COPD/ PPOK

PAST - PRESENT - FUTURE

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 PPOK definisi :

PPOK adalah penyakit yang bisa dicegah dan

diobat serta mempunyai efek ekstrapulmoner
yang signifikan. Komponen paru dicirikan oleh
keterbatasan aliran yang tidak sepenuhnya
reversibel. Keterbatasan aliran ini biasanya
progresif dan berkaitan dengan respon inflamasi
yang tidak normal dari paru terhadap partikel
atau gas beracun.(GOLD,2009)
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FAKTOR - FAKTOR RESIKO (1)

Asap rokok: perokok aktif maupun

pasif

Polusi udara (dalam ruangan, luar

ruangan, di tempat kerja)

Infeksi saluran nafas berulang

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 FAKTOR - FAKTOR RESIKO (2)
Defisiensi alfa 1-antitripsin (AAT) :
Mekanisme melawan protease dilakukan AAT.
Menurunnya AAT menyebabkan peleburan dinding
alveolus. Defisiensi AAT dapat herediter

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FAKTOR - FAKTOR RESIKO (3)

Sosial ekonomi : banyak pada

sosio-ekonomi rendah.
Ras : Kulit putih lebih banyak.
Sex : Pria lebih banyak.

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Global Strategy for Diagnosis, Management and Prevention of COPD

Risk Factors for COPD

Genes

Infections

Socio-economic
status

Aging Populations
2015 Global Initiative for Chronic Obstructive Lung Disease
PATOGENESIS

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Bronkitis kronik
Kelainan sal. napas
ditandai batuk berdahak
minim 3 bln setahunnya,
sekurangnya 2 thn
berturutan, tak sebab
penyakit lain.

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Emfisema
Kelainan anatomis
paru luas ditandai
pelebaran rongga
udara distal
bronkiolus terminal,
dng kerusakan
dinding alveoli.

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Professor Peter J. Barnes, MD
National Heart and Lung Institute, London UK
Professor Peter J. Barnes, MD
National Heart and Lung Institute, London UK
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 DIAGNOSIS
Anamnesis
Riwayat merokok, terpajan zat iritan,
riwayat keluarga emfisema.

Batuk produktif. Purulen bila ada

infeksi.

Sesak napas, awalnya saat aktifitas,

bisa disertai mengi.
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 Global Strategy for Diagnosis, Management and Prevention of COPD

Diagnosis of COPD

EXPOSURE TO RISK
SYMPTOMS FACTORS
shortness of breath
tobacco
chronic cough occupation
sputum indoor/outdoor pollution

SPIROMETRY: Required to establish

diagnosis
2015 Global Initiative for Chronic Obstructive Lung Disease
Indikator Kunci Diagnosis PPOK
 Gambaran Klinis
Inspeksi: barrel chest, otot napas
tambahan menonjol, pursed lips. Posisi
meringankan sesak.
Palpasi: sela iga melebar dan cekung
Perkusi: hipersonor, diafragma rendah
gerakan terbatas, jantung sempit dan
panjang, hepar tertekan ke bawah.
Auskultasi: ekspirasi memanjang, suara
napas melemah, bunyi jantung jauh.
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Penegakan Dx PPOK di faskes I
Penegakan Dx PPOK di faskes I
Radiologis

Emfisema
volume membesar, sela
iga lebar dan datar,
diafragma rendah dan
datar, hiperaerasi,
vaskular menipis,
jantung panjang dan
sempit (tear drop app).
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Bronkitis
Corakan
paru
bertambah

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SPIROMETER
SPIROMETER

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 FAAL PARU/
SPIROMETRI
Tanda utama : obstruksi kronis
progresif ireversibel.

Obstruksi saluran napas kecil dan

peningkatkan volume paru istirahat.

