PENYAKIT PARU OBSTRUKSI

KRONIK (PPOK)
Dr Budi Enoch SpPD
 2

• Chronic obstructive pulmonary disease

(COPD), also known as chronic obstructive
lung disease (COLD) and chronic
obstructive airway disease (COAD), among
others, is a type of obstructive lung disease
characterized by chronically poor airflow.
• It typically worsens over time.
• The main symptoms include shortness of
breath, cough, and sputum production.
• Most people with chronic bronchitis have
COPD
 3

• Bronchitis is a term that describes

inflammation of the bronchial tubes
(bronchi and the smaller branches
termed bronchioles) that results in excessive
secretions of mucus into the tubes with tissue
swelling that may narrow or close off
bronchial tubes.
• Chronic bronchitis is defined as a cough that
occurs every day with sputum production
that lasts for at least 3 months, 2 years in a
row.
• Emphysema gradually damages the air sacs
(alveoli) in lungs, making progressively more
short of breath.
 FAKTOR RISIKO 4

Global Initiative for Chronic Obstructive Lung Disease. 2010. Global Strategy for The Diagnosis, Management, and
Prevention of Chronic Obstructive Pulmonary Disease. Barcelona: Medical Communications Resources
 RISK FACTORS -> CIGARETTE SMOKING
• By 1964, the Advisory Committee to the Surgeon General of the United
States had concluded that cigarette smoking was a major risk factor
for mortality from chronic bronchitis and emphysema.
• Subsequent longitudinal studies have shown accelerated decline in
the volume of air exhaled within the first second of the forced
expiratory maneuver (FEV1) in a dose-response relationship to the
intensity of cigarette smoking, which is typically expressed as pack-
years (average number of packs of cigarettes smoked per day
multiplied by the total number of years of smoking).
• This dose-response relationship between reduced pulmonary function
and cigarette smoking intensity accounts for the higher prevalence
rates for COPD with increasing age.
• The historically higher rate of smoking among males is the likely
explanation for the higher prevalence of COPD among males;
however, the prevalence of COPD among females is increasing as the
gender gap in smoking rates has diminished in the past 50 years.
 7

• Gross pathology of lung showing centrilobular emphysema

characteristic of smoking. Closeup of fixed, cut surface shows
multiple cavities lined by heavy black carbon deposits.
 PATOGENESIS 8

Perhimpunan Dokter Paru Indonesia. 2006. PPOK (Penyakit Paru Obstruktif Kronik) Pedoman Praktis Diagnosis dan
Penatalaksanaan di Indonesia. Jakarta: Perhimpunan Dokter Paru Indonesia.
 10

Barnes, PJ. Immunology of asthma and chronic obstructive pulmonary disease. Nat Rev Immunol 2008;8:183-92.
 11

Barnes, PJ. Immunology of asthma and chronic obstructive pulmonary disease. Nat Rev Immunol 2008;8:183-92.
 12

• Airflow limitation in
COPD

Chung KF. The role of airway smooth muscle in the pathogenesis of airway remodelling in COPD. Proc Am
Thorac Soc 2005;2:347-54.
 13

• Mucociliary effects in
the COPD airway

Danahay H & Jackson AD. Epithelial mucus-hypersecretion and respiratory disease. Curr Drug Targets
Inflamm Allergy 2005;4:651-64.
 GAMBARAN RADIOLOGI
BRONKITIS KRONIS
 Dirty chest
 Tramline - Gambaran garis-garis paralel yang terpisah 3 mm
antargaris.
 Penyempitan trakea
 Airbronkogram (+)
 Corakan bronkovaskuler bertambah
 Diafragma letak rendah dan mendatar
 Pada golongan yang berat ditemukan dapat disertai cor pulmonale
sebagai komplikasi bronkitis kronik
Gambar Rontgen penderita Bronkitis Kronis
Tramline appearance
http://radiopaedia.org/articles/pulmonary-
emphysema
 EMFISEMA
Emphysema gradually damages
the air sacs (alveoli) in your
lungs, making you progressively
more short of breath.
 19

