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ASTHMA Oleh : Fransiska Maria C. Bag. FKK-FFUJ FARMAKOTERAPI TERAPAN.

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Presentasi berjudul: "ASTHMA Oleh : Fransiska Maria C. Bag. FKK-FFUJ FARMAKOTERAPI TERAPAN."— Transcript presentasi:

1 ASTHMA Oleh : Fransiska Maria C. Bag. FKK-FFUJ FARMAKOTERAPI TERAPAN

2 DEFINITION  “Asthma” (Greek)  Panting  Asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role: in particular, mast cells, eosinophils, T-lymphocytes, macrophages, neutrophils, and epithelial cells. ( The National Institutes of Health, National Asthma Education and Prevention Program (NAEPP) Expert Panel Report 3 (EPR3) in Dipiro, 2014)

3 A Wheezing B Shortness of breath C Chest tightness D Coughing Recurrent episodes of … (GINA, 2014) Symptoms

4 Etiology & Risk Factor

5 Patofisiology Inflamasi Bronkrokons triksi Hipersekresi mukus Hiperres ponsif

6 Asthmatic bronchus VS Normal bronchus (Dipiro, 2014)

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8 Pulmonary Function Test Spirometry  FEV 1 & FVC Peak flow meter  PEF FEV 1 /FVC  75 % ASTHMA..???

9 Management for CHRONIC ASTHMA

10 MANAGEMENT OF ASTHMA  Long-term GOALs:  Symptom control  Risk reduction (risk of exacerbations, airway limtation & damage, lung function, medication side-effects)

11 The control-based asthma management cycle (GINA, 2014)

12

13 Clasifiying asthma severity & initiating therapy (NHLBI, 2012)

14 Pharmacological Treatment Inhaled Corticosteroids (ICS) ICS & long acting  2 -agonist broncodilator (LABA) combination (ICS/LABA) Methylxantines Leukotriene modifiers Chromones Anti-IgE CONTROLLER MEDICATIONS RELIEVER MEDICATIONS Short acting inhaled  2 -agonist broncodilator (SABA) Anticholinergics

15 Low, medium & high daily doses of ICS

16  2 -AGONIST BRONCHODILATORS (SABA & LABA) Salbutamol …..???

17 Stepwise approach to asthma treatment

18 Clinical Guidelines for the Diagnosis, Evaluation and Management of Adults and Children with Asthma, 2013

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21 ASSESSING ASTHMA CONTROL & ADJUSTING THERAPY

22 ADJUSTING THERAPY

23 STEP-DOWN

24 Management for SEVERE ACUTE ASTHMA

25 Home management of acute asthma exacerbation (Dipiro, 2014)

26 Emergency department & hospital care of acute asthma exacerbation (Dipiro, 2014) To be continued

27 Cont’ Moderate exacerbation Severe exacerbation

28 ASTHMA DEVICE

29 Device dalam terapi inhalasi INHALER MDI (Metered Dose Inhaler) DPI (Dry Powder Inhaler) NebulizerJet-nebulizer Ultrasonic- nebulizer

30 PERBEDAAN MDI  Aerosol, suspensi, larutan dg propelan CFC/HFA  Inspirasi pelan & dalam  Perlu dikocok  Dapat menggunakan spacer DPI  Serbuk kering, tanpa propelan  Inspirasi cepat, kuat & dalam  Tidak perlu dikocok  Tanpa spacer  Sulit pada anak kecil

31 MDI (Metered Dose Inhaler)

32 Cara Penggunaan MDI

33 DPI (Dry powder Inhaler) DPI typeDevice nameCompany Single-unit doseAerolizerNovartis CyclohalerPharmachemie RotahalerGSK SpinhalerAventis InhalatorB-Ingelheim HandihalerB-Ingelheim Multi-dose reservoir ClickhalerInnovata Biomed EasyhalerOrion Pharma PulvinalChiesi TurbuhalerAstra Zeneca TwisthalerSchering-Plough NovolizerAsta Medica Multi-unit doseAerohalerB-Ingelheim DiskhalerGSK Diskus/AccuhalerGSK

34 Turbuhaler

35 Diskus

36 Cara penggunaan nebulizer 1.Udara dalam ruangan harus segar, ventilasi baik 2.Pasien duduk tegak, rileks atau tidur miring setengah duduk 3.Bernafas biasa (volume tidal), sesekali menarik nafas dalam 4.Pergunakan mouthpiece atau masker 5.Waktu pengguaan 5-15 menit, jika diperlukan dapat dilakukan bbrp kali dlm sehari

37 Cara penggunaan nebulizer 6.Jika ada bronkokontriksi, berikan bronkodilator dahulu (atau bisa digabung dg kortikosteroid) 7.Jangan memberikan mukolitik saat pasien masih sesak, terutama pd serangan akut berat 8.Sekret yg dikeluarkan jgn sampai tertelan  sediakan wadah 9.Perhatikan tanda2 yg tidak biasa (sianosis atau sesak semakin parah, dll) 10.Pergunakan alat yg disposable, pisahkan terhadap pasien tertentu 11.Jika selesai, bersihkan peralatan yg dipakai

38 See U next time …


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