PPOK

Penyakit Paru Obstruksi Kronik

Budi Sutedja, Sp.P
RSUD Dr R. Sosodoro Djatikoesoemo
Bojonegoro

lobal
Initiative
for
G
Chronic

bstructive
O

ung

isease

DEFINISI
Penyakit Paru
Dicegah
Diobati
Hambatan Aliran Udara Half Reversibel
Progresif
Inflamasi Paru, Gas / Partikel Gas
Ektra Paru yang terhadap Derajat Berat Penyakit

PPOK
EMFISEMA ---------- PATOLOGI

BRONKHITIS KRONIS ----- DIAGNOSA

KLINIS

 > 3 JUTA MENINGGAL ( 2012 )

6 % DARI SEMUA KEMATIAN ( 2012 )
URUTAN KE 6 KEMATIAN DI DUNIA
URUTAN KE 3 SETELAH KARDIOVASKULER DAN
KANKER
ASIA : 56,6 JUTA PX ( 6,3 % )
INDONESIA : 4,8 JUTA ( 5,6 % )
USIA > 40 TH
PRIA > WANITA

 SKRT

DARI

10

PENYEBAB

KESAKITAN UTAMA ( 1986 )

SKRT

DARI

10

PENYEBAB

KESAKITAN UTAMA ( 1992)

DEPKES 2004 : URUTAN PERTAMA
SUSENAS 2001 : 54,5 % PRIA DAN 1,2
% WANITA

Leading Causes of Death

1990

2020

Ischemic heart disease

Cerebrovascular disease

1
2

1
2

COPD

Lower respiratory infection 3

Lung cancer
10
Road traffic accidents
9
Tuberculosis
7
Stomach cancer
14

4
5
6
7
8

WHO Global Burden of Disease study

RESIKO PPOK
1. ASAP ROKOK
2. POLUSI UDARA
3. STRESS OKSIDATIF
4. INFEKSI SAL NAPAS BAWAH BERULANG
5. SOSIAL EKONOMI
6. TUMBUH KEMBANG PARU
7. ASMA
8. GEN

Profile Perokok dari Penderita PPOK di

RS Persahabatan, 2002
Non Perokok (3,8%)
Perokok
(31,4%)

Ex Perokok(64,8%)

PATOFISIOLOGI
INFLAMASI
AIR TRAPING
STRESS OKSIDATIF
PROTEASE -- ANTI PROTEASE
AIRWAY LIMITATION
HIPERSEKRESI
GAS EXCHANGE
EKSASERBASI

DIAGNOSA
GEJALA

KETERANGAN

SESAK

PROGRESIF
PERSISTEN
BERAT

BATUK KRONIK

HILANG TIMBUL
TIDAK BERDAHAK

BATUK KRONIK BERDAHAK

INDIKASI

RIWAYAT TERPAJAN FAKTOR

RESIKO

ASAP ROKOK
DEBU
BAHAN KIMIA
ASAP DAPUR

DIAGNOSA
ANAMNESA
PEMERIKSAAN FISIK
PEMERIKSAAN FUNGSI PARU
LABORATORIUM
RADIOLOGI
ECG
KADAR -1 ANTITRIPSIN
BAKTERIOLOGI

DIAGNOSA
PPOK
GEJALA
BATU
K
DAHA
DAHA
K
SESAK

TERPAPAR FAKTOR RESIKO

ASAP ROKOK
LINGKUNGAN
POLUSI

FAAL PARU

KLASIFIKASI
DERAJAT
I / RINGAN

KLINIS
BATUK KRONIK
PRODUKSI SPUTUM

FAAL PARU
VEP 1/KVP < 70 %
VEP1 > 80 % pRED

II / SEDANG SESAK
BATUK KRONIK
PRODUKSI SPUTUM

VEP 1/KVP < 70 %

50 % < VEP1 < 80 % PRED

III / BERAT

LELAH , AKTIFITAS
MENURUN
SESAK , BATUK KRONIK
EKSASERBASI

VEP 1/KVP < 70 %

30 % < VEP1 < 50 % PRED

IV /
SANGAT
BERAT

GAGAL NAPAS
GAGAL JANTUNG

VEP 1/KVP < 70 %

VEP1 < 30 % PRED

MASALAH DIAGNOSA PPOK DI

INDONESIA
No. pop (2000) 214 m
PUSKESMAS : 7.000
RS Type
D : 200
C : 500
B : 54
A : 4

Spiro
+
+

X-ray
+
+
+
+

If spirometry is not available

(the issue of PEF)
PEF cannot differentiate obstructive and
restrictive
It can be used to exclude asthma but not
to diagnosed COPD
In patients with partially reversible
obstruction (asthmatic component), serial
PEF measurement may have some value
BTS 2001
Asia-Pacific Roundtable Group

Minispirometer

Spirometry: Normal and

COPD

CXR

Chronic Bronchitis

Emphysema

A CXRs are seldom diagnostic, it can be useful for excluding

other diseases

PENATALAKSANAAN
EDUKASI
BERHENTI MEROKOK
OBAT
REHABILITASI
TERAPI OKSIGEN
VENTILASI MEKANIS
NUTRISI

GOLD
GOLD Workshop
Workshop Report
Report

Four Components of COPD

Management

1. Assess and monitor

disease
2. Reduce risk factors
3. Manage stable COPD

Education
Pharmacologic
Non-pharmacologic

4. Manage
exacerbations

COPD management
Established
diagnosis

Stop smoking

Asses
symptoms

Immunization

Treat
obstruction
Assess
hypoxemia
Pulmonary
rehabilitation
program

Healthy lifestyle

BRONCHODILATO
RS
Long-term oxygen
therapy

Management of COPD by
Severity of Disease

Stage 0: At risk
Stage 1: Mild COPD
Stage 2: Moderate COPD
Stage 3: Severe COPD

Management of COPD:
All stages
Avoidance of noxious agents
- smoking cessation
- reduction of indoor pollution
- reduction of occupational
exposure

Influenza vaccination

Avoid risk factors: cessation of smoking

improves post-bronchodilator FEV1
Post-bronchodilator FEV1 (l)

Sustained quitters
Continuing
smokers

2.9
2.8
2.7
2.6
2.5
2.
4

Adapted from Scanlon et al 2000

2
3
Follow-up (y)