• Your lungs' alveoli are clustered like bunches of

grapes.
• In emphysema, the inner walls of the air sacs
weaken and eventually rupture — creating one
larger air space instead of many small ones.
• This reduces the surface area of the lungs and, in
turn, the amount of oxygen that reaches your
bloodstream.
• When you exhale, the damaged alveoli don't work
properly and old air becomes trapped, leaving no
room for fresh, oxygen-rich air to enter. Treatment
may slow the progression of emphysema, but it
can't reverse the damage.
 KLASIFIKASI EMFISEMA
• Berdasarkan perubahan yang terjadi dalam paru-
paru :
• Emfisema Sentrilobular (CLE)
• Emfisema Panlobular (PLE)
• Emfisema Paraseptal
 1.EMFISEMA CENTRILOBULAR(CLE)
• Merupakan tipe yang sering muncul
• Menghasilkan kerusakan bronchiolus,
biasanya pada bagian atas paru
• Inflamasi berkembang pada
bronchiolus tetapi biasanya kantung
alveolar tetap tersisa

http://learningradiology.com/lectures/chestlectures/copd/Chronic%20Obstructive%20Pulmonary%20Disease%20%20COPD/Chronic%20Obstructive%20Pulmonary%20Disease%20%20COPD.html
 2. EMFISEMA PANLOBULAR
• Merusak ruang udara pada seluruh
asinus
• bentuk lokal : distribusi
multilobular bentuk diffuse :
distribusi tidak berhubungan dengan
anatomi zonal dari paru-paru
• Bentuk ini biasanya disebut
panacinar emfisema
• Timbul sangat sering pada seorang
perokok
http://learningradiology.com/lectures/chestlectures/copd/Chronic%20Obstructive%20Pulmonary%20Disease%20%20COPD/Chronic%20Obstructive%20Pulmonary%20Disease%20%20COPD.html
 3. EMFISEMA PARASEPTAL

pada ujung distal alveolus di sepanjang septum

interlobularis dan di bawah pleura

http://learningradiology.com/lectures/chestlectures/copd/Chronic%20Obstructive%20Pulmonary%20Disease%20%20COPD/Chronic%20Obstructive%20Pulmonary%20Disease%20%20COPD.html
http://radiopaedia.org/articles/pulmonary-
emphysema
GAMBARAN RADIOLOGI UMUM
EFISEMA

http://radiopaedia.org/articles/pulmonary-emphysema
 A lung with
emphysema shows
increased
anteroposterior (AP)
diameter, increased
retrosternal airspace,
and flattened
diaphragms on lateral
chest radiograph.
 28

GEJALA KLINIS

Sesak Napas

Batuk Kronis

Sesak napas (wheezing)

Batuk Darah

Anoreksia dan berat badan menurun

Perhimpunan Dokter Paru Indonesia. 2006. PPOK (Penyakit Paru Obstruktif Kronik) Pedoman Praktis Diagnosis dan
Penatalaksanaan di Indonesia. Jakarta: Perhimpunan Dokter Paru Indonesia.
 Pemeriksaan Fisik
Inspeksi
Pursed-lips breathing 29
Barrel chest
Penggunaan otot bantu
napas
Hipertrofi otot bantu napas
Pelebaran sela iga
Bila telah terjadi gagal
jantung kanan terlihat
denyut vena jugularis di
leher dan edema tungkai
Penampilan pink puffer atau
blue bloaters
Perhimpunan Dokter Paru Indonesia. 2006. PPOK (Penyakit Paru Obstruktif Kronik) Pedoman Praktis Diagnosis dan
Penatalaksanaan di Indonesia. Jakarta: Perhimpunan Dokter Paru Indonesia.
30
 Pemeriksaan Fisik
Palpasi
Pada emfisema fremitus melemah, sela iga melebar. 31
Perkusi
Pada emfisema hipersonor dan batas jantung mengecil, letak
diafragma rendah, hepar terdorong ke bawah.
Auskultasi
Suara napas vesikular normal atau melemah
Terdapat ronki atau mengi pada waktu bernapas biasa atau
pada ekspirasi biasa.
Ekspirasi memanjang
Bunyi jantung terdengar jauh

Perhimpunan Dokter Paru Indonesia. 2006. PPOK (Penyakit Paru Obstruktif Kronik) Pedoman Praktis Diagnosis dan
Penatalaksanaan di Indonesia. Jakarta: Perhimpunan Dokter Paru Indonesia.
 SPIROMETRY
• Spirometry provides objective information about
pulmonary function and assesses the results of therapy.
• Pulmonary function tests early in the course of COPD
reveal only evidence of abnormal closing volume and
reduced midexpiratory flow rate.
• Reductions in FEV1 and in the ratio of forced expiratory
volume to vital capacity (FEV1% or FEV1/FVC ratio)
occur later.
• In severe disease, the FVC is markedly reduced.
• Lung volume measurements reveal a marked increase
in residual volume (RV), an increase in total lung
capacity (TLC), and an elevation of the RV/TLC ratio,
indicative of air trapping, particularly in emphysema.
Tingkat keparahan PPOK

