DEBBY SANDERS

2014 -83-060

LO S K 3

O bat-O bat untuk Asm a

Turunan xantin (bronkodilatasi), ex:

aminophilyn, theofillyn.
Kortikosteroid (anti inflamasi)
ex:prednison, metilprednisolon
Imunosupresan (obat yang menekan
reaksi AgAb juga sebagai anti inflamasi)
ex:metotreksat
Garam-garam kromolin (profilaksis,
untuk mencegah keluarnya AH=anti
histamin)
Farmakologi Sosial_Rina Yuniarti, S.Farm, APT.

PEN G O BATAN
MENCEGAH IKATAN ALERGEN- IG E

Hiposensitisasi : Suntikan alergen

tubuh akan membentuk Ig G (blocking
antibody) mencegah ikatan alergen
dgn sel mast

M encegah pelepasan m ediator

Natrium Kromolin mencegah

spasme brokus yg dicetuskan oleh

alergen
Mekanisme kerja ?
Obat tidak mengatasi spasme
bronkus yg tjadi obat profilaktik
pada terapi pemeliharaan
Efektif untuk pasien anak
penyebab alergi

M elebarkan saluran nafas dengan

bronkodilator
Simpatomimetik
1. Agonis beta 2 ( salbutamol, ter-

butalin, fenoterol, prokaterol)

atasi serangan asma akut , dpt di
beri secara : MDI & nebulizer
2. Epinefrin
Subkutan, sbg pengganti angonis
beta 2 pada serangan asma berat
(asma anak dan dewasa muda)

 Aminofilin

u/ serangan asma akut. Diberi dosis

awal & diikuti dosis pemeliharaan
Kortikosteriod sistemik bkn
Bronkodilator
Antikolinergik (ipatropium
bromida)
Terutama di pakai sebagai suplemen
bronkolidlator agonis beta 2 pd
serangan asma

M engurangirespon dgn jalan

m eredam infl
am asisaluran napas
Kromolin & lebih poten dgn

kortikosteroid baik secara :

oral,parenteral, atau inhalasi
PENCEGAH (controller)
obat anti inflamasi (kortikosteroid
hirup)
Obat anti alergi
Bronkodilator

 Ada juga :

Kortikosteroid hirup, sistemik,

natrium kromolin, natrium
nedokkromil, TLL, , agonis beta 2
kerja panjang hirup (salmaterol dan
formoterol), obat anti alergi,

PEN G H ILAN G G EJALA

(a/RELI
EVER)
obat
yg merelaksasi
bronkokonstriksi& gejala akut yg
menyertainya dgn segera
Seperti :
Agonis beta 2 hirup jangka pendek
short-acting)
Kortikosteroid sistemik
Anti kolinergik hirup
Teofilin kerja pendek
Agonis beta 2 oral kerja pendek

 Agonis beta 2 hirup (fenoterol, salbutamol,

tarbutalin, prokaterol) obat terpilih untuk

cegah serangan dan kegiatan jasmani
Kortikosteroid sistemik pada serangan akut a/
mencegah perburukan gejala lebih lanjut
Antikolinergik hirup & lpatropium bromida
(tambahan agonis beta 2) sbg obat alternatif
NOTE : TEOFILIN DAN AGONIS BETA 2 ORAL
DIPAKAI PADA PASIEN YG SECARA TEKNIS TDK
BISA MEMAKAI SEDIAAN HIRUP

ASM A M EN U RU T G IN A 1995
1. Bina hubungan yg baik antara
2.
3.
4.
5.

pasien dgn dokter

Identifikasi dankurangi pemaparan
faktor resiko
Penilaian, pengobatan dan
pemantauan keaadaan kontrol asma
Atasi serangan asma
Penataksaan keadaan khusus

CLASSIFYING ASTHMA SEVERITY AND INITIATING

TREATMENT IN
EPR-3, p74, 344

YOUTHS > 12 YEARS AND ADULTS

Components of
Severity

Classification of Asthma Severity

Intermitte
nt

Impairme
nt
Normal
FEV1/FVC
8-19 yr 85%

Symptoms

<2 days/week

Nighttime
Awakening
s

<2x/month

not daily
3-4x/month

<2 days/week

>2

SABA use for

sx control
Interference with
normal activity

60-80 yr 70%

none

20-39 yr 80%
40-59 yr 75%

Lung Function

Normal FEV1
between
exacerbations
FEV1 > 80%

Risk

Persistent
Mild
Moderat
e
Daily
>2 days/week

Exacerbation
s
(consider
frequency
and severity)

