Fathur Nur Kholis,dr.

SpPD
Divisi Respirologi dan Perawatan Penyakit Kritis
KSM/Bagian Penyakit Dalam FK UNDIP/RSUP. Dr. Kariadi
 PASIEN GAWAT DARURAT
pasien yg.tiba tiba dlm.keadaan
gawat / akan mengalami gawat
& terancam nyawanya / anggota
ba-dannya (cacat) bila
tdk.mendapat pertolongan
secepatnya.
 PASIEN GAWAT TIDAK
DARURAT
pasien berada dlm.keadaan gawat
tetapi tdk.memerlukan tindakan
darurat.
Dep.Kes.RI, 1992
 Gawat darurat Asma Br
 Sebagai penyakit kronik, Asma Br
juga dapat berbentuk akut dan
melibatkan sistem organ manapun
serta berakibat kegagalan multi
organ.
 Membutuhkan perhatian dalam
penegakan diagnosis tepat cepat
karena spektrum klinisnya
overlapping dg penyakit lain
 Kematian dan kecacatan tinggi
 Membutuhkan pertolongan cepat
Apakah asma bronkhiale?

Asma bronkhiale adalah kelainan inflamasi kronik cabang

trakeo-bronkial yang berakibat hiperresponsif bronkus,
ditandai adanya serangan obstruksi saluran nafas berulang
berupa:
 sesak nafas,
 mengi,
 rasa tertekan di dada
 batuk – batuk,
 umumnya terjadi malam hari / pagi.
Serangan sesak nafas umumnya reversibel dengan atau tanpa
pengobatan.
Kelainan ini tdk dapat dihilangkan tp dapat di kendalikan
 Assesment Kegawatan
SCORING KESADARAN
(GLASGOW COMA SCALE)

BUKA MATA
1. Tidak ada
2. Bila dirangsang nyeri
Abnormal airway sounds
3. Bila disuruh dengan perkataan
4. Spontan membuka sendiri
Abnormal positioning
RESPON MOTORIK
Retractions

Wo
1. Tidak ada

e
2. Ekstensi Nasal flaring

nc

rk
3. Fleksi tidak normal
4. Menarik bila terangsang

of
5.
6.
Menunjuk pada tempat nyeri
Sesuai dengan perintah
ra

Bre
ea
RESPON VERBAL
1. Tidak ada
p

a
2. Tidak ada artinya

thi
Ap

3. Berkata tapi tidak benar

4. Berbicara ngacau

ng
5. Orientasi baik
Circulation to Skin
Circulation to Skin
1. Heart rate 2. Systematic perfusion 3. Blood pressure
Peripheral pulses
Skin perfusion
Appearance (Urine output)
Respiratory distress Shock

N  N N

N N
Primary CNS dysfunction/
metabolic abnormality Cardiopulmonary failure

N N N /

N N
 KEGAWATAN
Kesadaran
ASMA Br
Respiratory dysfunction
Reflek pertahanan tidak baik / tidak ada Potential respiratory failure
Gangguan reflek batuk : mudah teraspirasi isi
lambung dan menumpuknya lendir jalan nafas
Probable respiratory failure
→ sumbatan jalan nafas. Hipoksia
Gangguan reflek menelan : mudah muntah

Gangguan jalan nafas : mudah tersumbat.

Gangguan orientasi diri: mudah jatuh, gaduh gelisah Syok

Compensated
Decompensated

Gangguan fungsi
Cardiovasculer-sirkulasi
Cardiopulmonary failure
 Trombo-emboli,DIC
 Syok Distributif
 Kontraktilitas miokard 
 Cardiac output 
 Tensi 
 Perfusi ke organ2 
 Respon vaskular thd katekolamin 
 Syok Distributif
Differential diagnostic

• COPD
• SOPT
• Upper airway obstruction and inhaled foreign bodies
• Vocal cord dysfunction
• Diffuse parenchymal lung disease
• Hyperventilation syndrome
• Left ventricular failure
 Asma Serangan akut

