Asma Bronkiale

d r. N u r r a h m a h Yu s u f ,
M.Ked(Paru),Sp.P(K),FISR

Your Title Here

BAGIAN/KSM PULMONOLOGI DAN
KEDOKTERAN RESPIRASI
More..
FAKULTAS KEDOKTERAN UNSYIAH
RSUDZA BANDA ACEH
 Definisi Asma – Penyakit
Inflamasi Kronis
Definisi asma – GINA 20021:
Asthma is a chronic inflammatory disorder of the
airways in which many cells and cellular elements play a role

Definisi asma – GINA 20142

Asthma is a heterogeneous disease, usually characterized by
chronic airway inflammation.

Definisi asma – GINA 20193

Asthma is a heterogeneous disease, usually characterized
by chronic airway inflammation.

1. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2002. Available from: www.ginashtma.org
2. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2014. Available from: www.ginashtma.org
3. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2019. Available from: www.ginashtma.org
 Perbedaan Klinis Antara PPOK
Dan Asma
PPOK Asma
Usia onset penyakit Biasanya > 40 tahun Biasanya < 40 tahun
Riwayat merokok Biasanya > 200 indeks brinkman Umumnya tidak merokok
(jumlah
rata-rata batang rokok/ hari kali
lama
merokok dalam tahun)
Produksi Sering Jarang
Sputum/berdahak
Perjalanan penyakit Progresif memburuk (dengan Stabil (dengan
eksaserbasi) eksaserbasi)
Spirometri Dapat membaik tetapi tidak Dapat normal
normal
Gejala klinis Persisten, bisa setiap hari Intermiten/ episodik dan
variabel
 Derajat berat asma
Derajat Asma Gejala Gejala Malam Faal paru
I. Intermiten  Bulanan    APE  80%
  * Gejala < 1x/minggu *  2 kali sebulan * VEP1 80% nilai prediksi
* Tanpa gejala di luar
serangan APE  80% nilai terbaik
* Serangan singkat * Variabiliti APE < 20%
 
II. Persisten Ringan  Mingguan    APE > 80%
  * Gejala > 1x/minggu, * > 2 kali sebulan * VEP  80% nilai prediksi
1
tetapi < 1x/ hari
* Serangan dapat APE  80% nilai terbaik
mengganggu aktiviti * Variabiliti APE 20-30%
dan tidur  

III. Persisten Sedang  Harian    APE 60 – 80%

  * Gejala setiap hari * > 1x / * VEP1 60-80% nilai
* Serangan mengganggu seminggu prediksi
aktiviti dan tidur APE 60-80% nilai terbaik
*Membutuhkan * Variabiliti APE > 30%
bronkodilator  
setiap hari  

IV. Persisten Berat  Kontinyu    APE  60%

  * Gejala terus menerus * Sering * VEP1 60% nilai prediksi
* Sering kambuh
* Aktiviti fisik terbatas APE  60% nilai terbaik
* Variabiliti APE > 30%
 
 Derajat Kontrol asma
Kontrol Gejala Tingkat Kontrol Gejala
Asma
Dalam 4 minggu terkakhir apakah pasien Terkon Terko Tidak
memiliki : trol ntrol Terkon
Penuh Sebagi trol
an
1. Gejala asma harian lebih Ya Tidak
dari dua kali dalam 1 minggu
2. Terbangun di malam hari Ya Tidak
karena asma Tidak Terdapat 1- Terdapat
2 3-4
3. Penggunaaan obat pelega Ya Tidak terda kriteria kriteria
untuk mengatasi gejala* lebih pat
dari dari dua kali dalam 1 satup
minggu un
kriter
4. Keterbatasan aktifitas Ya Tidak ia
fisik karena asma

* Penggunaan obat pelega sebelum ‘exercise’ tidak termasuk, oleh karena banyak pasien
menggunakannya secara rutin
 Diagnosis
Asma stabil:
• Derajat berat asma : intermiten / persisten
ringan/ sedang / berat, dengan
• Derajat kontrol asma : terkontrol / terkontrol
sebagian / tidak terkontrol
 Diagnosis
Asma akut :
• Serangan (ringan-sedang / berat / mengancam
jiwa), dengan
• Derajat berat asma : intermiten / persisten
ringan/ sedang / berat, dengan
• Derajat kontrol asma : terkontrol / terkontrol
sebagian / tidak terkontrol
TATALAKSANA ASMA

