Kuliah Asma USU 2010

7/21/2019 Kuliah Asma USU 2010

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CURRICULUM VITAE

N A M A : Prof.dr.TAMSIL SYAFIUDDIN Sp.P (K)ALAMAT : Jln.KARSA No F 1 KMPLEKS EKS K!IL"AN I

SEI.A#UL MEDAN $%11&

PEKERJAAN : #'r' *+r FK, UISU - FK, USU

K'+ Pr/0p'n+n Do2r P+r' Indon*0+ C+3+n4 SUMUT

RI!AYAT PENDIDIKAN :

,Do2r U' FK,USU Md+n516&6

,Do2r Sp*0+l0* I P+r' FK,UI J+2+r+5 166%

,Do2r Sp*0+l0* II P+r' Kon*'l+n A*+-PPK5 1667

Pnd0d02+n +3+/+n:

, Pl+0/+n K+n2r P+r'5 TSUKA#UC"I "o*p0+l5 Ko3, J+p+n 1686

, Pl+0/+n PPK5 AMA#ASAKI "o*p0+l5 Ko3, J+p+n 166%

, Pl+0/+n R*p0r+or9 P/9*0olo405 JAPAN RESPIRATRY P"YSIL#IST

CLU5 K9oo, J+p+n 166%

, Sp0ror9 Tr+0n0n4 Co'r*5 Dp+rn of R*p0r+or9 Md0;0n5

N+0on+l Un0<r*09 "o*p0+l S0n4+por5 S0n4+por 166&



,=!or2*/op of ron;/o*;op9 +nd A'ofl'or;n ron;/o*;op95RS Pr*+/+3++n J+2+r+5 J+2+r+ Sp3r $%%7

,=Tr+0n0n4 of / n> 0nr<n0on+l ;/n0?' of 3ron;/o*f03r*;op9(p0;+l Co/rn; Too4r+/9) 5 Dp+rn of T/or+;0; S'r4r95To29o Md0;+l Un0<r*09 "o*p0+l5To29o , J+p+n $%%&

, !or2*/op on Md0;+l T/or+;o*;op95 T/ Ar0;+n Coll4 of C/*P/9*0;0+n*,T/ Indon*0+n A**o;0+0on of P'lonolo40*5 RS Pr*+/+3++n

J+2+r+5 J+2+r+ No<3r 166&

, !or2*/op on Rfor+0on of "04r Ed';+0on S9*5"EDS,JICA5J+2+r+1668

,P'lon+r9 Inf;0on* Co'r*5 Po*4r+d'+ Md0;+l In*0'5S0n4+por #nr+l "o*p0+l5 S0n4+por $%%1

, ron;/o*;op9 @T/or+;o*;op9 !or2*/op5 Po*4r+d'+ Md0;+l In*0'5S0n4+por #nr+l "o*p0+l5 S0n4+por $%%7

- !or2*/op on Tr+n*3ron;/0+l L'n4 0op*9 +nd Tr+*3ron;/0+l Ndl

A*p0r+0on PDPI C+3+n4 J+2+r+5 RS Pr*+/+3++n J+2+r+ 5J+2+r+ M+r

166&

, !or2*/op on R*p0r+or9 P/9*0olo49 +nd I* Cl0n0;+l Appl0;+0on5 RS P'*+

An42++n D+r+ #+o S'3roo J+2+r+5 J+2+r+ J'n0 166&

,=!or2*/op of N> T;/n0?' of ron;/o*;op9 5 Po*4r+d'+ Md0;+lIn0'5S0n4+por #nr+l "o*p0+l $%%8



Dp+rn P'lonolo40 @ Kdo2r+n R*p0r+*0

F+2'l+* Kdo2r+n

Un0<r*0+* S'+r+ U+r+$%1%

AsthmaP3r0 K'l0+/:



L<l* of ;opn;

Standar Kompetensi Dokter , Konsil Kedokteran Indonesia, 2006



Standar Kompetensi Dokter , Konsil Kedokteran Indonesia, 2006

L<l of ;opn; :

• M+p' 3'+ diagnosis klinik 3rd+*+r2+n

B pemeriksaan fisik d+n ‘pemeriksaan tambahan’

9+n4 d00n+ ol/ do2r (0*+ln9+: pr02*++n

l+3or+or' *dr/+n+ ++' ,r+9).

