asma bronkiale kuliah drdonnie (1)
DESCRIPTION
bahan kuliah fkTRANSCRIPT
![Page 1: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/1.jpg)
Hard to breath and wheezz….
![Page 2: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/2.jpg)
Asthma Bronchial
Donnie Lumban GaolDepartemen Ilmu Penyakit Dalam FK UKI.
BLOK 11: RespirasiFakultas Kedokteran Universitas Kristen Indonesia
![Page 3: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/3.jpg)
DEFINISI Gangguan inflamasi kronik saluran
nafas Melibatkan banyak sel-sel dan
elemennya Menyebabkan hiperresponsif saluran
nafas Gejala episodik berulang mengi,
sesak nafas, dada terasa berat dan batuk-batuk
Terutama malam dan atau dini hari
![Page 4: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/4.jpg)
Faktor-faktor resiko lingkungan
(penyebab)
Inflamasi
hiperesponsif Obstruksi jalan
saluran nafas nafas
Pencetus Gejala
![Page 5: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/5.jpg)
Asthma pathophysiologyKey components: inflammation, bronchial hyper-reactivity, airway remodeling1970’s 1980’s 1990’s present
Bronchospasm Bronchospasm+ Inflammation
Bronchospasm+ Inflammation+ Remodeling
CHEST 2013; 144(3):1026–1032.
T cell Eosinophil Th-2
IL-5 / IL-13
Th17
Dendritic cells
Th17
![Page 6: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/6.jpg)
![Page 7: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/7.jpg)
![Page 8: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/8.jpg)
PATOGENESIS Mekanisme imunologik inflamsi saluran nafas Berhubungan dengan manifestasi tetapi melalui
mekanisme IgE – dependent Sel – sel yang berperan
* Limfosit T-helper :T-CD4 + mengeluarkan sitokinInterleukin (IL-3)IL-4, IL-5, IL 13Granulocyte macrophage colony
stimulating factor (GM CSF)* Eosinofil* Sel epitel* Sel mast* Makrofag mediator antara lain leukotrien PAF, sejumlah sitokin
![Page 9: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/9.jpg)
PATOGENESISInflamasi akut Inflamasi kronik Airway remodeling
Gejala Exacerbations Obstruksi(Bronkokonstriksi) non-spesific persisten aliran
hyperreactivity udara
Hubungan antara inflamasi akut, kronik dan airway remodeling dengan gejala klinis
![Page 10: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/10.jpg)
PATOGENESIS Perubahan struktur yang tejadi :
- Hipertropi dan hiperplasi otot polos- Hipertropi dan hiperplasi kelenjar mukus- Penebalan membran retikuler basal- P. darah meningkat- Matriks ekstraseluler fungsinya meningkat- Perubahan struktur parenkim- Peningkatan fibrogenik growth factor
menjadikan fibrosis
![Page 11: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/11.jpg)
Airway RemodelingProses inflamasi kronik kerusakan jaringan proses penyembuhan perbaikan
pergantian sel-sel yang rusak
melibatkan jaringan yang sama dan jaringan
penyambung (scar)
![Page 12: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/12.jpg)
Mekanisme yang timbul - heterogen- sangat kompleks- sangat dinamis
Konsekuensi klinis airway remodeling terjadi peningkatan gejala :
- hiperreaktifitas- distensibility- obstruksi jalan nafas
![Page 13: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/13.jpg)
![Page 14: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/14.jpg)
EPIDEMIOLOGI Prevalensi total dunia : 7.2% (6% dewasa,
10% anak)
Penelitian ISAAC (International Study of Asthma and Alergy in Children) Fase I 1996 : 56 negara, 155 senter, usia 6-7 thn
dan 13-14 thn Indonesia usia 6-14 thn : 1.6% Inggris : 36.8%
![Page 15: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/15.jpg)
