6. Bronchial Asthma

8/10/2019 6. Bronchial Asthma

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BBronchial Asthmaronchial AsthmaTherapyTherapy

Bachtiar Arif N.H20090310153



DDefnisi Asthmaefnisi Asthma

BronchialBronchial

Asthma bronchiale adalahpenyakit inamasi kronis

dari jalan nafas yangberhubungan denganhipereaktiftas bronchial

dan obstruksi jalan nafastotal atau partial yangreversible. Dimana pada

beberapa kasus hilang



AAsthma Bronchialesthma Bronchiale

• Reversible obstruction

• Varisi simptom dalam sehari-hari

• Terdapat riwayat keluarga

• Dapat menyerang berbagai usia lebihsering pada!

–"#-"$% anak-anak

– $-"#% dewasa• Tidak adak riwayat merokok

• allergy rhinitis ec&ema 'bisa

terdapat(tidak)



EEtiopatogenesistiopatogenesis

•

INFLAMMATININFLAMMATIN mengaktifasimastocytes macrophages eosinophilshelper Th-lymfocytes *+ membentuk danmelepaskan mediator in,amasi! histamine

leucotriens prostaglandins bradykinin

bronchoconstriction mucus secretion plasmaeudation dan bronchial hyperreactivity

air!ay remo"elation



T#$#anT#$#an terapi Asmaterapi Asma

BronkialBronkial• Menghilangkan "an mengen"alikan

ge$ala asma

• Mencegah eksaserbasi ak#t

• Meningkatkan "an mempertahankan%aal par# seoptimal m#ngkin

• Meng#payakan aktiviti normaltermas#k exercise

• Menghin"ari e%ek samping obat• Mencegah ter$a"i keterbatasan aliran

#"ara 'airo! limitation( ireversibel

• Mencegah kematian karena asma



TTerapi Asma Bronkialerapi Asma Bronkial

• NonpharmacologicalNonpharmacological – /dukasi kepada pasien

– 0enghindari faktor resiko dan pencetus asma

• )harmacological)harmacological

– A N T I I N F L A M M A T * +• 0enghilangkan in,amasi and hipereakti1tas bronchial

• 2enggunaan secara teratur dan jangka panjang

– B * N ,- D I L A T * + • 0enghilangkan simptom dari keterbatasan aliran saat

ekspirasi

• Terapi pertama saat terjadi kekambuhan asma



bat.obat Asma Bronkialbat.obat Asma BronkialA/A/ ,NT*LLE*0,NT*LLE*0

– 3bat-obat preventive controlling inammationcontrolling inammation – dipakai secara terat#r1 "an $angka !akt# lamaterat#r1 "an $angka !akt# lama

untuk mengkontrol asma

antiinammatory "r#gsantiinammatory "r#gs

long acting inhalatory broncho"ilatorslong acting inhalatory broncho"ilatorsB/B/ *ELIE2E*0*ELIE2E*0

menghilangkan bronchospasm

relieving * fast acting bronchodilators

,/,/ batbat ANTIA0T-MATI,ANTIA0T-MATI, lainnyalainnya – 0onoclonal Ab against 4g/ * omali&umab '$# pat. in

5R)

– ketotifen

– 4munosupressives



A/A/ ,NT*LLE*0,NT*LLE*0

• inhalatory corticoi"s ⇒ ICS

• long.acting 3.sympathomimetics

(long-acting betaagonists )⇒

LABA,(8-15h.)

• natri#m kromoglikat1

• Natri#m ne"okromil

• antihistamin aksi lambat4

•Teoflin lepas lambat.



B/ *ELIE2E*0

• inhalatory short.acting 3.

sympathomimetics ( short-acting

betaagonists ) ⇒

0ABA (till 4-6 h.)

• inhalatory anticholinergics short-

acting

• Amino1llin

• Adrenalin



• Peroral

• Parenteral

• Dengan inhalation ⇒

Efek obat ira!akan lang!"ng Ak!i ari obat ce#at

$e%an&"ran 'ang %ak!i%al

(o)er thera#e"tic o!e! * %e%ini%alkan re!iko

keka%b"han 'g ak"t Keterbatasan dari pihak pasienKeterbatasan dari pihak pasien +tekhnik inhala!i,

ker&a!a%a "nt"k #at"h-

Resistensi dariResistensi dari inspiratoryinspiratory, har"! iata!i

*#te pemberianme"ikasi



0acam-macam carapemberian obat inhalasi

• 4nhalasi dosis terukur'4DT)( etere!-!ose inhaler '0D4)

• 4DT dengan alat 6antu 'spacer)• Breath-act"ate! #$I

• $r% &o'!er inhaler 'D24)

• Turbuhaler

• 7ebuliser



nhalator'/'!te%!

No)aa'!



6633. 0+M)AT. 0+M)AT--MIMETIMIMETI,0,0

• Mechanism o% action * bronkodilatasimenurunkan permeabilitas kapiler danmencegahpelepasan mediator dari selmast dan baso1l salbutamol terbutalin

7474 Long.actingLong.acting 66330M0M (long-acting betaagonists ) = LABA

– ,ontrollers "nt" tera&i *anga &an*ang !anterat"r broncho!ilation

3434 0hort.acting0hort.acting 66330M0M (short-acting betaagonists ) = SABA

– *elievers tera&i *anga &en!e, "nt" tera&i saat

ter*a!i eab"han



ββ22 –sympathomimetics –sympathomimetics

(LABA and SABA)(LABA and SABA)

Fast beinnin!

short d"rationinhal.

salb"tamol! #enoterol

Fast beinnin!

lon d"ration

inhal. #ormoterol

Slo$ beinnin!

short d"rationoral

salb"tamol rt. c#!.