• Do2r d+p+ memutuskan d+n +p' menangan0

pro3l 0' *;+r+ mandiri /0n44+ 'n+*.



R;n 0**'*R;n 0**'*

0n +*/+ +n+4n0n +*/+ +n+4n

•==T/ Un Nd* of +*/+ =T/ Un Nd* of +*/+ = T/ of !orld A*/+ D+9 $%%7-$%%T/ of !orld A*/+ D+9 $%%7-$%%

== Yo' ;+n ;onrol 9o'r +*/+ = Yo' ;+n ;onrol 9o'r +*/+ =

T/ of !orld A*/+ D+9 $%%&-$%%8-$%%6-$%1%T/ of !orld A*/+ D+9 $%%&-$%%8-$%%6-$%1%

•==Ad/rn; =Ad/rn; =

Slf M+n+4nSlf M+n+4n

•==UUD No $6 - $%% : Pr+202 Kdo2r+nUUD No $6 - $%% : Pr+202 Kdo2r+n

Copn;9Copn;9

•==P/+r+;o;ono0; ;on*0dr+0onP/+r+;o;ono0; ;on*0dr+0on

'+l09 of L0f'+l09 of L0f



Df0n00on of +*/+G C/ron0; 0nfl++or9 d0*+* of +0r>+9* (A!)

H r*pon*0<n** of r+;/o3ron;/0+l r

• P/9*0olo40; +n0f*+0on:A! n+rro>0n4 rl0<d *pon+no'*l9 or >0/ D

C*r • Cl0n0;+l +n0f*+0on*:

+ r0+d of p+ro9** of ;o'4/5 d9*pn+ +nd>/0n4.



D0*+* P+rn

G Ep0*od0; ,,, +;' +;r3+0on* 0nr*pr*d

>0/ *9po,fr pr0od*

G C/ron0; ,,, d+0l9 A! o3*r';0on >/0;/

+9 3 0ld5 odr+ or *<r

*'pr0po*d +;' +;r3+0on*

G L0f,/r+n0n4,,, *lo>,on* or f+*,on*

(f++l >0/0n $ /o'r*)



Asthma is an inflammatory diseasesAsthma is an inflammatory diseases



Nor+lNor+l A*/+A*/+

Infl++0onInfl++0on

(+)(–)

ron;/0+l /9prr+;0<09 ( )ron;/0+l /9prr+;0<09 ( , )

S9po* ()S9po* ()S9po* (,)S9po* (,)

T r

0 4 4 ) r * • •

•

•

•

••

••

•

ron;/o;on*r0;0on ( , ) ron;/o;on*r0;0on ( )

T r

0 4 4 ) r *

==p+/o4n*0* of +*/+ frop+/o4n*0* of +*/+ fro 0nfl++0on0nfl++0on oo *9po**9po*



Ig EIg E

AgAg

YY

MethylMethyl

transferasetransferasePhospholipidPhospholipid PhosphatidylPhosphatidyl

ethanolamineethanolamine

PhosphatidylPhosphatidyl

cholinecholine

PhosphoPhospholipase Alipase A

22

CaCa++++ HistaminHistamin

CaCa++++HistaminHistamin

ECF !CFECF !CFArachidonic acidArachidonic acid

lypo"ygenaselypo"ygenase cycloo"ygenasecycloo"ygenase

#$HE%E#$HE%E&e'cotrienes&e'cotrienes

&%&%

&%C&%C

&%*&%*

&%E&%E

%hromo"anes%hromo"anes

%,A%,A22

ProstaglandinsProstaglandins

P-*P-* P-FP-F

22



"! T DIA#NSIS"! T DIA#NSIS



IDENTIFIKASI MASALAH/DIFF DIAGNOSI

MASALAH/KELUHAN:

PEMECAHAN MASALAH/

RENCANA(Planning):

KURIKULUM ERASIS KMPETENSI

(Pro3l +*d l+rn0n4)



IDENTIFIKASI MASALAH/DD:

•DATA LAIN

•RENCANA

BERIKUT PF,Ro

Batuk

Sesak napas

Batuk darah

Nyeri dada

OBS!"KI#

IN#$KSI

K$%ANASAN

&$N'AKI O!%AN (AIN

MASALAH/KELUHAN:

PEMECAHAN MASALAH/

RENCANA(Planning):

Da)tar keluhan Standar

Kompetensi Dokter Indonesia



IDENTIFIKASI MASALAH/D

•DATA LAIN:

Usia :Semua usia

Riwayat Keluara

Riwayat !e"i

Riwayat #$at %BD&

•RENCANA BERIKUT

Pem Fii! : Ta"'a #$tru(ti):

E(sirasi mema"*a"+!e"i

RO : Normal

S"i#$me%#i : Ta"'a o$stru(ti)

Batuk

Sesak napas

Batuk darah

Nyeri dada

STRUKTIF : ASMA5 PPK

IN#$KSI

K$%ANASAN

&$N'AKI O!%AN (AIN

MASALAH/KELUHAN:

PEMECAHAN MASALAH/

RENCANA(Planning):



"! T MANA#E"! T MANA#E



In&amma%i$n

B#$n'ial "e##ea'%i*i%

Sm"%$m

C$n%#$lle#C$n%#$lle#

Relie*e#Relie*e#

Md0;0n* +nd P+/o4n*0* of +*/+

B#$n'$'$n%#i'%i$n



Anti Inflammations isAnti Inflammations is

the mainstay therapythe mainstay therapy .



AST"MA MANA#EMENT: =CLINICAL

• UICK RELIEVE MEDICATIN(E+;3+0on)

• LN# TERM TREATMENT

(S+3l ;ond00on)



#'0dl0n* on A*/+ M+n+4n:

P+* +nd C'rrn Trnd*

LABA an+ICS

ICS

LABA,ICS

GINA -..(a+a"%e+)

GINA 011.

Se*e#e"e#i%en

%

M$+e#a%e"e#i%en

%

Mil+"e#i%en

%

In%e#mi%%en%

SAA - Ra"i+ $ne% $2 a'%i$n LABA

E+;r3+0onE+;r3+0on

S+3l ;ond00on

To+l ;onrol P+r0+ll9 ;onrol Un;onrol

Ol+'lai3'a%i$n

Ne4'lai3'a%i$n



G A;' *<r +*/+:

MANA#EMENT 1

1.Id0+ R:

$ %,% +*2 or ;+nn'l+ SAA (*+l3'+ol 74)-

n3'l0r ICS $%% ;4- n3'l0r or /9dro;or0*on

$%%4 IV. !0/ l0f/r+n0n4 f+'r* +dd %.74

0pr+rop0' o n3'l0d O$ +4on0* A0nop/9ll0n $7%4

0< o<r $% 0n or *+l3'+ol $7%'4 o<r 1% 0n.

$. S'3*?'n R:

N3'l0d SAA /o'rl9 ICS $%%;4

or /9dro;or0*on $%%4 /o'rl9 IV %,% $.



MANA#EMENT $

G No 0pro<n +fr 17,% 0n:

N3'l0d O$ +4on0* <r9 17,% 0n Ipr+rop0'.

G S0ll no 0pro<n:

A0nop/9ll0n 0nf'*0on &7%4-$" (*+ll p)5 1 7%%4-$"

(l+r4 p)5 or +lrn+0<l9 *+l3'+ol 0nf'*0on.

G Mon0or R:

A0nop/9ll0n 3lood l<l* PEF +fr 17,% 0n

o9r9 (+0n+0n S+$ Q 6%) rp+ 3lood 4+**+fr $ /r* 0f 0n00+l P+$ %5 P+C$ nor+l or r+0*d +nd

p+0n dr0or+*.

G Dr0or+0on:

ICU5 0n'3+5 <n0l+ '*;l rl++n.



Inhalation therapy isInhalation therapy is

the mainstay therapythe mainstay therapy

Because minimally side effect

.



MP ECPMP ECP

Eo*0nop/0l

Ep0/l0'

AIR5A6 REMODELLING INAIR5A6 REMODELLING IN

ASTHMAASTHMA

*es/'amations of epitheli'm*es/'amations of epitheli'm

%hic0ening of asement memrane%hic0ening of asement memrane

Increase in air1ay smooth m'scleIncrease in air1ay smooth m'scle



Ep0/l0+l D++4Ep0/l0+l D++4

P 7e8e#9 in: A%ma9 A'a+emi' P#e -..