Penelitian AIRE (Asthma Insight and Reality in Europe) meliputi 73,880 rumah tangga berjumlah 213,158 orang current asthma : 2.7%
Di Indonesia : Yunus F (Jakarta) 2001 13-14 thn : 11.5% Kartasasmita CB (Bandung) 2002
6-7 : 3.0% 13-14 : 5.2%
Rahajoe NN (Jakarta) 2002 13-14 : 6.7%
![Page 16: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/16.jpg)
![Page 17: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/17.jpg)
FAKTOR RESIKOBakat yang diturunkan Pengaruh lingkungan- Asma - Alergen- Atopi / Alergik - Infeksi pernafasan- Hiperreaktivitas bronkus - Asap rokok / polusi- Faktor yang memodifikasi - Diet penyakit genetik - Status ekonomi
Asimptomatik atau Asma dini
Manifestasi klinik asma (perubahan irreversibelpada struktur dan fungsi jalan nafas
Interaksi faktor genetik dan lingkungan pada kejadian asma
![Page 18: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/18.jpg)
DIAGNOSIS dan KLASIFIKASI Riwayat penyakit dan gejala
- Episodik sering reversibel dengan / tanpa pengobatan- Batuk, sesak nafas, rasa berat di dada, berdahak- Gejala timbul / memburuk terutama malam / dini hari- Diawali faktor pencetus- Respon terhadap bronchodilator
![Page 19: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/19.jpg)
Hal-hal lain :- riwayat keluarga- riwayat alergi / atopi- penyakit yang memberatkan- perkembangan penyakit dan
pengobatan
![Page 20: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/20.jpg)
Pemeriksaan Jasmani
Expirium memanjang mengi Serangan yg sangat berat silent chest
asma berat, disertai tanda-tanda sianosis, gelisah, takikardia, hiperinflasi, penggunaan otot-otot bantu nafas, sukar bicara
![Page 21: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/21.jpg)
Establishing the diagnosisNot all that wheezes is asthma
The medical history! Pulmonary function testing with
bronchodilator Reversibility: 12% AND 200 cc change in FEV1
Obstructive physiology on pulmonary function test (FEV1 reduced much more than FVC)
Bronchoprovocation testing Methacholine, histamine, exercise
Exhaled nitric oxide (NO)
![Page 22: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/22.jpg)
Faal Paru Spirometri
- pemeriksaan obyektif faal paru- menyamakan persepsi- parameter obyektif
Menilai : - obstruksi jalan nafas- reversibiliti- variabiliti variasi diurnal
Yang diukur : - Kapasitas Vital Paksa (KVP) - Arus Puncak Ekspirasi (APE)- Volume ekspirasi detik pertama (VEP1)
![Page 23: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/23.jpg)
![Page 24: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/24.jpg)
![Page 25: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/25.jpg)
![Page 26: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/26.jpg)
Pemeriksaan Lain
Uji provokasi bronkus Pengukuran status alergi - Uji kulit - Pengukuran IgE spesifik
![Page 27: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/27.jpg)
![Page 28: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/28.jpg)
Diagnosis Banding Dewasa :- PPOK- Bronkitis kronik- Gagal jantung kongestif- Batuk kronik akibat lain- Disfungsi laring- Obstruksi mekanik (misal : tumor)- Emboli paru
Anak :- Benda asing- Laringotrakeomalasia- Pembesaran kelenjar limf- Tumor- Stenosis trakea- Bronkiolitis
![Page 29: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/29.jpg)
Klasifikasi
EtiologiBerat penyakitKeterbatasan aliran udara
![Page 30: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/30.jpg)
Treatment of acute severe asthma requiring hospitalizationWhy do patients develop respiratory failure with severe asthma attacks?