 Asma akut : perburukan serangan asma

secara progresif berupa sesak nafas,mengi
dan dada berat
 Asma akut merupakan kedaruratan medik
yang dapat menyebabkan kematian.
  A flare-up or exacerbation is an acute or sub-acute worsening
of symptoms and lung function compared with the patient’s usual
status
 Terminology
 ‘Flare-up’ is the preferred term for discussion with patients
 ‘Exacerbation’ is a difficult term for patients
 ‘Attack’ has highly variable meanings for patients and clinicians
 ‘Episode’ does not convey clinical urgency
 Consider management of worsening asthma as a continuum
 Self-management with a written asthma action plan
 Management in primary care
 Management in the emergency department and hospital
 Follow-up after any exacerbation

GINA 2015
 Beberapa pertanyaan yang mengarah
pada diagnosis asma bronkhiale

• Apakah pasien pernah atau berulangkali mengalami

serangan sesak nafas mengi?
• Apakah pasien mempunyai keluhan batuk malam hari yang
cukup mengganggu?
• Apakah pasien mengalami sesak mengi dan batuk batuk
setelah melakukan aktifitas/olah raga?
• Apakah pasien mengalami sesak nafas, nafas mengi atau
batuk batuk setelah terpapar/mengirup alergen atau
• Apakah keluhan keluhan diatas berkurang atau
menghilang dengan pemberian obat-obat asma?
  Patients at increased risk of asthma-related death should be identified
 Any history of near-fatal asthma requiring intubation and ventilation
 Hospitalization or emergency care for asthma in last 12 months
 Not currently using ICS, or poor adherence with ICS
 Currently using or recently stopped using OCS
▪ (indicating the severity of recent events)
 Over-use of SABAs, especially if more than 1 canister/month
 Lack of a written asthma action plan
 History of psychiatric disease or psychosocial problems
 Confirmed food allergy in a patient with asthma
 Flag these patients for more frequent review

GINA 2017, Box 4-1

 Rationale for change in recommendation about
controller therapy in asthma action plans

For the last 10 years, most guidelines recommended treating

worsening asthma with SABA alone until OCS were needed, but ...
Most exacerbations are characterised by increased inflammation
Most evidence for self-management involved doubling ICS dose
 Outcomes were consistently better if the action plan prescribed both increased ICS,
and OCS
Lack of generalisability of placebo-controlled RCTs of doubling ICS
 Participants were required to be highly adherent
 Study inhalers were not started, on average, until symptoms and airflow limitation
had been worsening for 4-5 days.
Severe exacerbations are reduced by short-term treatment with
 Quadrupled dose of ICS
 Quadrupled dose of budesonide/formoterol
 Early small increase in ICS/formoterol (maintenance & reliever regimen)
Adherence by community patients is poor
 Patients commonly take only 25-35% of prescribed controller dose
 Patients often delay seeking care for fear of being given OCS

GINA 2017
 Patofisiologi

 Kontraksi otot polos bronkus

 Hiperreaktifitas bronkus

 Proses peradangan saluran nafas

 Pemeriksaan Fisik
 KU : kesadaran normal/ menurun, gelisah,
takipneu/bradipneu
 Kerja otot2 bantu nafas, dada empisema
 Stridor ekspirasi, eksperium diperpanjang,
mengi ( wheezing)
 Auskultasi : suara dasar melemah, wheezing
diffus, eksperium memanjang, silent chest
(dalam keadaan berat)
 Pulsus paradoksus
 Klasifikasi beratnya asma eksaserbasi
Tanda / Gejala Ringan Sedang Berat AncamanGagal Nafas

Sesak nafas Berjalan Berbicara Istirahat

Dapat terlentang Lebih suka duduk Membungkuk

Berbicara Membuat kalimat Membuat frase Membuat kata

Kesadaran Mungkin gelisah Selalu gelisah Selalu gelisah Mengantuk atau
bingung

Laju pernafasan Meningkat Meningkat > 30/menit

Otot tambahan retraksi Tidak Biasa ada Biasa ada Pergerakan poradok
suprasternal torako abdominal

Wheezing Sedang sering pada keras Sangat keras Tidak ada wheezing.
saat ekspirasi

Nadi/menit < 100 100 - 120 > 120 Bradikardi

Pulsus paradoksus < 10 mmHg 10 – 25 mmHg > 25 mmHg Tidak ada
Dicurigai adanya kelelahan
otot nafas.

