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FARMAKOTERAPI II
*Tujuan pembelajaran
* wheeze,
* shortness of breath,
* chest tightness and
* cough
that vary over time and in intensity, together with
variable expiratory airflow limitation
*Definition of asma
*Description of
Asthma
*Cont
*Diagnosis Asma
*Asthma Control
*TERAPI ASMA
*Long-Term Goals
attentiveness)
* Allowing the patient to express their goals, beliefs
and concerns
* Empathy, reassurance, and prompt handling of any
concerns
* Giving encouragement and praise
* Giving appropriate (personalized) information
* Providing feedback and review
*Communication
* Controller medications
* Reliever (rescue) medications
* Add-on therapies for patients with severe
*Categories of asthma
medication
treatment.
* They reduce airway inflammation, control
symptoms, and reduce future risks such as
exacerbations and decline in lung function.
*Controller medications
*Reliever Medications
*Initial Controller
Treatment
possible
*Record the patients level of symptom control
and risk factors, including lung function (Box 22, p17)
*Consider factors influencing choice of treatment
*Ensure that the patient can use the inhaler
correctly
*Schedule an appointment for a follow-up visit
controller treatment
treatment.
* A step up in treatment may be recommended if the
symptoms are confirmed to be due to asthma; inhaler
technique and adherence are satisfactory; and modifiable
risk factors such as smoking have been addressed
* Any step-up should be regarded as a therapeutic trial,
and the response reviewed after 23 months.
* If there is no response, treatment should be reduced to
the previous level, and alternative treatment options or
referral considered.
*Stepping Up Asthma
Treatment
* Day-to-day adjustment:
* for patients prescribed combination
budesonide/formoterol or
beclometasone/formoterol as maintenance and
reliever treatment, the patient adjusts the
number of as-needed doses of ICS/formoterol
from day to day according to their symptoms,
while continuing the maintenance dosage.
* Once good asthma control has been achieved and maintained for
3 months and lung function has reached a plateau, treatment
can often be successfully reduced, without loss of asthma
control.
* The aims of stepping down are:
*Stepping Down
*General Principles
*Non Pharmcological
intervention
* CHOOSE
* Strategies to ensure
* CHECK
*CORRECT
* CONFIRM
*Adherence
*Identifying poor
adherence
* Medication/regimen factors
*Factor contribtuing
to poor adherence
adherence
prescription
* Check the date and dose counter on the inhaler
* In some health systems, prescribing and
dispensing frequency can be monitored
electronically by clinicians and/or pharmacists
*Examples of
successful adherence
interventions
*Management of
worsening asthma
and exacerbations
* The action plan should include when and how to change reliever and
dyspnea, respiratory rate, pulse rate, oxygen saturation and lung function,
while starting short-acting beta2-agonist (SABA) and oxygen therapy.
* Immediate transfer should be arranged to an acute care facility if there
are signs of severe exacerbation, or to intensive care if the patient is
drowsy, confused, or has a silent chest. While transferring the patient,
inhaled SABA therapy, ipratropium bromide, controlled oxygen and
systemic corticosteroids should be given.
* Treatment should be started with repeated administration of SABA (in
most patients, by pressurized metered dose inhaler and spacer), early
introduction of oral corticosteroids, and controlled flow oxygen if
available. Response of symptoms, oxygen saturation and lung function
should be reviewed after 1 hour.
severe exacerbations.
* Intravenous magnesium sulfate should be considered for
patients with severe exacerbations not responding to initial
treatment.
* Chest X-ray is not routinely recommended.
* Decisions about hospitalization should be based on clinical
status, lung function, response to treatment, recent and past
history of exacerbations, and ability to manage at home.
* Before the patient goes home, ongoing treatment should be
arranged. This should include starting controller treatment or
stepping up the dose of existing controller treatment for 24
weeks, and reducing reliever medication to as-needed use.
*Management
Exacerbations
*Primary prevention
*THANK YOU
*Case Studies