BP4 KOTA TEGAL

Global Strategy for Diagnosis, Management and Prevention of COPD

Differential Diagnosis:
COPD and Asthma
COPD ASTHMA
• Onset in mid-life • Onset early in life (often
childhood)
• Symptoms slowly
progressive • Symptoms vary from day to day
• Long smoking history • Symptoms worse at night/early
morning
• Allergy, rhinitis, and/or eczema
also present
• Family history of asthma
© 2015 Global Initiative for Chronic Obstructive Lung Disease
 Asthma Control Test
DALAM 4 MINGGU TERAKHIR
1. berapa kali asma mengganggu pekerjaan 4 Seberapa sering pakai obat semprot atau Obat
sehari-hari (kantor, sekolah atau rumah)? oral untuk melegakan pernafasan?
a. Selalu (1) a. > 3 x sehari (1)
b. 1-2 x sehari (2)
b. Sering (2)
c. 2-3 x seminggu (3)
c. Kadang ( > 2X / mg) (3) d. < 1 x seminggu (4)
d. Jarang (≤ 2X / mg) (4) e. Tidak pernah (5)
e. Tidak pernah (5) 5. Bagaimana anda menilai sendiri tingkat kontrol
2. Seberapa sering mengalami sesak nafas? asma
a. >1 x sehari (1) a. Tidak terkontrol sama sekali (1)
b. 1x sehari (2) b. Kurang terkontrol (2)
c. 3-6 x seminggu (3) c. Cukup terkontrol (3)
d. 1-2 x seminggu (4) d. Terkontrol dengan baik (4)
e. Tidak pernah (5) e. Sangat terkontrol (5)
3. seberapa sering gejala asma (wheezing, batuk,
sesak nafas, nyeri dada atau tertekan didada)
menyebabkan terbangun di malam hari / lebih
awal dari biasanya?  < 19 = tidak terkontrol
a. >4x seminggu (1)
b 2-3 x seminggu (2)  20-24 = terkontrol sebagian
c. 1 x seminggu (3)  25 = terkontrol total
d. 1-2x sebulan (4)
e. Tidak pernah (5)
ASMA
Medikamentosa

RELIEVER CONTROLLER

- β2 agonis kerja singkat - Steroid

- Anticholinergic - Leukotrien inhibitor
-Methilxantine -Ig E
-Adrenalin -β2 agonis kerja lama
 ASMA
Stepwise management - pharmacotherapy

STEP 5

STEP 4

STEP 3 Refer for

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

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

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

low dose ICS/formoterol**

*For children 6-11 years, theophylline is not recommended, and preferred Step 3 is medium dose ICS
**For patients prescribed Beclometason/formoterol or Budesonide/formoterol maintenance and reliever therapy
# Tiotropium by soft-mist inhaler is indicated as add-on treatment for patients with a history of exacerbations; it is not indicated
in children <18 years.
GINA 2015, Box 3-5, Step 2 (5/8)
 ASMA

Tata laksana Non farmakologi

 Hindari paparan polusi
 Hindari alergen
 Menurunkan berat badan untuk obesitas
 Makanan sehat
 Bronkial thermoplasty
 Menghindari stress
 Olah raga
 ASMA

Peninjauan respons & penyesuaian terapi

Kapan ditinjau?
 1-3 bulan setelah mulai terapi, selanjutnya tiap 3-12
bulan
 Hamil, tiap 4-6 minggu
 Pasca eksaserbasi : 1 minggu
 Pembagian Pasien PPOK

FEV1 < 30% Pasien : Pasien :

(Klasifikasi GOLD Pembatasan aliran udara)

prediksi
Risiko tinggi Risiko tinggi
4 Sedikit gejala Banyak gejala
≥2
atau
≥1

(Riwayat Eksaserbasi)
30% ≤ FEV1 < 50% dirawat di
prediksi
(C) (D) Rumah sakit
3
Risiko

Risiko
50% ≤ FEV1 < 80% Pasien : Pasien :
prediksi
Risiko rendah Risiko rendah 1 (tidak dirawat

2 Sedikit gejala Banyak gejala

di Rumah sakit)

FEV1 ≥ 80%
prediksi (A) (B)
1 0
CAT < 10 CAT ≥ 10
Gejala mMRC ≥ 2
CAT : COPD assessment test
mMRC 0–1
Sesak Napas
mMRC : modified medical research council
FEV1 : forced expiratory volume in 1 second
Global Strategy for The Diagnosis, Management, And Prevention of Chronic Obstructive Pulmonary Disease (updated 2015). Available from www.goldcopd.org. Accessed on March
01, 2015.
COPD Assessment test
(CAT)
12
 Terapi Farmakologi 1st CHOICE

C D
(Klasifikasi GOLD Pembatasan aliran udara)

FEV1 < 30%

prediksi Risiko tinggi Risiko tinggi
4 Sedikit gejala Banyak gejala ≥2
atau
ICS + LABA ICS + LABA ≥1

(Riwayat Eksaserbasi)
30% ≤ FEV1 < 50% dirawat di
prediksi atau dan/atau Rumah sakit
3 LAMA LAMA
Risiko

Risiko
50% ≤ FEV1 < 50% A B
prediksi Risiko rendah Risiko rendah
1 (tidak dirawat
Sedikit gejala Banyak gejala
2 di Rumah sakit)

SAMA prn LABA

FEV1 ≥ 80% atau atau
prediksi
SABA prn LAMA
1 0
CAT : COPD assessment test
CAT < 10 CAT ≥ 10
mMRC : modified medical research council mMRC 0–1 Gejala mMRC ≥ 2
FEV1 : forced expiratory volume in 1 second Sesak Napas
prn : pro re nata (sesuai kebutuhan)
Global Strategy for The Diagnosis, Management, And Prevention of Chronic Obstructive Pulmonary Disease (updated 2015). Available from www.goldcopd.org. Accessed on March
01, 2015.
 Global Strategy for Diagnosis, Management and Prevention of COPD
Manage Stable COPD: Pharmacologic Therapy
(Medications in each box are mentioned in alphabetical order, and therefore not
necessarily in order of preference.)

Patient Recommended Alternative choice Other Possible

First choice Treatments
LAMA
SAMA prn or
A or LABA Theophylline
SABA prn or
SABA and SAMA
LAMA
SABA and/or SAMA
B or LAMA and LABA
Theophylline
LABA
ICS + LABA LAMA and LABA or
or LAMA and PDE4-inh. or SABA and/or SAMA
C
LAMA LABA and PDE4-inh. Theophylline

ICS + LABA ICS + LABA and LAMA or Carbocysteine

and/or ICS+LABA and PDE4-inh. or N-acetylcysteine
D
LAMA LAMA and LABA or SABA and/or SAMA
LAMA and PDE4-inh. Theophylline
TERIMA KASIH

15
 Low, medium and high dose inhaled corticosteroids
Adults and adolescents (≥12 years)
Inhaled corticosteroid Total daily dose (mcg)
Low Medium High

Beclometasone dipropionate (CFC) 200–500 >500–1000 >1000

Beclometasone dipropionate (HFA) 100–200 >200–400 >400
Budesonide (DPI) 200–400 >400–800 >800
Ciclesonide (HFA) 80–160 >160–320 >320
Fluticasone propionate (DPI or HFA) 100–250 >250–500 >500
Mometasone furoate 110–220 >220–440 >440
Triamcinolone acetonide 400–1000 >1000–2000 >2000

GINA 2015, Box 3-6 (1/2)