APE > 80% 60 – 80 % < 60 %

PaO2 Normal > 60 mmHg < 60 mmHg
PaCO2 < 45 mmHg < 45 mmHg > 45 mmHg

SaO2% > 95 % 91 – 95 % <90 %

 Tempat perawatan penderita kumat asma
Ditentukan berdasarkan berat – ringan kumat asma :
1. Serangan ringan :
 di rumah penderita
 perawatan mandiri penderita
2. Serangan sedang (di UGD RS / Puskesmas) :
 rawat jalan
 rawat sementara ( Kp )
3. Serangan berat, (perlu acute care setting) :
 UGD sementara (pengawasan)
 RS (ruang biasa)
 ICU ?
4. Serangan berat dan mengancam jiwa
 di ICU (dipenuhi indikasi tertentu)
 Tujuan dari Penatalaksanaan
Eksaserbasi Asma (asma akut)

• Membebaskan obstruksi jalan napas dan

hipoksemia secepat mungkin
• Mencegah kekambuhan

Catatan: makin cepat pengobatan dimulai, makin mudah mengatasi serangan .

GINA Updated 2017

PENANGANAN
ASMA AKUT

DI RUMAH
 Effective asthma self-management education requires:

• Self-monitoring of symptoms and/or lung function If PEF or FEV1

<60% best, or not
• Written asthma action plan improving after
• Regular medical review 48 hours
All patients Continue reliever

Increase reliever Continue controller

Early increase in Add prednisolone

controller as below 40–50 mg/day

Review response Contact doctor

EARLY OR MILD LATE OR SEVERE

GINA 2017, Box 4-2 (1/2)

 NILAI BERAT SERANGAN
TERAPI AWAL

RESPON

BAIK (mild episode)

>>> ke dokter

KURANG (moderate episode)

>>> ke dokter

BURUK (severe episode)

>>> ke IGD
 TERAPI AWAL

2 - 4 x SEMPROT/HIRUP PELEGA
 DIULANG TIAP 20 menit
 BOLEH SAMPAI 3x
ATAU NEBULISER 1 jam
 RESPON BAIK
mild episode

1. APE > 80 %
2. MENGI/SESAK HILANG
RESPON BERTAHAN 4 JAM

 P/r-m:

 LANJUTKAN PELEGA TIAP 3-4 JAM DALAM 24-48 JAM

 PASIEN DENGAN STEROID INHALER DOSIS
DIGANDAKAN UNTUK 7-10 HARI
>>> KONTAK KE DOKTER
 RESPON KURANG
moderate episode

1.APE 60 - 80 %
2.MENGI DAN SESAK MASIH tetap
P/r-m:

TAMBAH STEROID MINUM (Sistemik)

 LANJUTKAN PELEGA INHALER
>>> KONTAK KE DOKTER SEGERA
 RESPON BURUK
severe episode
1.APE < 60 %
2.MENGI DAN SESAK masih tetap/Tambah berat

P/r-m:
 TAMBAH STEROID MINUM
 PELEGA DIULANG
 TIDAK RESPON
>>> BAWA KE IGD
Obat Asma yang ideal

 Berfungsi sebagai controller dan

reliever
 Bentuk inhalasi
 Dosis cukup di dalam saluran nafas
 Efektif
 Efek samping minimal
 Penggunaan praktis
 METODE LAMA

Kosong ¼ ½ ¾ penuh
penuh penuh penuh

METODE BARU
Alat dosis tunggal/ single dose

Alat Multidosis
Inhalasi Agonis B-2
Onset Durasi
Singkat Lama

Cepat Fenoterol Formoterol

Prokaterol
Salbutamol
Albuterol
Terbutalin
Pirbuterol

Lambat Salmeterol
Obat-Obatan Reliever

Cortikosteroid
Bronkodilator
antikolinergik
 Managing exacerbations in primary care
PRIMARY CARE Patient presents with acute or sub-acute asthma exacerbation

Is it asthma?

