Penyakit Paru Obstruktif Kronik (PPOK)

Lia safriana Penyakit Paru Obstruktif Kronik(PPOK)DefinisiPenyakit paru yg dpt dicegah & diobati, ditandai oleh hambatan aliran udara yg tdk sepenuhnya reversibel, bersifat progresif & berhubungan dengan respon inflamasi paru terhadap partikel yg beracun, disertai efek ekstraparu yg berkontribusi terhadap derajat berat penyakit.

Epidemiologi Penyebab kematian no. 4 didunia Prevalensi cenderung meningkat, krn:Kabiasaan merokok meningkatPertambahan pendudukIndustrialisasiPolusi udaraFaktor resikoAsap rokokStress oksidatifInfeksi saluran napas berulangSosial ekonomiAsmaGen

Manisfestasi klinis Sesak progresif, tambah berat saat aktivitas, perlu usaha utk napas, napas berat, sukar, terengah-engahBatuk kronikBatuk kronik berdahakRiwayat terpajan faktor resikoDiagnosis Anamnesis Px. FisikInspeksi Pursed lips breathingBarrel chestPenggunaan otot pernapasan tambahan & hipertrofiPelebaran sela igaBisa + gagal jantung kananPink pufferBlue bloater

Palpasi fremitus melemahPerkusi Hipersonor, diafragma rendah Auskultasi Suara napas vesikuler normal/melemahRonki&/mengi Ekspirasi memanjang

Px rutin Faal paru ( spirometri )% VEP1 < 80% OBSTRUKSIUji bronkodilator Lab darah Radiologi (foto toraks)Emfisema hiperinflasi, hiperlusen, ruang retrosternal melebar, diafragma mendatarBronkitis kronik normal, corakan bronkovaskuler

Klasifikasi

Global Strategy for Diagnosis, Management and Prevention of COPDCombined Assessment of COPDRisk (GOLD Classification of Airflow Limitation)Risk (Exacerbation history)> 2 1 0(C)(D) (A)(B)mMRC 0-1CAT < 10 4321 mMRC > 2CAT > 10 Symptoms(mMRC or CAT score))High riskLess symptomsLow riskLess symptoms High riskMore symptomsLow riskMore symptoms10

Global Strategy for Diagnosis, Management and Prevention of COPDCombined Assessment of COPD(C)(D) (A)(B)mMRC 0-1CAT < 10 mMRC > 2CAT > 10 Symptoms(mMRC or CAT score))If mMRC 0-1 or CAT < 10: Less Symptoms (A or C)

If mMRC > 2 or CAT > 10: More Symptoms (B or D)

Assess symptoms first13Global Strategy for Diagnosis, Management and Prevention of COPDClassification of Severity of Airflow Limitation in COPD*In patients with FEV1/FVC < 0.70:

GOLD 1: Mild FEV1 > 80% predicted GOLD 2: Moderate 50% < FEV1 < 80% predicted

GOLD 3: Severe 30% < FEV1 < 50% predicted

GOLD 4: Very Severe FEV1 < 30% predicted

*Based on Post-Bronchodilator FEV114Global Strategy for Diagnosis, Management and Prevention of COPDCombined Assessment of COPDRisk (GOLD Classification of Airflow Limitation)Risk (Exacerbation history)> 2 1 0(C)(D) (A)(B)mMRC 0-1CAT < 10 4321 mMRC > 2CAT > 10 Symptoms(mMRC or CAT score))If GOLD 1 or 2 and only 0 or 1 exacerbations per year: Low Risk (A or B)

If GOLD 3 or 4 or two ormore exacerbations per year: High Risk (C or D)

Assess risk of exacerbations next15Gold treatment copd FEV1 / FVC < 70%I: MildFEV1>80% predII:ModerateFEV1 50-80% predIII: SevereFEV1 30-50% predIV: Very SevereFEV1 < 30% pred or FEV1