+*n M3r+n+*n M3r+nT/0;2n0n4T/0;2n0n4




Smooth 4usle 5yperplasiaSmooth 4usle 5yperplasia




Conrollr:Conrollr:

An0 0nfl++0onAn0 0nfl++0on

• ;+e$ni+e(P;lmi'$#%)

(In&ami+

)

• e'l$me%a$ne+i"#$"i$na%e(Be'$%i+e)

• %#iam'in$l$ne

• $+i;m '#$m$gli'a%e

(In%al)

• !e%$%i2en

• $+i;m ne+$'#$mil

In/+ld Cor0;o Sro0dIn/+ld Cor0;o Sro0d

( ICS ) :( ICS ) :

Non *ro0d:Non *ro0d:



ron;/od0l+or ron;/od0l+or

∀ $$ ,, +4on0*+4on0*

• +n/0n+n/0n•An0;/ol0nr40;An0;/ol0nr40;

Relie*e#Relie*e#

RNC"DILATRRNC"DILATR



RNC"DILATRRNC"DILATR

S/or A;0n4S/or A;0n4 $$ A#NIST (SAA):A#NIST (SAA):•*+l3'+ol-+l3'rol (Vnol0n*+l3'+ol-+l3'rol (Vnol0n ))

•r3'+l0n (r0;+*+r3'+l0n (r0;+*+))

•pro;+rolpro;+rol

•fnorolfnorol•or;0prn+l0n5 ;or;0prn+l0n5 ;

$.ANTIC"LINER#IC:$.ANTIC"LINER#IC:

•+rop0n *'lf++rop0n *'lf+

•0pr+rop0' 3ro0d0pr+rop0' 3ro0d•0orop0' 3ro0d0orop0' 3ro0d

.T"ER SYMP"ATMIMETIC:.T"ER SYMP"ATMIMETIC:

•p/dr0np/dr0n•+drn+l0n5 ;+drn+l0n5 ;

.ANT"INE:.ANT"INE:

•/op/9ll0n/op/9ll0n

•+0nop/9ll0n+0nop/9ll0n

Lon4 A;0n4Lon4 A;0n4$$ A#NIST:A#NIST:

(LAA)(LAA)

•*+lorol*+lorol

•fororolfororol

1.SYMP"ATMIMETIC 51.SYMP"ATMIMETIC 5 $$ A#NISTA#NIST



Comination therapy IC3 + &AAComination therapy IC3 + &AA

3ymicort3ymicort

'desonide + Formoterol'desonide + Formoterol

3eretide3eretide

Fl'ticasone + 3almoterolFl'ticasone + 3almoterol



%he eginning of%he eginning of%reatment%reatment



E"acerationE"aceration

%he eginning of treatment%he eginning of treatment 4

3tale condition3tale condition√

x



A*/+ +n+4n

S+3l ;ond00on

Lon4,r /r+p9



#'0dl0n* on A*/+ M+n+4n:

P+* +nd C'rrn Trnd*

LABA an+ICS

ICS

LABA,ICS

GINA -..(a+a"%e+)

GINA 011.

Se*e#e"e#i%en

%

M$+e#a%e"e#i%en

%

Mil+"e#i%en

%

In%e#mi%%en%

SAA - Ra"i+ $ne% $2 a'%i$n LABA

E+;r3+0onE+;r3+0on

S+3l ;ond00on

To+l ;onrol P+r0+ll9 ;onrol Un;onrol

Ol+'lai3'a%i$n

Ne4'lai3'a%i$n



DIFFERENTIAL DIA#NSIS

1. Uppr +0r>+9 o3*r';0on 4lo0; d9*f'n;0on.

$. A;' LV f+0l'r p'lon+r9 od+.

. P'lon+r9 3ol0*.. Endo3ron;/0+l d0*+*.

7. C/ron0; 3ron;/00*.

. Eo*0nop/0l0; pn'on0+.

&. C+r*0no0d *9ndro.8. V+*;'l00*.



