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<h1 class="amp-wp-title">PENGGUNAAN KORTIKOSTEROID INHALASI
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<p align="center"><b>PENGGUNAAN KORTIKOSTEROID INHALASI DALAM
TERAPI ASMA</b></p><p align="center"><b>(Natalia Sugianti 078115060)</b></p><p
align="center"><b> </b></p><p align="justify"><b>PENDAHULUAN</b></p><div
align="justify"></div><p align="justify">Asma merupakan penyakit yang disebabkan karena
adanya inflamasi/ peradangan kronis pada saluran pernafasan dengan ciri-ciri seperti serangan
akut secara berkala, sesak nafas, mudah tersengal-sengal, disertai batuk dan hipersekresi
dahak, serta â​​mengiâ​​ pada pasien asma yang sudah parah. Jumlah penderita asma dari tahun
ke tahun mengalami peningkatan yang cukup tinggi, sehingga diperlukan pengobatan yang
tepat dan benar agar tidak sampai menyebabkan kematian.</p><div align="justify"></div><p
align="justify">Asma dapat terjadi karena meningkatnya kepekaan otot polos di sekitar saluran
nafas seseorang dibandingkan saluran nafas normal terhadap stimuli tidak spesifik yang dihirup
dari udara, yang pada orang sehat tidak memberikan reaksi pada saluran pernafasan seperti
perubahan suhu, dingin, polusi udara (asap rokok), dll. Selain itu dapat pula terjadi karena
reaksi alergi, atau karena infeksi saluran pernafasan yang dapat menyebabkan radang/
inflamasi sehingga saluran nafas pada pasien asma lebih menyempit lagi.</p><div
align="justify"></div><p align="justify"><b>PENTATALAKSANAAN TERAPI</b></p><div
align="justify"></div><p align="justify">Sasaran terapi pada pasien asma dengan menggunakan
kortikosteroid inhalasi yaitu peradangan saluran nafas dan gejala asma. Terapi asma disini
bertujuan untuk menghambat atau mengurangi peradangan saluran pernafasan serta
mencegah dan atau mengontrol gejala asma, sehingga gejala asma berkurang/ hilang dan
pasien tetap dapat bernafas dengan baik.</p><div align="justify"></div><p
align="justify">Strategi terapi asma dapat dibagi menjadi dua yaitu terapi non farmakologi
(tanpa menggunakan obat) dan terapi farmakologi (dengan obat).</p><div
align="justify"></div><p align="justify"><u>Terapi Non Farmakologi</u></p><div
align="justify"></div><p align="justify">Untuk terapi non farmakologi, dapat dilakukan dengan
olah raga secara teratur, misalnya saja renang. Sebagian orang berpendapat bahwa dengan
berenang, gejala sesak nafas akan semakin jarang terjadi. Hal ini mungkin karena dengan
berenang, pasien dituntut untuk menarik nafas panjang-panjang, yang berfungsi untuk latihan
pernafasan, sehingga otot-otot pernafasan menjadi lebih kuat. Selain itu, lama kelamaan pasien
akan terbiasa dengan udara dingin sehingga mengurangi timbulnya gejala asma. Namun
hendaknya olah raga ini dilakukan secara bertahap dan dengan melihat kondisi pasien.</p><div
align="justify"></div><p align="justify">Selain itu dapat diberikan penjelasan kepada pasien
agar menghindari atau menjauhkan diri dari faktor-faktor yang diketahui dapat menyebabkan
timbulnya asma, serta penanganan yang harus dilakukan jika serangan asma terjadi.</p><div
align="justify"></div><p align="justify"><u>Terapi Farmakologi</u></p><div
align="justify"></div><p align="justify">Sedangkan untuk terapi farmakologi, dapat dibagi
menjadi dua jenis pengobatan yaitu:</p><div align="justify">
<ul><li><i>Quick-relief medicines,</i> yaitu pengobatan yang digunakan untuk merelaksasi
otot-otot di saluran pernafasan, memudahkan pasien untuk bernafas, memberikan kelegaan
bernafas, dan digunakan saat terjadi serangan asma (<i>asthma attack</i>). Contohnya
yaitu bronkodilator.</li>
<li><i>Long-term medicines,</i> yaitu pengobatan yang digunakan untuk mengobati
inflamasi pada saluran pernafasan, mengurangi udem dan mukus berlebih, memberikan
kontrol untuk jangka waktu lama, dan digunakan untuk membantu mencegah timbulnya
serangan asma (<i>asthma attack</i>). Contohnya yaitu kortikosteroid bentuk inalasi.</li>
</ul></div><p align="justify">Obat-obat asma yang digunakan antara lain bronkodilator
(simpatomimetika: salbutamol, metilsantin: teofilin, antikolinergik: apratropium bromide),
kortikosteroid (prednisolon, budesonida,dll) dan obat-obatan lain seperti ekspektoran
(guaifenesin), mukolitik (bromheksin), antihistamin (ketotifen), dan antileukotrien (zafirlukast).
Untuk memaksimalkan pengobatan asma biasanya digunakan kombinasi beberapa obat.
Obat-obat asma tersedia dalam berbagai macam bentuk sediaan, yaitu oral, parenteral, dan
inhalasi. Namun yang akan dibahas lebih lanjut disini yaitu kortikosteroid bentuk
inhalasi.</p><div align="justify"></div><p align="justify"><b>KORTIKOSTEROID INHALASI
</b></p><div align="justify"></div><p align="justify">Kortikosteroid terdapat dalam beberapa
bentuk sediaan antara lain oral, parenteral, dan inhalasi. Ditemukannya kortikosteroid yang larut
lemak (<i>lipid-soluble</i>) seperti beclomethasone, budesonide, flunisolide, fluticasone, and
triamcinolone, memungkinkan untuk mengantarkan kortikosteroid ini ke saluran pernafasan
dengan absorbsi sistemik yang minim. Pemberian kortikosteroid secara inhalasi memiliki
keuntungan yaitu diberikan dalam dosis kecil secara langsung ke saluran pernafasan (efek
lokal), sehingga tidak menimbulkan efek samping sistemik yang serius. Biasanya, jika
penggunaan secara inhalasi tidak mencukupi barulah kortikosteroid diberikan secara oral, atau
diberikan bersama dengan obat lain (kombinasi, misalnya dengan bronkodilator). Kortikosteroid
inhalasi tidak dapat menyembuhkan asma. Pada kebanyakan pasien, asma akan kembali
kambuh beberapa minggu setelah berhenti menggunakan kortikosteroid inhalasi, walaupun
pasien telah menggunakan kortikosteroid inhalasi dengan dosis tinggi selama 2 tahun atau
lebih. Kortikosteroid inhalasi tunggal juga tidak efektif untuk pertolongan pertama pada
serangan akut yang parah.</p><div align="justify"></div><p align="justify">Berikut ini contoh
kortikosteroid inhalasi yang tersedia di Indonesia antara lain:</p><div align="justify"></div>

