asma-1-uht-2013 (1)
DESCRIPTION
asmaTRANSCRIPT
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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
55
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
Penyakit 'enyakit Pernafasan
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GINA = Global Initatve For Asthma Per!im'unan %okter Paru -n#onesia
2/
www.ginasthma.org
211
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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66
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
ercentage Distribution
of Current Asthmaf Current Asthma
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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. PatoenesisPatoenesis7'at!ofisioloi7'at!ofisioloi
/./. aktor isikoaktor isiko
.. %ianosis #an Klasifikasi%ianosis #an Klasifikasi
3.3. PenatalaksanaanPenatalaksanaan78anaemen78anaemen AsmaAsma4.4. Obat AsmaObat Asma
5.5. Kon#isi K!ususKon#isi K!usus
6.6. Penea!anPenea!an
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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
B ell
'ast 1ell
I. /
I. /
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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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. PatoenesisPatoenesis7Patofisioloi7Patofisioloi
/./. 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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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
"1"1
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I'$4& 5& 13I'$4& 5& 13
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balane
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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 o aller.i diseasesan important role in the development o aller.i diseases
"1"1
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"2"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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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 o aller.i diseasesan important role in the development o aller.i diseases
"1"1
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"2"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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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 o aller.i diseasesan important role in the development o aller.i diseases
"1"1
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"2"2
I'$4& 5& 13I'$4& 5& 13
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6 Eliminates )arasiteEliminates )arasite6 Aller+i/ diseases Aller+i/ diseases6 7 77 7
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An imbalane o #h2 and #h3 ells, espeiall #h3 ells plasAn imbalane o #h2 and #h3 ells, espeiall #h3 ells plas
an important role in the development o aller.i diseasesan important role in the development o aller.i diseases
"1"1
I#N$I#N$%%& I'$2& I'$2
"2"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
0/0/2D32D344
0"0"2D'2D'44
BB2D152D1544
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Allergy March
llergy March
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atopy
topy
Ig(
I'$4
I'$)
I'$10
**+3,a!t -ell
Alle.gen
"2 / -ell
(O
**+3
I'$5
I'$)
G,$*#
I'$4
I'$13
,H* "*+ *40' *40
Ig(
P.o + d. Ka.nen Ga.na /a.ataidaa& pP& KAI& #AAAAI
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Ind-tion and ee-to. me-ani!m in "ype I ype.!en!itiity
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1ell derived 'ediators1ell derived 'ediators
A th I ti 2 ll d
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Source: Peter J. Barnes, MDSource: Peter J. Barnes, MD
Asthma Inammation: 2ells and
Mediators
Ba"an mediator
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Penga. ,(IA"O+ pada !al.an naa!Penga. ,(IA"O+ pada !al.an naa!
Otot Polo!
/.onkokon!t.ik!i
O8!t.k!i al.an naa!
el Go8let Hipe.!ek.e!i !ek.et
,ko!a !al naa! (dema ,ko!a
Ke.!akan epitel
Hi!tamin& PG
'ekot.in
Dspnea 6heein.Dspnea 6heein.
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Per$bahan +al$ran Naas
pada Asma Bronkiale
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EnironmentalEnironmentalfa/torsfa/tors$eneti/ fa/tors$eneti/ fa/tors
0ri++ers0ri++ers6 8iral infe/tions8iral infe/tions
6 E9)ose toE9)ose toaller+ensaller+ens
6 PollutantsPollutants
6 7 77 7
Aller+i/ inflammation Aller+i/ inflammation
2lini/al s*m)toms2lini/al s*m)toms
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eaksi inflammasi ok alerieaksi inflammasi ok aleri
>aso#ilatasi
E#ema
1 ' k All
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-n!alasi :%ebu ruma!, te'un sari,
obat nyamuk, bau<bauan #ll
-n!alasi :%ebu ruma!, te'un sari,
obat nyamuk, bau<bauan #ll
Oral :?#an, -kan laut, telur,
susu, obat #ll
Oral :?#an, -kan laut, telur,
susu, obat #ll
Kontak lansun :
;at<at kimia, obat<obatan,
#ebu #ll
Kontak lansun :
;at<at kimia, obat<obatan,
#ebu #ll
Kulit :Obat< 2 an, at kimia,
iitan serana #ll
Kulit :Obat< 2 an, at kimia,
iitan serana #ll
1ara 'as$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
SKIN
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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$e+ala Aleri
Serin bersin
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Penga.
'ingkngan
9mi! paanan
Ale.gen:
Penga.
'ingkngan
9mi! paanan
Ale.gen:
Genetik
A!ma
Genetik
A!maInlama!i
9 +adang ::
Inlama!i
9 +adang ::/.onkokon!t.ik!i
8e.a.ia!i
/.onkokon!t.ik!i
8e.a.ia!i/atk inte.miten&
mengi dan !e!ak
/atk inte.miten&
mengi dan !e!ak
+ang!ang
!pe!iik
9ale.gen: dan
non!pe!iik
Hipe.eaktiita!
