma

Ti'e lambat(0<12 +am )

eaksi asma

Ti'e lambat(0<12 +am )

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0.0. PatoenesisPatoenesis7Patofisioloi7Patofisioloi

Penatalaksanaan AsmaPenatalaksanaan Asma4.4. Obat AsmaObat Asma

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HygieneHygiene

ypote!i!ypote!i!

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An imbalane o #h2 and #h3 ells, espeiall #h3 ells plasAn imbalane o #h2 and #h3 ells, espeiall #h3 ells plas

an important role in the development oan important role in the development o aller.i diseasesaller.i diseases

I#N$I#N$%%& I'$2& I'$2"2"2

I'$4& 5& 13I'$4& 5& 13

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an important role in the development o aller.i diseasesan important role in the development o aller.i diseases

I#N$I#N$%%& I'$2& I'$2

I'$4& 5& 13I'$4& 5& 13

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imbalane

Eliminates miroEliminates miro

oranisms an# tumorsoranisms an# tumors Auto<immune #iseaseAuto<immune #isease Trans'lant re+etionTrans'lant re+etion

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I#N$I#N$%%& I'$2& I'$2

I'$4& 5& 13I'$4& 5& 13

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imbalane

Eliminates miroEliminates miro

oranisms an# tumorsoranisms an# tumors Auto<immune #iseaseAuto<immune #isease Trans'lant re+etionTrans'lant re+etion

AllerenD %ietD

es'iratory

>irusesD intrauterin

en=ironment

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I#N$I#N$%%& I'$2& I'$2

I'$4& 5& 13I'$4& 5& 13

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6 Eliminates )arasiteEliminates )arasite6 Aller+i/ diseases Aller+i/ diseases6 7 77 7

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I#N$I#N$%%& I'$2& I'$2

I'$4& 5& 13I'$4& 5& 13

6 Eliminates )arasiteEliminates )arasite6 Aller+i/ diseases Aller+i/ diseases6 7 77 7

Eliminates miroEliminates mirooranisms an# tumorsoranisms an# tumors Auto<immune #iseaseAuto<immune #isease Trans'lant re+etionTrans'lant re+etion

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Allergy March

llergy March

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**+3,a!t -ell

Alle.gen

"2 / -ell

,H* "*+ *40' *40

P.o + d. Ka.nen Ga.na /a.ataidaa& pP& KAI& #AAAAI

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Ind-tion and ee-to. me-ani!m in "ype I ype.!en!itiity

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1ell derived 'ediators1ell derived 'ediators

A th I ti 2 ll d

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Source: Peter J. Barnes, MDSource: Peter J. Barnes, MD

Asthma Inammation: 2ells and

Mediators

Ba"an mediator

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Penga. ,(IA"O+ pada !al.an naa!Penga. ,(IA"O+ pada !al.an naa!

Otot Polo!

/.onkokon!t.ik!i

O8!t.k!i al.an naa!

el Go8let Hipe.!ek.e!i !ek.et

,ko!a !al naa! (dema ,ko!a

Ke.!akan epitel

Hi!tamin& PG

'ekot.in

Dspnea 6heein.Dspnea 6heein.

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Per$bahan +al$ran Naas

pada Asma Bronkiale

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EnironmentalEnironmentalfa/torsfa/tors$eneti/ fa/tors$eneti/ fa/tors

0ri++ers0ri++ers6 8iral infe/tions8iral infe/tions

6 E9)ose toE9)ose toaller+ensaller+ens

6 PollutantsPollutants

6 7 77 7

Aller+i/ inflammation Aller+i/ inflammation

2lini/al s*m)toms2lini/al s*m)toms

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eaksi inflammasi ok alerieaksi inflammasi ok aleri

>aso#ilatasi

1 ' k All

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-n!alasi :%ebu ruma!, te'un sari,

obat nyamuk, bau<bauan #ll

-n!alasi :%ebu ruma!, te'un sari,

obat nyamuk, bau<bauan #ll

Oral :?#an, -kan laut, telur,

susu, obat #ll

Oral :?#an, -kan laut, telur,

susu, obat #ll

Kontak lansun :

;at<at kimia, obat<obatan,

#ebu #ll

Kontak lansun :

;at<at kimia, obat<obatan,

#ebu #ll

Kulit :Obat< 2 an, at kimia,

iitan serana #ll

Kulit :Obat< 2 an, at kimia,

iitan serana #ll

1ara 'as$k Aller.en1ara 'as$k Aller.en

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Alleri #iseases Alleri #iseases

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Aller., one eat$re 6ith man aes

AIRWAYS

$e+ala e+ala Aleri

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$e+ala< e+ala Aleri

8ata mera!,

$atal, berair

Bersin,&i#un buntu

Tenorokan atal,

serak, batuk

$ + l Al i

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$e+ala Aleri

Serin bersin

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Penga.

