Pharmaceutical Care ASMA

Apt. Hasbi As-Shiddiq. M.Farm.Klin

Definisi ASMA
ASMA
Asma: penyakit heterogen, ditandai
dengan adanya peradangan saluran
napas kronis. Dapat diidentifikasi
dengan melihat riwayat gejala
gangguan pernapasan seperti mengi,
sesak napas, dada sesak, dan batuk
yang bervariasi dari waktu ke waktu
terutama malam atau dini hari, dan
dalam intensitasnya, bersama dengan
variable limitasi dari expiratory
airflow. Umumnya eposodik dan
reversible.
 ASMA

Tujuan utama penatalaksanaan asma adalah dengan

meningkatkan dan mempertahankan kualitas
hidup agar pasien asma dapat hidup normal tanpa
hambatan dalam melakukan aktivitas seharihari

Peran apoteker dalam penanganan penyakit asma

adalah mengatasi masalah terkait obat yang
mungkin timbul, memberikan informasi dan
konseling, memotivasi pasien untuk patuh dalam
pengobatan serta membantu dalam pencatatan

ASMA
untuk pengobatan (Medication Record).
ETIOLOGY
Faktor predisposisi Genetik:
Terdapat 11 Faktor genetik berperan
dalam meningkatkan kerentan
pasien mengalami asma 60% hingga
80% . Penelitian menunjukkan
terdapat hubungan antara gen pada
kromosom 17q21, interleukin genes,
HLA-DQ dan SMAD3 dengan
kejadian asma melalui abnormalitas
adatif pada respon imun.

Faktor Presipitasi Environmental :

status sosial ekonomi, paparan asap
rokok saat bayi dan dalam kandungan,
alergen, polusi udara, Infeksi virus
pada saluran pernafasan seperti
respiratory syncytial virus (RSV) dan
rhinovirus dan penurunan paparan
agen infeksius masa kanak-kanak
 FAKTOR RESIKO
• predisposisi genetik asma; alergi;
Faktor pejamu (host) hipereaktifitas bronkus; jenis kelamin;
ras/etnik
Lingkungan

Mempengaruhi individu dengan Alergen di dalam maupun di luar ruangan (binatang, alergen
kecenderungan /predisposisi kecoa, jamur, tepung sari bunga); sensitisasi (bahan) lingkungan
asma untuk kerja; asap rokok; polusi udara; infeksi pernapasan (virus); diet;
berkembang menjadi asma status sosioekonomi; obesit

Alergen di dalam maupun di luar ruangan; polusi; infeksi

Menyebabkan eksaserbasi pernapasan; olah raga dan hiperventilasi; perubahan cuaca;
(serangan) dan/atau makanan, additif (pengawet, penyedap, pewarna makanan)
menyebabkan gejala obat-obatan (asetil salisilat); ekspresi emosi yang berlebihan; asap
asma menetap rokok; iritan (parfum, bau-bauan yang merangsang)
PATHOPHYSIOLOGY

Serangan asma terjadi apabila alergen masuk

ke dalam tubuh. Alergen tersebut
menyebabkan terjadinya bronkokontriksi,
edema dan hipersekresi saluran napas yang
pada akhirnya menyebabkan obstruksi
saluran napas sehingga terjadi ganguan
ventilasi berupa kesulitan bernapas

Gejala asma bersifat episodik, seringkali reversibel dengan/atau tanpa
pengobatan
Gejala awal
-batuk terutama pada malam
atau dini hari
- sesak napas
- napas berbunyi (mengi)
saat pasien menghembuskan
napas
- rasa berat di dada
- dahak sulit keluar.
GEJALA
Gejala berat/mengancam jiwa
-Serangan batuk hebat
- Sesak napas berat dan
tersengal-sengal
- Sianosis (kulit kebiruan, yang
dimulai dari sekitar mulut)
- Sulit tidur dan posisi tidur
yang nyaman adalah dalam
keadaan duduk
- Kesadaran menurun
 DIAGNOSIS

• Peak Expiratory Flow (PEF)

APE (Arus Puncak • Aliran udara maksimum yang dicapai selama
Ekspirasi) ekspirasi paksa maksimal, setelah inspirasi paksa.
• peak expiratory flow meter.