ASSESS the PATIENT Risk factors for asthma-related death?

Severity of exacerbation?

MILD or MODERATE SEVERE

Talks in phrases, prefers
sitting to lying, not agitated
Respiratory rate increased
Accessory muscles not used
Pulse rate 100–120 bpm
O2 saturation (on air) 90–95%
PEF >50% predicted or best
Talks in words, sits hunched
LIFE-THREATENING
forwards, agitated Drowsy, confused
Respiratory rate >30/min or silent chest
Accessory muscles in use
Pulse rate >120 bpm
O2 saturation (on air) <90%
PEF ≤50% predicted or best URGENT

START TREATMENT
SABA 4–10 puffs by pMDI + spacer, TRANSFER TO ACUTE
repeat every 20 minutes for 1 hour CARE FACILITY
WORSENING
Prednisolone: adults 1 mg/kg, max.
50 mg, children 1–2 mg/kg, max. 40 mg While waiting: give inhaled SABA
and ipratropium bromide, O2,
Controlled oxygen (if available): target
systemic corticosteroid
saturation 93–95% (children: 94-98%)

CONTINUE TREATMENT with SABA as needed

WORSENING
ASSESS RESPONSE AT 1 HOUR (or earlier)

IMPROVING

ASSESS FOR DISCHARGE ARRANGE at DISCHARGE

Symptoms improved, not needing SABA Reliever: continue as needed
PEF improving, and >60-80% of personal Controller: start, or step up. Check inhaler
best or predicted technique, adherence
Oxygen saturation >94% room air Prednisolone: continue, usually for 5–7 days
Resources at home adequate (3-5 days for children)
Follow up: within 2–7 days

FOLLOW UP
Reliever: reduce to as-needed
Controller: continue higher dose for short term (1–2 weeks) or long term (3 months), depending
on background to exacerbation
Risk factors: check and correct modifiable risk factors that may have contributed to exacerbation,
including inhaler technique and adherence
Action plan: Is it understood? Was it used appropriately? Does it need modification?

GINA 2017, Box 4-3 (1/7)

 PRIMARY CARE Patient presents with acute or sub-acute asthma exacerbation

Is it asthma?
ASSESS the PATIENT Risk factors for asthma-related death?
Severity of exacerbation?

LIFE-THREATENING
Drowsy, confused
or silent chest

URGENT

TRANSFER TO ACUTE
CARE FACILITY
While waiting: give inhaled SABA and
ipratropium bromide, O2, systemic
corticosteroid

GINA 2017, Box 4-3 (2/7) © Global Initiative for Asthma

 PRIMARY CARE
ASSESS the PATIENT
MILD or MODERATE
Talks in phrases, prefers
sitting to lying, not agitated
Respiratory rate increased
Accessory muscles not used
Pulse rate 100–120 bpm
O2 saturation (on air) 90–95%
PEF >50% predicted or best
GINA 2017, Box 4-3 (3/7)
Patient presents with acute or sub-acute asthma exacerbation
Is it asthma?
Risk factors for asthma-related death?
Severity of exacerbation?
SEVERE
Talks in words, sits hunched LIFE-THREATENING
forwards, agitated Drowsy, confused
Respiratory rate >30/min or silent chest
Accessory muscles in use
Pulse rate >120 bpm
O2 saturation (on air) <90%
PEF ≤50% predicted or best URGENT
TRANSFER TO ACUTE
CARE FACILITY
While waiting: give inhaled SABA and
ipratropium bromide, O2, systemic
corticosteroid
© Global Initiative for Asthma
 PRIMARY CARE Patient presents with acute or sub-acute asthma exacerbation

Is it asthma?
ASSESS the PATIENT Risk factors for asthma-related death?
Severity of exacerbation?

