2
Penyakit radang paru yang ditandai dengan adanya hambatan aliran
udara di saluran nafas yang tidak sepenuhnya reversibel, dan gangguan
pernafasan persisten, yang disebabkan oleh inhalasi partikel atau gas
berbahaya dalam jangka panjang
akibat
gangguan pada
saluran nafas
kecil Hambatan aliran
(bronkiolitis udara pada PPOK
obstruktif) bersifat progresif
kerusakan
parenkim paru
(emfisema)
Nagai A, Aizawa H, Aoshiba K, Asano K, Hirata K, Ichinose M, et al. Guidelines for the Diagnosis and Treatment of COPD Pocket
Guide. 3rd ed. Japan: The Japanese Respiratory Society; 2010. p. 4-7, 13-26.
Supari SF. Keputusan Menteri Kesehatan Republik Indonesia Nomor 1022/MENKES/SK/XI/2008 tentang Pedoman Pengendalian 3
Penyakit Paru Obstruktif Kronik. Jakarta: Menteri Kesehatan Republik Indonesia; 2008. p. 6.
Riset
WHO empat besar penyakit Kesehatan
tidak menular yang Dasar Prevalensi PPOK di
memiliki angka
Indonesia adalah
kematian tertinggi di
sebesar 3,7%
dunia (4,2 juta jiwa per
tahun)
Perubahan pada
Dispneu, Batuk persisten dan eksaserbasi
warna dan
kronik progresif PPOK
jumlah sputum
Alwan A, Amstrong T, Bettcher D, Branca F, Chisholm D, Ezzati M, et al. Global Status Report on
Noncommunicable Diseases 2010. Switzerland: WHO Press; 2011. p. 9-11.
Trihono. Riset Kesehatan Dasar 2013. Jakarta: Badan Penelitian dan Pengembangan Kesehatan Kementerian
Kesehatan RI; 2013. p. 85-7.
Khachi H, Barnes N, Antoniou S. COPD Clinical Features and Diagnosis. Clin Pharmacist. 2010;2:382-8. 4
mengupayakan
pencegahan
progresivitas
penyakit,
evaluasi dan
besarnya masalah penurunan gejala
modifikasi dari
yang ditimbulkan 2001 GOLD yang GOLD 2018
laporan konsensus
oleh PPOK memperburuk
GOLD sebelumnya
kualitas hidup,
serta pemecahan
masalah efek
samping obat
5
BAB II
EPIDEMIOLOGI DAN FAKTOR
RISIKO PPOK
6
Epidemiologi
dewasa usia > 40 tahun
bukan perokok, yaitu
prevalensi PPOK grade 2
sebesar 3-11%
atau lebih adalah 10,1%
Alwan A, Amstrong T, Bettcher D, Branca F, Chisholm D, Ezzati M, et al. Global Status Report on Noncommunicable Diseases 2010.
Switzerland: WHO Press; 2011. p. 9.
Trihono. Riset Kesehatan Dasar 2013. Jakarta: Badan Penelitian dan Pengembangan Kesehatan Kementerian Kesehatan RI; 2013. p.
85-6. 7
Faktor Risiko
Faktor Risiko Faktor Risiko Penting Faktor Risiko yang Mungkin
Terbesar
Faktor Asap Rokok Polusi Udara Infeksi pernafasan
Eksogen Perokok Pasif Faktor sosial ekonomi
Paparan pekerjaan terhadap
debu dan zat kimia
Faktor Defisiensi α-1 Mutasi gen
Endogen antitrypsin Hipersentivitas saluran
nafas
Respons autoimun
Penuaan
Nagai A, Aizawa H, Aoshiba K, Asano K, Hirata K, Ichinose M, et al. Guidelines for the Diagnosis and Treatment of COPD Pocket Guide. 3rd ed.
Japan: The Japanese Respiratory Society; 2010. p. 13-26.
Agusti A, Celli BR, Chen R, Criner G, Frith P, Halpin D, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive
Pulmonary Disease 2018 Report. Global Initiative for Chronic Obstructive Lung Disease; 2018. p. 4, 11, 79-94, 98-108
8
Khachi H, Barnes N, Antoniou S. COPD Clinical Features and Diagnosis. Clin Pharmacist. 2010;2:382-8.
BAB III
PATOFISIOLOGI PPOK
9
Penyebab Perubahan Patologis Paru pada
PPOK
Ketidakseimbangan
Sel dan Mediator
Stres Oksidatif Protease –
Inflamasi
Antiprotease
Agusti A, Celli BR, Chen R, Criner G, Frith P, Halpin D, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic
Obstructive Pulmonary Disease 2018 Report. Global Initiative for Chronic Obstructive Lung Disease; 2018. p. 4, 11, 79-94, 98-108.