• Forced expiratory volume in one second (FEV 1)

VEP 1 (Volume • volume maksimal udara yang dikeluarkan pada detik
Ekspirasi Paksa) pertama ekspirasi paksa dari inspirasi maksimal.
• Spirometri
DIAGNOSIS

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Klasifikasi Derajat Asma Berdasarkan Gambaran Klinis
Derajat Asma Gejala Gejala Malam Faal Paru
Bulanan APE ≥ 80%
Gejala <1x/minggu Tanpa gejala di luar ≤ 2 kali sebulan VEP 1 ≥ 80% nilai prediksi
I. Intermitten APE ≥ 80% nilai terbaik
serangan. Serangan singkat
Variabiliti APE < 20%
Mingguan APE ≥ 80%
II. Persisten > 2 kali sebulan VEP1 ≥ 80% nilai prediksi
Gejala >1x/minggu, tetapi <1x/hari
Ringan APE 60-80% nilai terbaik
Serangan dapat menganggu tidur
Variabiliti APE > 30%
Harian APE ≤ 60 %
III. Persisten > 1x/seminggu VEP1 60-80% nilai prediksi
Gejala setiap hari Serangan menganggu
Sedang APE 60-80% nilai terbaik
aktivitas dan tidur Membutuhkan
bronkodilator Variabiliti APE > 30%

IV.Persisten Kontinyu APE ≤ 60%

Berat Sering VEP1 60% nilai prediksi
Gejala terus menerus Sering kambuh
Aktivitas fisik terbatas APE ≤ 60% nilai terbaik
Variabiliti APE > 30%
Asthma control
Telah Pengendalian Pengendalian
berkurang gejala resiko
atau hilang
melalui
pengendalian asma

pengobatan Alergen
Tingkat

Mengi; sesak
Tidak Rokok
membaik Batuk; nyeri
dada dll Infeksi dll
Asthma control
Bagaimana menggambarkan
pengendalian asma pasien??
Pengendalian
asma harus
dijelaskan baik RESIKO
dalam KEPARAHAN
pengendalian
gejala maupun Nona X memiliki pengendalian gejala asma yang baik, namun ia berisiko lebih
domain risiko tinggi mengalami eksaserbasi di masa depan karena ia mengalami eksaserbasi
di masa depan. parah dalam setahun terakhir

Tuan Y memiliki kontrol gejala asma yang buruk. Ia juga memiliki beberapa
faktor risiko tambahan untuk eksaserbasi di masa depan termasuk fungsi paru-
paru yang rendah, kebiasaan merokok, dan kepatuhan pengobatan yang buruk
Asthma control

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Asthma control

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Asthma control

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 ASSESSING ASTHMA SEVERITY

Severe asthma is defined as asthma that remains uncontrolled despite

optimized treatment with high-dose ICS-LABA, or that requires high-dose ICS-
LABA to prevent it from becoming uncontrolled.
The current
concept of
Moderate asthma is currently defined as asthma that is well controlled with asthma
Step 3 or Step 4 treatment. e.g. with low- or medium-dose ICS-LABA in either severity is
treatment track. based on
‘difficulty to
Mild asthma is currently defined as asthma that is well controlled with low- treat’
intensity treatment, i.e., as-needed low-dose ICS-formoterol, or low-dose ICS
plus as-needed SABA.

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Common Medical Problem

Asthma Symtomps (Adult and Adholecens) : Wheeze, shortness of

breath, chest tightness and cough

Asthma exacerbations

Asthma + COPD

Asthma < 5 years

 To achieve good control of
symptoms and maintain
normal activity levels
LONG-TERM GOALS OF
ASTHMA MANAGEMENT
To minimize the risk of
asthma-related death,
exacerbations, persistent
airflow limitation and side-
effects.
MEDICATIONS AND STRATEGIES FOR SYMPTOM CONTROL AND
RISK REDUCTION

Over-use of SABA (e.g., dispensing of

three or more 200-dose canisters in a
year, corresponding to average use
more than daily) increases the risk of
asthma exacerbations

In patients previously using

SABA alone, as-needed low-
dose ICS- formoterol also
significantly reduces the risk low-dose ICS-formoterol reduces the
of severe exacerbations
needing OCS, compared with
risk of severe exacerbations and
daily ICS. emergency department visits or
hospitalizations by 65% compared with
SABA-only treatment
MEDICATIONS AND STRATEGIES FOR SYMPTOM CONTROL AND
RISK REDUCTION

Asthma treatment that is

prescribed for use every day (or on
Maintenance a regularly scheduled basis)
treatment (ICS, ICS-LABA, ICS-LABA-LAMA), as
well as LTRA and biologic therapy.