MILD or MODERATE SEVERE

Talks in phrases, prefers Talks in words, sits hunched LIFE-THREATENING
sitting to lying, not agitated forwards, agitated Drowsy, confused
Respiratory rate increased Respiratory rate >30/min or silent chest
Accessory muscles not used Accessory muscles in use
Pulse rate 100–120 bpm Pulse rate >120 bpm
O2 saturation (on air) 90–95% O2 saturation (on air) <90%
PEF >50% predicted or best PEF ≤50% predicted or best URGENT

START TREATMENT
TRANSFER TO ACUTE
SABA 4–10 puffs by pMDI + spacer,
repeat every 20 minutes for 1 hour CARE FACILITY
WORSENING While waiting: give inhaled SABA and
Prednisolone: adults 1 mg/kg, max.
50 mg, children 1–2 mg/kg, max. 40 mg ipratropium bromide, O2, systemic
Controlled oxygen (if available): target corticosteroid
saturation 93–95% (children: 94-98%)

GINA 2017, Box 4-3 (4/7) © Global Initiative for Asthma

 START TREATMENT
SABA 4–10 puffs by pMDI + spacer, TRANSFER TO ACUTE
repeat every 20 minutes for 1 hour CARE FACILITY
Prednisolone: adults 1 mg/kg, max. WORSENING
While waiting: give inhaled SABA and
50 mg, children 1–2 mg/kg, max. 40 mg ipratropium bromide, O2, systemic
Controlled oxygen (if available): target corticosteroid
saturation 93–95% (children: 94-98%)

CONTINUE TREATMENT with SABA as needed

WORSENING
ASSESS RESPONSE AT 1 HOUR (or earlier)

IMPROVING

ASSESS FOR DISCHARGE

Symptoms improved, not needing SABA
PEF improving, and >60-80% of personal
best or predicted
Oxygen saturation >94% room air
Resources at home adequate

GINA 2017, Box 4-3 (5/7)

START TREATMENT
SABA 4–10 puffs by pMDI + spacer, TRANSFER TO ACUTE
repeat every 20 minutes for 1 hour CARE FACILITY
Prednisolone: adults 1 mg/kg, max. WORSENING
While waiting: give inhaled SABA and
50 mg, children 1–2 mg/kg, max. 40 mg ipratropium bromide, O2, systemic
Controlled oxygen (if available): target corticosteroid
saturation 93–95% (children: 94-98%)

CONTINUE TREATMENT with SABA as needed

WORSENING
ASSESS RESPONSE AT 1 HOUR (or earlier)

IMPROVING

ASSESS FOR DISCHARGE ARRANGE at DISCHARGE

Symptoms improved, not needing SABA Reliever: continue as needed
PEF improving, and >60-80% of personal Controller: start, or step up. Check inhaler technique,
best or predicted adherence
Oxygen saturation >94% room air Prednisolone: continue, usually for 5–7 days
Resources at home adequate (3-5 days for children)
Follow up: within 2–7 days
 START TREATMENT
SABA 4–10 puffs by pMDI + spacer, TRANSFER TO ACUTE
repeat every 20 minutes for 1 hour CARE FACILITY
Prednisolone: adults 1 mg/kg, max. WORSENING
While waiting: give inhaled SABA and
50 mg, children 1–2 mg/kg, max. 40 mg ipratropium bromide, O2, systemic
Controlled oxygen (if available): target corticosteroid
saturation 93–95% (children: 94-98%)

CONTINUE TREATMENT with SABA as needed

WORSENING
ASSESS RESPONSE AT 1 HOUR (or earlier)

IMPROVING

ASSESS FOR DISCHARGE ARRANGE at DISCHARGE

Symptoms improved, not needing SABA Reliever: continue as needed
PEF improving, and >60-80% of personal Controller: start, or step up. Check inhaler technique,
best or predicted adherence
Oxygen saturation >94% room air Prednisolone: continue, usually for 5–7 days
Resources at home adequate (3-5 days for children)
Follow up: within 2–7 days

FOLLOW UP
Reliever: reduce to as-needed
Controller: continue higher dose for short term (1–2 weeks) or long term (3 months), depending
on background to exacerbation
Risk factors: check and correct modifiable risk factors that may have contributed to exacerbation,
including inhaler technique and adherence
Action plan: Is it understood? Was it used appropriately? Does it need modification?