Asma Stabil

Asma Akut /
Eksaserbasi
 Tujuan jangka panjang penatalaksanaan
asma

1. Kontrol gejala: untuk mencapai kontrol asma

yang baik dan mempertahankan aktifitas normal

2. Penurunan risiko : meminimalisasi resiko eksaserbasi,

keterbatasan aliran udara yang menetap, dan efek
samping obat

Global Strategy for Asthma Management and Prevention, Global

Initiative for Asthma 2019
 OBAT PELEGA NAPAS

Dipakai saat serangan

Bersifat bronkodilator
OBAT PENGONTROL ASMA

 Dipakai rutin setiap hari

 Anti inflamasi

 Bronkodilator kerja lama

 Box 3-5A Confirmation of diagnosis if necessary
Adults & adolescents 12+ years Symptom control & modifiable
risk factors (including lung function)
Comorbidities
Inhaler technique & adherence
Patient goals

Personalized asthma management:

Assess, Adjust, Review response

Symptoms
Exacerbations
Side-effects
Lung function
Patient
satisfaction
Treatment of modifiable risk
factors & comorbidities STEP 5
Non-pharmacological strategies
Education & skills training High dose
Asthma medications ICS-
Asthma medication options: LABA
Adjust treatment up and down for STEP 4 Refer for
individual patient needs phenotypic
Medium dose
STEP 3 assessment
ICS-LABA ± add-on
STEP 2 therapy,
Low dose
PREFERRED e.g.tiotropium,
STEP 1 ICS-LABA
CONTROLLER Daily low dose inhaled corticosteroid (ICS), anti-IgE,
anti-IL5/5R,
to prevent exacerbations As-needed or as-needed low dose ICS-formoterol *
anti-IL4R
and control symptoms low dose
ICS-
formoterol
*
Other Low dose ICS Leukotriene receptor antagonist (LTRA), or Medium dose High dose Add low dose
controller options taken whenever low dose ICS taken whenever SABA taken † ICS, or low ICS, add-on OCS, but
SABA is taken dose tiotropium, or consider
† add-on LTRA # side-effects
ICS+LTRA #

PREFERRED As-needed low dose ICS-formoterol * As-needed low dose ICS-formoterol ‡

RELIEVER
Other
reliever option As-needed short-acting β 2 -agonist (SABA)

* Off-label; data only with budesonide-formoterol (bud-form)
† Off-label; separate or combination ICS and SABA inhalers
© Global Initiative for Asthma, www.ginasthma.org
‡ Low-dose ICS-form is the reliever for patients prescribed
bud-form or BDP-form maintenance and reliever therapy
# Consider adding HDM SLIT for sensitized patients with
allergic rhinitis and FEV >70% predicted
1
 Box 3-5A Confirmation of diagnosis if necessary
Adults & adolescents 12+ years Symptom control & modifiable
risk factors (including lung function)
Comorbidities
Inhaler technique & adherence
Patient goals

Personalized asthma management:

Assess, Adjust, Review response

Symptoms
Exacerbations
Side-effects
Lung function
Patient
satisfaction
Treatment of modifiable risk
factors & comorbidities STEP 5
Non-pharmacological strategies
Education & skills training High dose
Asthma medications ICS-
Asthma medication options: LABA
Adjust treatment up and down for STEP 4 Refer for
individual patient needs phenotypic
Medium dose
STEP 3 assessment
ICS-LABA ± add-on
STEP 2 therapy,
Low dose
PREFERRED e.g.tiotropium,
STEP 1 ICS-LABA
CONTROLLER Daily low dose inhaled corticosteroid (ICS), anti-IgE,
anti-IL5/5R,
to prevent exacerbations As-needed or as-needed low dose ICS-formoterol *
anti-IL4R
and control symptoms low dose
ICS-
formoterol
*
Other Low dose ICS Leukotriene receptor antagonist (LTRA), or Medium dose High dose Add low dose
controller options taken whenever low dose ICS taken whenever SABA taken † ICS, or low ICS, add-on OCS, but
SABA is taken dose tiotropium, or consider
† add-on LTRA # side-effects
ICS+LTRA #

