JOURNAL

READING : ASMA
Raden Muhamad Hidayat
 Definisi
Asma adalah kelaianan berupa inflamasi kronik
saluran napas yang menyebabkan hipereaktivitas
bronkus terhadap berbagai rangsangan yang ditandai
dengan gejala episodik berulang mengi, batuk,
sesak napas dan rasa berat di dada terutama
pada malam hari yang umumnya bersifat reversibel.
Pedoman pengendalian penyakit asma, kementrian kesehatan Republik Indonesia Tahun 2008
 Definisi
Asthma is a heterogeneous disease, usually
characterized by chronic airway inflammation. It is
defined by the history of respiratory symptoms such a
wheeze, shortness of breath, chest
tightness and cough that vary over time and
in intensity, together with variable expiratory
airflow limitation.
Pocket guide for asthma management and prevention 2019
 Epidemiologi
■ Asthma affects an estimated 300 million individuals worldwide.
Annually, the World Health Organization (WHO) has estimated that 15
million disability-adjusted life-years are lost and 250,000 asthma deaths
are reported worldwide.
■ Asthma predominantly occurs in boys in childhood, with a male-to-
female ratio of 2:1 until puberty, when the male-to-female ratio becomes
1:1. Asthma prevalence is greater in females after puberty, and the
majority of adult-onset cases diagnosed in persons older than 40 years
occur in females.

Global strategy for asthma management and prevention: GINA executive summary.
Eur Respir J.  2008; 31(1):143-78 (ISSN: 1399-3003)
Bateman ED; Hurd SS; Barnes PJ; Bousquet J; Drazen JM; FitzGerald JM; Gibson P; Ohta K; O'Byrne P; Pedersen SE; Pizzichini E; Sullivan SD; Wenzel SE; Zar HJ
 PATOGENESIS

Pedoman pengendalian penyakit asma, kementrian kesehatan Republik Indonesia Tahun 2008
PATOGENESIS

Theocharis Konstantinidis
Democritus University of Thrace
 DIAGNOSIS : Anamnesis

Mengi, Napas pendek, dada terasa sesak, batuk

■ Secara umum pasien dengan asma mengalami gejala di atas, dari waktu ke waktu
bervariasi,
■ akan bertambah berat saat dingin, malam dan saat terbangun,
■ mingkin terpicu latihan, alergen, dan udara dingin
■ Mungkin memburuk saat infeksi virus
■ Apakah keluarga mengalami hal serupa

Pocket guide for asthma management and prevention 2019

DIAGNOSIS : Anamnesis

Pocket guide for asthma management and prevention 2019

DIAGNOSIS
: Anamnesis
DIAGNOSIS : PF

I : pasien gelisah, sesak (napas cuping hidung,

retraksi sela iga, retraksi epigastrium, retraksi
suprasternal)
P : pada serangan berat terdapat pulsus paradoksus
P:-
A : Ekspirasi memanjang, mengi, suara lendir
Diagnosis : Pemeriksaan Penunjang

■ Faal paru, Spirometri : low FEV1 ,

FEV1/FVC lower than 0,75 (kelainan
obstruksi)
Treatment
■ STEP 1
Preferred controller: As-needed low dose ICS-formoterol
(off-label)
■ Step 1 recommendations are for patients with symptoms less
than twice a month and no exacerbation risk
factors, a group that is rarely studied.

Classification : Mild
■ Step 2 :
■ Daily low dose ICS with as-needed SABA: there is a large
body of evidence from RCTs and observational studies
showing that the risks of severe exacerbations, hospitalizations
and mortality are substantially reduced with regular low dose
ICS; symptoms and exercise-induced bronchoconstriction are
also reduced. Severe exacerbations are halved even in
patients with symptoms 0-1 days a week
(Reddel et al, Lancet 2017).
Classification : Mild
■ STEP 3
■ Preferred controller: Low dose ICS-LABA maintenance plus as-needed
SABA, OR low dose ICS-formoterol maintenance and reliever therapy

■ is For patients whose asthma is uncontrolled on

low dose ICS, low dose combination ICS-LABA leads to ~20%
reduction in exacerbation risk and higher lung function, but little
difference in reliever use. For patients with ≥1 exacerbation in the last
year, maintenance and reliever treatment with low dose BDP-formoterol
or BUD-formoterol is more effective than maintenance ICS-LABA or
higher dose ICS with as-needed SABA in reducing severe exacerbations,
with a similar level of symptom control.

Classification : Moderate
■ STEP 4
■ Preferred controller: Low dose ICS-formoterol as
maintenance and reliever therapy, OR medium dose ICS-
LABA maintenance plus as- needed SABA
■ Although at a group level most benefit from ICS is obtained
at low dose, individual
ICS responsiveness
varies, and some patients whose asthma is
uncontrolled on low dose ICS-LABA despite
good adherence and correct technique may benefit from
increasing the maintenance dose to medium.
Classification : Moderate
■ STEP 5: Refer for phenotypic investigation ± add-on treatment

■ The Patients with uncontrolled symptoms and/or

exacerbations despite Step 4 treatment should be assessed
for contributory factors, treatment optimized, and referred for expert
assessment including severe asthma phenotype, and potential add-on
treatment.
■ Add-on treatments include tiotropium by mist inhaler for patients ≥6
years with a history of exacerbations; for severe allergic asthma, anti-IgE
(SC omalizumab, ≥6 years); and for severe eosinophilic asthma,
anti-IL5 (SC mepolizumab, ≥6 years, or IV reslizumab, ≥18
years) or anti-IL5R (SC benralizumab, ≥12 years) or anti-IL4R
(SC dupilumab, ≥12 years). See glossary (p.33) and check local
eligibility criteria for specific add-on therapies.
Classification : Severe
Klasifikasi
Klasifikasi
Treatment
Asma Exaserbasi

■ Exacerbations represent an acute or sub-

acute worsening in symptoms and lung
function from the patient’s usual status, or
in some cases, a patient may present for the
first time during an exacerbation.