CURRICULUM VITAE

N AM A
ALAMAT
PEKERJAAN

: Prof.Dr.TAMSIL SYAFIUDDIN Sp.P (K)

: Jln.KARSA No F 1 KOMPLEKS EKS KOWILHAN I
SEI.AGUL MEDAN 20117
: Guru Besar FK- UISU / FK- USU

RIWAYAT PENDIDIKAN :
-Dokter Umum FK-USU Medan,1979
-Dokter Spesialis I Paru FK-UI Jakarta, 1990
-Dokter Spesialis II Paru Konsultan Asma/PPOK, 1995
Pendidikan tambahan:
- Pelatihan Kanker Paru, TSUKAGUCHI Hospital, Kobe- Japan 1989
- Pelatihan PPOK, AMAGASAKI Hospital, Kobe- Japan 1990
- Pelatihan Respiratory Physiologi, JAPAN RESPIRATORY PHYSIOLOGIST
CLUB, Kyoto- Japan 1990
- Spirometry Training Course, Department of Respiratory Medicine,
National University Hospital Singapore, Singapore 1997

- Workshop on Transbronchial Lung Biopsy and Trasbronchial Needle

Aspiration PDPI Cabang Jakarta, RS Persahabatan Jakarta ,Jakarta Maret
1997
- Workshop on Respiratory Physiology and Its Clinical Application, RS Pusat
Angkatan Darat Gatot Subroto Jakarta, Jakarta Juni 1997
- Workshop on Medical Thoracoscopy, The American College of Chest
Physicians-The Indonesian Association of Pulmonologist, RS Persahabatan
Jakarta, Jakarta November 1997
- Workshop on Reformation of Higer Education System,HEDS-JICA,Jakarta
1998
-Pulmonary Infections Course, Postgraduate Medical Institute,
Singapore General Hospital, Singapore 2001
- Bronchoscopy &Thoracoscopy Workshop, Postgraduate Medical Institute,
Singapore General Hospital, Singapore 2005
-Workshop of Bronchoscopy and Autofluorecent Bronchoscopy,
RS Persahabatan Jakarta, Jakarta September 2005
-Training of the new interventional technique of bronchosfiberscopy
(Optical Coherence Tommograhy) , Department of Thoracic Surgery,
Tokyo Medical University Hospital,Tokyo - Japan 2007

COPD
( PPOK )

Prof.Dr.Tamsil Syafiuddin, SpP(K)

Departemen Pulmonologi
Fakultas Kedokteran
Universitas Islam Sumatera Utara
2008

Table 1. Alternative terminology of COPD

Indonesia
PPOK Penyakit Paru Obstruktif Kronik
PPOM Penyakit Paru Obstruktif Menahun
English
COLD
COAD
COB

Chronic Obstructive Lung Disease

Chronic Obstructive Airways Disease
Chronic Obstructive Bronchitis

Dutch
COLL

Chronisch Obstructief Longlijden

French
BPCO Broncho Pneumopathie Chronique Obstructive

Tingkat kemampuan yang diharapkan dicapai pada

akhir pendidikan dokter
Tingkat Kemampuan 1
Dapat mengenali dan menempatkan gambaran-gambaran klinik sesuai
penyakit ini ketika membaca literatur. Dalam korespondensi, ia dapat
mengenal gambaran klinik ini, dan tahu bagaimana mendapatkan informasi
lebih lanjut. Level ini mengindikasikan overview level.
Bila menghadapi pasien dengan gambaran klinik ini dan menduga
penyakitnya, Dokter segera merujuk.

Tingkat Kemampuan 2
Mampu membuat diagnosis klinik berdasarkan pemeriksaan fisik dan
pemeriksaanpemeriksaan tambahan yang diminta oleh dokter (misalnya :
pemeriksaan laboratorium sederhana atau X-ray).
Dokter mampu merujuk pasien secepatnya ke spesialis yang relevan
dan mampu menindaklanjuti sesudahnya

Tingkat Kemampuan 3
3a. Mampu membuat diagnosis klinik berdasarkan pemeriksaan fisik dan
pemeriksaanpemeriksaan tambahan yang diminta oleh dokter (misalnya :
pemeriksaan laboratorium sederhana atau X-ray).
Dokter dapat memutuskan dan memberi terapi pendahuluan, serta merujuk
ke spesialis yang relevan (bukan kasus gawat darurat).
3b. Mampu membuat diagnosis klinik berdasarkan pemeriksaan fisik dan
pemeriksaanpemeriksaan tambahan yang diminta oleh dokter (misalnya :
pemeriksaan laboratorium sederhana atau X-ray).
Dokter dapat memutuskan dan memberi terapi pendahuluan, serta merujuk
ke spesialis yang relevan (kasus gawat darurat).
.

