DIAGNOSIS BANDING

Asthma
Asthma adalah penyakit heterogenous yang disebabkan inflamasi saluran napas kronis.
Asthma didefinisikan sebagai riwayat gejala pernapasan seperti mengi, sesak napas,
sakit dada dan batuk yang bervariasi dari masa ke semasa dan intesitas, serta limitasi
aliran udara ekspirasi.
PPOK
PPOK adalah penyakit umum yang bisa dicegah dan dirawat, yang mempunyai ciriciri seperti limitan aliran udara yang bersidat progressif dan menetap dan dihubungkan
dengan respon inflammatorik yang kronik terhadap gas-gas dan partikel noksius.
Eksasebasi dan kormibiditas menyumbang kepada beratnya penyakit dalam suatu
individu.
Asthma-COPD overlap syndrome (ACOS)
Asthma-COPD overlap syndrome (ACOS) adalah penyakit dengan limitasi aliran
udara yang menetap dengan beberapa ciri yang sering diasosiasikan dengan asma
dan juga PPOK. Dengan itu, ACOS adalah penyakit yang mempunyai ciri-ciri
yang sama dengan PPOK dan asthma.

Gambar 1 menunjukkan cara

mendiagnosa penyakit limitasi aliran
udara kronis
Langkah 1: Menentukan sama ada
penyakit saluran napas kronik
Langkah 2: Menentukan diagnosa
Asthma, PPOK atau ACOS
a.

Menyenaraikan gejala yang berkait

dengan asthma dan PPOK

b.

Membandingkan jumlah gejala lebih ke

Asthma atau PPOK

Langkah 3: Spirometri

Feature

Asthma

COPD

Usually childhood
Usually > 40 years of
onset but can
age
commence at any
Pattern of age.
Symptoms may
Chronic usually
respiratory vary over time (day continuous
symptoms to day, or over
symptoms,
longer periods),
particularly during
often limiting
exercise, with better
activity. Often
and worse days
triggered by
exercise, emotions
including
laughter,
Current
and/or
FEV1 may be
Lung
historical
improved by therapy,
function
variable airflow
but post-BD FEV1/FVC
limitation,
< 0.7 persists
Lung
May be normal
Persistent airflow
function
between symptoms limitation
between
symptoms
Past
Many patients have History of exposure to
Age of
onset

history or
family
history
Time
course

allergies and a
personal history of
asthma in childhood,
and/or family history
of asthma
Often
improves
spontaneously or
with treatment, but
may result in fixed
airflow limitation

noxious particles and

gases (mainly
tobacco smoking and
biomass fuels)
Generally, slowly
progressive over
years despite
treatment

Severe hyperinflation
& other changes of
COPD
Exacerbatio Exacerbations occur, Exacerbations can be
ns
but the risk of
reduced by
exacerbations can
treatment. If present,
be considerably
comorbidities
reduced by
contribute to
treatment
impairment
Chest X-ray Usually normal

Airway
Eosinophils and/or
inflammati neutrophils
on

ACOS
Usually age 40 years,
but may have had
symptoms in childhood
or
early adulthood
Respiratory
symptoms
including exertional
dyspnea are persistent
but variability may be
prominent

More likely to be asthma

if several of ...*
q

More likely to be COPD

if several of...*

Onset before age 20

years

q Variation in symptoms
over minutes, hours or
days
q Symptoms worse
during the night or
early morning
q Symptoms triggered by
exercise,
Record
ofemotions
variable

Onset after age 40

years

q Persistence of symptoms
despite treatment
q Good and bad days but
always daily symptoms
and exertional dyspnea
q Chronic cough and
sputum preceded onset of
dyspnea, unrelated to
triggersof persistent
q Record

Airflow limitation not

q
fully reversible, but often
with current or historical
variability
q
Persistent airflow
limitation

airflow limitation
(spirometry, peak
flow)
Lung function normal

Frequently a history of
q
doctor- diagnosed asthma
(current or previous),
q
allergies and a family
history of asthma, and/or
a history ofare
noxious
Symptoms
partly but q

Previous doctor diagnosis q

of asthma
Family history of asthma,
q
and other allergic
conditions (allergic rhinitis
or eczema)
No
worsening of
q

Previous doctor diagnosis

of COPD, chronic
bronchitis or emphysema
Heavy exposure to a risk
factor: tobacco smoke,
biomass fuels
Symptoms
slowly

symptoms over time.

Symptoms vary either
seasonally, or from year to
year
q
q May improve
spontaneously or have an
q Normal

worsening over time

(progressive course
over years)
Rapid-acting
bronchodilator treatment
provides only limited
q Severe
hyperinflation

significantly reduced by
treatment. Progression is
usual and treatment
needs are high
Similar to COPD

between
symptoms

airflow limitation (postbronchodilator FEV1/FVC

0.7)function
q<
Lung
abnormal between
symptoms

Exacerbations may be
**Jika jumlah gejala bagi PPOK dan Asthma
more common than in
adalah sama, diagnose ACOS perlu
COPD but are reduced by dipertimbangkan
treatment. Comorbidities
can contribute to
impairment

Neutrophils
Eosinophils and/or
eosinophils in
neutrophils in sputum.
sputum, lymphocytes
in airways, may have
systemic
inflammation

Spirometri
Spirometric variable

Asthma

COPD

ACOS

Normal
FEV1/FVC preatau pasca
bronokdilatatau

Sesuai dengan diagnosis

Tidak sesuai dengan diagnosis Tideak sesuai melainkan

dengan evidens lain yang
menunjukkan limitasi aliran
napas kronik

Pasca
bronkodilator
FEV1/FVC <0.7

Indikasi pada limitasi aliran

udara tetapi bias membaik
secara spontan atau
pengobatan

Diperlukan untuk diagnosis

(GOLD)

Selalu ada

FEV1 80%
prediksi

Sesuai dengan diagnosis

(good asthma control atau
interval between symptoms)

Sesuai dengan klasifikasi

GOLD untuk limitasi aliran
udara derajat ringan
FEV1/FVC <0.7

Sesuai dengan diagnosis

ACOS ringan

FEV1 <80%
prediksi

Sesuai dengan diagnosis.

Faktor resiko untuk
eksersabasi asthma

Sebagai indikasi untuk derjat

Sebagai indikasi untuk derjat
limitasi aliran udara dan resiko limitasi aliran udara dan
resiko di masa depan
di masa depan

Pasca
bronkodilator

Biasa pada suatu tahap

Sering dan lebih
penyakit, tapi bias juga tidak berkemungkinan bila FEV1
ada pada kondisi teratur
rendah
pengobatannya

Sering dan lebih

berkemungkinan bila FEV1
rendah

Tinggi probabilitas untuk

asthma

Sesuai dengan diagnosis of

ACOS

Meningkat FEV1
>12% dan 200 ml
dari baseline
Pasca
bronkodilator
Meningkat FEV1
>12% dan 400ml
dari baseline

Tidak selalu dalam PPOK.

ACOS dipertimbangkan