1. Chronic obstructive pulmonary disease (COPD) involves chronic inflammation in the airways that causes difficulty emptying air from the lungs. It includes chronic bronchitis and emphysema.
2. Chronic bronchitis involves increased swelling and mucus production in the airways, causing them to become smaller. Emphysema damages the walls of the air sacs in the lungs, causing them to lose elasticity and become overinflated.
3. The airway obstruction that occurs in COPD is irreversible due to structural changes in the small airways like inflammation, fibrosis, goblet cell metaplasia, and smooth muscle hypertrophy.
1. Chronic obstructive pulmonary disease (COPD) involves chronic inflammation in the airways that causes difficulty emptying air from the lungs. It includes chronic bronchitis and emphysema.
2. Chronic bronchitis involves increased swelling and mucus production in the airways, causing them to become smaller. Emphysema damages the walls of the air sacs in the lungs, causing them to lose elasticity and become overinflated.
3. The airway obstruction that occurs in COPD is irreversible due to structural changes in the small airways like inflammation, fibrosis, goblet cell metaplasia, and smooth muscle hypertrophy.
1. Chronic obstructive pulmonary disease (COPD) involves chronic inflammation in the airways that causes difficulty emptying air from the lungs. It includes chronic bronchitis and emphysema.
2. Chronic bronchitis involves increased swelling and mucus production in the airways, causing them to become smaller. Emphysema damages the walls of the air sacs in the lungs, causing them to lose elasticity and become overinflated.
3. The airway obstruction that occurs in COPD is irreversible due to structural changes in the small airways like inflammation, fibrosis, goblet cell metaplasia, and smooth muscle hypertrophy.
• PPOK adalah penyakit paru kronik yang ditandai oleh hambatan aliran udara di saluran napas yang bersifat progressif nonreversibel atau reversibel parsial. PPOK terdiri dari bronkitis kronik dan emfisema atau gabungan keduanya (PDPI, 2003). • Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable disease that makes it difficult to empty air out of the lungs (American Thoracic Society, 2013). • Chronic bronchitis is a condition of increased swelling and mucus (phlegm or sputum) production in the breathing tubes (airways) (American Thoracic Society, 2013). • Kelainan saluran napas yang ditandai oleh batuk kronik berdahak minimal 3 bulan dalam setahun, sekurang-kurangnya dua tahun berturut - turut, tidak disebabkan penyakit lainnya (PDPI, 2013). Airway obstruction occurs in chronic bronchitis because the swelling and extra mucus causes the inside of the breathing tubes to be smaller than normal. • Emfisema merupakan uatu kelainan anatomis paru yang ditandai oleh pelebaran rongga udara distal bronkiolus terminal, disertai kerusakan dinding alveoli (PDPI, 2013). • Emphysema a progressive (or increasing) condition of the lungs that causes shortness of breath and decreased capacity for physical activity. It is caused by damage to the small air sacs and small airways in the lungs. • Emphysema is a condition that involves damage to the walls of the air sacs (alveoli) of the lung. Normally there are more than 300 million alveoli in the lung ((American Thoracic Society, 2013). • In emphysema, the walls of some of the alveoli have been damaged. When this happens, the alveoli lose their stretchiness and trap air. • Since it is difficult to push all of the air out of the lungs, the lungs do not empty efficiently and therefore contain more air than normal. • This is called air trapping and causes hyperinflation in the lungs. Asma adalah gangguan infl amasi kronik jalan napas yang melibatkan banyak sel dan elemennya. Inflamasi kronik tersebut menyebabkan peningkatan hiperensponsif jalan napas yang menimbulkan gejala episodik berulang berupa mengi, sesak napas, dada terasa berat dan batuk terutama malam hari dan atau dini hari. Asthma is a common chronic disorder of the airways that is complex and characterized by variable and recurring symptoms, airflow obstruction, bronchial hyperresponsiveness, and an underlying inflammation • Inflammation has a central role in the pathophysiology of asthma. As noted in the definition of