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BBronchial Asthmaronchial AsthmaTherapyTherapy
Bachtiar Arif N.H20090310153
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DDefnisi Asthmaefnisi Asthma
BronchialBronchial
Asthma bronchiale adalahpenyakit inamasi kronis
dari jalan nafas yangberhubungan denganhipereaktiftas bronchial
dan obstruksi jalan nafastotal atau partial yangreversible. Dimana pada
beberapa kasus hilang
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AAsthma Bronchialesthma Bronchiale
• Reversible obstruction
• Varisi simptom dalam sehari-hari
• Terdapat riwayat keluarga
• Dapat menyerang berbagai usia lebihsering pada!
–"#-"$% anak-anak
– $-"#% dewasa• Tidak adak riwayat merokok
• allergy rhinitis ec&ema 'bisa
terdapat(tidak)
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EEtiopatogenesistiopatogenesis
•
INFLAMMATININFLAMMATIN mengaktifasimastocytes macrophages eosinophilshelper Th-lymfocytes *+ membentuk danmelepaskan mediator in,amasi! histamine
leucotriens prostaglandins bradykinin
bronchoconstriction mucus secretion plasmaeudation dan bronchial hyperreactivity
air!ay remo"elation
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T#$#anT#$#an terapi Asmaterapi Asma
BronkialBronkial• Menghilangkan "an mengen"alikan
ge$ala asma
• Mencegah eksaserbasi ak#t
• Meningkatkan "an mempertahankan%aal par# seoptimal m#ngkin
• Meng#payakan aktiviti normaltermas#k exercise
• Menghin"ari e%ek samping obat• Mencegah ter$a"i keterbatasan aliran
#"ara 'airo! limitation( ireversibel
• Mencegah kematian karena asma
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TTerapi Asma Bronkialerapi Asma Bronkial
• NonpharmacologicalNonpharmacological – /dukasi kepada pasien
– 0enghindari faktor resiko dan pencetus asma
• )harmacological)harmacological
– A N T I I N F L A M M A T * +• 0enghilangkan in,amasi and hipereakti1tas bronchial
• 2enggunaan secara teratur dan jangka panjang
– B * N ,- D I L A T * + • 0enghilangkan simptom dari keterbatasan aliran saat
ekspirasi
• Terapi pertama saat terjadi kekambuhan asma
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bat.obat Asma Bronkialbat.obat Asma BronkialA/A/ ,NT*LLE*0,NT*LLE*0
– 3bat-obat preventive controlling inammationcontrolling inammation – dipakai secara terat#r1 "an $angka !akt# lamaterat#r1 "an $angka !akt# lama
untuk mengkontrol asma
antiinammatory "r#gsantiinammatory "r#gs
long acting inhalatory broncho"ilatorslong acting inhalatory broncho"ilatorsB/B/ *ELIE2E*0*ELIE2E*0
menghilangkan bronchospasm
relieving * fast acting bronchodilators
,/,/ batbat ANTIA0T-MATI,ANTIA0T-MATI, lainnyalainnya – 0onoclonal Ab against 4g/ * omali&umab '$# pat. in
5R)
– ketotifen
– 4munosupressives
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A/A/ ,NT*LLE*0,NT*LLE*0
• inhalatory corticoi"s ⇒ ICS
• long.acting 3.sympathomimetics
(long-acting betaagonists )⇒
LABA,(8-15h.)
• natri#m kromoglikat1
• Natri#m ne"okromil
• antihistamin aksi lambat4
•Teoflin lepas lambat.
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B/ *ELIE2E*0
• inhalatory short.acting 3.
sympathomimetics ( short-acting
betaagonists ) ⇒
0ABA (till 4-6 h.)
• inhalatory anticholinergics short-
acting
• Amino1llin
• Adrenalin
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• Peroral
• Parenteral
• Dengan inhalation ⇒
Efek obat ira!akan lang!"ng Ak!i ari obat ce#at
$e%an&"ran 'ang %ak!i%al
(o)er thera#e"tic o!e! * %e%ini%alkan re!iko
keka%b"han 'g ak"t Keterbatasan dari pihak pasienKeterbatasan dari pihak pasien +tekhnik inhala!i,
ker&a!a%a "nt"k #at"h-
Resistensi dariResistensi dari inspiratoryinspiratory, har"! iata!i
*#te pemberianme"ikasi
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0acam-macam carapemberian obat inhalasi
• 4nhalasi dosis terukur'4DT)( etere!-!ose inhaler '0D4)
• 4DT dengan alat 6antu 'spacer)• Breath-act"ate! #$I
• $r% &o'!er inhaler 'D24)
• Turbuhaler
• 7ebuliser
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nhalator'/'!te%!
No)aa'!
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6633. 0+M)AT. 0+M)AT--MIMETIMIMETI,0,0
• Mechanism o% action * bronkodilatasimenurunkan permeabilitas kapiler danmencegahpelepasan mediator dari selmast dan baso1l salbutamol terbutalin
7474 Long.actingLong.acting 66330M0M (long-acting betaagonists ) = LABA
– ,ontrollers "nt" tera&i *anga &an*ang !anterat"r broncho!ilation
3434 0hort.acting0hort.acting 66330M0M (short-acting betaagonists ) = SABA
– *elievers tera&i *anga &en!e, "nt" tera&i saat
ter*a!i eab"han
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ββ22 –sympathomimetics –sympathomimetics
(LABA and SABA)(LABA and SABA)
Fast beinnin!
short d"rationinhal.
salb"tamol! #enoterol
Fast beinnin!
lon d"ration
inhal. #ormoterol
Slo$ beinnin!
short d"rationoral
salb"tamol rt. c#!.