8.onk!
Hipe.eaktiita!
8.onk!
Obstruksi sal nafas
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'ast 1ell de.ran$lation'ast 1ell de.ran$lation
2. *on Aleri1. Aleri
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a.a. i!erator ;istamin : <at *an+ da)ati!erator ;istamin : <at *an+ da)at
men*e!a!kan )ele)asan "istamin :men*e!a!kan )ele)asan "istamin :1. o)iat % /odein, morfin (1. o)iat % /odein, morfin (
. )elemas otot. )elemas otot
=. )olimiksin=. )olimiksin'. tiamin'. tiamin
>. mur!ei, tomat, )uti" telur, lo!ster >. mur!ei, tomat, )uti" telur, lo!ster
'ast 1ell de.ran$lation'ast 1ell de.ran$lation
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>. $etaran i!rasi
'ast 1ell de.ran$lation'ast 1ell de.ran$lation
2. *on Aleri ( mekanisme non imun )
' t 1 ll d l ti' t 1 ll d l ti
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/./. ati"an #asmani :ati"an #asmani :
E9er/iseE9er/ise asetilkolinasetilkolin de+ranulasi mast /ell.de+ranulasi mast /ell.
d.d. PsikisPsikis
e.e. Pen+"am!at ensim siklooksi+enase :Pen+"am!at ensim siklooksi+enase :
@ As)irin@ As)irin @ NSAID@ NSAID
@ <at arna tartrain@ <at arna tartrain
@ Pen+aet sodium !enoat@ Pen+aet sodium !enoat
'ast 1ell de.ran$lation'ast 1ell de.ran$lation
2. *on Aleri ( mekanisme non imun )
%smotik(
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Hipe.t.oi
el$!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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Geala
/.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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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 Asma
4.4. Obat AsmaObat Asma
5.5. Kon#isi K!ususKon#isi K!usus
6.6. Penea!anPenea!an
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Faktor Risiko Asma
aktor Risiko Asma
Asma (<)
$enetik (F)
Asma (<)
$enetik (F)Asma (F)
$enetik (F)
Asma (F)
$enetik (F)Asma
Eksaserbasi
Asma
Eksaserbasi
1
1
2
2
Fi.$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$an
asma
Seran$an
asmaPaparanaler$enspesi-
Ati#itas-si
Peruahan ,ua,a
.apiritan
P"lusi
udara
In+esi
/irus Sala+as
In+esiaterial
2at imia4Oat(an4maanan
Em"si4 ete$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…
Pets
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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Pokok bahasan Asma BronkialePokok bahasan Asma Bronkiale
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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 Asma
4.4. Obat AsmaObat Asma
5.5. Kon#isi K!ususKon#isi K!usus
6.6. Penea!anPenea!an
Kla!iika!i A!ma /.onkiale
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
Pokok bahasan Asma BronkialePokok bahasan Asma Bronkiale
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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 Asma
4.4. Obat AsmaObat Asma
5.5. Kon#isi K!ususKon#isi K!usus
6.6. Penea!anPenea!an
%ianosis Asma Bronkiale
%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)
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)
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
Asma. !edoman "iagnosis 9 !enatala)sanaan di Indonesia. !"!I $%%6
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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.
2onsider ast"ma if any of t"e folloin+ si+ns or s*m)toms are )resent.
Pemeriksaan ?isik
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
Asma. !edoman "iagnosis 9 !enatala)sanaan di Indonesia. !"!I $%%6
= ?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(
=. ?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
=. ?aal Paru %S)irometri(=. ?aal Paru %S)irometri(
OOstrusi Saluran a+asstrusi Saluran a+as
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pada asmapada asma
*ormal
Asma
Obstruksi Obstruksi
Asma
$anuan >entilasi
Pemeriksaan S'irometri (aal Paru)
= ?aal Paru %S)irometri(
= ?aal Paru %S)irometri(
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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
=. ?aal Paru %S)irometri(=. ?aal Paru %S)irometri(
InterpretasiFaalParu
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
atau
>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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2onsider ast"ma if any of t"e folloin+ si+ns or s*m)toms are )resent.
!/@/!+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
E>1
2</ in!alasi salbutamol
E>1
Post bronko#ilatorPre bronko#ilator
DIA&N%IN& A%!'MA ( cont) *
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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.
2onsider ast"ma if any of t"e folloin+ si+ns or s*m)toms are )resent.
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
8aria!ilitas )ada Asma
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8aria!ilitas )ada Asma8aria!ilitas )ada Asma
Asthma Normal
DIA&N%IN& A%!'MA ( cont) *
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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 $% ; from mornin measurement
u'on arisin to measurement 12 !ours later in 'atientstakin a bron!o#ilator.
2onsider ast"ma if any of t"e folloin+ si+ns or s*m)toms are )resent.
3 Ui #aal pa.
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Pen$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)
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
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+
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
Deasa
Kom)likasi Asma Bronkiale
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