<table align="justify" border="1" cellpadding="0" cellspacing="0" width="477"><tbody><tr><td


valign="top" width="115">Nama generik</td><td valign="top" width="177">Nama dagang di
Indonesia</td><td valign="top" width="111">Bentuk Sediaan</td><td valign="top"
width="181">Dosis dan Aturan pakai</td></tr><tr><td valign="top"
width="115">Beclomethasone dipropionate</td><td valign="top"
width="177"><i>Becloment</i><i> </i>(beclomethasone dipropionate 200μg/ dosis)<i>
</i></td><td valign="top" width="111">Inhalasi aerosol</td><td valign="top"
width="181"><u>Inhalasi aerosol</u>: 200μg , 2 kali sehari<u>anak</u>: 50-100 μg 2 kali
sehari</td></tr><tr><td valign="top" width="115">Budesonide</td><td valign="top"
width="177"><i> </i><i>Pulmicort </i>(budesonide
<p>100 μg, 200 μg, 400 μg / dosis)</p></td><td valign="top" width="111">Inhalasi
aerosolSerbuk inhalasi</td><td valign="top" width="181"><u>Inhalasi aerosol:</u> 200 μg, 2
kali sehari<u>Serbuk inhalasi:</u> 200-1600 μg / hari dalam dosis terbagi<u>anak</u>:
200-800 μg/ hari dalam dosis terbagi</td></tr><tr><td valign="top"
width="115">Fluticasone</td><td valign="top" width="177"><i>Flixotide </i>(flutikason
propionate50 μg , 125 μg /dosis)</td><td valign="top" width="111">Inhalasi aerosol</td><td
valign="top" width="181"><u>Dewasa dan anak &gt; 16 tahun</u>: 100-250 μg, 2 kali
sehari<u>Anak 4-16 tahun</u>; 50-100 μg, 2 kali sehari</td></tr></tbody></table><div
align="justify"></div><p align="justify">Dosis untuk masing-masing individu pasien dapat
berbeda, sehingga harus dikonsultasikan lebih lanjut dengan dokter, dan jangan menghentikan
penggunaan kortikosteroid secara langsung, harus secara bertahap dengan pengurangan
dosis.</p><div align="justify"></div><p align="justify"><u>MEKANISME AKSI</u></p><div
align="justify"></div><p align="justify">Kortikosteroid bekerja dengan memblok enzim
<i>fosfolipase-A<sub>2</sub></i>, sehingga menghambat pembentukan mediator peradangan
seperti prostaglandin dan leukotrien. Selain itu berfungsi mengurangi sekresi mukus dan
menghambat proses peradangan. Kortikosteroid tidak dapat merelaksasi otot polos jalan nafas
secara langsung tetapi dengan jalan mengurangi reaktifitas otot polos disekitar saluran nafas,
meningkatkan sirkulasi jalan nafas, dan mengurangi frekuensi keparahan asma jika digunakan
secara teratur.</p><div align="justify"></div><p align="justify"><u>INDIKASI</u></p><div
align="justify"></div><p align="justify">Kortikosteroid inhalasi secara teratur digunakan untuk
mengontrol dan mencegah gejala asma.</p><div align="justify"></div><p
align="justify"><u>KONTRAINDIKASI</u></p><div align="justify"></div><p
align="justify">Kontraindikasi bagi pasien yang hipersensitifitas terhadap kortikosteroid.</p><div
align="justify"></div><p align="justify"><u>EFEK SAMPING</u></p><div
align="justify"></div><p align="justify">Efek samping kortikosteroid berkisar dari rendah, parah,
sampai mematikan. Hal ini tergantung dari rute, dosis, dan frekuensi pemberiannya. Efek
samping pada pemberian kortikosteroid oral lebih besar daripada pemberian inhalasi. Pada
pemberian secara oral dapat menimbulkan katarak, osteoporosis, menghambat pertumbuhan,
berefek pada susunan saraf pusat dan gangguan mental, serta meningkatkan resiko terkena
infeksi. Kortikosteroid inhalasi secara umum lebih aman, karena efek samping yang timbul
seringkali bersifat lokal seperti <i>candidiasis </i>(infeksi karena jamur candida)<i> </i>di
sekitar mulut, <i>dysphonia </i>(kesulitan berbicara), sakit tenggorokan, iritasi tenggorokan,