PREFERRED As-needed low dose ICS-formoterol * As-needed low dose ICS-formoterol ‡

RELIEVER
Other
reliever option As-needed short-acting β 2 -agonist (SABA)

* Off-label; data only with budesonide-formoterol (bud-form)
† Off-label; separate or combination ICS and SABA inhalers
© Global Initiative for Asthma, www.ginasthma.org
‡ Low-dose ICS-form is the reliever for patients prescribed
bud-form or BDP-form maintenance and reliever therapy
# Consider adding HDM SLIT for sensitized patients with
allergic rhinitis and FEV >70% predicted
1
 Box 3-5A Confirmation of diagnosis if necessary
Adults & adolescents 12+ years Symptom control & modifiable
risk factors (including lung function)
Comorbidities
Inhaler technique & adherence
Patient goals

Personalized asthma management:

Assess, Adjust, Review response

Symptoms
Exacerbations
‘Controller’
‘Controller’ treatment
treatment Side-effects
Lung function
means
means the
the treatment
treatment Patient
satisfaction
taken
taken to
to prevent
prevent Treatment of modifiable risk
factors & comorbidities STEP 5
exacerbations
exacerbations Non-pharmacological strategies
Education & skills training High dose
Asthma medications ICS-
Asthma medication options: LABA
Adjust treatment up and down for STEP 4 Refer for
individual patient needs phenotypic
Medium dose
STEP 3 assessment
ICS-LABA ± add-on
STEP 2 therapy,
Low dose
PREFERRED e.g.tiotropium,
STEP 1 ICS-LABA
CONTROLLER Daily low dose inhaled corticosteroid (ICS), anti-IgE,
anti-IL5/5R,
to prevent exacerbations As-needed or as-needed low dose ICS-formoterol *
anti-IL4R
and control symptoms low dose
ICS-
formoterol
*
Other Low dose ICS Leukotriene receptor antagonist (LTRA), or Medium dose High dose Add low dose
controller options ICS, add-on OCS, but
taken whenever low dose ICS taken whenever SABA taken † ICS, or low
SABA is taken dose tiotropium, or consider
† add-on LTRA # side-effects
ICS+LTRA #

PREFERRED As-needed low dose ICS-formoterol * As-needed low dose ICS-formoterol ‡

RELIEVER
Other
reliever option As-needed short-acting β 2 -agonist (SABA)

* Off-label; data only with budesonide-formoterol (bud-form)
† Off-label; separate or combination ICS and SABA inhalers
© Global Initiative for Asthma, www.ginasthma.org
‡ Low-dose ICS-form is the reliever for patients prescribed
bud-form or BDP-form maintenance and reliever therapy
# Consider adding HDM SLIT for sensitized patients with
allergic rhinitis and FEV >70% predicted
1
 Box 3-5A Confirmation of diagnosis if necessary
Adults & adolescents 12+ years Symptom control & modifiable
risk factors (including lung function)
Comorbidities
Inhaler technique & adherence
Patient goals

Personalized asthma management:

Assess, Adjust, Review response

Symptoms
Exacerbations
Side-effects
Lung function
Patient
satisfaction
Treatment of modifiable risk
factors & comorbidities STEP 5
Non-pharmacological strategies
Education & skills training High dose
Asthma medications ICS-
Asthma medication options: LABA
Adjust treatment up and down for STEP 4 Refer for
individual patient needs phenotypic
Medium dose
STEP 3 assessment
ICS-LABA ± add-on
STEP 2 therapy,
Low dose
PREFERRED e.g.tiotropium,
STEP 1 ICS-LABA
CONTROLLER Daily low dose inhaled corticosteroid (ICS), anti-IgE,
anti-IL5/5R,
to prevent exacerbations As-needed or as-needed low dose ICS-formoterol *
anti-IL4R
and control symptoms low dose
ICS-
formoterol
*
Other Low dose ICS Leukotriene receptor antagonist (LTRA), or Medium dose High dose Add low dose
controller options taken whenever low dose ICS taken whenever SABA taken † ICS, or low ICS, add-on OCS, but
SABA is taken dose tiotropium, or consider
† add-on LTRA # side-effects
ICS+LTRA #