NHLBI Asthma web educ resources
Air trappingMucus pluggingIncreased work of breathing
![Page 31: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/31.jpg)
KLASIFIKASI DERAJAT BERAT ASMA : Berdasarkan gambaran klinis
Derajat Asma Gejala Gejala Malam Faal Paru
I. Intermiten Bulanan APE ≥ 80 %
- Gejala < 1x / minggu- Tanpa gejala di luar serangan- Serangan singkat
≤ 2x / bulan VEP1 ≥ 80% nilai prediksiAPE ≥ 80 % nilai terbaikVariabiliti APE < 20%
II. Persisten ringan Mingguan APE ≥ 80%
- Gejala > 1x/mgg, tetapi < 1x/hari- Mengg. aktiviti & tidur
> 2x / bulan VEP1 ≥ 80% N.PAPE ≥ 80% N.TVariabiliti APE 20-30%
III. Persisten sedang Harian VEP1 60-80% N.P
- Gejala tiap hari- Mengg. aktiviti & tidur- Butuh BD tiap hr
> 1x / minggu APE 60-80% N.TVariabiliti > 30%
IV. Persisten berat Kontinyu APE ≤ 60%
- Gejala terus menerus- Sering kambuh-aktivitas terbatas
Sering VEP1 ≤ 60% N.PAPE ≤ 60% N.TVAR : > 30%
![Page 32: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/32.jpg)
![Page 33: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/33.jpg)
Penatalaksanaan Asma Tujuan
- Menghilangkan dan mengendalikan asma - Mencegah eksersebasi akut- Meningkatkan dan mempertahankan faal paru seoptimal mungkin- Mengupayakan aktiviti normal termasuk exercise- Menghindari efek samping obat (ESO)- Mencegah keterbatasan aliran udara, ireversibiliti- Mencegah kematian akibat asma
![Page 34: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/34.jpg)
Terkontrol bila :- Gejala minimal / tidak ada- Tidak ada keterbatasan aktivitas- Kebutuhan bronkodilator minimal / sebaiknya (–)- Variasi harian APE < 20 %- Nilai APE N / mendekati N- ESO tidak ada- Tidak ada kunjungan ke UGD
![Page 35: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/35.jpg)
Meliputi 7 komponen :1. Edukasi2. Menilai dan monitor berat asma secara berkala3. Identifikasi dan mengendalikan faktor pencetus4. Merencanakan & memberi pengobatan jangka panjang5. Menetapkan pengobatan pada serangan akut6. Kontrol secara teratur7. Pola hidup sehat
![Page 36: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/36.jpg)
![Page 37: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/37.jpg)
![Page 38: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/38.jpg)
![Page 39: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/39.jpg)
![Page 40: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/40.jpg)
![Page 41: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/41.jpg)
![Page 42: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/42.jpg)
![Page 43: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/43.jpg)
Acute AsthmaInitial Assessment and Management
Assess severity
Inhaled SABA
Good response
Incomplete response
Poor response
HistoryPhysical ExamPeak flow determination
Up to 2 treatments 20 minutes apart
• Normal peak flow• Consider brief
trial of oral corticosteroids
• Peak flow 50-80% predicted
• Start oral corticosteroids
• Contact primary MD
• Peak flow <50% predicted
• Start oral corticosteroids
• Contact primary MD
ERAdmit
Modified from NHLBI EPR3 2007
![Page 44: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/44.jpg)
![Page 45: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/45.jpg)
Acute Asthma Management Clinical and Laboratory Assessment
Assess clinically – accessory muscle use, tachypnea, tachycardia, diaphoresis, pulsus paradoxus, exhaustion.
Assess airflow limitation – peak flow measurement.
Assess oxygenation – pulse oximetry. Assess for hypercapnia – selected patients
especially if somnolent, fatigued, difficulty with speech, elderly, concomitant use of sedatives.
Imaging – chest X ray Blood work – CBC, glucose.
![Page 46: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/46.jpg)
Treatment of Acute Severe AsthmaPrinciples and Primary Goals of care
Relieve airflow limitation: bronchodilator therapy Treat airway inflammation: steroids. Treat hypoxemia or hypercapnia if present. Non-invasive ventilation / mechanical ventilation
in severe cases (clinical judgment). Limited or no role for antibiotics and
methylxanthines.
![Page 47: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/47.jpg)
Treatment of Acute Asthma Bronchodilator therapy
Albuterol (or salbutamol) provides rapid, dose-dependent bronchodilation.
Continuous administration may be more effective in severe exacerbations.
![Page 48: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/48.jpg)
Treatment of Acute Asthma Corticosteroid therapy
Oral administration of prednisone is often equivalent to iv methylprednisolone unless there is nausea.
Give a 5- to 10-day course. Current evidence is insufficient to permit
conclusions about using inhaled corticosteroids in acute asthma.