Pada emfisema kapasitas paru total

meningkat dan luas permukaan
alveoli berkurang. 27
Spirometry: Normal Trace Showing
FEV1 and FVC

5 FVC
4
Volume, liters

FEV1 = 4L
3
FVC = 5L
2
FEV1/FVC = 0.8
1

1 2 3 4 5 6

Time, sec
2015 Global Initiative for Chronic Obstructive Lung Disease
 Spirometry: Obstructive Disease

5 Normal

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Volume, liters

3
FEV1 = 1.8L
2 FVC = 3.2L
Obstructive
FEV1/FVC = 0.56
1

1 2 3 4 5 6

Time, seconds

2015 Global Initiative for Chronic Obstructive Lung Disease

Analisa gas darah arterial
Hipoksia,
pada keadaan berat hiperkapnia.

Kapasitas difusi ( gas transfer )

Kapasitas difusi CO ( DLCO )
menurun, juga transfer oksigen.

Exercise testing
Pada PPOK ringan terjadi hipoksia saat
latihan, mengukur gradasi. 30
DD PPOK dan ASMA
Professor Peter J. Barnes, MD
National Heart and Lung Institute, London UK
Penatalaksanaan
Penatalaksanaan PPOK stabil
 Global Strategy for Diagnosis, Management and Prevention of COPD
Therapeutic Options: COPD Medications

Beta2-agonists
Short-acting beta2-agonists
Long-acting beta2-agonists
Anticholinergics
Short-acting anticholinergics
Long-acting anticholinergics
Combination short-acting beta2-agonists + anticholinergic in one inhaler
Combination long-acting beta2-agonist + anticholinergic in one inhaler
Methylxanthines
Inhaled corticosteroids
Combination long-acting beta2-agonists + corticosteroids in one inhaler
Systemic corticosteroids
Phosphodiesterase-4 inhibitors

2015 Global Initiative for Chronic Obstructive Lung Disease

 Global Strategy for Diagnosis, Management and Prevention of COPD

Manage Exacerbations

An exacerbation of COPD is:

an acute event characterized by a
worsening of the patients respiratory
symptoms that is beyond normal day-
to-day variations and leads to a
change in medication.

2015 Global Initiative for Chronic Obstructive Lung Disease

 Global Strategy for Diagnosis, Management and Prevention of COPD

Manage Exacerbations: Key Points

The most common causes of COPD exacerbations
are viral upper respiratory tract infections and
infection of the tracheobronchial tree.
Diagnosis relies exclusively on the clinical
presentation of the patient complaining of an acute
change of symptoms that is beyond normal day-to-
day variation.
The goal of treatment is to minimize the impact of
the current exacerbation and to prevent the
development of subsequent exacerbations.
2015 Global Initiative for Chronic Obstructive Lung Disease
 Global Strategy for Diagnosis, Management and Prevention of COPD

Manage Exacerbations: Key Points

Short-acting inhaled beta2-agonists with or without
short-acting anticholinergics are usually the
preferred bronchodilators for treatment of an
exacerbation.
Systemic corticosteroids and antibiotics can shorten
recovery time, improve lung function (FEV1) and
arterial hypoxemia (PaO2), and reduce the risk of
early relapse, treatment failure, and length of
hospital stay.
COPD exacerbations can often be prevented.
2015 Global Initiative for Chronic Obstructive Lung Disease
 Global Strategy for Diagnosis, Management and Prevention of COPD

Manage Exacerbations: Assessments

Arterial blood gas measurements (in hospital) : PaO2 < 8.0 kPa
with or without PaCO2 > 6.7 kPa when breathing room air
indicates respiratory failure.
Chest radiographs: useful to exclude alternative diagnoses.
ECG: may aid in the diagnosis of coexisting cardiac problems.
Whole blood count: identify polycythemia, anemia or bleeding.
Purulent sputum during an exacerbation: indication to begin
empirical antibiotic treatment.
Biochemical tests: detect electrolyte disturbances, diabetes, and
poor nutrition.
Spirometric tests: not recommended during an exacerbation.
2015 Global Initiative for Chronic Obstructive Lung Disease
 Global Strategy for Diagnosis, Management and Prevention of COPD

Manage Exacerbations: Treatment Options

Oxygen: titrate to improve the patients hypoxemia with a target

saturation of 88-92%.

Bronchodilators: Short-acting inhaled beta2-agonists with or without

short-acting anticholinergics are preferred.

