REVISED 2011
PPOK adalah penyakit dapat dicegah dan
diobati dengan beberapa efek ekstrapulmoner
yang berkontribusi signifikan terhadap tingkat
keparahan
PPOK ditandai dengan keterbatasan aliran udara
yang tidak sepenuhnya reversibel. Keterbatasan
aliran udara biasanya progresif dan berhubungan
dengan respon inflamasi abnormal dari paru-paru
terhadap partikel dan gas beracun
Risk Factors for COPD
Nutrition
Infections
Socio-economic
status
Aging Populations
GOLD Update 2011
PATHOGENESIS OF COPD
PARTICLE
NOXIOUS GASES
HOST FACTORS
ANTI OXIDANTS
[ environmental ]
LUNG INFLAMMATION
REPAIR REPAIR
MECHANISM MECHANISM
AIRFLOW LIMITATION
AIRFLOW LIMITATION
GOLD Revision 2011
Air trapping
Airway obstruction
Lung hyperinflation
Normal COPD
Assessment of COPD
Assess symptoms
Assess degree of airflow limitation using
spirometry
Assess risk of exacerbations
Assess comorbidities
Airflow Limitation
Reversible Irreversible
Source:
1.http://bola.okezone.com/index.php/ReadStory/2008/05/02/50/105935/50/beijing-mulai-
Assessment of COPD
Assess symptoms
Assess degree of airflow limitation using spirometry
Use the
Assess riskCOPD Assessment Test(CAT)
of exacerbations
Assess comorbidities
or
mMRC Breathlessness scale
COPD Assessment
Test (CAT): An 8-
item measure of
health status
impairment in COPD
(http://catestonline.or
g).
Assessment of COPD
Assess symptoms
Assess degree of airflow limitation using spirometry
Assess risk of exacerbations
Assess
Usecomorbidities
spirometry for grading severity
according to spirometry, using four
grades split at 80%, 50% and 30% of
predicted value
Assess symptoms
Assess degree of airflow limitation using spirometry
Assess risk of exacerbations
Assess comorbidities
Use history of exacerbations and spirometry.
Two exacerbations or more within the last year
or an FEV1 < 50 % of predicted value are
indicators of high risk
(Exacerbation history)
3
Risk
Risk
2
1
(A) (B)
1 0
1 2
EXPOSURE TO
SYMPTOMS RISK FACTORS
COUGH Tobacco Smoke
SPUTUM Occupation
DYSPNEA Indoor / outdoor
pollution
SPIROMETRY
Manage Stable COPD:
Goals of Therapy
Relieve symptoms
Improve exercise tolerance Reduce
Improve health status symptoms
LAMA
SAMA prn or
A or LABA Theophylline
SABA prn or
SABA and SAMA
LAMA
SABA and/or SAMA
B or LAMA and LABA
Theophylline
LABA
ICS + LABA
PDE4-inh.
or
C LAMA and LABA SABA and/or SAMA
LAMA
Theophylline
REDUCE EXACERBATIONS
REDUCE MORTALITY
COPD MANAGEMENT
1
STOP SMOKING
ESTABLISH DIAGNOSIS HEALTHY LIFESTYLE
ASSESS SYMPTOMS IMMUNISATION
2
TREAT OBSTRUCTION BRONCHODILATORS
3
ASSESS FOR HYPOXIA LONG TERM
OXYGEN THERAPY
4
PULMONARY REHABILITATION
PROGRAMME
The Vicious Cycle of COPD
Shortness of
breath
Reduced
Anxiety activities
Reduced Muscle
activities weakness
Depression &
Malnutrition
social isolation
COPD
Prevention is always better than
cure