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Differential Diagnosis:
COPD and Asthma
COPD ASTHMA
• Onset in mid-life • Onset early in life (often
childhood)
• Symptoms slowly
progressive • Symptoms vary from day to day
• Long smoking history • Symptoms worse at night/early
morning
• Allergy, rhinitis, and/or eczema
also present
• Family history of asthma
© 2015 Global Initiative for Chronic Obstructive Lung Disease
Asthma Control Test
DALAM 4 MINGGU TERAKHIR
1. berapa kali asma mengganggu pekerjaan 4 Seberapa sering pakai obat semprot atau Obat
sehari-hari (kantor, sekolah atau rumah)? oral untuk melegakan pernafasan?
a. Selalu (1) a. > 3 x sehari (1)
b. 1-2 x sehari (2)
b. Sering (2)
c. 2-3 x seminggu (3)
c. Kadang ( > 2X / mg) (3) d. < 1 x seminggu (4)
d. Jarang (≤ 2X / mg) (4) e. Tidak pernah (5)
e. Tidak pernah (5) 5. Bagaimana anda menilai sendiri tingkat kontrol
2. Seberapa sering mengalami sesak nafas? asma
a. >1 x sehari (1) a. Tidak terkontrol sama sekali (1)
b. 1x sehari (2) b. Kurang terkontrol (2)
c. 3-6 x seminggu (3) c. Cukup terkontrol (3)
d. 1-2 x seminggu (4) d. Terkontrol dengan baik (4)
e. Tidak pernah (5) e. Sangat terkontrol (5)
3. seberapa sering gejala asma (wheezing, batuk,
sesak nafas, nyeri dada atau tertekan didada)
menyebabkan terbangun di malam hari / lebih
awal dari biasanya? < 19 = tidak terkontrol
a. >4x seminggu (1)
b 2-3 x seminggu (2) 20-24 = terkontrol sebagian
c. 1 x seminggu (3) 25 = terkontrol total
d. 1-2x sebulan (4)
e. Tidak pernah (5)
ASMA
Medikamentosa
RELIEVER CONTROLLER
STEP 5
STEP 4
Other Consider low Leukotriene receptor antagonists (LTRA) Med/high dose ICS Add tiotropium# Add
tiotropium#
controller dose ICS Low dose theophylline* Low dose ICS+LTRA High dose ICS
+ LTRA Add low
options (or + theoph*)
(or + theoph*) dose OCS
*For children 6-11 years, theophylline is not recommended, and preferred Step 3 is medium dose ICS
**For patients prescribed Beclometason/formoterol or Budesonide/formoterol maintenance and reliever therapy
# Tiotropium by soft-mist inhaler is indicated as add-on treatment for patients with a history of exacerbations; it is not indicated
in children <18 years.
GINA 2015, Box 3-5, Step 2 (5/8)
ASMA
prediksi
Risiko tinggi Risiko tinggi
4 Sedikit gejala Banyak gejala
≥2
atau
≥1
(Riwayat Eksaserbasi)
30% ≤ FEV1 < 50% dirawat di
prediksi
(C) (D) Rumah sakit
3
Risiko
Risiko
50% ≤ FEV1 < 80% Pasien : Pasien :
prediksi
Risiko rendah Risiko rendah 1 (tidak dirawat
FEV1 ≥ 80%
prediksi (A) (B)
1 0
CAT < 10 CAT ≥ 10
Gejala mMRC ≥ 2
CAT : COPD assessment test
mMRC 0–1
Sesak Napas
mMRC : modified medical research council
FEV1 : forced expiratory volume in 1 second
Global Strategy for The Diagnosis, Management, And Prevention of Chronic Obstructive Pulmonary Disease (updated 2015). Available from www.goldcopd.org. Accessed on March
01, 2015.
COPD Assessment test
(CAT)
12
Terapi Farmakologi 1st CHOICE
C D
(Klasifikasi GOLD Pembatasan aliran udara)
(Riwayat Eksaserbasi)
30% ≤ FEV1 < 50% dirawat di
prediksi atau dan/atau Rumah sakit
3 LAMA LAMA
Risiko
Risiko
50% ≤ FEV1 < 50% A B
prediksi Risiko rendah Risiko rendah
1 (tidak dirawat
Sedikit gejala Banyak gejala
2 di Rumah sakit)
15
Low, medium and high dose inhaled corticosteroids
Adults and adolescents (≥12 years)
Inhaled corticosteroid Total daily dose (mcg)
Low Medium High