Referat Asma Eksaserbasi

Waskito Setiaji
192011101006

Pembimbing :
dr. Retna Dwi P., SpP

FAKULTAS KEDOKTERAN UNIVERSITAS JEMBER

SMF/LAB. ILMU PENYAKIT DALAM
RSD dr. SOEBANDI JEMBER
2019
 Definisi Asma
Asma merupakan penyakit heterogen yang
ditandai dengan inflamasi saluran napas
kronis, disertai keterbatasan aliran udara
ekspirasi yang bervariasi, diikuti gejala
mengi, sesak napas, dada terasa berat,
batuk yang terjadi pada intensitas dan
waktu yang bervariasi.

Gangguan inflamasi kronis saluran napas

pada asma melibatkan banyak sel dan
mediator inflamasi di paru.

Adapted from GINA Updated 2019

 MEKANISME ASMA
Alergen
1
Respon Segera (Initial Phase) 2 Respon Tertunda (Late Phase)

Sel
Sel Limfosit T
dendritik
Mast
Histamin Makrofag,
Asam Arakidonat
Interleukin
Prostaglandin Leukotrien Eosinofil
Leukotrien Faktor
Reseptor di Otot Polos Saluran Napas Aktivasi
Platelet
Asma Bronkokonstriksi, Inflamasi,
Edema, Hipersekresi mukus
 Mediator inflamasi sel mast pada asma

The biology of asthma. Fishman’s pulmonary diseases and

disorders. 5th edition.
 Produk eosinofil yang berperan dalam asma
Granule proteins
• medicate local tissue damage Chemokines
• induction of mast cell and basophil degranulation • Promote localization of immune cells
• increase airway mucus production to the site of airway inflammation
•Increase reactive oxygen species

Cytokines
Lipid mediators
• Propagate further in inflamatory response
• Increase airway smooth muscle contraction
• Activation of other inflammatory cells
• Increase mucus production
• Upregulate expression of adhesion markers
• Increase vascular permeability
• Promote airway remodelling
• Increase recruitment of inflammatory cells
Note: PGE2 is thought to protect against bronchospasm and
inhibit inflammatory cell recruitment
The biology of asthma. Fishman’s pulmonary diseases and disorders. 5thedition.
Diagnosis
Klasifikasi ASMA
Manajemen Kontrol Asma
 Box 3-5A Confirmation of diagnosis if necessary
Adults & adolescents 12+ years Symptom control & modifiable
risk factors (including lung function)
Comorbidities
Inhaler technique & adherence
Personalized asthma management: Patient goals
Assess, Adjust, Review response
Symptoms
Exacerbations
Side-effects
Lung function
Patient Treatment of modifiable risk STEP 5
satisfaction factors & comorbidities
Non-pharmacological strategies High dose
Education & skills training ICS-
Asthma medication options: Asthma medications STEP 4 LABA
Adjust treatment up and down for
Refer for
individual patient needs STEP 3 Medium dose phenotypic
STEP 2 ICS-LABA assessment
PREFERRED STEP 1 Low dose ± add-on
ICS-LABA therapy,
CONTROLLER Daily low dose inhaled corticosteroid (ICS),
As-needed e.g.tiotropium,
to prevent exacerbations or as-needed low dose ICS-formoterol * anti-IgE,
and control symptoms low dose
ICS- anti-IL5/5R,
formoterol anti-IL4R
Other Low
* dose ICS Leukotriene receptor antagonist (LTRA), or Medium dose High dose Add low dose
controller options taken whenever low dose ICS taken whenever SABA taken † ICS, or low ICS, add-on OCS, but
SABA is taken dose tiotropium, or consider
† side-effects
ICS+LTRA # add-on LTRA
PREFERRED As-needed low dose ICS-formoterol * # dose ICS-formoterol ‡
As-needed low
RELIEVER
Other
reliever option As-needed short-acting β2 -agonist (SABA)
* Off-label; data only with budesonide-formoterol (bud-form) ‡ Low-dose ICS-form is the reliever for patients prescribed
† Off-label; separate or combination ICS and SABA inhalers bud-form or BDP-form maintenance and reliever therapy
# Consider adding HDM SLIT for sensitized patients with
© Global Initiative for Asthma, www.ginasthma.org allergic rhinitis and1 FEV >70% predicted
 Asthma Medication
Anti-inflamasi

Controller Dipakai rutin

setiap hari
Lama penggunaan sesuai
Obat asma parameter kontrol asma
Bronkodilator
Reliever
Dipakai saat serangan
Asma Eksaserbasi
Asma Eksaserbasi
Adalah keadaan akut maupun sub-akut dimana
terdapat perburukan pada gejala dan fungsional paru
dari keadaan sehari-hari pasien. (GINA, 2019)
Faktor resiko
Riwayat serangan asma yang mengancam dibuktikan dengan riwayat
pemasangan intubasi dan ventilator di rumah sakit atau fasilitas gawat
darurat lainnya dalam kurun setahun yang lalu.
Ketidakadekuatan penggunaan inhaler kortikosteroid (ICS), riwayat
pengguna SABA yang berlebihan lebih dari 1 canister dalam sebulan.
Adanya riwayat gangguan psikis dan masalah psikososial yang diderita
oleh pasien; serta riwayat alergi makanan pada penderita asma.
Tidak adanya pengetahuan dan perencanaan terapi (written asthma
action plan) pada pasien itu sendiri.
TERAPI
PADA
PRIMARY
CARE
Management saat
di IGD
Management saa
di IGD
CONTOH OBAT-
OBATAN ASMA
CONTOH OBAT-
OBATAN ASMA
CONTOH OBAT-
OBATAN ASMA
 DAFTAR PUSTAKA
 GINA. 2019. ASTHMA MANAGEMENT AND PREVENTION. GINA
website www.ginastma.org
 GINA. 2018. ASTHMA MANAGEMENT AND PREVENTION. GINA
website www.ginastma.org
 PDPI. 2017. GUIDELINE ASTHMA. Pedoman Diagnosis &
Penatalaksanaan Asma Di Indonesia
 Badan Penelitian dan Pengembangan Kesehatan Kementerian Kesehatan
RI. 2013. Riset Kesehatan Dasar.
 WHO. 2017. Global Assesing Respiratorious Disease.
 Kementerian Kesehatan RI. 2015. Pusat Data dan Informasi Kesehatan RI.