Dr. Oka Wijaya, Sp.

P
• Asthma is an inflammatory disorder of the
airways, which involves several
inflammatory cells and multiple mediators
that result in characteristic
patophysiological changes

Beasley R. The Global Burden of Asthma Report, Global Initiative for Asthma (GINA) 2010
• Airway smooth muscle contraction in response to
multiple bronchoconstrictor mediators and
neurotransmitter  predominant mechanism
• Airway edema is due to increased microvascular
leakage in response to inflammatory mediators
• Mucus hypersecretion may lead to luminal
occlusion (‘mucus plugging’)
• Airway thickening due to structural changes, often
termed ‘remodelling’  important in more severe
disease

Beasley R. The Global Burden of Asthma Report, Global Initiative for Asthma (GINA) 2010
Pedoman Diagnosis dan Penatalaksanaan Asma Indonesia 2010
Bagaimana proses terjadinya asma?

Normal Asma
Apa yang terjadi pada asma?

Saluran napas Asma

Asma berat
normal ringan/sedang
Apa yang dirasakan oleh pasien
asma?
Gejala yang terus
muncul
• Sensitif terhadap cuaca
dingin
• Batuk-batuk
• Sesak napas
• Aktifitas fisik terbatas
• Sering terbangun dimalam
hari karena gejala asmanya
• Penurunan kegiatan sosial

ID/SFC/0024/14 – AD. 19/09/2014 – ED. 19/09/2016 - Hanya untuk kalangan profesional kesehatan
LEVEL OF ASTHMA CONTROL
(STABLE ASTHMA)
 Reducing a patient’s exposure to some categories
of risk factors
 The aims of treatment :
◦ Relieve airflow obstruction and hypoxemia as quickly
as possible
◦ Plan the prevention of future relapses
 Inhaled therapy gives the advantage of delivering
directly into the airways, producing higher
concentrations with less risk of systemic side
effects.

Beasley R. The Global Burden of Asthma Report, Global Initiative for Asthma (GINA) 2010
 Pilihan pengobatan
Obat Pelega / Reliever
1. Inhalasi β2-agonis kerja singkat
Short-acting (SABA) dan
Long-acting (LABA) dg onset yang
cepat
2. Systemic glucocorticosteroids
3. Antikolinergik
4. Teofilin
5. Short-acting oral β2-agonists
2013 Global Initiative for Asthma http//www.gina
 Pilihan pengobatan
Obat Pengontrol / Controller
1. Inhaled glucocorticosteroids (ICS)
2. Leukotriene modifiers
3. Long-acting inhaled β2-agonists (LABA) yang
dikombinasikan dengan inhaled
glucocorticosteroids (ICS) → LABA + ICS =
LABACs
4. Systemic glucocorticosteroids
5. Theophylline
6. Cromones
7. Anti-IgE
2013 Global Initiative for Asthma http//www.ginaasthma.org
 Systemic
◦ parenteral (injection): IV, IM, IC, SC
◦ enteral (oral): tablet, capsule, syrup, etc

 Inhalation
◦ Nebulizer
◦ Dry powder inhaler (MDI)
◦ Metered dose inhaler (DPI)
 ORAL INJECTION INHALATION
EFFECT Systemic Systemic Local (except in
high dose)
METABOLISM (+) (+) (+)
DOSAGE >> > <<
ONSET 15 min A couple of min Fast
SIDE EFFECT GIT Invasive Minimal
BENEFIT (+) (+) ( + ) ↑ mucocilliary
clearance
 Metered Delivered dose Respiratory
dose to patient availability

Liver
Portal
vein
Systemic
availability is
the sum of the
respiratory & the
oral component Gut Systemic
Metabolism availability

Pedersen & O’Byrne, 1997

 Gejala akut asma: Penyebab dasar asma:
sesak napas, mengi, batuk peradangan

Obat Pelega Obat Pengontrol

 dipakai hanya pada
saat serangan
 berfungsi melebarkan
saluran napas
 pemakaian yang sering
 asma tidak terkontrol
 dipakai rutin setiap hari
 berfungsi mengatasi
peradangan, mencegah/
mengurangi frekuensi dan
berat serangan
• = Asthma attacks / acute asthma
• Episode of progressive increase in shortness of
breath, cough, wheezing, chest tightness, or its
combination
• Characterized by decreases in expiratory airflow
(PEF or FEV1)
• Transient worsening of asthma may occur as a
result of exposure to risk factors or ‘triggers’
• Severe exacerbations are life-threatening medical
emergencies

Beasley R. The Global Burden of Asthma Report, Global Initiative for Asthma (GINA) 2010
 Faktor yang menyebabkan
eksaserbasi pada Asma

1. Alergen
2. Infeksi saluran pernapasan
3. Aktivitas dan hiperventilasi
4. Perubahan cuaca
5. Sulfur dioksida
6. Makanan, zat aditif, obat-obatan
2013 Global Initiative for Asthma http//www.ginaasthma.org
Pedoman Diagnosis dan Penatalaksanaan Asma Indonesia 2010
• For mild to moderate exacerbations, repeated
administration of rapid-acting inhaled β2
agonists (2-4 puffs every 20 minutes for the
first hour) is usually the best and most cost-
effective method

• Bronchodilator therapy delivered via MDI

produces at least an equivalent improvement in
lung function as the same dose delivered via
nebulizer

Beasley R. The Global Burden of Asthma Report, Global Initiative for Asthma (GINA) 2010
RSU SILOAM KUPANG

KLINIK ASMA
 www.asthmacontroltest.com

ID/SFC/0024/14 – AD. 19/09/2014 – ED. 19/09/2016 - Hanya untuk kalangan profesional kesehatan
ID/SFC/0024/14 – AD. 19/09/2014 – ED. 19/09/2016 - Hanya untuk kalangan profesional kesehatan