Professional Documents
Culture Documents
ALAMAT
PEKERJAAN
CURRICULUM VITAE
Prof.dr.TAMSIL SYAFIUDDIN Sp.P (K)
:
: Jln.KARSA No F 1 KOMPLEKS EKS KOWILHAN I
SEI.AGUL MEDAN 20117
: Guru Besar FK- UISU / FK- USU
Ketua Perhimpunan Dokter Paru Indonesia Cabang SUMUT
RIWAYAT PENDIDIKAN :
-Dokter Umum FK-USU Medan,1979
-Dokter Spesialis I Paru FK-UI Jakarta, 1990
-Dokter Spesialis II Paru Konsultan Asma/PPOK, 1995
Pendidikan tambahan:
- Pelatihan Kanker Paru, TSUKAGUCHI Hospital, Kobe- Japan 1989
- Pelatihan PPOK, AMAGASAKI Hospital, Kobe- Japan 1990
- Pelatihan Respiratory Physiologi, JAPAN RESPIRATORY PHYSIOLOGIST
CLUB, Kyoto- Japan 1990
- Spirometry Training Course, Department of Respiratory Medicine,
National University Hospital Singapore, Singapore 1997
Asthma
Pemberi Kuliah:
Levels of competence
Level of competence 4:
Mampu membuat diagnosis klinik berdasarkan
pemeriksaan fisik dan pemeriksaan tambahan
yang diminta oleh dokter (misalnya: pemeriksaan
laboratorum sederhana atau X-ray).
Dokter dapat memutuskan dan mampu menangani
problem itu secara mandiri hingga tuntas.
Recent issues
in asthma management
The Unmet Needs of asthma
Theme of World Asthma Day 2005/2006
Adherence
Self Management
Pharmacoeconomic consideration
Quality of Life
Definition of asthma
Chronic inflammatory disease of airways (AW)
responsiveness of tracheobronchial tree
Physiologic manifestation:
AW narrowing relieved spontaneously or with BD
Cster
Clinical manifestations:
a triad of paroxysms of cough, dyspnea and
wheezing.
Disease Pattern
Episodic --- acute exacerbations interspersed
with symptom-free periods
Chronic --- daily AW obstruction which
may be mild, moderate or severe
superimposed acute exacerbations
Life-threatening--- slow-onset or fast-onset
(fatal within 2 hours)
Inflammation
(+)
Asthma
Bronchial hyperreactivity ( - )
Bronchoconstriction ( - )
Symptoms (-)
Triggers
Triggers
Normal
()
Bronchial hyperreactivity ( + )
Bronchoconstriction ( + )
Symptoms (+)
Ag
Ig E
Ca++ Histamin
YY
Phospholipid
Methyl
transferase
Phosphatidyl
ethanolamine
Phosphatidyl
choline
Phospho Ca++
Arachidonic acid lipase A2
lypoxygenase
cyclooxygenase
5-HETE
Leucotrienes
LTB4
LTC4
LTD4
LTE4
Histamin
ECF, NCF
Thromboxanes Prostaglandins
TXA2
PGD
PGF2
HOW TO DIAGNOSIS?
MASALAH/KELUHAN:
PEMECAHAN MASALAH/
RENCANA(Planning):
DATA LAIN
RENCANA
BERIKUT
Ro
Batuk
Sesak napas
Batuk darah
Nyeri dada
PF,
IDENTIFIKASI MASALAH/DD:
OBSTRUKTIF
INFEKSI
KEGANASAN
PENYAKIT ORGAN LAIN
MASALAH/KELUHAN:
PEMECAHAN MASALAH/
RENCANA(Planning):
DATA LAIN:
Usia :Semua usia
Batuk
Sesak napas
Batuk darah
Nyeri dada
Riwayat Keluarga
Riwayat Mengi
Riwayat Obat (BD)
RENCANA BERIKUT
IDENTIFIKASI MASALAH/DD
Pem Fisik :Tanda Obtruktif:
KEGANASAN
RO
: Normal
HOW TO MANAGE?
Inflammation
Controller
Bronchial hyperreactivity
Bronchoconstriction
Reliever
Symptoms
Medicines and Pathogenesis of asthma
Anti Inflammations is
the mainstay therapy
ICS treatment
introduced
1972
Adding
LAA to ICS therapy
Single
inhaler
therapy
ICS+LABA
(GINA 2009)
Fear of
short-acting
2-agonists
1980
1985
1990
Bronchospasm
1995
Inflammation
Remodelling
2000
Severe
Moderate
persisten persisten
t
t
Mild
Intermittent persisten
t
Total control
Partially control
Uncontrol
Old
classification
Exacerbation
New
classification
GINA 1998
(adapted)
GINA 2009
ICS
LABA and
ICS
LABA+ICS
Stable condition
MANAGEMENT 2
No improvement after 15-30 min:
Nebulized 2 agonist every 15-30 min + Ipratropium.