dan batuk. Efek samping ini dapat dihindari dengan berkumur setelah menggunakan sediaan
inhalasi. Efek samping sistemik dapat terjadi pada penggunaan kortikosteroid inhalasi dosis
tinggi yaitu pertumbuhan yang terhambat pada anak-anak, osteoporosis, dan karatak.</p><div
align="justify"></div><p align="justify"><u>RESIKO KHUSUS</u></p><div
align="justify"></div><p align="justify">Pada anak-anak, penggunaan kortikosteroid inhalasi
dosis tinggi menunjukkan pertumbuhan anak yang sedikit lambat, namun asma sendiri juga
dapat menunda pubertas, dan tidak ada bukti bahwa kortikosteriod inhalasi dapat
mempengaruhi tinggi badan orang dewasa.</p><div align="justify"></div><p
align="justify">Hindari penggunaan kortikosteroid pada ibu hamil, karena bersifat
teratogenik.</p><div align="justify"></div><p align="justify"><u> </u></p><div
align="justify"></div><p align="justify"><b>CARA PENGGUNAAN INHALER </b></p><div
align="justify">
<ul><li>Sebelum menarik nafas, buanglah nafas seluruhnya, sebanyak mungkin</li>
<li>Ambillah inhaler, kemudian kocok</li>
<li>Peganglah inhaler, sedemikian hingga mulut inhaler terletak dibagian bawah</li>
<li>Tempatkanlah inhaler dengan jarak kurang lebih dua jari di depan mulut (jangan
meletakkan mulut kita terlalu dekat dengan bagian mulut inhaler)</li>
<li>Bukalah mulut dan tariklah nafas perlahan-lahan dan dalam, bersamaan dengan
menekan inhaler (waktu saat menarik nafas dan menekan inhaler adalah waktu yang
penting bagi obat untuk bekerja secara efektif)</li>
<li>Segera setelah obat masuk, tahan nafas selama 10 detik (jika tidak membawa jam,
sebaiknya hitung dalam hati dari satu hingga sepuluh)</li>
<li>Setelah itu, jika masih dibutuhkan dapat mengulangi menghirup lagi seperti cara
diatas, sesuai aturan pakai yang diresepkan oleh dokter</li>
<li>Setelah selesai, bilas atau kumur dengan air putih untuk mencegah efek samping
yang mungkin terjadi.</li>
</ul></div><p align="justify"><b>PENUTUP</b></p><div align="justify"></div><p
align="justify">Pengobatan asma harus dilakukan secara tepat dan benar untuk mengurangi
gejala yang timbul. Pengobatan asma memerlukan kerja sama antara pasien, keluarga, dan
dokternya. Oleh karena itu pasien asma dan keluarganya harus diberi informasi lengkap
tentang obat yang dikonsumsinya; kegunaan, dosis, aturan pakai, cara pakai dan efek samping
yang mungkin timbul. Pasien hendaknya juga menghindari faktor yang menjadi penyebab
timbulnya asma. Selain itu, pasien harus diingatkan untuk selalu membawa obat asma
kemanapun dia pergi, menyimpan obat-obatnya dengan baik, serta mengecek tanggal
kadaluarsa obat tersebut. Hal ini perlu diperhatikan agar semakin hari kualitas hidup pasien
semakin meningkat.</p><div align="justify"></div><p align="justify"><b>DAFTAR
PUSTAKA</b></p><div align="justify"></div><p align="justify">Anonim, 1998, <i>Buku Saku
Kedokteran Dorland edisi 25</i>, Penerbit ECG, Jakarta</p><div align="justify"></div><p
align="justify">Anonim, 2000, <i>Informatorium Obat Nasional Indonesia</i>, Departemen
Kesehatan Republik Indonesia, Jakarta</p><div align="justify"></div><p
align="justify">Boushey H.A., 2001, Obat-obat Asma dalam Katzung, B.G., <i>Farmakologi
Dasar &amp; Klinik</i>, Ed.I, diterjemahkan oleh Sjbana, D., dkk, Salemba Medika,
Jakarta</p><div align="justify"></div><p align="justify">Brenner, MD, 2005, <i>Current Clinical
Strategies</i> , Laguna Hills, California</p><div align="justify"></div><p
align="justify">Dipiro,JT., dkk, 2005, <i>Pharmacotherapy: A Pathophysiologic Approach, Sixth
Edition</i>, The McGraw-Hill Companies, Inc.., USA</p> </div>