asthma, airway inflammation involves an interact ion of many cell types and multiple mediators with the airways that eventually results in the characteristic pathophysiological features of the disease: bronchial inflammation and airflow limitation that result in recurrent episodes of cough, wheeze, and shortness of breath. • The processes by which these interactive events occur and lead to clinical asthma are still under investigation. Moreover, although distinct phenotypes of asthma exist (e.g., intermittent, persistent, exercise- associated, aspirin-sensitive, or severe asthma), airway inflammation remains a consistent pattern. • The pattern of airway inflammation in asthma, however, does not necessarily vary depending upon disease severity, persistence, and duration of disease. The cellular profile and the response of the structural Bronchoconstriction. Airway edema. Airway hyperresponsiveness Airway remodeling. • In acute exacerbations of asthma, bronchial smooth muscle contraction (bronchoconstriction) occurs quickly to narrow the airways in response to exposure to a variety of stimuli including allergens or irritants. • Allergen-induced acute bronchoconstriction results from an IgE- dependent release of mediators from mast cells that includes histamine, tryptase, leukotrienes, and prostaglandins that directly contract airway smooth muscle (Busse and Lemanske 2001). • In addition, other stimuli (including exercise, cold air, and irritants) can cause acute airflow obstruction. As the disease becomes more persistent and inflammation more progressive, other factors further limit airflow. These include edema, inflammation, mucus hypersecretion and the formation of inspissated mucus plugs, as well as structural changes including hypertrophy and hyperplasia of the airway smooth muscle. The degree to which airway hyperresponsiveness can be defined by contractile responses to challenges with methacholine correlates with the clinical severity of asthma. The mechanisms influencing airway hyperresponsiveness are multiple and include inflammation, dysfunctional neuroregulation, and structural changes; inflammation appears to be a major factor in determining the degree of airway hyperresponsiveness. • Airway remodeling involves an activation of many of the structural cells, with consequent permanent changes in the airway that increase airflow obstruction and airway responsiveness and render the patient less responsive to therapy (Holgate and Polosa 2006). • These structural changes can include thickening of the sub-basement membrane, subepithelial fibrosis, airway smooth muscle hypertrophy and hyperplasia, blood vessel proliferation and dilation, and mucous gland hyperplasia and hypersecretion (box 2–2). 1. Kebiasaan merokok merupakan satu - satunya penyebab kausal yang terpenting, jauh lebih penting dari faktor penyebab lainnya. Dalam pencatatan riwayat merokok perlu diperhatikan : Riwayat merokok - Perokok aktif - Perokok pasif - Bekas perokok b. Derajat berat merokok dengan Indeks Brinkman (IB), yaitu perkalian jumlah rata-rata batang rokok dihisap sehari dikalikan lama merokok dalam tahun - Ringan : 0-200 - Sedang : 200-600 - Berat : >600 2. Riwayat terpajan polusi udara di lingkungan dan tempat kerja 3. Hipereaktiviti bronkus 4. Riwayat infeksi saluran napas bawah berulang • Pada bronkitis kronik terdapat pembesaran kelenjar mukosa bronkus, metaplasia sel goblet, inflamasi, hipertrofi otot polos pernapasan serta distorsi akibat fibrosis. • Emfisema ditandai oleh pelebaran rongga udara distal bronkiolus terminal, disertai kerusakan dinding alveoli. Secara anatomik dibedakan tiga jenis emfisema: • Emfisema sentriasinar, dimulai dari bronkiolus respiratori dan meluas ke perifer, terutama mengenai bagian atas paru sering akibat kebiasaan merokok lama • Emfisema panasinar (panlobuler), melibatkan seluruh alveoli secara merata dan terbanyak pada paru bagian bawah • Emfisema asinar distal (paraseptal), lebih banyak mengenai saluran napas distal, duktus dan sakus alveoler. Proses terlokalisir di septa atau dekat pleura. • Obstruksi saluran napas pada PPOK bersifat ireversibel dan terjadi karena perubahan struktural pada saluran napas kecil yaitu : inflamasi, fibrosis, metaplasi sel goblet dan hipertropi otot polos penyebab utama obstruksi jalan napas.