Slo$ beinnin!

lon d"rationinhal. salmeterol

speed o# e##ectbeinnin

FAST

SL%&

S'%RT L%d"ration o# action

resc"e treatment

m a

i n t a n a n c e t h e r a p

y

LABASABA



Efek !a%#ing obat golongan agoni! beta2•gangg"an karioa!k"ler •#eningkatan tekanan arah•re%or •Pal#ita!i•takikari an !akit ke#ala

Pe%akaian agoni! beta2 !ecara reg"ler han'aiberikan #aa #enerita a!%a kronik berat 'angtiak a#at le#a! ari bronkoilator



*2+ sympatho

,-,.T-/S

0 S,

Anti ,+cholineric 0 1sL

actiate !'%#athicN/

dilatebronchi

block#ara!'%#athic N/

dilatebronchi



LoLoccalialisation o% sation o% **eceptoreceptorss

cholinercholinericic (parasympat(parasympathhic)ic)

aadrenerdrenericic

(sympat(sympathhic)ic)



LABALABA the best fast and intense acting b-dilatans

"#ration o% "#ration o% actionaction 8873 ho#rs73 ho#rsMMekanismeekanisme AAksiksi//

Broncho"ilation thro#gh 93 :8 rela;ation o% smooth

m#scle

0eningkatkan pembersihan mucociliar

0enurunkan permeabilitas vaskular

0engatur pelepasan mediator dari mastocytes

ba&ophils



,ole,olecc"l"laar mechanir mechanissmm o# o# positiepositieinterainteractionction -/S a-/S andnd LABALABA

Glucocorticoid

receptor

ß2 -Adrenoceptor

/orticosteroid

Anti+in#lammatory e##ect

• .##ect o# corticosteroids on *.##ect o# corticosteroids on *22+adrenoceptors+adrenoceptors

• .##ect o# *.##ect o# *22+aonists on l"cocorticoid receptors+aonists on l"cocorticoid receptors

*2+Aonist

Bronchodilatation



LABA• %ormoterol• salmeterol

MonotMonothheraperapyy LABA/LABA/

• ↓ effectivity of :A6A vs. 4;5• improving sleeping but !itho#t!itho#t e% e% % % eect toct to

pp#lmonary#lmonary %#n%#nctionsctions

• !itho#t!itho#t ee% % %e%ect on inam4ct on inam4 in airways

'biopsia)



BATBAT ANTILE5<T*IENANTILE5<T*IENEE

• controllerscontrollers untuk mengontrol simptom dalam jangka waktu lama

• antagonists o% le#kotriene 7 ',ysLT7( receptors

–

montel#kast1 =afrl#kast1 pranl#kast• ↓ inhibitors o% >.lipoo;ygenase

– &ileuton

• 2eroral• MA/ . additive antiin,amasi

. mengurangi eosinophilia jaringan

. mild bronchodilation

. bronchoprotective



MET-+L?ANT-INE0MET-+L?ANT-INE0

• controllers untuk terapi simpom jangka panjang

• 4mprovement of clinical symptomatology

– broncho"ilation - without signif. increase of </V"(

improvement of lung function parameters through

inhibition of fosfodiesterase 4. to 4V. *+ cAM) – antiinam4 imm#nomo"#latory e=ects

– positive e=ect on phenomenon o% @corticoi" resist4

• AE/ cephalea nausea vomiting tachycardiapalpitations ↑↑↑ plasm. conc. 'TD0) arrhytmias epileptic spasms even death

• potential toicity pro1le of A/⇒

broncho"ilators o% the thir" choice



0ABA0ABA

basic relieversbasic relievers used ad hoc to relieve or to remove

symptoms

• salb#tamol (+entolin)

• %enoterol

IN-ALAT*+IN-ALAT*+



IN-ALAT*+IN-ALAT*+ANTI,-LINE*I, D*50ANTI,-LINE*I, D*50

*elievers o% the secon" choice1 at AE*elievers o% the secon" choice1 at AE competitivecompetitive antagonistsantagonists on M71 M3 an" MCon M71 M3 an" MC

receptors of parasympathicus ⇒

cholinergic ton#scholinergic ton#s

Division/Division/

• with short.lastingshort.lasting e=ect! ipratropi#m bromi"eipratropi#m bromi"e

• with long.lastinglong.lasting e=ect! tiotropi#m bromi"etiotropi#m bromi"e

',-)D(',-)D(

,, ii ii t ii



1re+anlio3ner

1arasympatick4

anlion

1ost+anlio3

ner

A/h

'ladk3 sal

icotino3 receptor (5)

,6 receptor (5)

,2 receptor (–)

,7 receptor (5)

,"s,"sccar ar iinnicic receptoryreceptorys ins inair$aysair$ays

Barne! P4. E"r e!#ir e 1996

IN-ALAT*+



IN-ALAT*+IN-ALAT*+

ANTI,-LINE*I, D*50ANTI,-LINE*I, D*50

• decrease n. vagus tonus• cause relaation• but no bronchoprotective action

• are in general less e=ective than @8?mimethics and have a little slowerbeginning of action

•advantageous combinations v "inhalation system!

• ipratropium• ipratropium>fenoterol



R b t b d k



Rencana pengobatan serangan asma berdasarkanberat serangan dan tempat pengobatan

6. Bronchial Asthma

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