PREFERRED As-needed low dose ICS-formoterol * As-needed low dose ICS-formoterol ‡

RELIEVER
Other
reliever option As-needed short-acting β 2 -agonist (SABA)

* Off-label; data only with budesonide-formoterol (bud-form)
† Off-label; separate or combination ICS and SABA inhalers
© Global Initiative for Asthma, www.ginasthma.org
‡ Low-dose ICS-form is the reliever for patients prescribed
bud-form or BDP-form maintenance and reliever therapy
# Consider adding HDM SLIT for sensitized patients with
allergic rhinitis and FEV >70% predicted
1
 Step 1
• Gejala <2x sebulan
• Tidak ada gejala malam dlm 1 bulan terakhir
• Tidak ada faktor risiko untuk serangan dlm 1
tahun terakhir
 Box 3-5A Confirmation of diagnosis if necessary
Adults & adolescents 12+ years Symptom control & modifiable
risk factors (including lung function)
Comorbidities
Inhaler technique & adherence
Patient goals

Personalized asthma management:

Assess, Adjust, Review response

Symptoms
Exacerbations
Side-effects
Lung function
Patient
satisfaction
Treatment of modifiable risk
factors & comorbidities STEP 5
Non-pharmacological strategies
Education & skills training High dose
Asthma medications ICS-
Asthma medication options: LABA
Adjust treatment up and down for STEP 4 Refer for
individual patient needs phenotypic
Medium dose
STEP 3 assessment
ICS-LABA ± add-on
STEP 2 therapy,
Low dose
PREFERRED e.g.tiotropium,
STEP 1 ICS-LABA
CONTROLLER Daily low dose inhaled corticosteroid (ICS), anti-IgE,
anti-IL5/5R,
to prevent exacerbations As-needed or as-needed low dose ICS-formoterol *
anti-IL4R
and control symptoms low dose
ICS-
formoterol
*
Other Low dose ICS Leukotriene receptor antagonist (LTRA), or Medium dose High dose Add low dose
controller options taken whenever low dose ICS taken whenever SABA taken † ICS, or low ICS, add-on OCS, but
SABA is taken dose tiotropium, or consider
† add-on LTRA # side-effects
ICS+LTRA #

PREFERRED As-needed low dose ICS-formoterol * As-needed low dose ICS-formoterol ‡

RELIEVER
Other
reliever option As-needed short-acting β 2 -agonist (SABA)

* Off-label; data only with budesonide-formoterol (bud-form)
† Off-label; separate or combination ICS and SABA inhalers
© Global Initiative for Asthma, www.ginasthma.org
‡ Low-dose ICS-form is the reliever for patients prescribed
bud-form or BDP-form maintenance and reliever therapy
# Consider adding HDM SLIT for sensitized patients with
allergic rhinitis and FEV >70% predicted
1
 Step 2
• Gejala jarang, tapi ada satu atau lebih faktor
risiko serangan, contoh: pasien dengan fungsi
paru rendah, atau serangan yang membutuhkan
kortikosteroid oral dalam setahun terakhir, atau
pernah dirawat di ruang intensif untuk asma
• Gejala asma atau butuh SABA 2x/minggu –
2x/bulan
• Gejala malam 1x/bulan
 Box 3-5A Confirmation of diagnosis if necessary
Adults & adolescents 12+ years Symptom control & modifiable
risk factors (including lung function)
Comorbidities
Inhaler technique & adherence
Patient goals

Personalized asthma management:

Assess, Adjust, Review response

Symptoms
Exacerbations
Side-effects
Lung function
Patient
satisfaction
Treatment of modifiable risk
factors & comorbidities STEP 5
Non-pharmacological strategies
Education & skills training High dose
Asthma medications ICS-
Asthma medication options: LABA
Adjust treatment up and down for STEP 4 Refer for
individual patient needs phenotypic
Medium dose
STEP 3 assessment
ICS-LABA ± add-on
STEP 2 therapy,
Low dose
PREFERRED e.g.tiotropium,
STEP 1 ICS-LABA
CONTROLLER Daily low dose inhaled corticosteroid (ICS), anti-IgE,
anti-IL5/5R,
to prevent exacerbations As-needed or as-needed low dose ICS-formoterol *
anti-IL4R
and control symptoms low dose
ICS-
formoterol
*
Other Low dose ICS Leukotriene receptor antagonist (LTRA), or Medium dose High dose Add low dose
controller options taken whenever low dose ICS taken whenever SABA taken † ICS, or low ICS, add-on OCS, but
SABA is taken dose tiotropium, or consider
† add-on LTRA # side-effects
ICS+LTRA #

