Duty 1st on Ward :

Duty 2nd :

Supervisor :

MORNING REPORT

DM Yaya

dr. Chandra J

dr. Isa, Sp.P

Pulmonary Department of Ulin Hospital

Rabu | 15 Juli 2015

Identity of patient

Name : Mr. MAge : 50 yoAdreess : Jl. Teluk TiramOccupation : Miner

Wednesday | January 11, 2012

• Main complain: Shortness of Breath• History of Present Illness: Shortness of Breath since 5 days.

Cough since 3 days ago with purulen sputum yellowish, fever (+) since 2 day ago. Patient has to ventolin inhaller to relievier, but shortness was increase.

• There is no loss of appetite and no loss of body weight, nausea (+), vomiting (-), chest pain (-)

• History of past illness:- DM(-), HT (-), asthma (-), Bloody cough (-) , Anti Tb Drug (-)

History of asthma bronchiale since 20 years ago and the last exaserbation was July 2015.

• SOB came at the patient hyeractivity and cold wheather

ANAMNESA

Phsical Examination Status Present: weakness , GCS : 456

Vital sign : BP :120/80 mmHg, P : 100 x/m, RR : 28 x/m, T : 38,7 oC Head/Neck : anemia (-), icteric (-), cyanosis (-), dyspneu (+),

Lymph node Colli (-), JVP (-), neck edema (-/-) Thorax :

Cor : S1-2 single, murmur (-), gallop (-), es (-) Pulmo :

Inspection : symetric Palpation :

Abd: distended (-), H / L : not palpable Ext: warm, edema - / -

LABORATORY

BLOOD

Hb 16,1

WBC 16,6

E 4,86

Ht 50

Trom 261

CXR

1. Shortness Of Breathing

2. Respiration tract infection

3. Asthma bronkhiale acut exaserbation

no Problem P Diagnosis P Therapy P Monitor

1. SOB - 02 nasal 4 lpm C/Vs

2. Respiratory Tract Infection

Check sputum gramk/s sputum aerob

Azitomisin 1X 500 mg DL 3 day post Ab

3. Asthma bronkhiale eksasebasi akut

Spiometri Test Ventolin nebule 1 amp/6 hInj Kotikosteroid 3 x 62,5 mgAzitromisin 1 x 500 mgInf Aminofilin 20 mg/KgBB/24h

SpirometriBGA

PEMBAHASAN

• Asthma is a heterogeneous disease, usually accompanied by chronic inflammation of the respiratory tract

• Asthma is marked by the presence of symptoms such as wheezing, shortness of breath, heaving and cough which varies during the course of the day and its intensity also accompanied by limited airway which is reversible in nature (Gina,2015)

Hipertrofi Sel-sel otot polosbronkus

Patofisiologi Asma

Infiltrasieosinofil, sel mast,

netrofil, sel T

Edema mukosa dan submukosa

Vasodilatasi danleakage

Penebalansub membrana basalis

Deposisi kolagen

Hipertrofi kelenjar sub mukosa& sel goblet

Deskuamasisel-sel epitel

Sumbatanoleh mukus

bronchus at asthma patient

Diagnosis of Asthma 1. Patient history and symptom pattern 2. Lung function testing Spirometry Peak expiratory flow / PEF 3. Airway responsiveness testing 4. Allergic status testing for identification of risk factors 5. Additional steps which may be required for asthma

diagnosis in less than 5 years old children and in the

Factors Which Cause Asthma Exacerbation

• 1. Allergens • 2. Respiratory tract infection • 3. Activity and hyperventilation • 4. Changes in weather • 5. Sulphur dioxide • 6. Food, additives, drugs

Asthma Management and Prevention Program

• Asthma may be effectively controlled in most patient through intervention which intended to suppress and decrease inflammation also treating bronchoconstriction and symptoms

• Early intervention aimed to stop exposure of risk factor to the sensitive respiratory tract may help to improve asthma control and decrease the need for medication.

Treating Asthma

Treatment options must be based on: 1. Asthma control level 2. Current treatment 3. Pharmacological properties and availability

of various asthma medication formulations 4. Economical considerations

Treatment Options Relieving Medications / Reliever

1. Inhaled short acting β2-agonists Short-acting (SABA) and Long-acting (LABA) with quick onset of acition

2. Systemic glucocorticosteroids 3. Anticholinergics 4. Theophylline 5. Oral short-acting β2-agonists

Treatment Options Controlling Medications / Controller

• 1. Inhaled glucocorticosteroids (ICS) • 2. Leukotriene modifiers • 3. Long-acting inhaled β2-agonists (LABA) combination

with inhaled glucocorticosteroids (ICS) → LABA + ICS = LABACs

• 4. Systemic glucocorticosteroids • 5. Theophylline • 6. Cromones • 7. Anti-IgE

Asthma Clinical Control

1. Assess the early asthma control stage or level to decide the type of medications to be used (assess the patient’s asthma control level)

2. Maintain the asthma control after initiation of therapy (assess the patient’s asthma risk)

Asthma Control Level Control the Symptoms Asthma Symptoms Control Level

During the past 4 weeks, did the patient experience:

Fully controlled Partially controlled Not controlled

1. Daily asthma symptoms more than two times within one week 2. Awakened at night due to asthma 3. Use of reliever medications to alleviate symptoms more than two times in 1 week 4. Limitation of activity due to asthma

Not even Found 1 - 2 criteria Found 3 - 4 criteria one criteria found

KESIMPULAN

Komponen kunci terapi asma• Edukasi penderita & keluarganya• Pengendalian lingkungan (hindari

alergen pencetus asma)• Terapi farmakologis• Evaluasi obyektif faal paru (menilai &

memonitor perjalanan penyakit)

Pulmonary Department of Ulin Hospital