PPOK PADA MANULA

DEFINISI
Penyakit Paru Obstruksi Kronik (PPOK) ialah
penyakit ditandai dengan hambatan aliran udara
di saluran napas yang bersifat progresif non
reversibel atau reversibel parsial.Hambatan ini
terjadi karana reaksi inflamasi abnormal paru
terhadap partikel atau gas beracun
FAKTOR-FAKTOR RESIKO
•Rokok
•Pollusi udara
•Riwayat infeksi saluran napas berulang
•Defisiensi alfa1 antitripsin (AAT)
•Lain-lain
 PATHOGENESIS OF COPD
PARTICLE
NOXIOUS GASES

HOST FACTORS
ANTI OXIDANTS
[ environmental ]

LUNG INFLAMMATION

ANTI OXIDANTS ANTI PROTEINASES

[ genetic ]

OXIDATIVE STRESS PROTEINASE IMBALANCE

REPAIR REPAIR
MECHANISM MECHANISM

COPD ANTI PROTEASE ENZYME

1-Antitrypsin
 INFLAMATION

Smoll airway disease Parenchymal destruction

Airway inflamation Loss of alveolar attachments
Airway remodeling Decrease of elastic recoil

AIRFLOW LIMITATION
 Indonesia - 3 Besar Negara
Pengkonsumsi Rokok
 Jumlah perokok no. 3 di dunia &
Negara Jumlah % Pria no. 1 di ASEAN
Perokok Perokok
(Sumber: (Sumber:
 70% perokok mulai merokok
WHO) WHO)
sebelum usia 19 tahun dan 12,77
% sudah merokok sejak SD
China 350,000,000 53.4%
 Penkonsumsi tembakau no. 5 di
dunia (215 miliar batang/tahun)
India 120,000,000 29.4%

Indonesia 62,800,000 69.0%

Source:
1.http://bola.okezone.com/index.php/ReadStory/2008/05/02/50/105935/50/beijing-mulai-
 DIAGNOSIS
OF COPD

1 2

EXPOSURE TO
SYMPTOMS RISK FACTORS
COUGH Tobacco Smoke
SPUTUM Occupation
DYSPNEA Indoor / outdoor
pollution

SPIROMETRY
 GOALS OF
2
COPD TREATMENT
SHORT
GLOBAL GOLD TERM
1 GOALS
SMOKING IMMEDIATE BENEFITS
CESSATION 3 RELIEF OF SYMPTOMS
[ BREATHLESSNESS ]
LONG TERM
GOALS

PREVENT DISEASE PROGRESSIVE

REDUCE EXACERBATIONS

IMPROVE QUALITY OF LIFE

IMPROVE EXERCISE TOLERANCE

REDUCE MORTALITY
 COPD MANAGEMENT

1
STOP SMOKING
ESTABLISH DIAGNOSIS HEALTHY LIFESTYLE
ASSESS SYMPTOMS IMMUNISATION

2
TREAT OBSTRUCTION BRONCHODILATORS

3
ASSESS FOR HYPOXIA LONG TERM
OXYGEN THERAPY

4
PULMONARY REHABILITATION
PROGRAMME
 Patient Case Study: Sarah, Aged
64
 Arrives for a routine consultation
 Has had a morning cough for some time (~1 year)
 Has a cough associated with production of a small amount of sputum
 Has noticed that she has become more breathless when walking over
recent years
 Has been a smoker (20/day) since the age of 16
 Referred for spirometry

Spirometry
 FEV1: 42% predicted
 FEV1/FVC ratio: 0.44
Post-bronchodilator
 FEV1: 43% predicted
 FEV1/FVC ratio: 0.45

Diagnosis? Moderate COPD (GOLD Stage II)

Severe COPD (GOLD Stage III)
 Staging Patients to Guide
Therapeutic Intervention

1GOLD. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary
Disease. Updated 2008; 2Bellamy, et al. IPCRG Guidelines. Prim Care Respir J 2006;15:48-57.
After Sarah was diagnosed, What is the best
therapeutic intervention for her?

• Smoking cessation & life-style changes?

Yes No

• Short-acting broncodilator?
Yes No

• Long-acting bronchodilator?
Yes No
After Sarah was diagnosed, What is the
best therapeutic intervention?

• Add physical rehabilitation?

Yes No

• Inhaled costicosteroid?
Yes No

• Long-term oxygen therapy?

Yes No
The Benefits of Smoking Cessation

Adapted from: Fletcher C, Peto R. BMJ 1977; 1: 1645—8.