Tingkat keparahan PPOK diukur

dari skala sesak napas. Menurut 33
American Thoracic Society (ATS)
Skala 0Tidak ada sesak kecuali
dengan aktivitas berat
Skala 1Sesak mulai timbul bila
berjalan cepat atau naik tangga satu
tingkat
Skala 2 Berjalan lebih lambat
karena merasa sesak
Skala 3Sesak timbul bila berjalan
100 m atau setelah beberapa menit
berjalan
Skala 4Sesak bila mandi atau
berpakaian
Global Initiative for Chronic Obstructive Lung Disease. 2010. Global Strategy for The Diagnosis,
Management, and Prevention of Chronic Obstructive Pulmonary Disease. Barcelona: Medical
Communications Resources.
Klasifikasi PPOK 35

Gold 2010
Derajat Klinis Faat Paru
Gejala Klinis Normal
(Batuk, produksi sputum
Derajat I : Gejala batuk kronik dan produksi sputum ada tetapi VEP1 / KVP < 70%
PPOK tidak sering. Pada derajat ini pasien sering tidak VEP1 ≥ 80% prediksi
Ringan menyadari bahwa fungsi paru mulai menurun

Derajat II : Gejala sesak mulai dirasakan saat aktivitas dan VEP1 / KVP <70%
PPOK kadang ditemukan gejala batuk dan produksi sputum. 50% < VEP1< 80% prediksi
Sedang Pada derajat ini biasanya pasien mulai
memeriksakan kesehatannya

Derajat III Gejala sesak lebih berat, penurunan aktivitas, rasa VEP1 / KVP < 70%
PPOK lelah dan serangan eksaserbasi semakin sering dan 30% < VEP1< 50% prediksi
Berat berdampak pada kualitas hidup pasien

Derajat IV Gejala diatas ditambah tanda-tanda gagal napas VEP1 / KVP < 70%
PPOK atau gagal jantung kanan dan ketergantungan VEP1< 30% prediksi atau
Sangat berat oksigen. Pada derajat ini kualitas hidup pasien VEP1< 50% prediksi disertai
memburuk dan jika eksaserbasi dapat mengancam gagal napas kronik
jiwa
Global Initiative for Chronic Obstructive Lung Disease. 2010. Global Strategy for The Diagnosis, Management, and Prevention of Chronic
Obstructive Pulmonary Disease. Barcelona: Medical Communications Resources.
Diagnosis Banding PPOK
36

Diagnosis Banding Gejala

PPOK Onset pada usia pertengahan
Gejala progresif lambat
Lamanya riwayat merokok
Sesak saat aktivitas
Sebagaian besar hambatan aliran udara ireversibel
Asma` Onset awal sering pada anak
Gejala bervariasi dari hari ke hari
Gejala pada malam/menjelang pagi
Disertai atopi, rhinitis dan eksim
Riwayat keluarga dengan asma
Sebagian besar hambatan aliran udara reversible

Perhimpunan Dokter Paru Indonesia. 2006. PPOK (Penyakit Paru Obstruktif Kronik) Pedoman Praktis Diagnosis dan
Penatalaksanaan di Indonesia. Jakarta: Perhimpunan Dokter Paru Indonesia.
Diagnosis Banding PPOK
37

Gagal jantung Auskultasi terdengar rhonki halus di bagian basal

kongestif Foto toraks tampak jantung membesar, edema paru
Uji faal paru menunjukkan restriksi, bukan obstruksi
Bronkiektasis Sputum produktif dan purulen
Umumnya terkait dengan infeksi bakteri
Auskultasi terdengar rhonki kasar
Fotot torak/CT scan torak menunjukkan pelebaran dan
penebalan bronkus
Tuberculosis Onset segala usia
Foto torak menunjukkan infiltrate
Konfirmasi mikrobiologi atau dengan sputum BTA
Prevalensi tuberculosis tinggi di daerah endemis

Perhimpunan Dokter Paru Indonesia. 2006. PPOK (Penyakit Paru Obstruktif Kronik) Pedoman Praktis Diagnosis dan
Penatalaksanaan di Indonesia. Jakarta: Perhimpunan Dokter Paru Indonesia.
Tatalaksana

