COPD

(Chronic Obstructive Pulmonary Diseases)

Fransiska Maria C.
Bagian FKK-UJ
Referensi

GOLD, 2019 PDPI, 2003 Dipiro, 2014

 Definition …
0 COPD (Chronic Obstructive Pulmonary Disease ) is a common
preventable and treatable disease that is characterized by
persistent respiratory symptoms and airflow limitation that is
due to airway and/or alveolar abnormalities usually caused by
significant exposure to noxious particles or gases. (GOLD, 2019)

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)
Etiology & Risk Factors
 deficiency of alpha-1 antitrypsin
(AATD), gene encoding matrix
metalloproteinase (MMP-12), glutation
S-transferase
Pathophysiology
Chronic airflow limitation in COPD

(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
gass exchaging
surface of the lung
(alveoli)
 Pathogenesis of
chronic bronchitis
Pathogenesis of emphysema
 Sputum
production
Cronic
cough

Dyspnea
Risk
factor

COPD SYMPTOMS
COPD vs ASTHMA

(Dipiro, 2014)
 ASMA vs PPOK

PDPI, 2003
DIAGNOSIS of COPD

(GOLD, 2017)
 Assesment of COPD
1. SPIROMETRY

(GOLD, 2018)
 Assesment of COPD
2. DYSPNEA SCALE (mMRC scale)

Modified Medical Research Council (mMRC)

 Assesment of COPD
3. CATTM (COPD Assesment test)
The Refined ABCD assessment tool

(GOLD, 2018)
 Tujuan Terapi

① Memperbaiki keadaan obstruksi saluran

nafas Rencana Magemen :
② Mencegah eksaserbasi berulang (1) Menilai dan
memonitor
③ M e m p e r b a i ki dan men cegah penyakit;
penurunan faal paru (2) Menurunkan
faktor resiko;
④ Menigkatkan kualitas hidup penderita (3) Memanagemen
⑤ Mencegah Progresifitas penyakit PPOK stabil ;
(4) Memanagemen
⑥ Mencegah dan mengobati komplikasi eksaserbasi.
⑦ Mengurangi angka kematian
 Non Pharmacologic Therapy
① Smoking cessation
② Limit environmental triggers exposure
③ Pulmonary rehabilitation (exercise)
④ Immuizations (influenza & pneumococcal)
⑤ Long term oxygen therapy (>15 jam/hari), 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
• BRONKODILATOR
 Agonis -2 (SABA & LABA)
 Antikolinergik/antimuskarinik (SAMA & LAMA)
 Metilxantin
• BRONKODILATOR KOMBINASI
 SABA/SAMA
 LABA/LAMA
 LABA/ICS
 LABA/LAMA/ICS
• ANTI-INFLAMASI
 ICS (kombinasi dg LABA)
 PDE4 Inhibitor (rofumilast)
• ANTIBIOTIK (azitromisin, eritromisin)
• MUKOLITIK/ANTIOKSIDAN (NAC,
karbosistein, erdostein) Evidence  GOLD, 2019
Tambahan terapi farmakologi
 -antitripsin replacement therapy (Evidence B)

 Antitusif (Evidence C)
 Vasodilator (Evidence B)
Pharmacologic Therapy

(Dipiro, 2014)
(BNF 61)
Pharmacologic Therapy

5-7 hari

5-7 hari

(Dipiro, 2014)
Tata laksana eksaserbasi PPOK

Klasifikasi

Mild Moderate Severe

No Acute
respiratory respiratory
failure failure

Non-life Life-
threatening threatening