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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.
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
INFLAMATION
Parenchymal destruction
Airway inflamation
Airway remodeling
AIRFLOW LIMITATION
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
COPD MANAGEMENT
1
ESTABLISH DIAGNOSIS ASSESS SYMPTOMS
2
TREAT OBSTRUCTION BRONCHODILATORS
3
ASSESS FOR HYPOXIA LONG TERM OXYGEN THERAPY
1 STOP SMOKING
TRIAL OF BUPROPION NICOTINE REPLACEMENT
5
COPD PHARMACOTHERAPY
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
2
BETA 2 AGONIST COMBINATION INHALER
IPRATOPRIUM BROMIDE & SHORT ACTING INHALED BETA 2 AGONIST
4 THEOPHYLLINE
DIFFERENTIAL DIAGNOSIS
Asthma : Onset early in life ( >> childhood)
- Allergy,rhinitis,and/or eczema.
- Family history of asthma. -Largely reversible airflow limitation
DD cont.
Bronchiectasis :
DD cont.
Tuberculosis :
nodul lesions.
- Microbialogical conformation. - High local prevalece of tuberculosis.
DD cont.
Congestive Heart Failure :