For severe exacerbations unresponsive to the albuterol and corticosteroid therapy, adjunctive treatments may be used: iv magnesium sulphate or heliox.
Expert Panel Report 3: National Heart Lung and Blood Institute 2007https://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf
![Page 49: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/49.jpg)
Medikasi Asma Pengontrol (Controllers)
- Kortikosteroid (KS) inhalasi- KS sistemik- Sodium kromoglikat- Nedokromil sodium- Metil santin (aminofilin, teofilin)- Agonis β2 kerja lama, inhalasi- Agonis β2 kerja lama, oral- Leukotrien modifier- Antihistamin generasi ke-2
![Page 50: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/50.jpg)
Pelega (Reliever)- Agonis β2 kerja singkat- KS sistemik- Antikolinergik- Aminofilin- Adrenalin
![Page 51: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/51.jpg)
Rute pemberian- Oral- Parenteral (subkutan, IM, IV)- Inhalasi :
* Inhalasi dosis terukur (IDT) = Metered Dose inhaler (MDI)
* IDT +* Breath actuated MDI* Dry powder inhaler (DPI)* Turbuhaler* Nebulizer
![Page 52: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/52.jpg)
Challenges in severe asthmaWhy do patients get hospitalized? Patient non-adherence to medication. Continued exposure to triggers (pets etc)
or exposure to second-hand smoke. Incomplete assessment of co-morbidities
like sleep apnea or GERD. Inadequate follow-up Pharmacogenomics and individualized
patient responses to medication.
Aldington S, Beasley R. Thorax 2007; 62: 447-458
![Page 53: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/53.jpg)
Asthma management
Post-hospital follow up of severe asthma 1) Identify triggers
2) Control inflammation
3) Provide bronchodilator for relief
4) Assess response
5) Modify (escalate/ de-escalate as appropriate) and educate. Assess for risk factors associated with higher mortality.
Corticosteroid therapyLeukotriene inhibitorsAnti-IgE therapyThermoplasty
Short acting beta-agonistsLong acting beta-agonistsLong acting anti-muscarinic
Symptom diary, pulmonary function testing, exhaled NO
![Page 54: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/54.jpg)
Penatalaksanaan Asma Bertujuan1.Menghilangkan dan mengendalikan gejala asma, agar kualitas hidup meningkat2.Mencegah eksaserbasi akut3.Meningkatkan dan mempertahankan faal paru seoptimal mungkin4. Mempertahankan aktivitas normal termasuk latihan jasmani dan aktivitas lainnya5. Menghindari efek samping obat6. Mencegah terjadinya keterbatasan aliran udara ireversibel7. Meminimalkan kunjngan ke gawat darurat
![Page 55: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/55.jpg)
Pengobatan Sesuai Berat AsmaBerat Asma Medikasi
Pengontrol HarianAlternatif /
Pilihan LainAlternatif Lain
Asma Intermitent Tidak perlu - -
Asma Persisten Ringan
KS inhalasi200 – 400 μg BD / hari
Teofilin lepas lambatKromolinLeukotrien modifier
Asma Persisten Sedang
Kombinasi inhalasiKS 400–800 μg BD / hrAgonis β2 kerja lama
a. KS inhalasi 400-800 μg / hr BDb. Agonis β2 kerja lama oral ataua + Teofilin lepas lambat oral atauKS inhalasi dosis tinggi> 800 μg BD atauKS inhalasi400 – 800 μg / hr + leukotrien modifier
Teofilin lepas lambat
Β2 agonis kerja lama oral
Asma Persisten Berat
KombinasiKS (> 800 μg BD / hr) & agonis β2 kerja lama + salah satu : teofilin lepas lambat, leukotrien modifier, KS oral
Prednisolon / metilprednisolon selang sehari 10 mg ditambah agonis β2 kerja lama oral, + teofilin lepas lambat
![Page 56: Asma Bronkiale Kuliah Drdonnie (1)](https://reader036.vdocuments.site/reader036/viewer/2022081513/55cf8f5b550346703b9b7e68/html5/thumbnails/56.jpg)
TERIMA KASIH
Selamat Belajar