Reliever inhaler that contains both

a low-dose ICS and a rapid-acting
Anti-
Controller Reliever inflammator
bronchodilator budesonide-
formoterol, beclomethasone
ICS-containing Includes SABAs (e.g., y reliever
medications
ASTHMA salbutamol [albuterol], (AIR)
formoterol and ICS-salbutamol
combinations
prescribed for MEDICATIONS terbutaline, ICS-
salbutamol), as-needed
regular daily ICS-formoterol, and as-
treatment needed ICS-SABA. Treatment regimen in which the
patient uses an ICS-formoterol
Maintenance inhaler every day (maintenance
-and- reliever dose), and also uses the same
therapy medication as needed for relief of
(MART) asthma symptoms (reliever doses)

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MEDICATIONS AND STRATEGIES FOR SYMPTOM CONTROL AND
RISK REDUCTION

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MEDICATIONS AND STRATEGIES FOR SYMPTOM CONTROL AND
RISK REDUCTION

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MEDICATIONS AND STRATEGIES FOR SYMPTOM CONTROL AND
RISK REDUCTION

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MEDICATIONS AND STRATEGIES FOR SYMPTOM CONTROL AND
RISK REDUCTION

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MEDICATIONS AND STRATEGIES FOR SYMPTOM CONTROL AND
RISK REDUCTION TRACK 1

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MEDICATIONS AND STRATEGIES FOR SYMPTOM CONTROL AND
RISK REDUCTION

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MEDICATIONS AND STRATEGIES FOR SYMPTOM CONTROL AND
RISK REDUCTION

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 What triggers asthma
exacerbations?
Viral respiratory infections,
e.g. rhinovirus, influenza, Allergen grass pollen, soybean
adenovirus, pertussis, dust, fungal spores
respiratory syncytial virus

Seasonal
changes and/or
Outdoor air Poor adherence
Food allergy returning to
pollution with ICS
school in fall
(autumn)

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Management of asthma exacerbations in
acute care facility, e.g. emergency
department

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Other treatments

• Ipratropium bromide (short-acting anticholinergic)

was associated with fewer hospitalizations and greater improvement in PEF and FEV1 compared with SABA
alone
• Aminophylline and theophylline (not recommended)
Intravenous aminophylline and theophylline should not be used in the management of asthma exacerbations, in
view of their poor efficacy and safety profile. The use of intravenous aminophylline is associated with severe
and potentially fatal side-effects
• Magnesium
administered as a single 2 g infusion over 20 minutes, it reduces hospital admissions in some patients. But not
recommended for routine use in asthma exacerbations.
• Helium oxygen therapy
A systematic review of studies comparing helium–oxygen with air–oxygen suggests there is no role for this
intervention in routine care (Evidence B), but it may be considered for patients who do not respond to standard
therapy
Other treatments

• Leukotriene receptor antagonists (LTRAs)

Small studies have demonstrated improvement in lung function, but the clinical role and safety of these
agents requires more study
• Antibiotics (not recommended)
Evidence does not support the routine use of antibiotics in the treatment of acute asthma exacerbations
unless there is strong evidence of lung infection
 Asthma+COPD, also called asthma-COPD overlap

istilah yang digunakan untuk menggambarkan secara kolektif pasien yang memiliki keterbatasan aliran udara
persisten dengan gambaran klinis yang konsisten dengan asma dan PPOK.Ini bukan definisi suatu entitas
penyakit tunggal, namun istilah deskriptif untuk penggunaan klinis yang mencakup beberapa fenotipe klinis
berbeda yang mencerminkan mekanisme dasar berbeda.
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Probability of asthma diagnosis in children 5 years
and younger

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Probability of asthma diagnosis in children 5 years
and younger

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GOALS OF ASTHMA MANAGEMENT
As with other age groups, the goals of asthma management in young children are:

To achieve good control of

symptoms and maintain
normal activity levels
LONG-TERM GOALS OF
ASTHMA MANAGEMENT
To minimize the risk of
asthma-related death,
exacerbations, persistent
airflow limitation and side-
effects.
Asthma control

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ASTHMA TREATMENT STEPS FOR CHILDREN AGED 5 YEARS AND
YOUNGER

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FACTORS ASSOCIATED WITH INCREASED OR
DECREASED RISK OF ASTHMA IN CHILDREN

Nutrition of mother and baby

• Maternal diet
• Maternal obesity and weight gain during pregnancy
• Reastfeeding
• Timing of introduction of solids
Dietary supplements for mothers and/or babies
• Vitamin D
• Fish oil and long-chain polyunsaturated fatty acids
• Probiotics
Inhalant allergens
Pollutants
Microbial effects
Medications and other factors
Psychosocial factors
Obesity

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TERAPI NON-FARMAKOLOGI

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