10
Khachi H, Barnes N, Antoniou S. COPD Clinical Features and Diagnosis. Clin Pharmacist. 2010;2:382-8.
Agusti A, Celli BR, Chen R, Criner G, Frith P, Halpin D, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic
Obstructive Pulmonary Disease 2018 Report. Global Initiative for Chronic Obstructive Lung Disease; 2018. p. 4, 11, 79-94, 98-108.
11
Khachi H, Barnes N, Antoniou S. COPD Clinical Features and Diagnosis. Clin Pharmacist. 2010;2:382-8.
PATOFISIOLOGI PPOK
Hambatan
Abnormalitas Hipersekresi
Aliran Udara dan
Pertukaran Gas Mukus
Gas Trapping
Hipertensi Gangguan
Eksaserbasi
Pulmonal Sistemik
Agusti A, Celli BR, Chen R, Criner G, Frith P, Halpin D, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic
Obstructive Pulmonary Disease 2018 Report. Global Initiative for Chronic Obstructive Lung Disease; 2018. p. 4, 11, 79-94, 98-108.
Antariksa B, Djajalaksana S, Pradjnaparamita, Riyadi J, Yunus F, Suradi, et al. PPOK Diagnosis dan Penatalaksanaan. 1st rev ed. Jakarta:
Perhimpunan Dokter Paru Indonesia; 2011. p. 36-68.
Brashier BB, Kodgule R. Risk Factors and Pathophysiology of Chronic Obstructive Pulmonary Disease (COPD). Supplement to JAPI.
12
2012;60:17-21.
BAB IV
TATALAKSANA PPOK STABIL
13
Terapi Non Farmakologi
Smoking Pulmonary
Vaksinasi
cessation rehabilitation
Terapi
Ventilasi
Terapi oksigen endoskopi dan
mekanik
pembedahan
Agusti A, Celli BR, Chen R, Criner G, Frith P, Halpin D, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic
Obstructive Pulmonary Disease 2018 Report. Global Initiative for Chronic Obstructive Lung Disease; 2018. p. 4, 11, 79-94, 98-108.
Antariksa B, Djajalaksana S, Pradjnaparamita, Riyadi J, Yunus F, Suradi, et al. PPOK Diagnosis dan Penatalaksanaan. 1st rev ed. Jakarta:
Perhimpunan Dokter Paru Indonesia; 2011. p. 36-68.
King DA, Cordova F, Scharf SM. Nutritional Aspects of Chronic Obstructive Pulmonary Disease. Proc Am Thorac Soc. 2008;5:519-23. 14
Smoking cessation
Nagai A, Aizawa H, Aoshiba K, Asano K, Hirata K, Ichinose M, et al. Guidelines for the Diagnosis and Treatment of COPD Pocket
Guide. 3rd ed. Japan: The Japanese Respiratory Society; 2010. p. 13-26.
Antariksa B, Djajalaksana S, Pradjnaparamita, Riyadi J, Yunus F, Suradi, et al. PPOK Diagnosis dan Penatalaksanaan. 1st rev ed.
Jakarta: Perhimpunan Dokter Paru Indonesia; 2011. p. 36-68.
Tonnesen P. Smoking Cessation and COPD. Eur Respir Rev. 2013;22:127,37-43. 15
Pulmonary rehabilitation
1. Edukasi
dan
Managemen
diri
3.
2. Latihan
Manajemen
Fisik
Nutrisi
Agusti A, Celli BR, Chen R, Criner G, Frith P, Halpin D, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic
Obstructive Pulmonary Disease 2018 Report. Global Initiative for Chronic Obstructive Lung Disease; 2018. p. 4, 11, 79-94, 98-108.
Reardon J, Casaburi R, Morgan M, Nici L, Rochester C. Pulmonary Rehabilitation for COPD. Resp Med. 2005;99:S19-27.
Corhay JL, Dang DN, Cauwenberge HV, Louis R. Pulmonary Rehabilitation and COPD: Providing Patients a Good Environment for
Optimizing Therapy. Int J Chron Obstruct Pulmon Dis. 2014;9:27-39. 16
Vaksinasi
Vaksin
1 dosis/ tahun
influenza
Vaksin
1-2 dosis/ tahun Pneumoc
occus
Agusti A, Celli BR, Chen R, Criner G, Frith P, Halpin D, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic
17
Obstructive Pulmonary Disease 2018 Report. Global Initiative for Chronic Obstructive Lung Disease; 2018. p. 4, 11, 79-94, 98-108.
Terapi Oksigen
Mempertahankan
Oksigenasi seluler
Mencegah
kerusakan sel
Agusti A, Celli BR, Chen R, Criner G, Frith P, Halpin D, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic
Obstructive Pulmonary Disease 2018 Report. Global Initiative for Chronic Obstructive Lung Disease; 2018. p. 4, 11, 79-94, 98-108.