Recommended Step for

Initiating Treatment

FEV1/FVC
normal

0-2/year

>1x/wee
k
not
Daily
nightly

Severe
Continuo
us

Often nightly
Several times daily

days/week
not daily
Minor limitation Some limitation
Extremely limited
FEV1 >80%

FEV1/FVC
normal
> 2 /year

FEV1 >60%
but < 80%
FEV1/FVC reduced

FEV1 <60%
FEV1/FVC
reduced>
5%

5%

Frequency and severity may vary over time for patients in any category
Relative annual risk of excaerbations may be related to FEV

Step 1

Step 2

Step 3

Step 4 or 5

Consider short course of oral steroids

In 2 -6 weeks, evaluate asthma control that is achieved and14

adjust therapy accordingly

EPR-3, p77,
345

ASSESSING ASTHMA CONTROL AND ADJUSTING THERAPY

IN
YOUTHS > 12 YEARS OF AGE AND ADULTS

Classification of Asthma Control

Components of Control

Well
Controlled

Symptoms

< 2 days/week
Throughout the day
Nighttime awakenings
< 2/month

IMPAIRMENT

Interference with
normal activity
SABA use

none
< 2 days/week

Validated
questionnaires
ATAQ/ACT
Exacerbations
Progressive loss of
lung function
Rx-related adverse effects

Recommended Action
For Treatment

Very Poorly
Controlled

> 2 days/week
1-3/week
Some limitation

> 4/week

Extremely limited

> 2 days/week

> 80% predicted/ 60-80% predicted/

personal best
personal best

FEV1or peak flow

RISK

Not Well
Controlled

0/> 20

1-2/16-19

0- 1 per year

2 - 3 per year

Several times/d
<60%
predicted/
personal best
3-4/< 15
> 3 per year

Evaluation requires long-term follow up care

Consider in overall assessment of risk

Maintain current
step

Consider step
down if well
controlled at least
3 months

Step up 1 step
Reevaluate in 2
- 6 weeks

Consider oral
steroids

Step up 1-2
weeks and
15 in 2
reevaluate
weeks

SEVERITY OF ASTHMA EXACERBATION

GINA 2006

16

17

Pharmacologic Treatment
Reliever

Controller

- Rapid acting inhaled 2

agonist
- Anticholinergic
- Theophylline
- Short- acting oral 2 -agonist

- Inhaled glucocorticoid
- Oral antileucotrienes
- inhaled long-acting 2agonist
- Cromones
- ( Theophylline )
- Oral long-acting 2-agonist
- Oral anti-Ig.E
- Systemic glucocorticoid
- Oral antiallergic
- Allergen specific
immunotherapy

18

EPR-3, p333-343

STEPWISE APPROACH FOR MANAGING

ASTHMA IN YOUTHS > 12 YEARS AND
ADULTS
Persistent Asthma: Daily Medication

Intermittent
Consult with asthma specialist if step 4 or higher care is required
Asthma
Consider consultation at step 3
Step up if
needed (check
adherence,
Preferred: environmental
Step 5 High-dose ICS
Preferred: + LABA + oral control and
comorbidities)
High dose ICS
Corticosteroid
+ LABA

Step 6

Step 4
Step 3

Preferred:
Medium-dose
ICS+LABA

AND

AND
Preferred:
Medium-dose
Consider
Preferred:
Alternative:
ICS OR
Consider Olamizumab
Low-dose ICSLow-dose ICS+ Medium-dose
for
Olamizumab
Alternative: either LABA,
ICS+either
Step 1
patients with
for
LTRA
LTRA,
LTRA,
Preferred:
Cromolyn Theophylline Theophlline patients with allergies
SABA prn Theophylline
Or Zileutin
allergies
Or Zileutin

Step 2

Assess
Control

Step down
if possible
(asthma
well
controlled
for 3
months)

Patient Education and Environmental Control at Each Step

EPR-3, p333-343

19