Systemic Corticosteroids: Shorten recovery time, improve lung

function (FEV1) and arterial hypoxemia (PaO2), and reduce the risk
of early relapse, treatment failure, and length of hospital stay. A
dose of 40 mg prednisone per day for 5 days is recommended .

2015 Global Initiative for Chronic Obstructive Lung Disease

 Global Strategy for Diagnosis, Management and Prevention of COPD

Manage Exacerbations: Treatment Options

Oxygen: titrate to improve the patients hypoxemia with a target

saturation of 88-92%.

Bronchodilators: Short-acting inhaled beta2-agonists with or

without short-acting anticholinergics are preferred.

Systemic Corticosteroids: Shorten recovery time, improve lung

function (FEV1) and arterial hypoxemia (PaO2), and reduce the risk
of early relapse, treatment failure, and length of hospital stay. A
dose of 40 mg prednisone per day for 5 days is recommended.
Nebulized magnesium as an adjuvent to salbutamol treatment in the
setting of acute exacerbations of COPD has no effect on FEV1.
2015 Global Initiative for Chronic Obstructive Lung Disease
 Global Strategy for Diagnosis, Management and Prevention of COPD

Manage Exacerbations: Treatment Options

Antibiotics should be given to patients with:

Three cardinal symptoms: increased

dyspnea, increased sputum volume, and
increased sputum purulence.
Who require mechanical ventilation.

2015 Global Initiative for Chronic Obstructive Lung Disease

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 DERAJAT PPOK

Derajat I : RINGAN
Dengan atau tanpa gejala klinis (batuk
produksi sputum)
VEP1 80% prediksi
VEP1 / KVP < 70%
SABA, short actring anticholinergic
(maintenance). Long acting anticholinergic
k/p
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 DERAJAT PPOK

Derajat II : SEDANG
Dengan atau tanpa gejala klinis (batuk, produksi
sputum) gejala bertambah sehingga menjadi sesak
VEP 1/ KVP < 70 %
50%< VEP1 < 80 % prediksi
LABA, Simptomatik, anti kolinergik kerja lama
(maintanance)
Rehabilitasi
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 DERAJAT PPOK

Derajat III BERAT

Dengan atau tanpa gejala klinis (batuk,
produksi sputum)Gejala bertambah hingga
menjadi sesak
VEP1/KVP < 70 %
30 %< VEP1<50% prediksi
Tx dengan lebih dari 1 bronkodilator,
Kortikosteroid inhalasi bila respon klinis baik.
Rehabilitasi.
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 DERAJAT PPOK

DERAJAT IV SANGAT BERAT

Gejala diatas ditambah tanda-tanda gagal
nafas atau gagal jantung kanan.
VEP1/KVP <70 %
VEP1 < 30 % prediksi
TX sama dengan diatas ditambah terapi
oksigen jika gagal nafas dan pertimbangkan
pembedahan.
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Penatalaksanaan PPOK

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 PENATALAKSANAAN
Tujuan
Memperlambat Progresivitas PPOK
Mengurangi berbagai keluhan, kelainan
dan menangani fase eksaserbasi akut
Memperbaiki kualitas hidup penderita
Menurunkan kematian

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 PENATALAKSANAAN
UMUM
Stop merokok, hindari
polutan
Pendidikan pasien dan
keluarga
Hindari infeksi
Lingkungan sehat
Kebutuhan cairan
cukup
Makanan cukup gizi
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 REHABILITASI
Fisioterapi
Bertujuan memobilisasi sputum, membuat
pernapasan lebih efektif dan mengembalikan
fisik ke tingkat yang optimal.

Latihan relaksasi.
Latihan bernapas dengan menyertakan otot-
otot dinding perut.
Perkusi dinding dada dan drainase postural.
Program uji latih dengan treadmill dan
sepeda ergometer. 51
 PEMBEDAHAN

a. Lung reduction surgery ( pneumoplasty )

b. Bulektomi
c. Transplantasi

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PROGNOSA
Lambat - cepat PPOK
menuju stadium
terminal, gagal napas
atau korpulmonale
kronik dekompensata.
Terjadinya infeksi bisa
berlarut-larut dan
menimbulkan kematian
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TERAPI INHALASI

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TERIMAKASIH

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