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STASE PARU

Patient with
respiratory symptoms
Are the symptoms typical of asthma?

NO
YES
Work up ASMA pada
pasien ini Detailed history/examination
for asthma
History/examination supports
asthma diagnosis?
Further history and tests for
NO alternative diagnoses
Clinical urgency, and
YES Alternative diagnosis confirmed?
other diagnoses unlikely

Perform spirometry/PEF
with reversibility test
Results support asthma diagnosis?

Repeat on another
NO
occasion or arrange
NO
YES other tests
Confirms asthma diagnosis?

Empiric treatment with YES NO YES


ICS and prn SABA
Review response
Consider trial of treatment for
Diagnostic testing most likely diagnosis, or refer
within 1-3 months for further investigations

Treat for ASTHMA Treat for alternative diagnosis

Global Initiative forAsthma


Global Initiative for Asthma
Classification of Severity
CLASSIFY SEVERITY
Clinical Features Before Treatment

Symptoms Nocturnal FEV1 or PEF


Symptoms
STEP 4 Continuous 60% predicted
Limited physical Frequent
Severe Variability > 30%
Persistent activity

STEP 3 Daily 60 - 80% predicted


> 1 time week
Moderate Attacks affect activity Variability > 30%
Persistent
STEP 2
> 2 times a month 80% predicted
> 1 time a week
Mild but < 1 time a day Variability 20 - 30%
Persistent

< 1 time a week


STEP 1 80% predicted
Asymptomatic 2 times a month
PASIEN Intermittent and normal PEF Variability < 20%
between attacks
The presence of one feature of severity is sufficient to place patient in that category.
Step 1 as-needed inhaled short-acting
beta2-agonist (SABA)

STEP 5

STEP 4

STEP 3 Refer for


PREFERRED STEP 1 STEP 2 add-on
CONTROLLER treatment
CHOICE e.g.
Med/high tiotropium,*
anti-IgE,
ICS/LABA anti-IL5*
Low dose
PASIEN Low dose ICS ICS/LABA**

Other Consider low Med/high dose ICS Add tiotropium* Add low
Leukotriene receptor antagonists (LTRA)
controller dose ICS Low dose ICS+LTRA High dose ICS dose OCS
Low dose theophylline*
options (or + theoph*) + LTRA
(or + theoph*)

RELIEVER As-needed short-acting beta2-agonist (SABA) As-needed SABA or


low dose ICS/formoterol#

*Not for children <12 years


**For children 6-11 years, the preferred Step 3 treatment is medium dose ICS
#For patients prescribed BDP/formoterol or BUD/ formoterol maintenance and reliever therapy
Tiotropium by mist inhaler is an add-on treatment for patients 12 years with a history of exacerbations
GINA 2017, Box 3-5, Step 1 (4/8)
Hal yang
ditemukan
pada pasien ini
AB pasien ini:
Inj. Ceftazidim
Inj. Ciprofloxacin
Pulmonary metastasis
Seenin 20-54% of extrathoracic
malignancies. Lungs are the second most
frequent site of metastases from
Pulmonal metastasis
extrathoracic malignancies. akan lebih jelas jika
dilakukan CT SCAN
Thoraks tanpa
kontras.

Some patients develop symptoms such


as hemoptysis, cough, shortness of
breath, chest pain, weakness, and
weight loss.