'ingkngan

9mi! paanan

Ale.gen:

Penga.

'ingkngan

9mi! paanan

Ale.gen:

Genetik

A!maInlama!i

9 +adang ::

Inlama!i

9 +adang ::/.onkokon!t.ik!i

8e.a.ia!i

/.onkokon!t.ik!i

8e.a.ia!i/atk inte.miten&

mengi dan !e!ak

/atk inte.miten&

mengi dan !e!ak

+ang!ang

!pe!iik

9ale.gen: dan

non!pe!iik

Hipe.eaktiita!

8.onk!

Hipe.eaktiita!

8.onk!

Obstruksi sal nafas

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'ast 1ell de.ran$lation'ast 1ell de.ran$lation

2. *on Aleri1. Aleri

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a.a. i!erator ;istamin : <at *an+ da)ati!erator ;istamin : <at *an+ da)at

men*e!a!kan )ele)asan "istamin :men*e!a!kan )ele)asan "istamin :1. o)iat % /odein, morfin (1. o)iat % /odein, morfin (

. )elemas otot. )elemas otot

=. )olimiksin=. )olimiksin'. tiamin'. tiamin

>. mur!ei, tomat, )uti" telur, lo!ster >. mur!ei, tomat, )uti" telur, lo!ster

2. *on Aleri ( mekanisme non imun )

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!.!. ?aktor ?isik :?aktor ?isik :

1. 2a"a*a1. 2a"a*a urtikaria solar.urtikaria solar.. Din+in. Din+in urtikaria din+inurtikaria din+in

=. $esekan tekanan=. $esekan tekanan

'. Panas'. Panas

>. $etaran i!rasi>. $etaran i!rasi

' t 1 ll d l ti' t 1 ll d l ti

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/./. ati"an #asmani :ati"an #asmani :

E9er/iseE9er/ise asetilkolinasetilkolin de+ranulasi mast /ell.de+ranulasi mast /ell.

d.d. PsikisPsikis

e.e. Pen+"am!at ensim siklooksi+enase :Pen+"am!at ensim siklooksi+enase :

@ As)irin@ As)irin @ NSAID@ NSAID

@ <at arna tartrain@ <at arna tartrain

@ Pen+aet sodium !enoat@ Pen+aet sodium !enoat

%smotik(

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Hipe.t.oi

el$!el otot polo!

8.onk!

Patofsiologi AsmaPatofsiologi Asma

Inilt.a!i

eo!inoil& !el ma!t&

net.oil& !el "

(dema mko!a

dan !8mko!a

;a!odilata!i dan

leakage

Pene8alan

!8 mem8.ana 8a!ali!

epo!i!i kolagen

Hipe.t.oikelena. !8 mko!a

< !el go8let

e!kama!i!el$!el epitel

m8atan

ole mk!

Pe.alanan a!ma 8.onkiale= .emodeling

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6 /.onko$

kon!t.ik!i6 (dema6 ek.e!i6 /atk

6 Penge.aan

!el6 Ke.!akan

epitel6 Pe.8aan

!t.kt. dini

6 P.olie.a!i

!ella. 6 Pe$ mat.ik!

ekt.a!ella. 6 Pe.8aan

!t.kt.

+emodelingN

+e!pon!

aktInlama!i

k.onik

Pe.alanan a!ma 8.onkiale= .emodeling

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Processes in Airway RemodelingProcesses in Airway Remodeling

"e.api Pe.alanan a!ma 8.onkiale= .emodeling

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/.onkokon!t.ik!i

6 (k!a!e.8a!i

non !pe!iik

O8!t.k!i

pe.!i!ten!al.an naa!

+emodelingN

+e!pon!

aktInlama!i

k.onik

"e.api Pe.alanan a!ma 8.onkiale= .emodeling

Bronko#ilator

(elie=er)

Anti -nflamatory

(Controler) CC

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1.1. Pen#a!uluan.Pen#a!uluan.2.2. %efinisi Asma Bronkiale.%efinisi Asma Bronkiale.

