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Asthma: Lebih Detail Patogenesis Asthma
Asthma: Lebih Detail Patogenesis Asthma
ASTHMA
Dr. M. Ilyas, Sp.PD,Sp.P
Melibatkan sist.imun
Inflamasi
kronishiperresponsifepisode
wheezing,sesak,batuk
Host factor
Environment
Alergen
Infeksi respiratori
Exercise
Cuaca dingin/perubahan cuaca
Sulfur dioxide
Food, drugs
GERD
Stress emosional
Patomekanisme Asthma
Airflow limitation (Obstruksi)
Airway hyper-responsiveness
Hiper bronkokonstriksi krn stimulus yg
tdk spesifik
mis exercise, cold air
Airway inflamation
Eosinofil,limfosit,mast
cell,neutrofiledema
otot polos hipertrofi&hiperplasia,
basement membrane
menebal mukus, epitelial damage
Patogenesis Asthma
*inflamasi sel goblethiper-sekresidahak
-sehinnga pd pasien asthma tdk diberikan
mukolitik tp cukup
dgn steroid inflamasi
*normal: inspirasi lbh pnjg drpd ekspirasi, tp pd
asthma
ekspirasi>inspirasi
Pengukuran hiper-responsif
Tes alergi skin prick test
TUJUAN TERAPI
Relieve symptomsbgt dtg dgn
sesak,,brikan obat inhalasi krja
singkat,,SABA(soft active B2
agnonist)cnthnya Salbutamol
Maintain (near) normal PF
dll
Obat
Obat
CONTROLLER
Inhaled glucocorticosteroids
Leukotriene modifiers
Long-acting inhaled 2-agonists
Systemic glucocorticosteroids
Theophylline
Cromones
Long-acting oral 2-agonists
Anti-IgE
Systemic glucocorticosteroids
RELIEVER
Rapid-acting inhaled 2-agonists
Systemic glucocorticosteroids
Anticholinergics
Theophylline
Short-acting oral 2-agonists
PATOGENESIS
Utama : asap rokok, tp partikel lain jg bs
PPOK
PPOK : Bronchitis kronik & Emfisema
Bisa dicegah dan diobati
Airflow limitation not fully reversible &
progresif
Abnormal inflamatory response
Thn 2020 diperkirakan oleh WHO mjd
penyebab kematian ke-3 stlh pnyakt
cardiovaskular
PATOFISIOLOGI
RISK FACTORS
Genetik
Exposure to particles: asap tobacco,
occupational dust, polusi
DD
Asthma
CHF
Bronkiektasis
TB
Bronchiolitis
GOLD
DIAGNOSIS COPD
TREATMENT
SPIROMETRI
Klp A
First choice: B2 agonist kerja singkat :
salbutamol
Alternative : LAMA
Pilihan terakhir : Teophylline
Klp C & D
Tambahkan ICS
BRONCHODILATOR for PPOK
PPOK : pilihan pertama Bronchodilator
ASTHMA : Inhaled corticosteroid
Device yg biasa digunakan utk treatment
ASTHMA-PPOK
Nebulizer
Metered-dose inhalers
Spacers, valved holding chambers
Dll
OBAT LAIN
Antibiotik : hanya diberikan bila ada
tanda infeksi
Antioksidan
Mukolitik,antitusif,vasodilator: tdk
direkomendasikan utk pasien PPOK
stabil (stadium 1 dan 2)
KLINIS
Onset
Gejala
Riwayat
Airflow
limitation
Goal of
treatment
IMUNOLO
GI
HISTO
ASTHMA
pd umur muda (srg pd anak)
Gejala bervariasi dr hari ke
hari, gejala srg muncul pd
malam hari atau early morning
Ada riwayat alergi dan biasanya
ada riwayat asthma pd keluarga
Airflow limitationreversible
PPOK
pd umur tua
Gejala progresif
Mengurangi gejala
CD4+
CD8+
Eosinofil
Small airway disease
Makrofag, neutrofil
Destruksi
parenkimal
Riwayat merokok yg
sdh lama
irreversible