Februari

2019

MANAGEMENT OF
ASTHMA EXACERBATION
Alfian Nur Rosyid
Pulmonologist, Universitas Airlangga
 ALFIAN NUR ROSYID, dr., Sp. P, FAPSR

Dosen Paru FK Unair – RSUD Dr.Soetomo

RS Pendidikan Unair
SD Nurul Ulum Surabaya 1996
AKTIVITAS:
SMP Mts Assalaam Surakarta 1998 Anggota Div.ASMA PPOK PARU FKUA
SMA Insan Cendekia Serpong 2000 KASI DIKLAT RS UNAIR
FK UNAIR Surabaya 2006 Humas PDPI PUSAT
Spesialis Paru FK UNAIR 2017 Anggota HALAL CENTER UNAIR
Ketua YAYASAN ZISWAF RS UNAIR
RS PHC SURABAYA 2007-2008 Anggota IDI SURABAYA
Anggota ATS
PKM BULUNGAN KALTIM 2008 - 2011
Anggota ERS
RSUD dr. Soetomo 2011-2017 Anggota APSR
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Anggota Chest
Pre Test

bit.ly/T23FEB

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 Defisini

Epidemiologi
-Patogenesis
MENU
Asma Outline Materi
Eksaserbasi

Diagnosis

Tatalaksana

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PENDAHULUAN
penyakit
airway ±300 Juta Pasien Asma
kronis

Prevalensi
Prevalensi
terus naik
1-18%
Sering bolos
Ringan  mematikan
 EPIDEMIOLOGI
DUNIA

Riskesdas 2018
Asma : 2.4% 6
ASMA WHO 2008

MEMATIKAN
1,4 juta kematian
karena penyakit
airway kronis

Asma (7,8%)
PPOK (86%)
Paru
Asma bronkial 4A

Status asmatikus 3B
(asma akut berat)
AsBro KELUHAN VARIABEL
BERULANG
Radang Kronis

9
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 Hiper
reaktif
Alergen
Cuaca
Ras /
Etnis Atopi Exercise
Makanan

Jenis
Kelamin
Gene Obat

Envi
Iritan

Polusi
Rokok Emosi
AIRWAY
REMODELING
Diagnosis Asma?
Riwayat gejala khas Asma

variabilitas aliran udara  SPIROMETRI

(tes bronkodilator, provokasi bronkus)

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 Perburukan Kondisi Stabil:
AsBro ada pencetus menginduksi inflamasi akut
Eksaserbasi
Akut
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Mudah Eksaserbasi
Alergi,
Pernah Intubasi krn Inhaler salah /
Eosinofilia,
eksaserbasi tidak teratur
FeNO naik

Eksaserbasi ≥
Hamil Obese 1x dlm 1 thn FEV1 rendah
lalu

Gejala tak terkontrol Merokok

Derajat
Eksaserbasi
Mengancam
Berat Nyawa
Sedang

Ringan
FASKES tk.1
 START TREATMENT
SABA 4–10 puffs by pMDI + spacer, TRANSFER TO ACUTE
repeat every 20 minutes for 1 hour CARE FACILITY
Prednisolone: adults 1 mg/kg, max. WORSENING
While waiting: give inhaled SABA
50 mg, children 1–2 mg/kg, max. 40 mg and ipratropium bromide, O2,
Controlled oxygen (if available): target systemic corticosteroid
saturation 93–95% (children: 94-98%)

CONTINUE TREATMENT with SABA as needed

WORSENING
ASSESS RESPONSE AT 1 HOUR (or earlier)

IMPROVING

ASSESS FOR DISCHARGE ARRANGE at DISCHARGE

Symptoms improved, not needing SABA Reliever: continue as needed
PEF improving, and >60-80% of personal Controller: start, or step up. Check inhaler technique,
best or predicted adherence
Oxygen saturation >94% room air Prednisolone: continue, usually for 5–7 days
(3-5 days for children)
Resources at home adequate
Follow up: within 2–7 days

FOLLOW UP
Reliever: reduce to as-needed
Controller: continue higher dose for short term (1–2 weeks) or long term (3 months), depending
on background to exacerbation
Risk factors: check and correct modifiable risk factors that may have contributed to exacerbation,
including inhaler technique and adherence
Action plan: Is it understood? Was it used appropriately? Does it need modification?

GINA 2017, Box 4-3 (7/7)

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Faskes Rujukan
• SABA
• Ipatroprium Bromide
• Oxygen
• Steroid

24
 Terapi di IGD
Steroid
Oksigen  SAMA +
SABA inhalasi 1
saturasi 93- SABA
inhalasi jam awal
95% inhalasi
eksaserbasi

• Epinefrin im : bila anafilaksis saja

• Steroid sistemik (iv/po): bila SABA gagal
• Aminofilin iv: tidak untuk kondisi akut
• MgSO4: tidak rutin (2g infus tunggal / 20 menit)
Hindari di IGD
Leukotrien : tidak untuk eksaserbasi

Antibiotika: kecuali ada infeksi paru

Obat penenang

NIV : kecuali pantau ketat, hindari bila pasien gelisah

Pertimbangan MRS bila:
• Wanita, tua, ras non putih
• SABA >8puff/24 jam
• Eksaserbasi berat
• Riwayat Eksaserbasi dengan intubasi / MRS
• Riwayat ke IGD dengan terapi steroid
Terapi pulang:
• Steroid oral: 5-7 hari
• Steroid inhalasi: dimulai sebelum KRS
• Bronkodilator: SABA mulai diganti prn. Stop SAMA
Mencegah Hindari Tingkatkan

Eksaserbasi

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DISKUSI
Unduh materi gratis:
bit.ly/asbro19

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POST TEST

kahoot.it
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