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GO5g.woff2") format("woff2"); unicode-range: U+102-103, U+110-111, U+1EA0-1EF9, U+20AB;
}

@font-face { font-family: Merriweather; font-style: italic; font-weight: 700; src:


local("Merriweather Bold Italic"), local("Merriweather-BoldItalic"),
url("https://fonts.gstatic.com/s/merriweather/v19/u-4l0qyriQwlOrhSvowK_l5-eR71Wvf2jvzDP3W
GO5g.woff2") format("woff2"); unicode-range: U+100-24F, U+259, U+1E00-1EFF, U+2020,
U+20A0-20AB, U+20AD-20CF, U+2113, U+2C60-2C7F, U+A720-A7FF; }

@font-face { font-family: Merriweather; font-style: italic; font-weight: 700; src:


local("Merriweather Bold Italic"), local("Merriweather-BoldItalic"),
url("https://fonts.gstatic.com/s/merriweather/v19/u-4l0qyriQwlOrhSvowK_l5-eR71Wvf4jvzDP3W
G.woff2") format("woff2"); unicode-range: U+0-FF, U+131, U+152-153, U+2BB-2BC, U+2C6,
U+2DA, U+2DC, U+2000-206F, U+2074, U+20AC, U+2122, U+2191, U+2193, U+2212,
U+2215, U+FEFF, U+FFFD; }

@font-face { font-family: Merriweather; font-style: normal; font-weight: 400; src:


local("Merriweather Regular"), local("Merriweather-Regular"),
url("https://fonts.gstatic.com/s/merriweather/v19/u-440qyriQwlOrhSvowK_l5-cSZMdeX3rsHo.wo
ff2") format("woff2"); unicode-range: U+460-52F, U+1C80-1C88, U+20B4, U+2DE0-2DFF,
U+A640-A69F, U+FE2E-FE2F; }