Slo$ beinnin!
lon d"rationinhal. salmeterol
speed o# e##ectbeinnin
FAST
SL%&
S'%RT L%d"ration o# action
resc"e treatment
m a
i n t a n a n c e t h e r a p
y
LABASABA
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Efek !a%#ing obat golongan agoni! beta2•gangg"an karioa!k"ler •#eningkatan tekanan arah•re%or •Pal#ita!i•takikari an !akit ke#ala
Pe%akaian agoni! beta2 !ecara reg"ler han'aiberikan #aa #enerita a!%a kronik berat 'angtiak a#at le#a! ari bronkoilator
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*2+ sympatho
,-,.T-/S
0 S,
Anti ,+cholineric 0 1sL
actiate !'%#athicN/
dilatebronchi
block#ara!'%#athic N/
dilatebronchi
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LoLoccalialisation o% sation o% **eceptoreceptorss
cholinercholinericic (parasympat(parasympathhic)ic)
aadrenerdrenericic
(sympat(sympathhic)ic)
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LABALABA the best fast and intense acting b-dilatans
"#ration o% "#ration o% actionaction 8873 ho#rs73 ho#rsMMekanismeekanisme AAksiksi//
Broncho"ilation thro#gh 93 :8 rela;ation o% smooth
m#scle
0eningkatkan pembersihan mucociliar
0enurunkan permeabilitas vaskular
0engatur pelepasan mediator dari mastocytes
ba&ophils
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,ole,olecc"l"laar mechanir mechanissmm o# o# positiepositieinterainteractionction -/S a-/S andnd LABALABA
Glucocorticoid
receptor
ß2 -Adrenoceptor
/orticosteroid
Anti+in#lammatory e##ect
• .##ect o# corticosteroids on *.##ect o# corticosteroids on *22+adrenoceptors+adrenoceptors
• .##ect o# *.##ect o# *22+aonists on l"cocorticoid receptors+aonists on l"cocorticoid receptors
*2+Aonist
Bronchodilatation
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LABA• %ormoterol• salmeterol
MonotMonothheraperapyy LABA/LABA/
• ↓ effectivity of :A6A vs. 4;5• improving sleeping but !itho#t!itho#t e% e% % % eect toct to
pp#lmonary#lmonary %#n%#nctionsctions
• !itho#t!itho#t ee% % %e%ect on inam4ct on inam4 in airways
'biopsia)
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BATBAT ANTILE5<T*IENANTILE5<T*IENEE
• controllerscontrollers untuk mengontrol simptom dalam jangka waktu lama
• antagonists o% le#kotriene 7 ',ysLT7( receptors
–
montel#kast1 =afrl#kast1 pranl#kast• ↓ inhibitors o% >.lipoo;ygenase
– &ileuton
• 2eroral• MA/ . additive antiin,amasi
. mengurangi eosinophilia jaringan
. mild bronchodilation
. bronchoprotective
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MET-+L?ANT-INE0MET-+L?ANT-INE0
• controllers untuk terapi simpom jangka panjang
• 4mprovement of clinical symptomatology
– broncho"ilation - without signif. increase of </V"(
improvement of lung function parameters through
inhibition of fosfodiesterase 4. to 4V. *+ cAM) – antiinam4 imm#nomo"#latory e=ects
– positive e=ect on phenomenon o% @corticoi" resist4
• AE/ cephalea nausea vomiting tachycardiapalpitations ↑↑↑ plasm. conc. 'TD0) arrhytmias epileptic spasms even death
• potential toicity pro1le of A/⇒
broncho"ilators o% the thir" choice
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0ABA0ABA
basic relieversbasic relievers used ad hoc to relieve or to remove
symptoms
• salb#tamol (+entolin)
• %enoterol
IN-ALAT*+IN-ALAT*+
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IN-ALAT*+IN-ALAT*+ANTI,-LINE*I, D*50ANTI,-LINE*I, D*50
*elievers o% the secon" choice1 at AE*elievers o% the secon" choice1 at AE competitivecompetitive antagonistsantagonists on M71 M3 an" MCon M71 M3 an" MC
receptors of parasympathicus ⇒
cholinergic ton#scholinergic ton#s
Division/Division/
• with short.lastingshort.lasting e=ect! ipratropi#m bromi"eipratropi#m bromi"e
• with long.lastinglong.lasting e=ect! tiotropi#m bromi"etiotropi#m bromi"e
',-)D(',-)D(
,, ii ii t ii
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1re+anlio3ner
1arasympatick4
anlion
1ost+anlio3
ner
A/h
'ladk3 sal
icotino3 receptor (5)
,6 receptor (5)
,2 receptor (–)
,7 receptor (5)
,"s,"sccar ar iinnicic receptoryreceptorys ins inair$aysair$ays
Barne! P4. E"r e!#ir e 1996
IN-ALAT*+
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IN-ALAT*+IN-ALAT*+
ANTI,-LINE*I, D*50ANTI,-LINE*I, D*50
• decrease n. vagus tonus• cause relaation• but no bronchoprotective action
• are in general less e=ective than @8?mimethics and have a little slowerbeginning of action
•advantageous combinations v "inhalation system!
• ipratropium• ipratropium>fenoterol
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R b t b d k
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Rencana pengobatan serangan asma berdasarkanberat serangan dan tempat pengobatan
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