Stoller JK, Panos RJ, Krachman S, Doherty DE, Make B. Oxygen Therapy for Patients with COPD: Current Evidence and the Long-Term
Oxygen Treatment Trial. CHEST. 2010;138(1):179-87.
Antariksa B, Djajalaksana S, Pradjnaparamita, Riyadi J, Yunus F, Suradi, et al. PPOK Diagnosis dan Penatalaksanaan. 1st rev ed. Jakarta: 18
Perhimpunan Dokter Paru Indonesia; 2011. p. 36-68.
Ventilasi mekanik
Gejala Lelah, dispneu, nyeri kepala pagi hari
Kriteria fisiologis Salah satu dari dibawah ini:
PaCO2 ≥ 55 mmHg
PaCO2 50-54 mmHg dan desaturasi nokturnal (oksimeter ≤
88% selama 5 menit berturut-turut saat sedang mendapat
terapi oksigen ≥ 2 l/menit.
PaCO2 50-54 mmHg dan riwayat rawatan yang berhubungan
dengan gagal nafas hiperkapnik rekuren ( ≥ 2 kali dalam
setahun)
Agusti A, Celli BR, Chen R, Criner G, Frith P, Halpin D, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic
19
Obstructive Pulmonary Disease 2018 Report. Global Initiative for Chronic Obstructive Lung Disease; 2018. p. 4, 11, 79-94, 98-108.
Terapi Endoskopi dan Pembedahan
Lung
volume emfisema lobus
reduction atas
surgery
advanced
bronchoscopic lung
emphyse
volume reduction
ma
bulla
yang bullectomy
besar
Agusti A, Celli BR, Chen R, Criner G, Frith P, Halpin D, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic
20
Obstructive Pulmonary Disease 2018 Report. Global Initiative for Chronic Obstructive Lung Disease; 2018. p. 4, 11, 79-94, 98-108.
Terapi Farmakologi
Agusti A, Celli BR, Chen R, Criner G, Frith P, Halpin D, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic
Obstructive Pulmonary Disease 2018 Report. Global Initiative for Chronic Obstructive Lung Disease; 2018. p. 4, 11, 79-94, 98-108. 21
Agusti A, Celli BR, Chen R, Criner G, Frith P, Halpin D, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic
Obstructive Pulmonary Disease 2018 Report. Global Initiative for Chronic Obstructive Lung Disease; 2018. p. 4, 11, 79-94, 98-108. 22
BAB V
TATALAKSANA PPOK EKSASERBASI
23
Terapi Non Farmakologi
2.Terapi High-Flow
Terapi Oksigen Oxygen dengan Ventilasi Mekanik
Nasal Kanul
Agusti A, Celli BR, Chen R, Criner G, Frith P, Halpin D, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic
Obstructive Pulmonary Disease 2018 Report. Global Initiative for Chronic Obstructive Lung Disease; 2018. p. 4, 11, 79-94, 98-108. 24
Agusti A, Celli BR, Chen R, Criner G, Frith P, Halpin D, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic
Obstructive Pulmonary Disease 2018 Report. Global Initiative for Chronic Obstructive Lung Disease; 2018. p. 4, 11, 79-94, 98-108. 25
Terapi Farmakologi
Agusti A, Celli BR, Chen R, Criner G, Frith P, Halpin D, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic
Obstructive Pulmonary Disease 2018 Report. Global Initiative for Chronic Obstructive Lung Disease; 2018. p. 4, 11, 79-94, 98-108.
Hunter MH, King DE. COPD: Management of Acute Exacerbations and Chronic Stable Disease. Am Fam Physician. 2001;64(4):603-12.
Roisin RR. COPD Exacerbations Management. Thorax. 2006;61:535-44. 26
BAB VI
PENUTUP
27
Simpulan
1.Penatalaksanaan PPOK stabil secara umum
yaitu terapi non farmakologi, meliputi smoking
cessation, pulmonary rehabilitation (edukasi dan
manajemen diri, latihan fisik, serta manajemen
nutrisi), vaksinasi, terapi pernafasan, serta terapi
endoskopi dan pembedahan.
28
1.Dalam GOLD 2018, terdapat paradigma baru dalam
pengobatan PPOK stabil, yaitu LAMA/LABA baik tunggal
ataupun kombinasi lebih direkomendasikan untuk terapi
awal pada sebagian besar grup PPOK.
29
1.Terdapat tiga gejala kardinal PPOK
eksaserbasi, yaitu sesak yang semakin berat,
peningkatan volume sputum, dan
peningkatan purulensi sputum.
31
TERIMA KASIH
32