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

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)

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

Etiology & Risk Factor

Patofisiology Inflamasi Bronkrokons triksi Hipersekresi mukus Hiperresponsif

Asthmatic bronchus VS Normal bronchus (Dipiro, 2014)

(Dipiro, 2014)

Pulmonary Function Test FEV1/FVC  75 % ASTHMA..??? Spirometry  FEV1 & FVC Peak flow meter  PEF

Management for CHRONIC ASTHMA

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

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

Clasifiying asthma severity & initiating therapy (NHLBI, 2012)

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

Low, medium & high daily doses of ICS

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

Stepwise approach to asthma treatment GINA, 2014

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

ASSESSING ASTHMA CONTROL & ADJUSTING THERAPY

ADJUSTING THERAPY 1 2 3 4 STEP UP

ADJUSTING THERAPY 4 3 2 1 STEP-DOWN

Management for SEVERE ACUTE ASTHMA

Home management of acute asthma exacerbation (Dipiro, 2014)

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

Moderate exacerbation Cont’ Moderate exacerbation Severe exacerbation

ASTHMA DEVICE

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

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

MDI (Metered Dose Inhaler)

Cara Penggunaan MDI

DPI (Dry powder Inhaler) DPI type Device name Company Single-unit dose Aerolizer Novartis Cyclohaler Pharmachemie Rotahaler GSK Spinhaler Aventis Inhalator B-Ingelheim Handihaler Multi-dose reservoir Clickhaler Innovata Biomed Easyhaler Orion Pharma Pulvinal Chiesi Turbuhaler Astra Zeneca Twisthaler Schering-Plough Novolizer Asta Medica Multi-unit dose Aerohaler Diskhaler Diskus/Accuhaler DPI (Dry powder Inhaler)

Turbuhaler

Diskus

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

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

See U next time …