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Definisi

PPOK adlh penyakit yang dapat dicegah & diobati ditandai dengan hambatan aliran udara yang tidak sepenuhnya reversibel Hambatan aliran udara tersebut bersifat progresif dan berhubungan dengan respon inflamasi paru terhadap partikel berbahaya atau gas, utamanya akibat asap rokok.

COPD RISK FACTORS


1
HOST FACTORS: GENETIC FACTOR SEX Airway hiperreaktiviti, IgE, Asma

2 EXPOSURES: Smoking Social-economic status Occupational Environmental pollution Recurrent brpulmonary infect diet

ASMA

Kecurigaan PPOK

Batuk kronis dgn dahak Sesak napas Riwayat terpapar faktor risiko

Diagnosis Pasti: SPIROMETRI

INFLAMATION

Small airway disease

Parenchymal destruction

Airway inflamation
Airway remodeling

Loss of alveolar attachments


Decrease of elastic recoil

AIRFLOW LIMITATION

Gejala klinis & laboratorium

Dua keluhan utama : sesak napas & batuk Progresif perlahan beberapa tahun Ringan gangguan aktiviti Suara mengi komponen reversibilitas PPOK Batuk kronis Batuk darah blood-streaked sputum Anoreksia & BB menurun

Pemeriksaan Fisis: Tergantung derajat/berat penyakit Awal: ekspirasi dan wheezing Lanjut: hiperinflasi & barrel chest Suara napas menurun, ekspirasi memanjang, suara jantung jauh, ronkhi basah Otot bantu napas, pursed-lip breathing Berat kor pulmonal kronik dekompensata.

Diagnosis

Dibuat atas dasar:


Gambaran Klinis Pemeriksaan Penunjang Rutin Khusus

COPD MANAGEMENT

1
ESTABLISH DIAGNOSIS ASSESS SYMPTOMS

STOP SMOKING HEALTHY LIFESTYLE IMMUNISATION

2
TREAT OBSTRUCTION BRONCHODILATORS

3
ASSESS FOR HYPOXIA LONG TERM OXYGEN THERAPY

4 PULMONARY REHABILITATION PROGRAMME

1 STOP SMOKING
TRIAL OF BUPROPION NICOTINE REPLACEMENT

LONG TERM OXYGEN THERAPY [ SELECTED PATIENT ]

5
COPD PHARMACOTHERAPY

NEW ANTI INFLAMMATORY TREATMENT NEEDED 2

BRONCHODILATORS

4
INHALED CORTICOSTEROIDS ONLY FOR CONCOMITANT ASTHMA
ANTICHOLINERGICS [ TIOTROPIUM SOON AVAILABLE ] LABA THEOPHYLLINE [ ANTI INFLAMMATORY EFFECT ]

1
AVOIDANCE OF POLLUTANT

SURGERY 7
OBESITY & NUTRITIONAL INTERVENTION NON PHARMACOLOGICAL MANAGEMENT

2 EXERCISE

3
EDUCATION

6 PHYSIOTHERAPY 5

4 VACCINATION

PULMONARY REHABILITATION

1 INHALED ANTICHOLINERGICS
IPRATROPIUM BROMIDE OXITROPIUM BROMIDE TIOTROPIUM BROMIDE

BRONCHODILATORS FOR COPD

2
BETA 2 AGONIST COMBINATION INHALER
IPRATOPRIUM BROMIDE & SHORT ACTING INHALED BETA 2 AGONIST

SHORT ACTING INHALED BETA 2 AGONIST

4 THEOPHYLLINE

DIFFERENTIAL DIAGNOSIS
Asthma : Onset early in life ( >> childhood)

- Symptom vary from day to day.


- Symptom at night/early morning.

- Allergy,rhinitis,and/or eczema.
- Family history of asthma. -Largely reversible airflow limitation

DD cont.
Bronchiectasis :

- Large volumes of purulent sputum.


- Commonly associated w/ b.infection

- Coarse crackles/clubbing on auscult


-Chest X ray/CT sho ws bronchial delation, bronchial wall thickening.

DD cont.
Tuberculosis :

- Onset all ages.


- Chest X-ray shows lung infiltrate or

nodul lesions.
- Microbialogical conformation. - High local prevalece of tuberculosis.

DD cont.
Congestive Heart Failure :

- Fine basilar crackles on auscultation.


-Chest X-ray delated heart, pulmonary edema

-Pulmonary function tests indicate volume


retriction, not airflow limitation

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