3.3. Penatalaksanaan AsmaPenatalaksanaan Asma

4.4. Obat AsmaObat Asma

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Faktor Risiko Asma

aktor Risiko Asma

Asma (<)

$enetik (F)

Asma (<)

$enetik (F)Asma (F)

$enetik (F)

Asma (F)

$enetik (F)Asma

Eksaserbasi

Fi.$re 2 3 Fators Inl$enin. the Development

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Fi.$re 273* Fators Inl$enin. the Development

and /(pression o Asthma

HOST FACTORS $eneti/, e.+.,

6 $enes )re@dis)osin+ to ato)*

6 $enes )re@dis)osin+ to aira*

"*)erres)onsieness

!esit* Se9

Fi.$re 2 3 Fators Inl$enin. the Development

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Fi.$re 273* Fators Inl$enin. the Development

and /(pression o Asthma

ENVIRNMEN!A" #A$!R% Allerens

-n#oor: %omesti mites, furre# animals (#os, ats, mie), okroa!

alleren, funi, mol#s, yeasts

Out#oor: Pollens, funi, mol#s, yeasts -nfetions ('re#ominantly =iral)

Ou'ational sensitiers

Tobao smoke

Passi=e smokin

Ati=e smokin

Out#oor7-n#oor Air Pollution

%iet%iet

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* i + t t* i + t t

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*era$ai +at"r pen,etus asma*era$ai +at"r pen,etus asma

Seran$an

asmaPaparanaler$enspesi-

Ati#itas-si

Peruahan ,ua,a

.apiritan

P"lusi

In+esi

/irus Sala+as

In+esiaterial

2at imia4Oat(an4maanan

Em"si4 ete$an$an

&ouse %ust 8ites ( Tunau )

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&ouse %ust 8ites ( Tunau )( %alam ba!asa +a"a : Tenu )

Tunau #ebu ruma!

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Tunau #ebu ruma!Tunau #ebu ruma!

Termasuk s'esies laba<labaTermasuk s'esies laba<laba

Ter#a'at 'a#a #ebu ruma! 9 tem'at ti#urTer#a'at 'a#a #ebu ruma! 9 tem'at ti#ur

Penyebab utama aleriPenyebab utama aleri

Ti#ak #a'at #ili!at #enan mata telan+anTi#ak #a'at #ili!at #enan mata telan+an

Po'ulasi banyak #i G 'ermukaan kasur ( ka'uk ) , busaPo'ulasi banyak #i G 'ermukaan kasur ( ka'uk ) , busa

8akanan #ari ser'i!an kulit manusia8akanan #ari ser'i!an kulit manusia

E l l llE l l ll

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Early postnatal allergenEarly postnatal allergen

exposure… exposure…

House dust mites

E i t l b tE i t l b t

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Environmental substancesEnvironmental substances= allergens (proteins…= allergens (proteins…

1. Inhalant allergens1. Inhalant allergens

house dust mites, pollenhouse dust mites, pollen

pets, mouldspets, moulds

2. Food allergens2. Food allergens

egg, cow’s milk, soy, wheat ( < yrs!egg, cow’s milk, soy, wheat ( < yrs!

peanuts, "ish, shrimp (# yrs!peanuts, "ish, shrimp (# yrs!

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Cockroaches

ockroaches

*o-k.oa-e!*o-k.oa-e!

Man* )eo)le it"Man* )eo)le it"

ast"ma are aller+i/ast"ma are aller+i/

to t"e driedto t"e dried

dro))in+s anddro))in+s and

remains ofremains of

/o/kroa/"es./o/kroa/"es.

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aktor Penetus Asma

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aktor Penetus Asma

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Ba"an aler+en makanan

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Kla!iika!i A!ma /.onkiale

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Kla!iika!i A!ma /.onkialeKla!iika!i A!ma /.onkiale

A!ma /.onkiale

(k!t.in!ik Kom8ina!i In!t.in!ik

1 Atopi > Ale.gi

2 Non Atopi

3 Kom8ina!i

1 (?e.-i!e Ind-ed A!tma2 O8at NAI

3 P!iki!

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Exercise-inuce asthma

xercise-inuce asthma

E9er/ise@indu/ed ast"ma is distin/t from aller+i/ ast"ma

in t"at it does not )rodu/e lon+@term in/rease in aira* a/tiit*.

