1. COPD (Chronic Obstructive Pulmonary Diseases) Fransiska Maria C. Bagian FKK-UJ

2. 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)

4. (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

5. Etiology & Risk Factors

6. Pathophysiology

7. Pathogenesis of chronic bronchitis

8. Pathogenesis of emphysema

9. COPD SYMPTOMS Dyspnea Cronic cough Sputum production Risk factor

10. COPD vs ASTHMA (Dipiro, 2015)

11. Assesment of COPD (GOLD, 2015)

12. Assesment of COPD Modified Medical Research Council (mMRC)

13. Assesment of COPD

14. (GOLD in Dipiro, 2015)

15. Tujuan Terapi ① Memperbaiki keadaan obstruksi saluran nafas ② Mencegah eksaserbasi berulang ③ Memperbai ki danmen cegah 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)Memanagen eksaserbasi.

16. Non Pharmacologic Therapy ① Smoking cessation ② Limit environmental triggers exposure ③ Pulmonary rehabilitation (exercise) ④ Immuizations ⑤ Long term oxygen therapy, if:  PaO 2 < 55 mmHg or SaO 2 < 88% (with/without hypercapnia)  55 < PaO 2 < 60 mmHg or SaO 2 < 88% (right-side HF, polycythemia, pulmonary HT)

17. Pharmacologic Therapy (Dipiro, 2015)

18. (GINA, 2015)

19. (BNF 61)

20. (GINA, 2015)

22. Tambahan terapi farmakologi  -antitripsin replacement therapy

23. Pharmacologic Therapy (Dipiro, 2015)

24. Terapi Antibiotik pada Kekambuhan PPOK

25. 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/Amoxicillin c ) Tetracycline Trimethoprim/Sulfamethoxazole ß-lactam/ß-lactamase inhibitor (Co-amoxiclav) Macrolides (Azithromycin, Clarithromycin, Roxithromycin d ) Cephalosporins - 2nd or 3rd generation Ketolides (Telithromycin) Group B ß-lactam/b-lactamase inhibitor (Co-amoxiclav) Fluoroquinolones d (Gatifloxacin, Gemifloxacin, Levofloxacin, Moxifloxacin) ß-lactam/b-lactamase inhibitor (Co-amoxiclav, ampicillin/sulbactam) Cephalosporins - 2nd or 3rd generation Fluoroquinolones d (Gatifloxacin, Levofloxacin, Moxifloxacin) Group C Fluoroquinolones (Ciprofloxacin, Levofloxacin - high dose e ) Fluoroquinolones (Ciprofloxacin, Levofloxacin - high dose e ) or ß-lactam with P.aeruginosa activity Terapi Antibiotik pada Kekambuhan PPOK

26. 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:ññ Increase doses or frequency. ññCombine fl 2 -agonists and anticholinergics. ññUse spacers or air-driven nebulizers. ññConsider adding intra- venous methylxanthine, if needed. Add glucocorticosteroids Consider antibiotics ññOral or intravenous. ññWhen 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. ññIdentify and treat associated conditions (e.g., heart failure, arrhythmias). ññClosely monitor condition of the patient. * Local resources need to be considered