PENATALAKSANAAN ASMA

PADA
BERBAGAI KOMPLIKASI

EDDY MART SALIM

Sub Bag Alergi Imunologi
Ilmu Penyakit Dalam FK Unsri/RSMH
Palembang
 Mechanisms Underlying the
Definition of Asthma
Risk Factors
(for development of asthma)

INFLAMMATION

Airway
Hyperresponsiveness Airflow Obstruction

Risk Factors Symptoms

(for exacerbations)
 Mechanism of early and late phase
allergic reaction
0 1 6 8 24 48 (h)
Early phase Late phase Very late phase
APC
TNF- Epithelium
Ag IL-
MBP, ECP,
FcεRI EDN, CLC etc
IL-3 RANTES
IL-4 MCP-4 MBP, ECP,
Mast cells IL-5 Eotaxin
IL-8 EDN, CLC etc
Th2 B cells
GM-CSF
Eos
IL-4
Histamin, PGD2, IL-3
TNF-
LTs etc IL-4 IL-4
IL-5 IL-5
Th0 IL-8 IL-6
Th2
GM-CSF IL-13
MIP-1 RANTES
MCP-3
IL-4
RANTES IL-13 RANTES
Eotaxin Baso MIP-1 Eotaxin
IL-8 IL-8
GM-CSF Histamin, LTC4 GM-CSF
Endothelium PAF
VCAM-1 PAF
ICAM-1 Endothelium
VCAM-1
E-selectin
Eos Th2 Baso Eos
 Allergy may involve multiple
target organs systemic:
Organ Disease

Respiratory tract ………………. Asthma

Nose ……………………………. Allergic rhinitis
Eye …………………………….. Allergic conjunctivitis
Skin ……………………………. Urticaria
Central Nervous System …….. Migraine
Neuro-musculosceletal ……… Neuromyalgia
Digestive tract ………………… Diarrhea
Cardiovascular ………………... Anaphylactic shock
 Genetic risk for asthma, allergic
rhinitis, and atopic dermatitis
Odds ratio for the children to have a disease

3,5

3
Allergic disease
2,5 in 1 parent
Asthma
2
Rhinitis
1,5 Dermatitis

0,5

0
Asthma Allergic Atopic
rhinitis dermatitis
Dold S, et al. Archives of Disease in Childhood 1992;67:1018-1022
 Poli Alergi Imun PDL
Asma sering disertai :

Penyakit Atopi lain (Rhinitis, Urticaria dll)

Hamil
Hipertensi
Penyakit jantung
GERD
Diabetes, dll
 Asma –Rhinitis Alergi
Penanganan rasional rhinitis  perbaikan
gejala asma:
– Terapi topikal steroid
– Nasal dekongestan
– Antihistamin nonsedatif, 3rd generation
Penanganan holistik  cost effective & ↑
kualitas hidup
Idealnya ada topikal steroid sekaligus
untuk asma dan rhinitis
 Asma -- Hipertensi

Efedrin, Adrenalin  tdk diberikan

Bronkodilator + steroid  Aerosol √
Salbutamol, terbutalin, prokaterol, agonis
ß-2 lain  oral, dosis rendah √
Teofilin  Bronkodilator + ↓ tensi √
 Asma -- Hipertensi
ß-blocker-nonkardioselektif 
KONTRAINDIKASI
Kardioselektif  hindari
Anti asma gol Reserpin,
+ guanetidin,  Spasme bronkus
simpatomimetik metildopa

Hidralazin
+ Bronkodilator  Palpitasi
Minoksidil
 Asma -- Hipertensi

Diuretika  sputum kental  + mukolitik,

ekspektoran, banyak minum
Ca-antagonis  OK
Clonidine  OK
ACE-inh  Batuk  serangan asma
(indiv)
 Asma --- Kelainan Jantung

ß-agonis short acting inhalasi  jarang

takikardi & hipoksemia relatif aman
Inhalasi berlebihan/ per-oral  aritmia
Teofilin  OK--- CHF  clearance ↓
Ischaemic heart  Ca-antagonist OK
ß-blocker  KONTRAINDIKASI
ABSOLUT
 Asma --- Kehamilan
Asma  O2 darah ibu ↓  O2 darah janin ↓
 fetal death, premature, BBLR
Greenberger obat yg aman:
* Teofilin * Aminofilin
* Efedrin * Kromolin
* Prednison * Prednisolon
* Kombinasi fenobarbital
* Beclomethason inhalasi
* Hidrokortison
 Asma --- Kehamilan

Secara umum Asma Hamil atau tidakSama

Bila tidak di obati oxigenasi janin ↓Danger !
Bebera hal perlu di perhatikan :
Epinefrin  perfusi uterus ↓
Epinefrin 4 bln I  malformasi fetus ↑
Terbutalin, salbutamol  sering dipakai
Terbutalin  aterm  relaksasi uterus KI
 Asma --- Kehamilan
Betamethason & Dexamethason  ≠ krn
tidak diinaktivasi enzim plasenta
Metil prednisolon & prednison  OK
Antihistamin OK: difenhidramin,
tripelenamin, CTM
TM I  hindari oral
Acute asthma attack  inhalasi/nebulizer
Asma -- Gastro-oesophageal Reflux

teofilin  reflux ↑
ß2 Ag relatif aman
Inhalasi  OK
Terapi anti reflux:
OMZ, PPI >>> Ranitidin, Simetidin
 Asma --- Diabetes

In general asthma drugs  SAFE

Steroid oral atau injeksi  HINDARI 
blood sugar ↑
Steroid inhalasi  OK
 Ringkasan

Secara umum  preparat inhalasi

Gabungan B2 Ag (LABA) + Steroid
Oral/ par-ent ∽ dng peny penyerta
Obat2 peny penyerta ~ Asma
Benefit and Risk  pertimbangkan
TERIMA KASIH