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Chronic Obstructive of Pulmonary Disease (COPD)

Siti Nabilah Baharudin

Muhammad NajibuddinAbdul Basit

Muhammad ai! bin

Ahmad

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D" #N#$#ON

Chronic obstructive %ulmonary disease (COPD) is apreventable and treatable disease state characterized byexpiratory airfow limitation that is not ully reversible. Theexpiratory airfow limitation is usually progressive and isassociated with an abnormal infammatory response o the

lungs to noxious particles or gases, primarily caused bycigarette smoking. Chronic bronchitis is de ned clinically as a chronic

productive cough or 3 months in each o successiveyears in a patient in whom other causes o productive

chronic cough have been excluded. "m%hysema is de ned pathologically as the presence o

permanent enlargement o the airspaces distal to theterminal bronchioles, accompanied by destruction o theirwalls and without obvious brosis.

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!"#$ %&'T(!#

Tobacco smoking &ge more than )* years old #moking both cigarette and &ir pollution secondhand smoke (ccupational hazards %amily history +reterm birth

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A&$O' '#S#&O . $ebiasaan merokok terutama -alam pencatatan riwayat merokok perlu diperhatikan a. !iwayat merokok / +erokok akti / +erokok pasi

/ 0ekas perokok b. -era1at berat merokok dengan "ndeks 0rinkman 2"0 ,yaitu perkalian 1umlah rata/rata batang rokok dihisapsehari dikalikan lama merokok dalam tahun

/ !ingan */ ** / #edang **/)**

/ 0erat 4)** . !iwayat terpa1an polusi udara di lingkungan dan tempatker1a

3. 5ipereaktiviti bronkus 6. !iwayat in eksi saluran napas bawah berulang 7. -e siensi antitripsin al a / , umumnya 1arang terdapat

di "ndonesia

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Cigarette smoke(and other irritants)

P'O$"AS"SNeutro%hil elastaseCathe%sinsMMPs

Alveolar all destruction("m%hysema)

Mucus hy%ersecretion

CD8 +lymphocyte

Alveolarmacrophage

Epithelial cells

ibrosis(Obstructive

bronchiolitis)

Fibroblast

MonocyteNeutrophil

Chemotactic factors

"nfammatory 'ells "nvolved in'(+-

Source Peter *+ Barnes,MD

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Bronchus

Wall thickening inflammation-- mucus glandhypertrophy

Secretions

Alveoli

Wall thinning -inflammation -elastolysis

Coalescence

Elasticity

Bronchiole

Wall thickening inflammation

repair-- remodeling

Loss of alveolarattachments

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S#-NS AND S.MP$OMS -yspnea 'hronic cough #putum productions (thers

wheezing or decreased breathing sounds, 'rackles +rolonged 'hest tightness 0arrel chest Tiredness and weight loss

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'(8T9 'or pulmonale

&nkle swelling 'lubbing nger +ursed lips breathing

:xacerbations "ncreased shortness o breath "ncreased sputum production 'hange in the color o the sputum rom clear to green or yellow "ncrease in cough "ncreased work o breathing such as ast breathing, a ast

heart rate, sweating, active use o muscles in the neck, a bluishtinge to the skin, and con usion i in a severe exacerbation.

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C/#N#CA/ C/ASS# #CA$#ONS Pink pufer ;ambaran yang khas pada em sema, penderita kurus, kulit

kemerahan dan pernapasan pursed lips breathing

Blue bloater

;ambaran khas pada bronkitis kronik, penderita gemuksianosis, terdapat edema tungkai dan ronki

basah di basal paru, sianosis sentral dan peri er

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'(8T9classi cation o'(+- based onspirometricimpairment andsymptoms

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#N0"S$#-A$#ONS

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-arah rutin 5b, 5t, leukosit

!adiologi %oto toraks +& dan lateral

+ada em sema terlihat gambaran / 5iperinfasi / 5iperlusen / !uang retrosternal melebar 8(!antung menggantung 21antung pendulum ? tear drop /

eye drop appearance

+ada bronkitis kronik @ 8ormal @ 'orakan bronkovaskuler bertambah pada A kasus

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+emeriksaan khusus 2tidak rutin

. %aal paru / Bolume !esidu 2B! , $apasiti !esidu %ungsional 2$!% , $apasiti

+aru Total 2$+T , B!?$!%, B!?$+T meningkat / -='( menurun pada em sema / !aw meningkat pada bronkitis kronik

/ #gaw meningkat / Bariabiliti 5arian &+: kurang dari * A

. C1i latih kardiopulmoner / #epeda statis 2ergocycle / >entera 2treadmill

/ >alan ) menit, lebih rendah dari normal3. C1i provokasi bronkus Cntuk menilai dera1at hipereaktiviti bronkus, pada sebagian

kecil ++($ terdapat hipereaktiviti bronkus dera1at ringan

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+emeriksaan khusus2lan1utan

6. C1i coba kortikosteroid

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D. :lektrokardiogra

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COMB#N" ASS"SSM"N$

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MANA-"M"N$

#low down the disease by avoiding tobacco smoke and airpollution.

=imit your symptoms, such as shortness o breath.

"ncrease your activity level. "mprove your overall health. +revent and treat fare/ups . & fare/up, or exacerbation, is

when your symptoms Huickly get worse and stay worse.

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'(8T9 ( 0ronchodilators

&nticholinergics 0eta agonist Iantin

&nti infammator #teroids

:xpectorants :ducations and supports

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Treatment or hospitalised patient

Bronchodilators / #hort/acting b /agonist and?or / "pratropium

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Treatment in patients reHuiring special orintensive care unit

Su%%lemental o1y2en 0entilatory su%%ort Bronchodilators #hort/acting b /agonist 2salbutamol 2albuterol and ipratropium

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