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