COPD (Chronic Obstructive Pulmonary Diseases) Fransiska Maria C. Bagian FKK-UJ
COPD(Chronic Obstructive Pulmonary Diseases)
Fransiska Maria C.Bagian FKK-UJ
Definition …
0 COPD (Chronic Obstructive Pulmonary Disease ) is a common preventable and treatable disease, is characterized by persistent airflow limitation that is usually progressive and associated with an enhanched chronic inflammatory response in the airways and the lungs to noxious particles or gases. (GOLD, 2015)
0 PPOK adalah penyakit paru kronik yang ditandai oleh hambatan aliran udara di saluran napas yang bersifat progresif non reversibel atau reversibel parsial (PDPI, 2003)
(clinical term) presence of cough and
sputum production for at least 3 months in each of 2 constitutive years
(anatomic pathological term) destruction of the
alveoli
Etiology & Risk Factors
Pathophysiology
Pathogenesis of chronic bronchitis
Pathogenesis of emphysema
COPD SYMPTOMS
Dyspnea
Cronic cough
Sputum production
Risk factor
COPD vs ASTHMA
(Dipiro, 2015)
Assesment of COPD
1. SPIROMETRY
(GOLD, 2015)
Assesment of COPD
2. DYSPNEA SCALE (mMRC scale)
Modified Medical Research Council (mMRC)
Assesment of COPD
3. CATTM (COPD Assesment test)
Interpretation
Assesment of COPD
COMBINED ASSESMENT OF COPD
(GOLD in Dipiro, 2015)
Tujuan Terapi
① Memperbaiki keadaan obstruksi saluran nafas
② Mencegah eksaserbasi berulang
③ M e m p e r b a i ki d a nm e n c e g a h penurunan faal paru
④ Menigkatkan kualitas hidup penderita
⑤ Mencegah Progresifitas penyakit
⑥ Mencegah dan mengobati komplikasi
⑦ Mengurangi angka kematian
Rencana Magemen :(1) Menilai dan
memonitor penyakit;
(2) Menurunkan faktor resiko;
(3) Memanagen PPOK stabil ;
(4) Memanageneksaserbasi.
Non Pharmacologic Therapy① Smoking cessation② Limit environmental triggers exposure
③ Pulmonary rehabilitation (exercise)
④ Immuizations
⑤ Long term oxygen therapy, if: PaO2 < 55 mmHg or SaO2 < 88% (with/without hypercapnia)
55 < PaO2 < 60 mmHg or SaO2 < 88% (right-side HF, polycythemia, pulmonary HT)
Pharmacologic Therapy
(Dipiro, 2015)
Stab
le C
OPD
(GINA, 2015)
Stab
le C
OPD
(BNF 61)
Stab
le C
OPD
(GINA, 2015)
(GINA, 2015)
Tambahan terapi farmakologi -antitripsin replacement therapy
Pharmacologic Therapy
(Dipiro, 2015)
Accu
te e
xace
rbati
on C
OPD
Terapi Antibiotik pada Kekambuhan PPOK
TABLE 19: Antibiotic treatment in exacerbations of COPD a,b
Oral Treatment(No particular order)
Alternative(No particular order)
Parental Treatment(No particular order)
Group A Patients with only one cardinal symptom should not receive antibiotics
If indication then:• ß-lactam (Ampicillin/Amoxicillinc)
• Tetracycline
• Trimethoprim/Sulfamethoxazole
• ß-lactam/ß-lactamase inhibitor (Co-amoxiclav)
• Macrolides (Azithromycin, Clarithromycin, Roxithromycind)
• Cephalosporins - 2nd or 3rd generation
• Ketolides (Telithromycin)Group B • ß-lactam/b-lactamase inhibitor
(Co-amoxiclav)• Fluoroquinolonesd (Gatifloxacin,
Gemifloxacin, Levofloxacin, Moxifloxacin)
• ß-lactam/b-lactamase inhibitor(Co-amoxiclav, ampicillin/sulbactam)
• Cephalosporins - 2nd or 3rd generation
• Fluoroquinolonesd (Gatifloxacin, Levofloxacin, Moxifloxacin)
Group C • Fluoroquinolones (Ciprofloxacin, Levofloxacin - high dosee)
• Fluoroquinolones (Ciprofloxacin, Levofloxacin - high dosee) or
• ß-lactam with P.aeruginosa activity
Terapi Antibiotik pada Kekambuhan PPOK
Table 13 - Management of Severe but Not Life- Threatening Exacerbations of COPD in the
Emergency Department or the Hospital*
• Assess severity of symptoms, blood gases, chest X-ray.• Administer controlled oxygen therapy and repeat arterial
blood gas measurement after 30 minutes.• Bronchodilators:
ññIncrease doses or frequency.
ññ Combine fl2-agonists and anticholinergics.
ññ Use spacers or air-driven nebulizers.
ññ Consider adding intra- venous methylxanthine, if needed.
• Add glucocorticosteroids
• Consider antibioticsññ Oral or intravenous.ññ When signs of bacterial
infection, oral or occasionally intravenous.
• Consider noninvasive mechanical ventilation.• At all times: ññ
ññ
Monitor fluid balance and nutrition.Consider subcutaneous heparin.
ññ Identify and treat associated conditions (e.g., heart failure, arrhythmias).
ññ Closely monitor condition of the patient.
* Local resources need to be considered