Perbedaan Asma Aller.i 8 Non Aller.i

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A!ma (k!t.in!ik

9 Atopi :

A!ma Int.in!ik

9 Non Atopi :

22 #imb$lna asma #imb$lna asma '$lai kanak 73'$lai kanak 73 +etelah de6asa +etelah de6asa

33 9el$ar.a den.an Asma 9el$ar.a den.an Asma Ada & )Ada & ) #idak ada & 7 )#idak ada & 7 )

;; Aler. - eksem 6akt$Aler. - eksem 6akt$

baibai

Ada & )Ada & ) #idak ada & 7 )#idak ada & 7 )

44 PenebabPenebab < "o$se D$st 'ite << < 1$aa, lin.k$n.an <

55 +kin #est Aller.+kin #est Aller. Positi & )Positi & ) Ne.ati & 7 )Ne.ati & 7 )

9adar I. / Darah9adar I. / Darah 'enin.kat'enin.kat NormalNormal

>> !i6aat penakit!i6aat penakit!hinitis Aler.!hinitis Aler. "$b* Den.an perker?aan"$b* Den.an perker?aan

Alle.gy Non Alle.gy

an "lder "& ith se#erean "lder "& ith se#ere

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an "lder "& ith se#ere4an "lder "& ith se#ere4

$enerali6ed e,6ema$enerali6ed e,6ema

- severe eczema in oler chil

- role o! "DM

- role o! in!ection

- #rognosis

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%ianosis Asma Bronkiale

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%ianosis Asma Bronkiale%ianosis Asma Bronkiale

"idak !ema peme.ik!aan pe.l dilakkan 8ila dg peme.ik!aan !da dapatditegakkan diagno!a

1. Anamnesa (i"ayat 'enyakit)2. Pemeriksaan isik

0. aal Paru (S'irometri)

/. @aboratorium

. ?+i Pro=okasi Bronkus

3. Pemeriksaan Status Aleri

1. Anamnesa (i"ayat 'enyakit)2. Pemeriksaan isik

0. aal Paru (S'irometri)

/. @aboratorium

. ?+i Pro=okasi Bronkus

3. Pemeriksaan Status Aleri

1 Anamnesa (i"ayat Penyakit)

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1. Anamnesa (i"ayat Penyakit)1. Anamnesa (i"ayat Penyakit)

1. E'iso#ik, re=ersibel #enan7tan'a 'enobatan

2. Batuk, sesak nafas, rasa berat #i#a#a, ber#a!ak

0. $e+ala timbul7memburuk terutama malam !ari

/. %ia"ali faktor 'enetus. es'on ter!a#a' bronko#ilator

1. E'iso#ik, re=ersibel #enan7tan'a 'enobatan

2. Batuk, sesak nafas, rasa berat #i#a#a, ber#a!ak0. $e+ala timbul7memburuk terutama malam !ari

/. %ia"ali faktor 'enetus

. es'on ter!a#a' bronko#ilator

$i%a&at Pen&a'it()e*ala :

Asma. !edoman "iagnosis 9 !enatala)sanaan di Indonesia. !"!I $%%6

1 Anamnesa (i"ayat Penyakit)

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1. Anamnesa (i"ayat Penyakit)1. Anamnesa (i"ayat Penyakit)

1. i"ayat keluara (ato'i)

2. i"ayat aleri 7 ato'i (obat, makanan, #ebu #ll)

0. Penyakit lain yan mem'erberat

/. Perkembanan 'enyakit 9 'enobatan

1. i"ayat keluara (ato'i)

2. i"ayat aleri 7 ato'i (obat, makanan, #ebu #ll)0. Penyakit lain yan mem'erberat

/. Perkembanan 'enyakit 9 'enobatan

"al lain &ang #erlu i#ertim+ang'an

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!esak paa malam hari

esak paa malam hari

Sala! satu iri asma

Sesak 'a#a "aktu malam !ari

DIA&N%IN& A%!'MA

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H!eein!i!<'it!e# "!istlin soun#s "!en

breat!in out.

&istory of any of t!e follo"in:

I Cou!, "orse 'artiularly at ni!t

I eurrent "!eee

I eurrent #iffiult breat!inI eurrent !est ti!tness.

2onsider ast"ma if any of t"e folloin+ si+ns or s*m)toms are )resent.

DIA&N%IN& A%!'MA ( cont) *

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Sym'toms our or "orsen at ni!t, a"akenin t!e 'atient.

Sym'toms our or "orsen in t!e 'resene of:

Animals "it! fur Eerise

Aerosol !emials Pollen

C!anes in tem'erature es'iratory (=iral) infetions

%omesti #ust mites Smoke

%rus (as'irin, beta blokers) Stron emotional

e'ression.