PREFERRED As-needed low dose ICS-formoterol * As-needed low dose ICS-formoterol ‡

RELIEVER
Other
reliever option As-needed short-acting β 2 -agonist (SABA)

* Off-label; data only with budesonide-formoterol (bud-form)
† Off-label; separate or combination ICS and SABA inhalers
© Global Initiative for Asthma, www.ginasthma.org
‡ Low-dose ICS-form is the reliever for patients prescribed
bud-form or BDP-form maintenance and reliever therapy
# Consider adding HDM SLIT for sensitized patients with
allergic rhinitis and FEV >70% predicted
1
 Step 3
• Gejala asma hampir setiap hari
• Gejala malam 1x/minggu
• Terdapat faktor risiko
 Box 3-5A Confirmation of diagnosis if necessary
Adults & adolescents 12+ years Symptom control & modifiable
risk factors (including lung function)
Comorbidities
Inhaler technique & adherence
Patient goals

Personalized asthma management:

Assess, Adjust, Review response
Step
Step 44 treatment
treatment isis
Symptoms medium
Exacerbations
medium dosedose ICS-LABA;
ICS-LABA;
Side-effects high
high dose
dose nownow in
in Step
Step 55
Lung function
Patient
satisfaction
Treatment of modifiable risk
factors & comorbidities STEP 5
Non-pharmacological strategies
Education & skills training High dose
Asthma medications ICS-
Asthma medication options: LABA
Adjust treatment up and down for STEP 4 Refer for
individual patient needs phenotypic
Medium dose
STEP 3 assessment
ICS-LABA ± add-on
STEP 2 therapy,
Low dose
PREFERRED e.g.tiotropium,
STEP 1 ICS-LABA
CONTROLLER Daily low dose inhaled corticosteroid (ICS), anti-IgE,
anti-IL5/5R,
to prevent exacerbations As-needed or as-needed low dose ICS-formoterol *
anti-IL4R
and control symptoms low dose
ICS-
formoterol
*
Other Low dose ICS Leukotriene receptor antagonist (LTRA), or Medium dose High dose Add low dose
controller options taken whenever low dose ICS taken whenever SABA taken † ICS, or low ICS, add-on OCS, but
SABA is taken dose tiotropium, or consider
† add-on LTRA # side-effects
ICS+LTRA #

PREFERRED As-needed low dose ICS-formoterol * As-needed low dose ICS-formoterol ‡

RELIEVER
Other
reliever option As-needed short-acting β 2 -agonist (SABA)

* Off-label; data only with budesonide-formoterol (bud-form)
† Off-label; separate or combination ICS and SABA inhalers
© Global Initiative for Asthma, www.ginasthma.org
‡ Low-dose ICS-form is the reliever for patients prescribed
bud-form or BDP-form maintenance and reliever therapy
# Consider adding HDM SLIT for sensitized patients with
allergic rhinitis and FEV >70% predicted
1
 Step 4
• Asma berat tidak terkontrol
• Eksaserbasi akut dan menggunakan
kortikosteroid oral jangka pendek
 Box 3-5A Confirmation of diagnosis if necessary
Adults & adolescents 12+ years Symptom control & modifiable
risk factors (including lung function)
Comorbidities
Inhaler technique & adherence
Patient goals

Personalized asthma management:

