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dr.Sumardi,SpPD-KP
Tempat/Tanggal Lahir : Jakarta/ 14 Agustus 1952
PENDIDIKAN TERAKHIR :
KONSULTAN PARU
RIWAYAT PEKERJAAN :
Kepala Puskesmas Tk2 Kabupaten Bungotebo – Tamat 1982
Ketua SMF Penyakit Dalam RSUD Sumbawa Besar NTB – Tamat 1996
Ketua P2TB Komite Medik RSUP DR Sardjito Yogyakarta – 1999
Ketua Tim Avian Influensa RSUP DR Sardjito Yogyakarta
SMOKING Exposure to hazardous
1 pack/day in 10 years Air Pollution chemicals & Biomass
(>10 packyears) smog
• Age >40 y.o
• Symptoms: Shortness of breath, prolonged expiration, chronic cough
or sputum production
History
• History of exposure to risk factors: smoking, occupation, indoor or
outdoor air pollution
Risk Factor
• Post-bronchodilator FEV1/FVC <0.70 confirms persistent airflow
limitation (spirometry)
Spirometry
Airflow limitation Risk
(Exacerbation history)
4
C D > 2/yr
2 1/yr
A B
1 0/yr
mMRC 0-1 mMRC > 2
CAT < 10 CAT > 10
Symptoms
Score: 35
Airflow limitation Risk
(Exacerbation history)
4
C D > 2/yr
2 1/yr
A B
1 0/yr
mMRC 0-1 mMRC > 2
CAT < 10 CAT > 10
Symptoms
Global Strategy for Diagnosis, Management and Prevention of COPD
2 A B LAMA or 1/yr
SABA or
SAMA prn LABA
1 0/yr
mMRC 0-1 mMRC > 2
CAT < 10 CAT > 10
Symptoms
Manage Stable COPD: Pharmacologic Therapy
(B)
No exacerbations (A)
< 2 ex/yr
Bronchodilators
ICS
Muc/NAC
Roflumilast
Antibiotics
STEP 3 Marked
reversible airflow limitation FEV1/FVC < 0.7
PERFORM post-BD
(pre-post bronchodilator) or other
SPIROMETRY proof of variable airflow limitation
Lung function Record of variable airflow limitation Record of persistent airflow limitation
(spirometry or peak flow) (FEV1/FVC < 0.7 post-BD)
Lung function between Normal Abnormal
symptoms
Past history or family history Previous doctor diagnosis of asthma Previous doctor diagnosis of COPD,
chronic bronchitis or emphysema
Family history of asthma, and other allergic conditions
(allergic rhinitis or eczema) Heavy exposure to risk factor: tobacco
smoke, biomass fuels
Time course No worsening of symptoms over time. Symptoms slowly worsening over time
Variation in symptoms either seasonally, or from year (progressive course over years)
to year
Rapid-acting bronchodilator treatment
May improve spontaneously or have an immediate provides only limited relief
response to bronchodilators or to ICS over weeks
GINA
GINA 2015, Box 5-4
2014 © Global Initiative for Asthma
Marked
STEP 3 reversible airflow limitation FEV1/FVC < 0.7
PERFORM (pre-post bronchodilator) or other post-BD
SPIROMETRY proof of variable airflow limitation
FENO (nitric oxide) If high (>50ppb) supports eosinophilic Usually normal. Low in current smokers
inflammation
Blood eosinophilia Supports asthma diagnosis May be found during exacerbations
Sputum inflammatory cell Role in differential diagnosis not established in large populations
analysis (eosinophil or neutrophil sputum)
GINA 2015, Box 5-5 © Global Initiative for Asthma
Long term efficacy benefits
30
20
10
0
0 1 2 3 4 5 6 7 8 9
Tahun
52 pasien meninggal akibat pnemonia pada grup pasien Budesonide/Formoterol dibandingkan dengan
97 pasien meninggal dunia akibat pneumonia pada Salmeterol/Fluticasone.
38
Dissolution time in airway
ASL
Mukosa/jaringan paru