@font-face { font-family: Merriweather; font-style: normal; font-weight: 400; src:


local("Merriweather Regular"), local("Merriweather-Regular"),
url("https://fonts.gstatic.com/s/merriweather/v19/u-440qyriQwlOrhSvowK_l5-eCZMdeX3rsHo.wo
ff2") format("woff2"); unicode-range: U+400-45F, U+490-491, U+4B0-4B1, U+2116; }

@font-face { font-family: Merriweather; font-style: normal; font-weight: 400; src:


local("Merriweather Regular"), local("Merriweather-Regular"),
url("https://fonts.gstatic.com/s/merriweather/v19/u-440qyriQwlOrhSvowK_l5-cyZMdeX3rsHo.wof
f2") format("woff2"); unicode-range: U+102-103, U+110-111, U+1EA0-1EF9, U+20AB; }

@font-face { font-family: Merriweather; font-style: normal; font-weight: 400; src:


local("Merriweather Regular"), local("Merriweather-Regular"),
url("https://fonts.gstatic.com/s/merriweather/v19/u-440qyriQwlOrhSvowK_l5-ciZMdeX3rsHo.woff
2") format("woff2"); unicode-range: U+100-24F, U+259, U+1E00-1EFF, U+2020, U+20A0-20AB,
U+20AD-20CF, U+2113, U+2C60-2C7F, U+A720-A7FF; }

@font-face { font-family: Merriweather; font-style: normal; font-weight: 400; src:


local("Merriweather Regular"), local("Merriweather-Regular"),
url("https://fonts.gstatic.com/s/merriweather/v19/u-440qyriQwlOrhSvowK_l5-fCZMdeX3rg.woff2"
) format("woff2"); unicode-range: U+0-FF, U+131, U+152-153, U+2BB-2BC, U+2C6, U+2DA,
U+2DC, U+2000-206F, U+2074, U+20AC, U+2122, U+2191, U+2193, U+2212, U+2215,
U+FEFF, U+FFFD; }

@font-face { font-family: Merriweather; font-style: normal; font-weight: 700; src:


local("Merriweather Bold"), local("Merriweather-Bold"),
url("https://fonts.gstatic.com/s/merriweather/v19/u-4n0qyriQwlOrhSvowK_l52xwNZVcf6hPvhPU
WH.woff2") format("woff2"); unicode-range: U+460-52F, U+1C80-1C88, U+20B4,
U+2DE0-2DFF, U+A640-A69F, U+FE2E-FE2F; }

@font-face { font-family: Merriweather; font-style: normal; font-weight: 700; src:


local("Merriweather Bold"), local("Merriweather-Bold"),
url("https://fonts.gstatic.com/s/merriweather/v19/u-4n0qyriQwlOrhSvowK_l52xwNZXMf6hPvhPU
WH.woff2") format("woff2"); unicode-range: U+400-45F, U+490-491, U+4B0-4B1, U+2116; }

@font-face { font-family: Merriweather; font-style: normal; font-weight: 700; src:


local("Merriweather Bold"), local("Merriweather-Bold"),
url("https://fonts.gstatic.com/s/merriweather/v19/u-4n0qyriQwlOrhSvowK_l52xwNZV8f6hPvhPU
WH.woff2") format("woff2"); unicode-range: U+102-103, U+110-111, U+1EA0-1EF9, U+20AB; }

@font-face { font-family: Merriweather; font-style: normal; font-weight: 700; src:


local("Merriweather Bold"), local("Merriweather-Bold"),
url("https://fonts.gstatic.com/s/merriweather/v19/u-4n0qyriQwlOrhSvowK_l52xwNZVsf6hPvhPU
WH.woff2") format("woff2"); unicode-range: U+100-24F, U+259, U+1E00-1EFF, U+2020,
U+20A0-20AB, U+20AD-20CF, U+2113, U+2C60-2C7F, U+A720-A7FF; }

@font-face { font-family: Merriweather; font-style: normal; font-weight: 700; src:


local("Merriweather Bold"), local("Merriweather-Bold"),
url("https://fonts.gstatic.com/s/merriweather/v19/u-4n0qyriQwlOrhSvowK_l52xwNZWMf6hPvhP
Q.woff2") format("woff2"); unicode-range: U+0-FF, U+131, U+152-153, U+2BB-2BC, U+2C6,
U+2DA, U+2DC, U+2000-206F, U+2074, U+20AC, U+2122, U+2191, U+2193, U+2212,
U+2215, U+FEFF, U+FFFD; }
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