GINA 2017, Box 4-3 (7/7)

 Riwayat asma berat atau risiko tinggi
 Tidak ada respons setelah inhalasi 1 jam
pertama.
 Pemakaian obat asma pelega yang tidak
respons pada gejala gejala asma
 INITIAL ASSESSMENT Are any of the following present?
A: airway B: breathing C: circulation Drowsiness, Confusion, Silent chest

NO
YES

Further TRIAGE BY CLINICAL STATUS Consult ICU, start SABA and O2,
according to worst feature and prepare patient for intubation

MILD or MODERATE SEVERE

Talks in phrases Talks in words

Prefers sitting to lying Sits hunched forwards
Not agitated Agitated
Respiratory rate increased Respiratory rate >30/min
Accessory muscles not used Accessory muscles being used
Pulse rate 100–120 bpm Pulse rate >120 bpm
O2 saturation (on air) 90–95% O2 saturation (on air) < 90%
PEF >50% predicted or best PEF ≤50% predicted or best

Short-acting beta2-agonists Short-acting beta2-agonists

Consider ipratropium bromide Ipratropium bromide
Controlled O2 to maintain Controlled O2 to maintain
saturation 93–95% (children 94-98%) saturation 93–95% (children 94-98%)
Oral corticosteroids Oral or IV corticosteroids
Consider IV magnesium
Consider high dose ICS

If continuing deterioration, treat as

severe and re-aassess for ICU

ASSESS CLINICAL PROGRESS FREQUENTLY

MEASURE LUNG FUNCTION
in all patients one hour after initial treatment

FEV1 or PEF 60-80% of predicted or FEV1 or PEF <60% of predicted or

personal best and symptoms improved personal best,or lack of clinical response
SEVERE
MODERATE
Continue treatment as above
Consider for discharge planning and reassess frequently

GINA 2017, Box 4-4 (1/4)

 INITIAL ASSESSMENT Are any of the following present?
A: airway B: breathing C: circulation Drowsiness, Confusion, Silent chest

NO
YES

Further TRIAGE BY CLINICAL STATUS Consult ICU, start SABA and O2,
according to worst feature and prepare patient for intubation

MILD or MODERATE SEVERE

Talks in phrases Talks in words
Prefers sitting to lying Sits hunched forwards
Not agitated Agitated
Respiratory rate increased Respiratory rate >30/min
Accessory muscles not used Accessory muscles being used
Pulse rate 100–120 bpm Pulse rate >120 bpm
O2 saturation (on air) 90–95% O2 saturation (on air) < 90%
PEF >50% predicted or best PEF ≤50% predicted or best

GINA 2017, Box 4-4 (2/4)

 MILD or MODERATE
Talks in phrases
Prefers sitting to lying
Not agitated
Respiratory rate increased
Accessory muscles not used
Pulse rate 100–120 bpm
O2 saturation (on air) 90–95%
PEF >50% predicted or best
Short-acting beta2-agonists
Consider ipratropium bromide
Controlled O2 to maintain
saturation 93–95% (children 94-98%)
Oral corticosteroids
GINA 2017, Box 4-4 (3/4)
SEVERE
Talks in words
Sits hunched forwards
Agitated
Respiratory rate >30/min
Accessory muscles being used
Pulse rate >120 bpm
O2 saturation (on air) < 90%
PEF ≤50% predicted or best
Short-acting beta2-agonists
Ipratropium bromide
Controlled O2 to maintain
saturation 93–95% (children 94-98%)
Oral or IV corticosteroids
Consider IV magnesium
Consider high dose ICS
 Short-acting beta2-agonists Short-acting beta2-agonists
Consider ipratropium bromide Ipratropium bromide
Controlled O2 to maintain Controlled O2 to maintain
saturation 93–95% (children 94-98%) saturation 93–95% (children 94-98%)
Oral corticosteroids Oral or IV corticosteroids
Consider IV magnesium
Consider high dose ICS

