Asthma

Retno Ariza S Soemarwoto

Pulmologist

An imbalance of Th1 and Th2 cells, especially Th2

cells plays an important role in the development of
allergic diseases

Eliminates parasite
Allergic diseases

Eliminates micro
organisms and tumors
Auto-immune disease
Transplant rejection

Th2
IL-4, 5, 13

Th1
IFN-, IL-2

Tc

Th

CD8+

CD4+

CD19+

Integrated Airway

Development of asthma

Allergic
rhinitis
Abnorma
l lung
functions

Remodeling &
Histo-pathological
changes

Asthma

Hyper-reactiveness
&viral infection

Genetic &
Environments
& Atopy

Lingkungan
Alergen
Usia
Polutan
Stress

Risiko
Genetik

Atopy
Kerusakan SN

Perbaikan yang
menyimpang

Infeksi SN bawah
Alergen
Perokok pasif
Zat toksik

Persistence Inflammation
Remodeling

Asthma

POTENTIAL BENEFITS
ABORTING THE ALLERGIC
MARCH

THE IMMUNOLOGIC BASIS OF LOCAL ALLERGIC

REACTIONS e.g. ATOPIC DERMATITIS. ALLERGIC
RHINITIS and ASTHMA: IS ACTUALLY A
SYSTEMIC DYSREGULATION OFTHE IMMUNE
SYSTEM
ATOPIC
DERMATITIS

ALLERGIC RHINITIS

BRONCHIAL
ASTHMA

Allergic reactions
Histamine
other mediators

Mast cell

Allergens

Attract Eosinophils
and other immune cells

Early phase reaction

Late phase reaction

(within the first hour)

(after several hours)

sneezing
rhinorrhea
nasal pruritus
ocular pruritus

nasal obstruction
swollen eyes
tiredness, irritability
sleep disturbance

Adcock I. Clin Exp Allerg Rev 2002; 2: 85-8.

Clinical
symptoms
Allergic
inflammation

Genetic
factors

Triggers
Viral infections
Expose to
allergens
Pollutants

Environment
al factors

Prevalence of asthma
Based on SKRT 1995 13/1000
Reseach :

In Indonesia
Child
11,5 % Adult 7,7 %
Wang et al 2001
Rhinitis 5,1%
Non rhinitis 0,75 %

asthma triggers
Debu, asap, polusi udara
Flu
Binatang berbulu (anjing, kucing, burung), kecoa
Pollen dari pohon, rumput
Bau menyengat
Perubahan cuaca, udara yg sangat dingin
Aktivitas berat, menangis, tertawa, teriak
Aspirin atau obat lain

How is asthma diagnosed?

Based on a physical examination,
personal history, and lung function
tests
Typical asthma symptoms such as
wheezing or coughing,
the personal history allergies or a
familial tendency towards asthma.

Treatment of asthma

mild

persistent

moderate
persistent

intermittent MDI steroid or

MDI LABA + Steroid
allergen and irritant avoidance
oral or MDI bronchodilator
immunotherapy

severe
persisten
t

Asthma treatment
Based on severity spirometry
Allergen avoidance
Gradation of severity:

Mild short acting bronchodilator

Moderate to severe bronchodilator &
antiinflammation

Spirometry

Peak flow meter

Nebulizer

To use M D I