Level of competence 4:
Mampu membuat diagnosis klinik berdasarkan
pemeriksaan fisik dan pemeriksaan tambahan
yang diminta oleh dokter (misalnya: pemeriksaan
laboratorum sederhana atau X-ray).
Dokter dapat memutuskan dan mampu menangani
problem itu secara mandiri hingga tuntas.

Standar Kompetensi Dokter , Konsil Kedokteran Indonesia, 2006

Bronchiectasis
COPD
SARS
Pneumonia
Avian influenzae
Lung abscess
Pulmonary embolism
Lung infarction
Pleurisy TBC
Pleurisy Cancer
Pleurisy Lupus
Pneumothorax
Cystic fibrosis
Aspiration pneumonia

1 2 3A 3B 4
1 2 3A 3B 4
1 2 3A 3B 4
1 2 3A 3B 4
1 2 3A 3B 4
1 2 3A 3B 4
1 2 3A 3B 4
1 2 3A 3B 4
1 2 3A 3B 4
1 2 3A 3B 4
1 2 3A 3B 4
1 2 3A 3B 4
1 2 3A 3B 4
1 2 3A 3B 4

Levels of competence

Standar Kompetensi Dokter , Konsil Kedokteran Indonesia, 2006

KURIKULUM BERBASIS KOMPETENSI

(Problem Based learning)
MASALAH/DATA:
PEMECAHAN MASALAH/
RENCANA(Planning):

IDENTIFIKASI MASALAH/ANALISIS:

MASALAH/DATA:

PEMECAHAN MASALAH/
RENCANA(Planning):

DATA LAIN

Daftar keluhan Standar Kompetensi

Dokter Indonesia

RENCANA
BERIKUT
Ro

Batuk
Batuk darah
Nyeri dada
Sesak napas

PF,
IDENTIFIKASI MASALAH/ANALISIS:

OBSTRUKTIF
INFEKSI
KEGANASAN
PENYAKIT ORGAN LAIN

MASALAH/DATA:

PEMECAHAN MASALAH/
RENCANA(Planning):
DATA LAIN

Usia :Tua

Riwayat Merokok

Batuk
Batuk darah
Nyeri dada
Sesak napas

Riwayat
Pekerjaan/Lingkungan
Riwayat Obat (BD)
RENCANA BERIKUT

IDENTIFIKASI MASALAH/ANALISI

Pem Fisik :-Tanda Obtruktif:

Eksirasi memanjang/Meng
-Hipesonor
RO : Emfisema/

Corakan vakuler bertambah

OBSTRUKTIF : PPOK
INFEKSI (Parenkim)
KEGANASAN
PENYAKIT ORGAN LAIN

Known cases
Being treated

CLINICAL
HORIZON

Unknown cases
Not being treated

Fig.2. Cases of COPD : known or unknown to the GP

Goals of QoL
People with COPD include:
Being able to participate in activities
Having uninterrupted sleep
Avoiding emergency room visits and
hospitalizations
Being on the fewest medications that
control COPD with a minimum of
medication side effects.

Good clinical
outcome
Morbidity &
Mortality

Able to do
activities

GOOD QoL
Enjoying
life

Good
rehabilitation

Affordable cost /
Pharmacoeconomic consideration

Air Trapping and Hyperinflation

Airflow limitation in COPD results from
airway obstruction and
premature closure of the airways

Compliance implies that the patient

will follow doctor's orders, is in a less
informed position and has little or no
input into their management strategy
Adherence focuses more on
commitment to the regimen where the
therapy is the controlling factor. There
is at least reasonable negotiation
between members of the COPD care
team and the person with COPD.

International literature suggests that :

50% of people who suffer from

chronic disease do not adhere to

their treatment regimen and therefore
do not derive optimum benefits
(Royal Pharmaceutical Society 1997).

A telling fact is that 50% of patients

leave their GP's office without even

knowing what they have been told to do
(DiMatteo 1994).

Adherence is an issue that

must be addressed by
health professionals concerned:
The health outcomes of their patients
To improve the quality of life
To improve patient self-management

EDUCATION
PATIENT

PHYSICIAN

ADHERENCE

OPTIMALISATION
THERAPY

GOOD QoL

A patient's motivation, beliefs

and capacities in relation to
medicine-taking or selfmanagement are major
influences on adherence.