E5al'ations

•3;0< <+l'*3;0< <+l'*

•ACT A*/+ Conrol T*ACT A*/+ Conrol T*



P+2 flo> r P+2 flo> r

%%,&%%

6

766

( nor+l )ObjectiveObjectivevaluesvalues



Peak Flow Meter /PEFR/APE

Must be avilable

PEFR M i% iPEFR M i% i



PEFR M$ni%$#ing:PEFR M$ni%$#ing:

A Ma=$# T$$l in A%ma Sel2>Managemen%A Ma=$# T$$l in A%ma Sel2>Managemen%

C#$ni' DieaeC#$ni' Dieae M$ni%$#M$ni%$#

H"e#%eni$nH"e#%eni$n

Diae%eDiae%e

A%maA%ma

Bl$$+ "#e;#eBl$$+ "#e;#e

Se#;m gl;'$eSe#;m gl;'$e

PEFRPEFR



Cl+**0f0;+0on of A*/+ S<r09 39

Cl0n0;+l F+'r* for Tr+n:

(old ;l+**0f0;+0on)Inr0n:Symptoms less than one a 7eek

Brie) e8aer9ations

Noturnal symptoms not more than t7ie a month

• #$: or &$# ; <0= predited

• &$# or #$: 3aria9ility > 20=

M0ld Pr*0*n:Symptoms more than one a 7eek 9ut less than one a day

$8aer9ations may a))et ati3ity and sleep

Noturnal symptoms more than t7ie a month

• #$: or &$# ; <0= predited

• &$# or #$: 3aria9ility > 20 ? @0=



Modr+ Pr*0*n:Symptoms daily

$8aer9ations may a))et ati3ity and sleepNoturnal symptoms more than one a 7eek

Daily use o) inhaled short-atin+ 2-a+onist

• #$: or &$# 60-<0= predited

• &$# or #$: 3aria9ility @0=

Se3ere &ersistentSymptoms daily

#reuent e8aer9ations

#reuent noturnal asthma symptoms(imitation o) physial ati3ities

• #$: or &$# C 60= predited

• &$# or #$: 3aria9ility @0=

/ t l ( l B d %INA



/ontrol (e3el Based on %INA(N> ;l+**0f0;+0on)

None 2 or

less E 7eekF

None

None

None 2 or less E

7eekF

Normal

None

Daytime symptoms

(imitations o)

ati3ities

No;'rn+l

*9po* -

+>+2n0n4Need )or resue E

*relie3er treatment

(un+ )untion

&$# or #$:F

$8aer9ation

CNTRLLEDCharacteristics

4ore than

t7ie E 7eek

Any

Any

4ore than

t7ie E 7eek

> <0= predited or

personal 9est i) kno7nF

on any day

OneEmore per

year

PARTLYCNTRLLED

@ or more)eatures o)

partly ontrolled

asthma present

in any 7eek

One in any

7eek

UNCNTRLLEDAsthma

Classification

%INA updated 2001

oLoL



Tr+n +r4* 0n ;oon ;/ron0; d0*+**

• /lear therapeuti tar+ets e8ist )or many

hroni diseases

• &hilosophy o) Gtreat to tar+etH

? 5ypertension B& 0E10 mm5+ or less

? Dia9etes 59A = or less

? Dyslipidaemia (D(-holesterol >00 m+Edl

A*/+ r+n 0* d*04nd o A*/+ r+n 0* d*04nd o

*p;0f0; +r4* +nd +;/0<*p;0f0; +r4* +nd +;/0< BCNTRLBCNTRL



5o7 7e an measure asthma ontrolJ



O9eti3e use o) A/



O9eti3e use o) A/

L ACT 0* + *;ord ool >/0;/ +llo>* n'r0;+l +r4* o 3 *.

S0pl o ;opl 7 ?'*0on* >0/ + 7 po0n r+0n4 *;+l (+:$7)

16 or l** Un;onrolld +*/+

$%,$ !ll ;onrolld

$7 To+l Conrol

2L Impro3es patient E physiian ommuniationL/lear and onise uestions that en+a+e patients in a moreopen, andid disussion

@L :alidated usin+ spirometry and speialist assessment



SELAMATSELAMATELAJARELAJAR

Kuliah Asma USU 2010

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