Prof. dr.H.Rusdidjas, SpA(K) Prof.dr.Hj. Rafita Ramayati.

SpA(K) dr Hj. Oke Rina Ramayani.SpA Bgn Ilmu Kes. Anak FK-UISU, Jalan

SM Raja Medan

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1. Bronchitis and 2. Aspiration Pneumonia

3. Emphysema; 4. Chronic Brochitis; 5. Asthma

1. Acute bronchitis Acute inflammation of the mucous

membranes of the trachea and bronchi (duration < 4 weeks)

+ productive cough

+ upper respiratory tract symptoms

+ general symptoms (in 10 - 50%)

29.8.2011

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CRDTF

Calor, Rubor, Dolor, Tumor, Fungsio lesa)

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Aetiology of acute bronchitis

Common resp. tract viruses (80%) RSV Bacteria (in about 20% of cases):

Pneumococci ( in 2 - 30%)? Haemophilus ( in 2 - 8%)? Mycoplasma (in 0.5 - 11%) Chlamydia (in 0 -18%) (Pertussis (in 0 - 7%))

(RSV) Respiratory Syncitial Virus

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Diagnosis of acute bronchitis

The aim is to Dari semua pasien yg BATUK, Identifikasi peny.

Lain yg memerlukan pengobatan spesifik ( ump: pneumonia, sinisitis, asthma)

(identify, among all patients with cough, those with other illnesses other illnesses needing specific treatment needing specific treatment (e.g. pneumonia, sinusitis, asthma)

Dari semua pasien yg BRONCHITIS, Identifikasi Peny. yg memerlukan Antibiotika (identify, among all patients with bronchitis, those who would who would benefit from antibiotics)benefit from antibiotics)

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(Differential) diagnosis

History (e.g. asthma)

Health status (general condition, auscultation) X-ray (to exclude pneumonia)

CRP (high CRP refers to bacterial aetiology or pneumonia)

Sinus ultrasound (to exclude sinusitis)

Antibody testing (of a few representative patients if needed to establish an epidemic)

Easy access to a follow-up visit (inform your assistants!)

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Kapan perlu di X-ray When is chest x-ray needed?

patient is particularly unwell (Kurang sahat) patient is particularly prone to pneumonia due

(menjurus ke )

to underlying disease, age or alcoholism history of pneumonia within the preceding year upper respiratory tract symptoms absent patient requests x-ray (pneumonia can not be

excluded on clinical symptoms and findings only)

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Treatment of acute bronchitis

First choice: First choice: no antibiotics!

Factors supporting antibiotic treatment:Factors supporting antibiotic treatment:

CRP > 50 mg/l patient is particularly unwell or becoming so pyrexia of over week’s duration or patient

pyrexial following a period of apyrexia epidemiological state patient is immunocompromised

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Antimicrobial therapy of acute bronchitis 1

First choice:First choice: in most cases good effect on pneumococci is

sufficient penicillin resistance in pneumococci in Finland is

low (R < 1%) (A) penicillin Vpenicillin V: 1-1.5 mega units 8 hourly for 5 – 7 days [ 1

tab = 250 mg = 400.000 unit] Dosis: < 12 thn : 25-50 mg/Kg/day dibagi 6-8 jam /x > 12 thn, adult : 125 – 500 mg/Kg/day –”- for patients with penicillin allergy a first -generation a first -generation

cephalosporincephalosporin

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Antimicrobial therapy of acute bronchitis 2

Other choices:Other choices: probable mycoplasma or chlamydia infection:

doxycyclinedoxycycline 100-150 mg daily for 5 – 7 days a macrolidea macrolide: erythromycin 500mg 3 - 4 times

daily, roxithromycin 150 mg twice daily, klarithromycin 250mg twice daily or azithromycin 250 mg daily for 5 –7 days

underlying chronic lung disease: amoxicillin, sulphatrimethoprimamoxicillin, sulphatrimethoprim

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Symptomatic treatment of acute bronchitis

No benefit is gained on cough with codeine, salbutamol or dextromethorphan as compared with a placebo,

...but cough improves considerably even during a placebo-treatment

patient often presents with additional symptoms, which can be eased with antihistamines, anticholinergic and/or sympatomimetic agents, but their benefit benefit remains controversialremains controversial!!

TKS

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Sambung ke Aspirasi pneumonia

2. Aspirasi Pneumonia

Pada anak Bayi sering ter sedak, masuk susu / ASI atau benda asing (corpus aliena) kedalam Alveoli. edema, cairan Radang

Pada anak Besar :-Kacang tojin-wang coin- Benda asing - dll

Managemen Aspirasi Pneumonia

Dpt dikethui dengan Anamnesis yang teliti

Konsultkan ke Bgn THT

Benda asing yang padat Endoskopy

Susu / ASI sama dgn pengobatan Pneumonia

Harus dirawat di RS

TKSS

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Emphysema Chronic Bronchitis Asthma

Obstructive and Inflammatory Lung Disease

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Chronic Bronchitis Recurrent or chronic productive cough

for a minimum of 3 months for 2 consecutive years.

Risk factors Cigarette smoke Air pollution

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Emphysema: Pathophysiology

Structural changes Hyperinflation of alveoli Destruction of alveolar &

alveolar-capillary walls Small airways narrow Lung elasticity

decreases

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Abnormal distension of air spaces

Actual cause is unknown

Ok ada Pores of Kohn (ada hubungan dari alv ke alv yg lain)

Emphysema: Pathophysiology

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Chronic Bronchitis Pathophysiology

Chronic inflammation

Hypertrophy & hyperplasia of bronchial glands that secrete mucus

Increase number of goblet cells

Cilia are destroyed

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Chronic Bronchitis Pathophysiology …….. Bronchospasm often occurs End result

Hypoxemia Hypercapnea Polycythemia (increase RBCs)

Cyanosis Cor pulmonale (enlargement of right side of heart)

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Narrowing of airway Starting w/ bronchi

smaller airways airflow resistance work of breathing Hypoventilation & CO2

retention hypoxemia & hypercapnea

Chronic Bronchitis Pathophysiology ……..

Chronic Bronchitis: Diagnostic Tests

PFTs (Pulmonary Function Tests) FVC: Forced vital capacity FEV1: Forcible exhale in 1 second FEV1/FVC = <70%

ABGs (Arterial Blood Gas analysis) PaCO2 PaO2

CBC (Cell Blood Counts) Hct

Asthma Reversible inflammation & obstruction Intermittent attacks Sudden onset Varies from person to person Severity can vary from shortness of breath

to death

Asthma Triggers

Allergens Exercise Respiratory infections Drugs and food additives Nose and sinus problems GERD Emotional stress

ANTIMICROBIAL TREATMENT STRATEGIES

Asthma: Pathophysiology

Swelling of mucus membranes (edema)

Spasm of smooth muscle in bronchioles

Increased airway resistance

Increased mucus gland secretion

QuickTime™ and aTIFF (LZW) decompressor

are needed to see this picture.

Asthma: Early Clinical Manifestations

Expiratory & inspiratory wheezing Dry or moist non-productive cough Chest tightness Dyspnea Anxious &Agitated Prolonged expiratory phase Increased respiratory & heart rate Decreased PEFR

Pencetus

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TKSS