Tujuan penatalaksanaan : 38

Mengurangi gejala
Mencegah progresivitas penyakit
Meningkatkan toleransi latihan
Meningkatkan status kesehatan
Mencegah dan menangani komplikasi
Mencegah dan menangani eksaserbasi
Menurunkan kematian

Perhimpunan Dokter Paru Indonesia. 2006. PPOK (Penyakit Paru Obstruktif Kronik) Pedoman Praktis Diagnosis dan
Penatalaksanaan di Indonesia. Jakarta: Perhimpunan Dokter Paru Indonesia.
Penatalaksanaan Menurut Derajat PPOK
39

DERAJAT I DERAJAT II DERAJAT III DERAJAT IV

VEP1/KVP <70% VEP1/KVP <70% VEP1/KVP ≤ 70% VEP1/KVP ≤ 70%
VEP1 ≥80% prediksi VEP1/KVP < 70% 30% ≤ VEP1 ≤ 50% 30% ≤ VEP1 ≤ 50%
50% < VEP1 < 80% prediksi Prediksi
prediksi
 Hindari faktor risiko: BERHENTI MEROKOK, PAJANAN KERJA
 Dipertimbangkan pemberian vaksin influenza
 Tambahksn bronkodilator kerja pendek (bila diperlukan)
 Berikan pengobatan rutin dengan satu atau lebih bronkodilator kerja lama
 Tambahkan rehabilitasi fisis
 Tambahkan inhalasi glukokortikosteroid jika
terjadi eksaserbasi berulang-ulang
 Tambahkan
pemberian oksigen
jangka panjang kalau
terjadi gagal napas
kronik
 Lakukan tindakan
operasi bila
diperlukan.
Global Initiative for Chronic Obstructive Lung Disease. 2010. Global Strategy for The Diagnosis, Management, and Prevention of Chronic
Obstructive Pulmonary Disease. Barcelona: Medical Communications Resources.
Penatalaksanaan PPOK stabil 40

Kriteria PPOK Stabil :

Tidak dalam kondisi gagal napas akut pada gagal
napas kronik
Dapat dalam kondisi gagal napas kronik stabil, yaitu
hasil analisis gas darah menunjukkan PH normal PCO2 >
60 mmHg dan PO2 < 60 mmHg
Sputum tidak berwarna atau jernih
Aktivitas terbatas tidak disertai sesak sesuai derajat
berat PPOK (hasil spirometri)
Penggunaan bronkodilator sesuai rencana pengobatan
Tidak ada penggunaan bronkodilator tambahan
Global Initiative for Chronic Obstructive Lung Disease. 2010. Global Strategy for The Diagnosis, Management, and Prevention of Chronic
Obstructive Pulmonary Disease. Barcelona: Medical Communications Resources.
Penatalaksanaan PPOK stabil 41

Edukasi Oksigen
Meningkatkan kemampuan Indikasi: PaO2< 55 mmHg
menanggulangi penyakit dan atau SaO2 < 88% dengan
status kesehatan secara atau tanpa hiperkapnea
umum. Edukasi terhadap atau PaO2 antara 55-60
faktor resiko penting untuk mmHg dan Sa02 89% tetapi
memperlambat progresifitas. ada tanda-tanda congestive
Farmakoterapi, terdiri dari: heart failure.
Bronkodilator Ventilator Mekanik
Kortikosteroid Rehabilitasi Medik
Mukolitik
Antioksidan

Global Initiative for Chronic Obstructive Lung Disease. 2010. Global Strategy for The Diagnosis, Management, and Prevention of Chronic
Obstructive Pulmonary Disease. Barcelona: Medical Communications Resources.
Penatalaksanaan PPOK Eksaserbasi Akut 42

Eksaserbasiperburukan kondisi pasien yang menetap dari keadaan

stabil dan di luar variasi normal sehari-hari yang mengharuskan
perubahan dari obat reguler. Eksaserbasi dapat disebabkan infeksi
atau faktor lainnya seperti polusi udara, kelelahan atau timbulnya
komplikasi.