Assess, Adjust, Review response See
See severe
severe asthma
asthma
Symptoms Pocket
Pocket Guide
Guide for
for
Exacerbations
Side-effects
details
details about
about Step
Step 55
Lung function
Patient
satisfaction
Treatment of modifiable risk
factors & comorbidities STEP 5
Non-pharmacological strategies
Education & skills training High dose
Asthma medications ICS-
Asthma medication options: LABA
Adjust treatment up and down for STEP 4 Refer for
individual patient needs phenotypic
Medium dose
STEP 3 assessment
ICS-LABA ± add-on
STEP 2 therapy,
Low dose
PREFERRED e.g.tiotropium,
STEP 1 ICS-LABA
CONTROLLER Daily low dose inhaled corticosteroid (ICS), anti-IgE,
anti-IL5/5R,
to prevent exacerbations As-needed or as-needed low dose ICS-formoterol *
anti-IL4R
and control symptoms low dose
ICS-
formoterol
*
Other Low dose ICS Leukotriene receptor antagonist (LTRA), or Medium dose High dose Add low dose
controller options taken whenever low dose ICS taken whenever SABA taken † ICS, or low ICS, add-on OCS, but
SABA is taken dose tiotropium, or consider
† add-on LTRA # side-effects
ICS+LTRA #

PREFERRED As-needed low dose ICS-formoterol * As-needed low dose ICS-formoterol ‡

RELIEVER
Other
reliever option As-needed short-acting β 2 -agonist (SABA)

* Off-label; data only with budesonide-formoterol (bud-form)
† Off-label; separate or combination ICS and SABA inhalers
© Global Initiative for Asthma, www.ginasthma.org
‡ Low-dose ICS-form is the reliever for patients prescribed
bud-form or BDP-form maintenance and reliever therapy
# Consider adding HDM SLIT for sensitized patients with
allergic rhinitis and FEV >70% predicted
1
 Step 5
• Pasien yang tidak memberikan respon adekuat
dengan pengobatan tahap 4
• Perhatikan fenotipe asma untuk pengobatan
selanjutnya
 Terapi Pada Asma Eksaserbasi

SABA (Short Acting B2 agonist) Kortikosteroid

• Bekerja sebagai bronkodilator • Terdapat 2 jenis kortikosteroid:
untuk mengatasi gejala asma • kortikosteroid sistemik
• kortikosteroid inhalasi
• Contoh: Terbutalin, Salbutamol,
etc

Oksigen Antikolinergik
• Untuk mencapai saturasi • Kombinasi SABA & antikolinergik
oksigen 93-95% (94- 98% menurunkan angka hospitalisasi dan
pada anak usia 6-11 tahun) meningkatkan FEV1 dan PEF

Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention. 2018.
Tersedia di: http://www.ginasthma.org/.
 Terapi Eksaserbasi Asma Dewasa berdasarkan Pedoman
Asma PDPI 2019

Asma Eksaserbasi
(serangan)

Klasifikasi RINGAN / SEDANG BERAT

• Bicara dalam frase
• Memilih duduk dari pada
terlentang
• Tidak agitasi
• Frekuensi napas meningkat
• Tidak menggunakan otot bantu
napas
• Frekuensi nadi 100-120 x/menit
• Saturasi O2 90-95% (udara
ruangan)
• APE > 50% dari nilai prediksi /
terbaik
• Bicara kata per kata
• Memilih membungkuk ke depan
• Agitasi
• Frekuensi napas > 30 kali / menit
• Menggunakan otot bantu napas
• Frekuensi nadi > 120 x/menit
• Saturasi O2 < 90% (udara
ruangan)
• APE ≤ 50% dari nilai prediksi /
terbaik

Pedoman Diagnosis dan Penatalaksanaan Asma di

Indonesia. PDPI 2019.
 Terapi Eksaserbasi Asma Dewasa berdasarkan
Pedoman Asma PDPI 2019

Asma Eksaserbasi (Serangan)

