MANAGEMENT OF ASTHMA EXACERBATION Februari 2019 MANAGEMENT OF ASTHMA EXACERBATION Alfian Nur Rosyid Pulmonologist, Universitas Airlangga
ALFIAN NUR ROSYID, dr. , Sp. P, FAPSR Dosen Paru FK Unair – RSUD Dr ALFIAN NUR ROSYID, dr., Sp. P, FAPSR Dosen Paru FK Unair – RSUD Dr.Soetomo RS Pendidikan Unair SD Nurul Ulum Surabaya 1996 SMP Mts Assalaam Surakarta 1998 SMA Insan Cendekia Serpong 2000 FK UNAIR Surabaya 2006 Spesialis Paru FK UNAIR 2017 AKTIVITAS: Anggota Div.ASMA PPOK PARU FKUA KASI DIKLAT RS UNAIR Humas PDPI PUSAT Anggota HALAL CENTER UNAIR Ketua YAYASAN ZISWAF RS UNAIR Anggota IDI SURABAYA Anggota ATS Anggota ERS Anggota APSR Anggota The Union Anggota Chest RS PHC SURABAYA 2007-2008 PKM BULUNGAN KALTIM 2008 - 2011 RSUD dr. Soetomo 2011-2017 RS UNAIR SURABAYA 2017 sd sekarang ADD A FOOTER
Pre Test bit.ly/T23FEB
MENU Asma Eksaserbasi Defisini Epidemiologi -Patogenesis Diagnosis Tatalaksana MENU Outline Materi ADD A FOOTER
PENDAHULUAN penyakit airway kronis Prevalensi Prevalensi terus naik ±300 Juta Pasien Asma Prevalensi 1-18% Prevalensi terus naik Sering bolos Ringan mematikan
EPIDEMIOLOGI DUNIA Riskesdas 2018 Asma : 2.4%
1,4 juta kematian karena penyakit airway kronis ASMA MEMATIKAN WHO 2008 1,4 juta kematian karena penyakit airway kronis Asma (7,8%) PPOK (86%)
Paru Asma bronkial 4A Status asmatikus 3B (asma akut berat)
AsBro KELUHAN VARIABEL BERULANG Radang Kronis
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Envi Gene Hiper reaktif Atopi Jenis Kelamin Ras / Etnis Alergen Makanan Obat Iritan Emosi Rokok Polusi Exercise Cuaca
AIRWAY REMODELING
Diagnosis Asma? Riwayat gejala khas Asma variabilitas aliran udara SPIROMETRI (tes bronkodilator, provokasi bronkus)
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AsBro Eksaserbasi Akut Perburukan Kondisi Stabil: ada pencetus menginduksi inflamasi akut AsBro Eksaserbasi Akut
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Mudah Eksaserbasi Pernah Intubasi krn eksaserbasi Gejala tak terkontrol Hamil Obese Merokok Eksaserbasi ≥ 1x dlm 1 thn lalu Inhaler salah / tidak teratur FEV1 rendah Alergi, Eosinofilia, FeNO naik
Ringan Sedang Berat Mengancam Nyawa Derajat Eksaserbasi
FASKES tk.1
TRANSFER TO ACUTE CARE FACILITY START TREATMENT SABA 4–10 puffs by pMDI + spacer, repeat every 20 minutes for 1 hour Prednisolone: adults 1 mg/kg, max. 50 mg, children 1–2 mg/kg, max. 40 mg Controlled oxygen (if available): target saturation 93–95% (children: 94-98%) TRANSFER TO ACUTE CARE FACILITY While waiting: give inhaled SABA and ipratropium bromide, O2, systemic corticosteroid WORSENING CONTINUE TREATMENT with SABA as needed ASSESS RESPONSE AT 1 HOUR (or earlier) WORSENING IMPROVING ASSESS FOR DISCHARGE Symptoms improved, not needing SABA PEF improving, and >60-80% of personal best or predicted Oxygen saturation >94% room air Resources at home adequate ARRANGE at DISCHARGE Reliever: continue as needed Controller: start, or step up. Check inhaler technique, adherence Prednisolone: continue, usually for 5–7 days (3-5 days for children) Follow up: within 2–7 days FOLLOW UP Reliever: reduce to as-needed Controller: continue higher dose for short term (1–2 weeks) or long term (3 months), depending on background to exacerbation Risk factors: check and correct modifiable risk factors that may have contributed to exacerbation, including inhaler technique and adherence Action plan: Is it understood? Was it used appropriately? Does it need modification? GINA 2017, Box 4-3 (7/7)
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Faskes Rujukan SABA Ipatroprium Bromide Oxygen Steroid
Steroid inhalasi 1 jam awal eksaserbasi Terapi di IGD Oksigen saturasi 93-95% SABA inhalasi Steroid inhalasi 1 jam awal eksaserbasi SAMA + SABA inhalasi Epinefrin im : bila anafilaksis saja Steroid sistemik (iv/po): bila SABA gagal Aminofilin iv: tidak untuk kondisi akut MgSO4: tidak rutin (2g infus tunggal / 20 menit)
Hindari di IGD Leukotrien : tidak untuk eksaserbasi Antibiotika: kecuali ada infeksi paru Obat penenang NIV : kecuali pantau ketat, hindari bila pasien gelisah
Pertimbangan MRS bila: Wanita, tua, ras non putih SABA >8puff/24 jam Eksaserbasi berat Riwayat Eksaserbasi dengan intubasi / MRS Riwayat ke IGD dengan terapi steroid
Terapi pulang: Steroid oral: 5-7 hari Steroid inhalasi: dimulai sebelum KRS Bronkodilator: SABA mulai diganti prn. Stop SAMA
Mencegah Eksaserbasi Hindari Tingkatkan Rajin Kontrol Rokok Imunitas Inhaler Rutin Imunitas Rajin Kontrol Alergen Rokok Mencegah Eksaserbasi ADD A FOOTER
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DISKUSI Unduh materi gratis: bit.ly/asbro19 ADD A FOOTER
kahoot.it POST TEST ADD A FOOTER https://create.kahoot.it/share/post-test-asma/042fbb6e-ff17-4695-beec-13679ef61703 Bit/ly/post23feb ADD A FOOTER