Pemeriksaan ?isik

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Pemeriksaan fisik : ber=ariasi < normal

1. Pemeriksaan Paru : H!eein eks'irasi

2. Kea#aan berat : (“:ilent chest*+

a. Cemas, elisa!, sukar biara, berkerinat

b. Tensi , *a#i 9 es'irasi meninkat. Sianosis ( 'uat kebiruan )

#. Penunaan otot bantu nafas

. Pemeriksaan ?isik. Pemeriksaan ?isik

= ?aal Paru %S)irometri(

=. ?aal Paru %S)irometri(

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=. ?aal Paru %S)irometri(=. ?aal Paru %S)irometri(

8anfaat aal Paru :

1. 8enentukan obstruksi saluran nafas

2. e=ersibilitas faal 'aru

0. >ariabilitas faal 'aru

=. ?aal Paru %S)irometri(

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1 #(;1 9 K(P1 : @ ;olme ek!pi.a!i pak!a detik pe.tama =

#umla" olume udara *an+ !isa dikeluarkan se/ara )aksa

dalam 1 detik )ertama setela" ins)irasi maksimal.

2 A P ( @ A.! Pn-ak (k!pi.a!i

P(# 9Peak (?pi.ato.y #lo +ate:

Parameter aal Paru?ntuk Obstruksi

OOstrusi Saluran a+asstrusi Saluran a+as

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pada asmapada asma

*ormal

Obstruksi Obstruksi

$anuan >entilasi

Pemeriksaan S'irometri (aal Paru)

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NormalNormal

ObstruksiObstruksi

Ada O8!t.k!i al Naa!&Ada O8!t.k!i al Naa!&

/ila = #(; 1 9;olme ek!pi.a!i pak!a 1/ila = #(; 1 9;olme ek!pi.a!i pak!a 1

detik pe.tama : men.n B0 C p.edi-teddetik pe.tama : men.n B0 C p.edi-ted

InterpretasiFaalParu

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%tandar Prediksi Normal rang Indonesia dari Pneumo+ile Pro,ect Indonesia.

Untuk menentukan dera-at o!struktif dan restriktif *aitu :

e.aat "ipe O8!t.k!i9 #(; 1 > p.edi-ted :

"ipe +e!t.ik!i9 #;* > p.edi-ted :

No.mal D B0 CD B0 C D B0CD B0C

+ingan 60 $ 75 C60 $ 75 C 60 $ B0C60 $ B0C

edang 40 $ 5) C40 $ 5) C 40 $ 60 C40 $ 60 C

/e.at 40C 40C 40C 40C

Interpretasi Faal ParuInterpretasi Faal Paru

Spirometri(FaalParu)untukdiagnosisAsma

Spirometri ( Faal Paru) untuk diagnosis Asma

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Pa.amete. yang dipe.ik!a pada !pi.omet.i =Pa.amete. yang dipe.ik!a pada !pi.omet.i =

1. ?E8 1 % 8EP 1 ( 8olume eks)irasi )aksa detik )ertama :

#umla" olume udara *an+ !isa dikeluarkan se/ara )aksa

dalam 1 detik )ertama setela" ins)irasi maksimal.

2 #;* % ?or/ed 8ital 2a)a/iti ( > K;P % ka)asitas ital )aksa (

Spirometri ( Faal Paru) untuk diagnosis Asmap ( ) g

Obstruksi Saluran nafas

asio >EP17K>P J 4

>EP1 J4 're#iksi

DIA&N%IN& A%!'MA ( cont) *2onsider ast"ma if any of t"e folloin+ si+ns or s*m)toms are )resent.

GINA !"AT#" $%&&

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!/@/!+IBII#A+

a'i# im'ro=ements in E>1 (or PE), measure# "it!in minutes after in!alation of ra'i#<atin bron!o#ilator (2</ u

salbutamol), or sustaine# im'ro=ement o=er #ays7"eeks after

in!ale# luoortiosteroi#.e=ersibiltas untuk #ianosis asma:

Peninkatan E>1 : 12 9 2 ml #ari 're<bronko#ilator

2</ in!alasi salbutamol

Post bronko#ilatorPre bronko#ilator

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=ariable airflo" limitationas measure# by usin a

s'irometer

< %iurnal =ariation in PE of more t!an 2 ("it!t"ie #aily rea#in) suests a #ianosis of ast!ma.