RINGAN / SEDANG BERAT

Terapi
• Pemberian O2 untuk • Pemberian O2 untuk
mempertahankan saturasi mempertahankan
93-95% (anak-anak 94- saturasi 93-95% (anak-
94) anak 94-94)
• Beta 2 agonis kerja • Beta 2 agonis kerja
singkat singkat
• Pertimbangkan • Ipratropium bromide
ipratropium bromide • Inhalasi kortikosteroid dosis
• Inhalasi kortikosteroid tinggi atau kortikosteroid
dosis tinggi atau intravena atau oral
kortikosteroid oral • Pertimbangkan magnesium
IV
Di unit gawat darurat:
• Pasien yang tidak mendapatkan kortikosteroid sistemik, pemberian ICS dosis tinggi dalam
satu jam
Pedoman Diagnosis pertama saat
dan Penatalaksanaan
Indonesia. PDPI 2019.
Asmaeksaserbasi
di mengurangi risiko rawat inap (Bukti A).
 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 2018, Box 4-4 (4/4) © Global Initiative for Asthma www.ginasthma.org
OSCE Asma
 Anamnesis
1. Keluhan respiratorik
 Sesak napas:
• Berapa lama, episodik
• Sesak menganggu aktivitas ?
• Terbangun malam karena sesak
• Gejala memburuk pada malam menjelang pagi
• Faktor pencetus? (debu, aktivitas, emosi, flu, dll)
• Napas berbunyi
• Dada terasa berat
 Batuk

2. Keluhan tambahan
 Demam (jika ada ISPA)

3. Riwayat penyakit terdahulu

 Asma dari kecil
 Rhinitis alergi
 Dermatitis atopi
 Riwayat alergi/ atopi
4. Riwayat pemakaian obat
 Inhaler/ bronkodilator
 Pernah masuk IGD atau dirawat di RS karena sesak
napas ?
5. Riwayat keluarga
 Ada keluarga yang menderita asma atau alergi ?
6. Riwayat sosial
 Pekerjaan
 Merokok
 Memelihara binatang
 Pemeriksaan fisik
1. KU/KG/KP
• Gelisah
• Dapat bicara kalimat / terbata-bata
• Duduk atau duduk condong kedepan
2. Vital sign : sens (cm/ penurunan kesadaran), TD, RR, HR,
SaO2
3. Toraks
• IPPA
• Ekspirasi memanjang, wheezing
• Silent chest
 Pemeriksaan Penunjang
1. APE
• Pre BD menurun
• Reversibilitas > 20% post BD 400mg, 2x2 puff

2. Spirometri
• VEP1/FVC < 75 % : Obstruksi
• Reversibiltas : VEP1 > 12 % dan > 200ml post BD
• Varibilitas diurnal : APE ≥ 20%
• Uji provokasi bronkus

3. Foto toraks
4. Darah rutin : eosinofil (≥300), Ig E
5. FeNo : >>> pada asma eosinofilik
6. Skin prick test
 Diagnosis
Asma stabil:
• Derajat berat asma : intermiten / persisten
ringan/ sedang / berat, dengan
• Derajat kontrol asma : terkontrol / terkontrol
sebagian / tidak terkontrol
 Diagnosis
Asma akut :
• Serangan (ringan-sedang / berat / mengancam
jiwa), dengan
• Derajat berat asma : intermiten / persisten
ringan/ sedang / berat, dengan
• Derajat kontrol asma : terkontrol / terkontrol
sebagian / tidak terkontrol
 Diagnosis/diagnosis banding
• Asma serangan akut berat
• PPOK eksaserbasi berat
• ACO eksaserbasi
• Bronkiektasis eksaserbasi
• ILD dengan inf sekunder
• Bronkitis Kronik dengan sekunder infeksi
 Tatalaksana
1. Emergensi : sesuaikan dengan algoritma eksaserbasi
• Nilai ulang setelah 1 jam
• Jika KU membaik, FEV1 atau APE 60-80%, Sa02 > 94%: dapat
dipulangkan
• Jika KU buruk, FEV1 atau APE < 60, SaO2 < 94%: ekserbasi berat
2. Obat pulang
• Sesuaikan dengan STEP
• Jika belum pernah pengobatan langsung ekaserbasi: langsung
STEP 3
• Jika sudah pernah pengobatan baru eksaserbasi: STEP nya naik
satu tingkat
3. Non farmakologi
• Edukasi : hindari faktor pencetus, polusi
• Berhenti merokok
• Senam asma
• Nutrisi
• Cara menggunakan inhaler yang benar dan
kepatuhan
• Cara atasi serangan asma dirumah: pelangi asma
 Menghindari Faktor Pencetus

1. Menghindari iritasi
2. Menghindari cuaca yang terlalu
panas/terlalu dingin
3. Menghindari aktivitas berlebihan
4. Jangan merokok