Still no improvement:
Aminophyllin infusion 750mg/24H (small pt), 1 500mg/24H
(large pt), or alternatively salbutamol infusion.
Monitor Rx:
Aminophyllin blood levels + PEF after 15-30 min +
oxymetry (maintain SaO2 > 90) + repeat blood gases
after 2 hrs if initial PaO2 < 60, PaCO2 normal or raised and
patient deteriorates.
Deterioration:
ICU, intubate, ventilate + muscle relaxant.
Inhalation therapy is
the mainstay therapy
AIRWAY REMODELLING IN
ASTHMA
Eosinophil
Desquamations of epithelium
MBP, ECP
Epithelium
Epithelial Damage
Basement Membrane
Thickening
Controller:
Anti inflammation
Non steroid:
sodium chromoglicate
(Intal)
budesonide
ketotifen
sodium nedocromil
(Pulmicort)
(Inflamid)
beclomethasone
dipropionate
(Becotide)
triamcinolone
Reliever
Bronchodilator
2 - agonist
Xanthin
Anticholinergic
BRONCHODILATOR
1.SYMPHATOMIMETIC , 2 AGONIST :
Short Acting 2 AGONIST (SABA):
salbutamol/albuterol (Ventolin )
terbutaline (Bricasma)
procaterol
fenoterol
orciprenaline, etc
(LABA)
2.ANTICHOLINERGIC:
atropine sulfate
ipratropium bromide
tiotropium bromide
salmoterol
formoterol
3.XANTHINE:
theophylline
aminophylline
4.OTHER SYMPHATOMIMETIC:
ephedrine
adrenaline, etc
Seretide
Fluticasone + Salmoterol
The Beginning of
Treatment
Exacerbation
Stable condition
Asthma management
* Stable condition
* Long-term therapy
Severe
Moderate
persisten persisten
t
t
Mild
Intermittent persisten
t
Total control
Partially control
Uncontrol
Old
classification
Exacerbation
New
classification
GINA 1998
(adapted)
GINA 2009
ICS
LABA and
ICS
LABA+ICS
Stable condition
DIFFERENTIAL DIAGNOSIS
1. Upper airway obstruction glottic dysfunction.
2. Acute LV failure pulmonary oedema.
3. Pulmonary embolism.
4. Endobronchial disease.
5. Chronic bronchitis.
6. Eosinophilic pneumonia.
7. Carsinoid syndrome.
8. Vasculitis.
Evaluations
Objective values
ACT =Asthma Control Test
Objective
values
600-700 (
300
normal )
Must be avilable
PEFR Monitoring:
A Major Tool in Asthma Self-Management
Chronic Diseases
Monitor
Hypertension
Blood pressure
Diabetes
Serum glucose
Asthma
PEFR
Mild Persistent:
Symptoms more than once a week but less than once a day
Exacerbations may affect activity and sleep
Nocturnal symptoms more than twice a month
FEV1 or PEF 80% predicted
PEF or FEV1 variability < 20 30%
Moderate Persistent:
Symptoms daily
Exacerbations may affect activity and sleep
Nocturnal symptoms more than once a week
Daily use of inhaled short-acting 2-agonist
FEV1 or PEF 60-80% predicted
PEF or FEV1 variability > 30%
Severe Persistent:
Symptoms daily
Frequent exacerbations
Frequent nocturnal asthma symptoms
Limitation of physical activities
FEV1 or PEF 60% predicted
PEF or FEV1 variability > 30%
Asthma
Characteristics
Classification
CONTROLLED
PARTLY
CONTROLLED
Daytime symptoms
None (2 or
less / week)
More than
twice / week
Limitations of
activities
None
Any
Nocturnal
symptoms /
awakening
None
Any
None (2 or less /
week)
More than
twice / week
Normal
None
Once/more per
year
UNCONTROLLED
QoL
3 or more
features of
partly controlled
asthma present
in any week
One in any
week
GINA updated 2009
Diabetes
HbA1c 7% or less
Dyslipidaemia
2.
3.
SELAMAT
BELAJAR