Peme.ik!aan #aal Pa. A P (

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9 A.! Pn-ak (k!pi.a!i :

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8aria!ilitas )ada Asma

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8aria!ilitas )ada Asma8aria!ilitas )ada Asma

Asthma Normal

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e=ersible an# =ariable airflo" limitationas

measure# by usin a s'irometer

< PE inreases L &7 ; 1 &7 to $% minutes after in!alation of a ra'i#<atin 2<aonist, or

< PE =aries L $% ; from mornin measurement

u'on arisin to measurement 12 !ours later in 'atientstakin a bron!o#ilator.

3 Ui #aal pa.

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Pen$n?an. dia.nosis1

'enent$kan dera?at penakit A+'A2

/val$asi hasil pen.obatan0

'enent$kan pro.nosis penakit/

4 Peme.ik!aan 'a8o.ato.im

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Peme.ik!aan la8o.ato.im =

a a.a =(o!inolia 9 Emla eo!inoil meningkat :

8 ptm = ditemkan eo!inoil & k.i!tal$2

- Peme.ik!aan Ig ( !pe!iik

d "e! Klit dengan alle.gen 9 "e! Alle.gi :

5 Peme.ik!aan +adiologi

Peme.ik!aan #oto "o.ak! 9 Pa. : = tidak 8enyak 8e.manaat ntk

diagno!a A"H,A

#oto "o.ak! 8e.manaat ntk menyingki.kan adanya penyakit lain

Peme.ik!aan daak 9 !ptm : pada pende.ita A!ma

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Pemeriksaan Aler.i

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Pemeriksaan Aler.i

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!kin rick "est

kin rick "est

Cara 'emeriksaan Tes Aleri

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Tes Aleri7Skin Prik Test ( SPT)

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en+an didesinfeksi d+ alko"ol & Fen+an didesinfeksi d+ alko"ol & F

Ekstrak aler+en diteteskan )ada len+an d+Ekstrak aler+en diteteskan )ada len+an d+

-arak /m -arak /m

Den+an -arum no GDen+an -arum no Glan/etlan/et ditusukan )adaditusukan )ada

tetesan aler+en dan men+an+kat sedikittetesan aler+en dan men+an+kat sedikit

e)idermis.e)idermis.

Ditun++u selamaDitun++u selama 1>@1>@& menit& menit

Di!a/a "asiln*a:Di!a/a "asiln*a:

1.1. Ne+atif %@(Ne+atif %@( : tidak ada indurasi : tidak ada indurasi

.. Positif % 4 ( :Positif % 4 ( : Indurasi = mmIndurasi = mm

=.=. Positif % 44 ( :Positif % 44 ( : Indurasi =@> mmIndurasi =@> mm

'.'. Positif % 444( :Positif % 444( : Indurasi H > mmIndurasi H > mm

>.>. Positif %4444( :Positif %4444( : Indurasi H >mm Indurasi H >mm

)seudo)odia)seudo)odia

-e.er 'V/ %kin Prick !esting0 1acin 2334

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Skin Pri/k 0est %SP0(Skin Pri/k 0est %SP0(

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Pemeriksaan Tes aleri

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6 Ui P.ooka!i 8.onk!

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Kegnaannya =

1 apat mengk. de.aat ipe..ea-tiita! 8.onk!

2 Ui P.ooka!i dilakkan 8ila ada ke-.igaan a!ma&

tetapi pada peme.ik!aan i!ik dan #aal Pa. No.mal

3 "e! P.ooka!i dapat dengan -a.a =

a /e8an ke.a

8 Uda.a dingin

- Inala!i 8aan alle.gen !pe!iik > i!tamin

4 Pa.amete. F P*20 F = kon!ent.a!i at inala!i yang

menim8lkan pen.nan #aal pa. #(;1 20C di8andingkan

!e8elm p.ooka!i

Dia+nosis Bandin+

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+ ++ +

1. PPK

. Bronkitis Kronis

=. $a+al #antun+ Kon+estif

'. Em!oli Paru

>. Disfun+si larin+G. !struksi mekanis %mis : tumor(

. Batuk kronis ok *an+ lain

Kom)likasi Asma Bronkiale

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1. Status Asmatikus % Asma !erat (

. Pneumotoraks

=. Emfisema )aru % Asma kronis (

'. Kor Pulmonale

>. Infeksi % )neumonia (G. $a+al Nafas

asma-1-uht-2013 (1)

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