If continuing deterioration, treat as

severe and re-assess for ICU

ASSESS CLINICAL PROGRESS FREQUENTLY

MEASURE LUNG FUNCTION
in all patients one hour after initial treatment

FEV1 or PEF <60% of predicted or

FEV1 or PEF 60-80% of predicted or
personal best,or lack of clinical response
personal best and symptoms improved
SEVERE
MODERATE
Continue treatment as above
Consider for discharge planning
and reassess frequently

GINA 2017, Box 4-4 (4/4)

  Follow up all patients regularly after an exacerbation, until
symptoms and lung function return to normal
 Patients are at increased risk during recovery from an exacerbation
 The opportunity
 Exacerbations often represent failures in chronic asthma care,
and they provide opportunities to review the patient’s asthma
management
 At follow-up visit(s), check:
 The patient’s understanding of the cause of the flare-up
 Modifiable risk factors, e.g. smoking
 Adherence with medications, and understanding of their purpose
 Inhaler technique skills
 Written asthma action plan

GINA 2017, Box 4-5

 Ringkasan ( 1 )
 Penderita kumat Asma Ringan di Rumah
 Penderita kumat Asma Ringan-Sedang di FKTP/Asma
sedang dan berat diseleksi di UGD RS dan diterapi awal
:
 penderita respons baik  berobat jalan
 penderita respons tidak adekuat  rawat di
RS (ruang biasa)
 penderita respons jelek  ICU
 Ringkasan ( 2 )
 Penderita di RS diterapi :
 O2 terukur sampai sat. 95 %
 beta-2 agonis + antikolinergik inhalasi
 glukokortikosteroid i.v. (segera)
 pertimbangkan beta-2 agonis i.v.
 pertimbangkan teofilin i.v.
 ICS Dosis tinggi
 MgSO4
 bila perlu intubasi / ventilasi mekanik
 Evaluasi terapi :
 respons terapi :
 Keluhan / fisik, sat. O2, AGDA (Kp)
 APE
Ringkasan ( 3 )
Pengobatan Utama untuk
Eksaserbasi Asma (asma akut)
• Penggunaan berulang dari Beta
2-agonis kerja singkat
• Menggunakan kortikosteroid
lebih awal
• Oksigen

Ref : GINA Updated 2017

 Ny. Mukidi sering biduran dan gatal bentol2
seluruh tubuh,,,pilek berulang terutama pagi
hari dan menghilang siang hari….mata sering
kemerahan dan gatal..nyeri tidak di
pengaruhi aktifitas dan pola makan… nyeri
dada seperti di tindih beban berat disangkal…
keringat hilang kalau sedang
istirahat….terbangun malam hari krn sesak di
sangkal…ny mukidi bicara per kalimat…
Namun sejak 2 hari ini serangan sesak memberat disertai
demam menggigil.. batuk dahak kuning kehijaun…nyeri
tenggorok seperti terbakar dan nyeri telan…penderita
nyaman dengan posisi duduk….sesak hampir sepanjang
hari dan penderita tidak bisa melakukan aktifitas sehari-
hari, kadang-kadang sesak timbul memberat malam hari
dan tidak mereda bila diberikan obat asma dari warung
KU lemah, dyspne, cenderung nyaman posisi orthopneu
Tensi 130/80 mmHg,
Nadi 120x/mnt,
RR 28 x/mnt,
Suhu 38.7 oC.

Tenggorok tampak hiperemis

Retraksi supra strenalis (+)

Cor :Takikardia,batas jantung dbn,sj I-II murni,bising (-)
Pulmo : Suara nafas bronkhovesikuler,Ronkhi -/-, di
kedua lapangan paru terdengar wheezing (+/+).
Abdomen : perut datar,BU meningkat, tymphani,nyeri tekan
epigastrium(-),H-L normal
Ekstremitas : edema-/-,cyanosis(-),akral dingin-/-
1. Asma br eksaserbasi akut ringan
2. Asma br eksaserbasi akut sedang
3. Asma br eksaserbasi akut berat
4. Asma br eksaserbasi akut Ancaman jiwa