Gejala eksaserbasi adalah :

Sesak bertambah
Produksi sputum meningkat
Perubahan warna sputum (sputum menjadi purulen)
Eksaserbasi akut dibagi menjadi tiga:
Tipe I (eksaserbasi berat)
Tipe II (eksaserbasi sedang)
Tipe III (eksaserbasi ringan)
Global Initiative for Chronic Obstructive Lung Disease. 2010. Global Strategy for The Diagnosis, Management, and Prevention of Chronic
Obstructive Pulmonary Disease. Barcelona: Medical Communications Resources.
Penatalaksanaan PPOK Eksaserbasi Akut 43

Oksigenasi adekuat, Cairan dan elektrolit

cukup menggunakan O2 perlu dimonitor
nasal 1-4 lpm. Sasaran Nutrisi yang adekuat,
PaO2 60-65 mmHg atau untuk mencegah proses
SaO2> 90% katabolik tubuh.
Bronkodilator Ventilator mekanik,
Kortikosteroid oral atau dapat diberikan pada
intravena dianjurkan pasien eksaserbasi
sebagai tambahan dengan stadium IV.
terhadap bronkodilator
dan oksigenasi
Antibiotika
Karakteristik Pengobatan Berdasarkan Derajat PPOK
44

DERAJAT PENGOBATAN
Semua - Edukasi (hindari faktor pencetus)
Derajat - Bronkodilator kerja singkat (SABA, Antikolinergik, kerja
cepat, Xantin) bila perlu
- Vaksinasi influenza
Derajat I: DERAJAT I Bronkodilator kerja singkat (SABA, Antikolinergik, kerja
PPOK VEP1/KVP < 70% cepat, Xantin) bila perlu
Ringan VEP1 ≥ 80% Prediksi,
dengan atau tanpa
gejala
Derajat II: DERAJAT II 1. Pengobatan reguler dengan bronkodilator:
PPOK VEP1/KVP < 70% a.Antikolinergik kerja lama sebagai terapi
Sedang 50% < VEP1 < 80% pemeliharaan
prediksi, dengan atau b. LABA
tanpa gejala c. Simptomatik
2. Rehabilitasi (edukasi, nutrisi, rehabilitasi respirasi)
Global Initiative for Chronic Obstructive Lung Disease. 2010. Global Strategy for The Diagnosis, Management, and Prevention of Chronic
Obstructive Pulmonary Disease. Barcelona: Medical Communications Resources.
Karakteristik Pengobatan Berdasarkan Derajat PPOK
45

Derajat III: DERAJAT III 1. Pengobatan reguler dengan 1 atau lebih bronkodilator:
PPOK Berat VEP1/KVP ≤ 70% a. Anti kolinergik kerja lama sebagai terapi pemeliharaan
30% ≤ VEP1 ≤ 50% b. LABA
prediksi dengan atau c. Simptomatik
tanpa gejala d. Kortikosteroid inhalasi bila memberikan respons klinis
atau eksasebasi
2. Rehabilitasi
DERAJAT IV DERAJAT III 1. Pengobatan reguler dengan 1 atau lebih bronkodilator :
PPOK VEP1/KVP ≤ 70% a. Anti kolinergik kerja lama sebagai terapi pemeliharaan
Sangat 30% ≤ VEP1 ≤ 50% b. LABA
Berat prediksi atau gagal c. Simptomatik
napas atau gagal d. Kortikosteroid inhalasi bila memberikan respons klinis
jantung kanan atau eksasebasi berulang
2. Rehabilitasi (edukasi, nutrisi, rehabilitasi respirasi)
3. Terapi oksigen jangka panjang bila gagal napas
4. Ventilasi mekanis noninvasive
5. Pertimbangkan terapi pembedahan
Global Initiative for Chronic Obstructive Lung Disease. 2010. Global Strategy for The Diagnosis, Management, and Prevention of Chronic
Obstructive Pulmonary Disease. Barcelona: Medical Communications Resources.
Obat-obatan PPOK berdasarkan gejala
46

Gejala Golongan Obat Obat dan kemasan Dosis

Tanpa gejala - Tanpa obat
Gejala Agonis β2 Inhalasi kerja cepat Bila perlu
intermitten
Gejala terus Antikolinergik Ipratropium bromida 20 2-4 semprot
menerus kerja singkat μgr 3-4x/hari
Antikolinergik Tiotropium bromida 80 μgr 1 hisap
kerja lama 1x/hari
Inhalasi agonis β2 Fenoterol 100 μgr/ semprot 2-4 semprot
kerja cepat 3-4 x/hari
Salbutamol 100 μgr/ 2-4 semprot
semprot 3-4 x/hari
Terbutalin 0,5 mg/ semprot 2-4 semprot
4x/hari
Prokaterol 10 μgr/ semprot 2-4 semprot
3x/hari
Indacaterol 1 hisap,
1x/hari
Kombinasi terapi Ipratroium bromida 20 μgr 2-4 semprot
+ salbutamol 100 μgr per 3-4x/hari
semprot
Obat-obatan PPOK berdasarkan gejala (2)
47

