MANAGEMENT OF ASTHMA EXACERBATION

Presentasi berjudul: "MANAGEMENT OF ASTHMA EXACERBATION"— Transcript presentasi:

1 MANAGEMENT OF ASTHMA EXACERBATION
Februari 2019 MANAGEMENT OF ASTHMA EXACERBATION Alfian Nur Rosyid Pulmonologist, Universitas Airlangga

2 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 PKM BULUNGAN KALTIM RSUD dr. Soetomo RS UNAIR SURABAYA 2017 sd sekarang ADD A FOOTER

3 Pre Test bit.ly/T23FEB

4 MENU Asma Eksaserbasi Defisini Epidemiologi -Patogenesis
Diagnosis Tatalaksana MENU Outline Materi ADD A FOOTER

5 PENDAHULUAN penyakit airway kronis Prevalensi Prevalensi terus naik
±300 Juta Pasien Asma Prevalensi 1-18% Prevalensi terus naik Sering bolos Ringan  mematikan

6 EPIDEMIOLOGI DUNIA Riskesdas 2018 Asma : 2.4%

7 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%)

8 Paru Asma bronkial 4A Status asmatikus 3B (asma akut berat)

9 AsBro KELUHAN VARIABEL BERULANG Radang Kronis

10 ADD A FOOTER

11 Envi Gene Hiper reaktif Atopi Jenis Kelamin Ras / Etnis Alergen
Makanan Obat Iritan Emosi Rokok Polusi Exercise Cuaca

12 AIRWAY REMODELING

13 Diagnosis Asma? Riwayat gejala khas Asma
variabilitas aliran udara  SPIROMETRI (tes bronkodilator, provokasi bronkus)

14 ADD A FOOTER

15 ADD A FOOTER

16 ADD A FOOTER

17 AsBro Eksaserbasi Akut
Perburukan Kondisi Stabil: ada pencetus menginduksi inflamasi akut AsBro Eksaserbasi Akut

18 ADD A FOOTER

19 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

20 Ringan Sedang Berat Mengancam Nyawa Derajat Eksaserbasi

21 FASKES tk.1

22 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 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)

23 ADD A FOOTER

24 Faskes Rujukan SABA Ipatroprium Bromide Oxygen Steroid

25 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)

26 Hindari di IGD Leukotrien : tidak untuk eksaserbasi
Antibiotika: kecuali ada infeksi paru Obat penenang NIV : kecuali pantau ketat, hindari bila pasien gelisah

27 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

28 Terapi pulang: Steroid oral: 5-7 hari
Steroid inhalasi: dimulai sebelum KRS Bronkodilator: SABA mulai diganti prn. Stop SAMA

29 Mencegah Eksaserbasi Hindari Tingkatkan Rajin Kontrol Rokok Imunitas
Inhaler Rutin Imunitas Rajin Kontrol Alergen Rokok Mencegah Eksaserbasi ADD A FOOTER

30 ADD A FOOTER

31

32 DISKUSI Unduh materi gratis: bit.ly/asbro19 ADD A FOOTER

33 kahoot.it POST TEST ADD A FOOTER
Bit/ly/post23feb ADD A FOOTER