'The doctor/patient
relationship is the
pivotal link in
influencing patient
behaviour change
The principal determinant of best
health outcomes of COPDs was a
partnership relationship with a
doctor.'
(Anderson 1997)

Compliance implies that the patient will follow doctor's

orders, is in a less informed position and has little or no
input into their management strategy.
Adherence focuses more on commitment to the
regimen where the therapy is the controlling factor.
There is at least reasonable negotiation between
members of the COPD care team and the person with
COPD.
Concordance is based on a notion of equality and
respect for the patient and their autonomy, the desired
relationship in a therapeutic alliance between the care
team and person with COPD.

Factors affecting adherence:

Regimen complexity
Readability of material
The patients health beliefs
Attitudes to medications
The quality of interactions between
health professionals and patients
Psychosocial factors

Cigarette smoke

Alveolar macrophage

CD8+
lymphocyte

Neutrophil Chemotactic factors

Cytokines (IL-8)
Mediators (LTB4)

Neutrophil

_
ATT

PROTEASE
INHIBITORS

PROTEASES

Neutrophil elastase
Cathepsins
Matrix metalloproteinases

SLPI
TIMPs

Alveolar wall destruction

(Emphysema)

Mucus hypersecretion
(Chronic bronchitis)

Fig. 4. Inflammatory mechanisms in COPD

Obstructive / FEV1
6

Volume (liters)

5
4
3

FEV1

FVC

2
1
0

Time (sec)
Fig 2. Normal forced expiration curve

Natural History of COPD

Lung Failure

COPD
Chronic Obstructive
Chronic Hypoxcemia
Pulmoner Hypertention

Malnutrtion

Right Ventricle Hypertrophy

Inspiratory Muscle

Right Hearth Failure

Pump Failure

Pump Failure

(Inspiratory Muscle)

Inspiratory Muscle Training

Fig 3. PumpFailure COPD

Inspiratory Muscle Feeding

Intervention on COPD

COPD

Smoking Cessation

Bronchodilator
Oxygen Therapy

Inspiratory Muscle Training

Inspiratory Muscle Feeding

Treatment Options

To Provide Better Health

Related Quality of Life
No complication

Bronchodilators are
the cornerstone of the
treatment of COPD

To Relive Symptoms

To Reduce Exacerbations

Fig 4. Better Treatment Options of COPD

DIAGNOSIS OF COPD

A diagnosis of COPD should be considered

in any patient who has symptoms of cough,
sputum production, or dyspnea, and/or a
history of exposure to risk factors for the
disease.
The diagnosis is confirmed by spirometrie

R. A. Pauwels et al. AJCCM 2001; 163:1256-76

NHLBI/WHO Global Initiative (GOLD)

Definition of Chronic Obstructive

Pulmonary Disease (COPD)

COPD is a disease state characterized by

airflow limitation that is not fully reversible
The airflow limitation is usually both
progressive and associated with an
abnormal inflammatory response of the
lungs to noxious particles or gases.

R. A. Pauwels et al. AJCCM 2001; 163:1256-76

NHLBI/WHO Global Initiative (GOLD)

Air Trapping

Occurs in patients with COPD

Results in an increase in the work of breathing
Places respiratory muscles at a mechanical disadvantage
Contributes to the sensation of breathlessness (dyspnea)

Normal

Hyperinflation

Images courtesy of Denis ODonnell, Queens University, Kingston, Canada

Cycle of Air Trapping, Dyspnea, Reduced

Exercise Endurance, and Poor HRQL
Expiratory airflow limitation
Air trapping
Hyperinflation
Dyspnea
Deconditioning
Reduced
activity
Poor health-related quality of life

Normal Alveolar Emptying

Alveolar Emptying in COPD

In COPD, airflow is limited because alveoli lose their elasticity,

supportive structures are lost, and small airways are narrowed

Breathing in COPD

COPD CLASSIFICATION BY
SEVERITY (I)

Stage

0:
At Risk

I: Mild COPD

R. A. Pauwels et al. AJCCM 2001; 163:1256-76

NHLBI/WHO Global Initiative (GOLD)

Characteristics

Normal spirometry
Chronic symptoms
(cough, sputum production)
FEV1/FVC <70%
FEV1 80% predict.
With or without chronic
symptoms (cough, sputum
production)

COPD CLASSIFICATION BY SEVERITY (II)

Stage

Characteristics

II: Moderate COPD

FEV1/FVC <70%
30% FEV1 <80% pred.
(IIA: 50% FEV1 <80% pred.)
(IIB: 30% FEV1 <50% pred.)
With or without chronic symptoms
(cough, sputum production, dyspnea)

III:Severe COPD

FEV1/FVC <70%
FEV1 <30% predict., or the presence
of respiratory failure, or clinical signs
of right heart failure

R. A. Pauwels et al. AJCCM 2001; 163:1256-76

NHLBI/WHO Global Initiative (GOLD)

Life is not problem to be solved,

but a reality to be experienced
( Soren Kierkegaard)