Gejala Golongan Obat Obat dan Kemasan Dosis

Pasien memakai Inhalasi agonis β2 kerja Formoterol 6 μgr, 1-2 semprot
inhalasi agonis lama (tidak dipakai 12 μgr/ semprot 2x/hari, tidak
β2 kerja singkat untuk eksaserbasi) melebihi 2x/hari
rutin

Indacaterol 1 hisap, 1x/hari

Atau
Salmeterol 25 μgr/ 1-2 semprot
Timbul gejala semprot 2x/hari, tidak
pada waktu melebihi 2x/hari
malam Teofilin Teofilin lepas 400-800 mg hari
hari/pagi hari lambat 3-4x/hari
Teofilin/aminofilin
150 mgx3-4 x/hari

Anti oksidan N asetil sistein 600 mg/hari

Global Initiative for Chronic Obstructive Lung Disease. 2010. Global Strategy for The Diagnosis, Management, and Prevention of Chronic
Obstructive Pulmonary Disease. Barcelona: Medical Communications Resources.
Obat-obatan PPOK berdasarkan gejala (3)
48

Gejala Golongan Obat Obat dan Kemasan Dosis

Pasien tetap Kortikosteroid Prednison 30-40
mempunyai oral Metil prednisolon mg/hari
gejala dan atau (uji Selama 2
terbatas dalam kortikosteroid) minggu
aktivitas harian
meskipun
mendapat
pengobatan
bronkodilator
maksimal

Global Initiative for Chronic Obstructive Lung Disease. 2010. Global Strategy for The Diagnosis, Management, and Prevention of Chronic
Obstructive Pulmonary Disease. Barcelona: Medical Communications Resources.
 IPRATROPIUM BROMIDE 49

• Ipratropium bromide, sold under the trade name Atrovent among

others, is a medication that opens up the medium and large
airways in the lungs. It is used to treat the symptoms of chronic
obstructive pulmonary disease and asthma.
• It is used by inhaler or nebulizer. Onset of action is typically within
15 to 30 minutes and lasts for three to five hours.
• Common side effects include dry mouth, cough,
and inflammation of the airways. Potentially serious side effects
include urinary retention, worsening spasms of the airways, and
a severe allergic reaction, It appears to be safe
in pregnancy andbreastfeeding.
• Ipratropium is an anticholinergic and muscarinic antagonist which
works by causing smooth muscles to relax.
• Ipratropium bromide was developed in Germany in 1976. It was
approved for medical use in the United States in 1986.
• It is on the World Health Organization's List of Essential Medicines,
the most important medications needed in a basic health system
 TIOTROPIUM BROMIDE 50

• Tiotropium bromide is a long-acting, 24-

hour, anticholinergic bronchodilator used in the management
of chronic obstructive pulmonary disease (COPD).
• Tiotropium bromide capsules for inhalation are co-promoted
by Boehringer-Ingelheim and Pfizer under the trade name Spiriva.
• Tiotroprium was discovered in 1991 and came to market in 2004
• Tiotropium is used for maintenance treatment of chronic obstructive
pulmonary disease (COPD) which includes chronic bronchitis and
emphysema.
• It is not however used for acute exacerbations.
• Adverse effects are mainly related to its antimuscarinic effects.
• Common adverse drug reactions (≥1% of patients) associated with
tiotropium therapy include: dry mouth and/or throat irritation. Rarely
(<0.1% of patients) treatment is associated with:urinary retention,
constipation, acute angle closure glaucoma, palpitations
(notably supraventricular tachycardia and atrial fibrillation) and/or
allergy (rash, angioedema, anaphylaxis).
• Once the powder capsules are removed from the blister pack, it should 51
be taken immediately via the inhalation device. If a capsule is exposed to
the air, it will rapidly degrade to the point the dose will become
ineffective. Any previously exposed capsules should be discarded.
• The capsules cannot be taken orally - they will not be effective as
respiratory medication if absorbed through the gastrointestinal tract and
may have side effects if absorbed via this route.
 52

KOMPLIKASI
Gagal napas kronik

Gagal napas akut pada gagal napas

kronik

Infeksi berulang

Kor
pulmonale
 53

TERIMA KASIH
Selamat Belajar 