Oleh : Fransiska Maria C. Bag. FKK-FFUJ

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

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

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

4 Etiology & Risk Factor

5 Patofisiology Inflamasi Bronkrokons triksi Hipersekresi mukus
Hiperresponsif

6 Asthmatic bronchus VS Normal bronchus
(Dipiro, 2014)

7 (Dipiro, 2014)

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

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 Short acting inhaled 2-agonist broncodilator (SABA) Anticholinergics RELIEVER MEDICATIONS

15 Low, medium & high daily doses of ICS

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

17 Stepwise approach to asthma treatment
GINA, 2014

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

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20

21 ASSESSING ASTHMA CONTROL & ADJUSTING THERAPY

22 ADJUSTING THERAPY 1 2 3 4 STEP UP

23 ADJUSTING THERAPY 4 3 2 1 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 Moderate exacerbation
Cont’ Moderate exacerbation Severe exacerbation

28 ASTHMA DEVICE

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

30 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

31 MDI (Metered Dose Inhaler)

32 Cara Penggunaan MDI

33 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)

34 Turbuhaler

35 Diskus

36 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

37 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

38 See U next time …