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    DR Sumardi PPOK - Emfisema-UII

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    trianaamalia
    1) Chronic obstructive pulmonary disease (COPD) includes chronic bronchitis and emphysema, both characterized by cough, sputum production, and breathlessness over many years due to smoking or air pollution. 2) Emphysema involves destruction of the alveoli causing difficulty breathing, chest distension, and hyperinflation visible on x-ray. It results from an imbalance between neutrophil elastase and alpha-1 antitrypsin protecting alveoli. 3) COPD exacerbations worsen symptoms and include increased cough and colored sputum, requiring rest, oxygen, antibiotics, steroids, and bronchodilators to treat airway inflammation and infection.

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    DR Sumardi PPOK - Emfisema-UII

    Uploaded by

    trianaamalia
    18 views22 pages
    1) Chronic obstructive pulmonary disease (COPD) includes chronic bronchitis and emphysema, both characterized by cough, sputum production, and breathlessness over many years due to smoking or air pollution. 2) Emphysema involves destruction of the alveoli causing difficulty breathing, chest distension, and hyperinflation visible on x-ray. It results from an imbalance between neutrophil elastase and alpha-1 antitrypsin protecting alveoli. 3) COPD exacerbations worsen symptoms and include increased cough and colored sputum, requiring rest, oxygen, antibiotics, steroids, and bronchodilators to treat airway inflammation and infection.

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    Dr Sumardi PPOK_Emfisema-UII

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    Dr Sumardi PPOK_Emfisema-UII

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    1) Chronic obstructive pulmonary disease (COPD) includes chronic bronchitis and emphysema, both characterized by cough, sputum production, and breathlessness over many years due to smoking or air pollution. 2) Emphysema involves destruction of the alveoli causing difficulty breathing, chest distension, and hyperinflation visible on x-ray. It results from an imbalance between neutrophil elastase and alpha-1 antitrypsin protecting alveoli. 3) COPD exacerbations worsen symptoms and include increased cough and colored sputum, requiring rest, oxygen, antibiotics, steroids, and bronchodilators to treat airway inflammation and infection.

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    18 views22 pages

    DR Sumardi PPOK - Emfisema-UII

    Uploaded by

    trianaamalia
    1) Chronic obstructive pulmonary disease (COPD) includes chronic bronchitis and emphysema, both characterized by cough, sputum production, and breathlessness over many years due to smoking or air pollution. 2) Emphysema involves destruction of the alveoli causing difficulty breathing, chest distension, and hyperinflation visible on x-ray. It results from an imbalance between neutrophil elastase and alpha-1 antitrypsin protecting alveoli. 3) COPD exacerbations worsen symptoms and include increased cough and colored sputum, requiring rest, oxygen, antibiotics, steroids, and bronchodilators to treat airway inflammation and infection.

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    of 22

    PENYAKIT PARU OBTRUKTIF

    KRONIK (PPOK)
    Bronkitis kronis
    Batuk + dahak kumat2-an lebih dari 2
    tahun oleh karena merokok atau polusi
    Emfisema
    Sesak nafas + batuk kumat2an lebih dari
    2 tahun oleh karena merokok atau polusi

    EMFISEMA
    Klinis: dyspnea keadaan istirahat, dada
    cembung (tong chest), hipersonor, sianotik, jari
    tabuh.
    CXR: hiperlusen, diafragma datar
    Kelainan utama pada cabang bronkus terminal
    yg. berhubungan dengan alveoli
    Septa alveoli rusak luas alveoli
    inefisiensi pertukaran gas
    Kerusakan septa o.k. elastase yang dihasilkan
    netrofil lebih tinggi dari alfa-1 antitripsin yg
    melindungi integritas alveoli
    Kerusakan bersifat irreversibel

    Emphysema. PA Chest radiography in a patient with


    severe emphysema secondary to alpha-1 antitrypsin
    deficiency

    Emphysema. Graphic depiction of centrilobular versus


    panlobular emphysema

    Pathology . 13 (normal parenchyma)

    Pathology . 14 (emphysema)

    Pathology . 15

    Pathology . 16 (normal small airway)

    Pathology . 17

    Small Airways Dysfunction


    Expiratory flow
    limitation
    On forced
    exhalation

    F
    l
    o
    w

    During exercise
    At rest
    Volume

    Wall thickening
    inflammation
    -- mucus gland
    hypertrophy

    Bronchus

    Secretions
    Wall thickening
    inflammation
    repair
    -- remodeling

    Bronchiole

    Loss of alveolar
    attachments
    Wall thinning inflammation elastolysis

    Alveoli

    Coalescence
    Elasticity

    COPD and the


    Distribution of Airway
    Resistance
    Silent Zone

    Large airway

    Airway
    Normal Central Air Small Airway Obst. way Obst.
    Resistance

    Small airway

    Central
    Peripheral
    R total

    80
    20
    100

    160
    20
    180

    80
    40
    120

    COPD Pathology and Abnormal


    Breathing Mechanics

    Airway resistance
    Elastic recoil
    Expir. flow limitation
    Air trapping and
    dynamic hyperinflation
    Work of breathing
    Dyspnea, cough and
    other respiratory ssx
    Quality of life

    Pathology of Breathing Peripheral Lung Zone


    Airways open
    and not prone
    to collapse
    low resistance
    Lung recoil
    strong enough
    to drive tidal
    expiration
    (passive)
    Work of
    breathing is
    minimal

    Pathology:Altered Lung Mechanics


    Airway wall
    thickened and
    collapsing
    high resistance
    Alveoli thinned
    out poor
    elastic recoil
    Expiratory flow
    limitation
    Residual volume
    increased

    Thin-section CT scan of a
    Smoker

    End-inspiration

    End-expiration

    Pathology ..

    Pathology ..

    Pathology ..

    PPOK
    Eksaserbasi Akut
    1. Batuk + dahak berlebihan
    2. Dahak berubah warna
    kuning,hijau,bau
    3. Demam tanda infeksi
    4. Sesak nafas memberat (emfisema)

    PPOK Eksaserbasi Akut


    Manajemen:
    1. Istirahat + O2 2-3 liter/menit
    2. Diet tinggi kalori,tinggi protein, rendah karbohidrat
    3. Antibiotika: makrolid, kuinolon, penisilin
    4. Steroid oral: metil prednisolon, prednison 40-60
    mg/hari 7-10 hari
    5. Steroid inhalasi: budesonid/flutikason 1-2 mg/hari
    6. Bronkodilator inhalasi: salbutamol/terbutalin 6001200 mcg/hari+Ipatrium bromid (Combivent)
    7. Aminofilin lepas lambat 200-400 mg 2x/hari
    8. Mukolitik: N asetil sistein, ambroksol, OBH, GG

    SUMMARY

    OXYDATIVE STRESS INFLAMATION


    INCREASE CYTOKINE + CHEMOKINE
    IMBALANCE PROTEASE-ANTIPROTEASE
    MUCOUS SECRETION
    REMODELLING SMALL AIRWAY

    PARTIALLY IRREVERSIBLE IRREVERSIBLE

    OBSTRUCTION AIRTRAPPING
    DESTRUCTION PARENCHYMA EMPHYSEMA

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