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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
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Dp+rn P'lonolo40 @ Kdo2r+n R*p0r+*0
F+2'l+* Kdo2r+n
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L<l* of ;opn;
Standar Kompetensi Dokter , Konsil Kedokteran Indonesia, 2006
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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+*.
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R;n 0**'*R;n 0**'*
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'+l09 of L0f'+l09 of L0f
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Df0n00on of +*/+G C/ron0; 0nfl++or9 d0*+* of +0r>+9* (A!)
H r*pon*0<n** of r+;/o3ron;/0+l r
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C*r • Cl0n0;+l +n0f*+0on*:
+ r0+d of p+ro9** of ;o'4/5 d9*pn+ +nd>/0n4.
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D0*+* P+rn
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G L0f,/r+n0n4,,, *lo>,on* or f+*,on*
(f++l >0/0n $ /o'r*)
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Asthma is an inflammatory diseasesAsthma is an inflammatory diseases
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Nor+lNor+l A*/+A*/+
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(+)(–)
ron;/0+l /9prr+;0<09 ( )ron;/0+l /9prr+;0<09 ( , )
S9po* ()S9po* ()S9po* (,)S9po* (,)
T r
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•
•
•
••
••
•
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==p+/o4n*0* of +*/+ frop+/o4n*0* of +*/+ fro 0nfl++0on0nfl++0on oo *9po**9po*
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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
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"! T DIA#NSIS"! T DIA#NSIS
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IDENTIFIKASI MASALAH/DIFF DIAGNOSI
MASALAH/KELUHAN:
PEMECAHAN MASALAH/
RENCANA(Planning):
KURIKULUM ERASIS KMPETENSI
(Pro3l +*d l+rn0n4)
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IDENTIFIKASI MASALAH/DD:
•DATA LAIN
•RENCANA
BERIKUT PF,Ro
Batuk
Sesak napas
Batuk darah
Nyeri dada
OBS!"KI#
IN#$KSI
K$%ANASAN
&$N'AKI O!%AN (AIN
MASALAH/KELUHAN:
PEMECAHAN MASALAH/
RENCANA(Planning):
Da)tar keluhan Standar
Kompetensi Dokter Indonesia
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IDENTIFIKASI MASALAH/D
•DATA LAIN:
Usia :Semua usia
Riwayat Keluara
Riwayat !e"i
Riwayat #$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):
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"! T MANA#E"! T MANA#E
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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$n
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Anti Inflammations isAnti Inflammations is
the mainstay therapythe mainstay therapy .
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AST"MA MANA#EMENT: =CLINICAL
• UICK RELIEVE MEDICATIN(E+;3+0on)
• LN# TERM TREATMENT
(S+3l ;ond00on)
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#'0dl0n* on A*/+ M+n+4n:
P+* +nd C'rrn Trnd*
LABA an+ICS
ICS
LABA,ICS
GINA -..(a+a"%e+)
GINA 011.
Se*e#e"e#i%en
%
M$+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
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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 %,% $.
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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:
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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.
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Inhalation therapy isInhalation therapy is
the mainstay therapythe mainstay therapy
Because minimally side effect
.
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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
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Ep0/l0+l D++4Ep0/l0+l D++4
P 7e8e#9 in: A%ma9 A'a+emi' P#e -..
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+*n M3r+n+*n M3r+nT/0;2n0n4T/0;2n0n4
P 7e8e#9 in: A%ma9 A'a+emi' P#e -..
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Smooth 4usle 5yperplasiaSmooth 4usle 5yperplasia
P 7e8e#9 in: A%ma9 A'a+emi' P#e -..
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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:
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ron;/od0l+or ron;/od0l+or
∀ $$ ,, +4on0*+4on0*
• +n/0n+n/0n•An0;/ol0nr40;An0;/ol0nr40;
Relie*e#Relie*e#
RNC"DILATRRNC"DILATR
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RNC"DILATRRNC"DILATR
S/or A;0n4S/or A;0n4 $$ 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
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Comination therapy IC3 + &AAComination therapy IC3 + &AA
3ymicort3ymicort
'desonide + Formoterol'desonide + Formoterol
3eretide3eretide
Fl'ticasone + 3almoterolFl'ticasone + 3almoterol
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%he eginning of%he eginning of%reatment%reatment
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E"acerationE"aceration
%he eginning of treatment%he eginning of treatment 4
3tale condition3tale condition√
x
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A*/+ +n+4n
S+3l ;ond00on
Lon4,r /r+p9
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#'0dl0n* on A*/+ M+n+4n:
P+* +nd C'rrn Trnd*
LABA an+ICS
ICS
LABA,ICS
GINA -..(a+a"%e+)
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%
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S+3l ;ond00on
To+l ;onrol P+r0+ll9 ;onrol Un;onrol
Ol+'lai3'a%i$n
Ne4'lai3'a%i$n
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DIFFERENTIAL DIA#NSIS
1. Uppr +0r>+9 o3*r';0on 4lo0; d9*f'n;0on.
$. A;' LV f+0l'r p'lon+r9 od+.
. P'lon+r9 3ol0*.. Endo3ron;/0+l d0*+*.
7. C/ron0; 3ron;/00*.
. Eo*0nop/0l0; pn'on0+.
&. C+r*0no0d *9ndro.8. V+*;'l00*.
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E5al'ations
•3;0< <+l'*3;0< <+l'*
•ACT A*/+ Conrol T*ACT A*/+ Conrol T*
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P+2 flo> r P+2 flo> r
%%,&%%
6
766
( nor+l )ObjectiveObjectivevaluesvalues
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Peak Flow Meter /PEFR/APE
Must be avilable
PEFR M i% iPEFR M i% i
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PEFR M$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
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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=
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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 #$: 3aria9ility @0=
/ t l ( l B d %INA
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/ontrol (e3el Based on %INA(N> ;l+**0f0;+0on)
None 2 or
less E 7eekF
None
None
None 2 or less E
7eekF
Normal
None
Daytime symptoms
(imitations o)
ati3ities
No;'rn+l
*9po* -
+>+2n0n4Need )or resue E
*relie3er treatment
(un+ )untion
&$# 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
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partly ontrolled
asthma present
in any 7eek
One in any
7eek
UNCNTRLLEDAsthma
Classification
%INA updated 2001
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5o7 7e an measure asthma ontrolJ
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O9eti3e use o) A/
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O9eti3e use o) A/
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SELAMATSELAMATELAJARELAJAR
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