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%. A&ute +ron&'itis
Acute inflammation of themucous membranes of the
trachea and bronchi (duration < 4
weeks)
productive cough
upper respirator tract smptoms
general smptoms (in !0 " #0$)
2%.&.20!!
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Aetio!ogy of a&ute +ron&'itis
'ommon resp. tract viruses (&0$) RS3
4Respiratory Synsitia! 3irus5
acteria (in about 20$ of cases) *neumococci ( in 2 " +0$),
-aemophilus ( in 2 " &$),
coplasma (in 0.# " !!$)
'hlamdia (in 0 "!&$)
(*ertussis (in 0 " /$))
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Diagnosis of a&ute +ron&'itis
7'e aim is to diffn&iated ari semua pasien g BATUK 1 dentifikasi *en.
3ain g memerlukan pengobatan spesifik ( ump
pneumonia, sinisitis, asthma)(identif1 among all patients with cough1 those with ot'er i!!nessesot'er i!!nesses
needing spe&ifi& treatmentneeding spe&ifi& treatment (e.g. pneumonia1 sinusitis1 asthma)
ari semua pasien g BRONCHITIS 1
dentifikasi *en. g memerlukan Antibiotika(identif1 among all patients with bronchitis, those 8'o 8ou!d8'o 8ou!d
+enefit from anti+ioti&s)+enefit from anti+ioti&s)
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(Differentia!) diagnosis
-istor (e.g. asthma) ada mengiik5
-ealth status (general conition, auscultation)
!"ra# (to e$clue %neumonia&
CR' (high CR' reers to bacterial aetiolog# or
%neumonia&
inus ultrasound (to e7clude sinusitis)
Antibod testing (of a few representative patientsif needed to establish an e%iemic )
8as access to a follow"up visit (inform our
assistants9)
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Kapan per!u di :#ray
;'en is &'est <#ray needed=
patient is particularl un)ell (Kurang sahat& patient is particularl %rone to %neumonia due
(menjurus ke pneumonia)
to underling disease1 age or alcoholism histor of pneumonia within the preceding ear upper respirator tract smptoms absent patient re:uests 7"ra (%neumonia can not be
e7cluded on clinical smptoms and findingsonl)
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7reatment of a&ute +ron&'itis
"irst &'oi&e?"irst &'oi&e? no anti+ioti&s@
"a&tors supporting anti+ioti& treatment?"a&tors supporting anti+ioti& treatment?
CR' * + mg-l patient is particularl un)el ! or becoming so %#re$ia of over week5s duration or patient
pre7ial following a period of apre7ia epidemio!ogi&a! state %atient is immunocom%romise
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Antimi&ro+ia! t'erapy of a&ute +ron&'itis %
"irst &'oi&e?"irst &'oi&e? in most cases good effect on pneumococci is sufficient penicillin resistance in pneumococci in ;inland is low
( < !$) (A)
peni&i!!in 3peni&i!!in 3 !"!.# mega units & hourl for # = / das > ! tab? 2#0 mg ? 400.000 unit@ osis
< !2 thn 2#"#0 mgBgda dibagi 6"& Cam 7
D !2 thn1 adult !2# = #00 mgBgda =E"
for patients with penicillin allerg a first #generationa first #generation
&ep'a!osporin&ep'a!osporin
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%0
Antimi&ro+ia! t'erapy of a&ute +ron&'itis
Ot'er &'oi&es?Ot'er &'oi&es?
probable mcoplasma or chlamdia infection doxycyclinedoxycycline !00"!#0 mg dail for # = / das a ma&ro!idea ma&ro!ide erthromcin #00mg + " 4
times dail1 ro7ithromcin !#0 mg twicedail1 klarithromcin 2#0mg twice dail oraFithromcin 2#0 mg dail for # =/ das
underling chronic lung disease
amo<i&i!!in, su!p'atrimet'oprimamo<i&i!!in, su!p'atrimet'oprim
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Symptomati& treatment of a&ute +ron&'itis
No benefit is gained on cough with codeine,salbutamol or dextromethorphan as compared
with a placebo,
...but cough improves considerably even during aplacebo-treatment
patient often presents with additional symptoms,
which can be eased with antihistamines,
anticholinergic and/or sympatomimetic
agents, but their benefit remains controversial benefit remains controversial !!
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TKS. Bersambung As%irasi
%nm/nia
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%
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. Aspirasi Pneumonia
*ada anak ai sering ter
sedak1 masuk susu A
atau benda asing (corpus
aliena) kedalam Alveoli. edema1 cairan adang
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Pada anak Besar ?
#Ka&ang tojin#8ang &oin
# Benda asing# d!!
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anagemen Aspirasi Pneumonia
Dpt dikethui dengan Anamnesis yang teliti
Konsultkan ke Bgn !
Benda asing yang padat "ndoskopy
#usu $ A#% sama dgn pengobatan
&neumoniaHarus dirawat di RS
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%1
+.!.'hronic bronchitis
+.2.8mphsema
+.+. Asthma
. O+stru&tiCe and nf!amtory
-ung Disease
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%9
.%. *'roni& Bron&'itis
ecurrent or chronic productive
cough for a minimum of +
months for 2 consecutive ears. isk factors
'igarette smoke Air pollution
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%>
*'roni& Bron&'itis
Pat'op'ysio!ogy 'hronic
inflammation
-pertroph Ghperplasia of
bronchial glands
that secrete mucus
ncrease number of
goblet cells
'ilia are destroed
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%
*'roni& Bron&'itis
Pat'op'ysio!ogy .. Bronchospasm often occurs
"nd result
!ypoxemia !ypercapnea
&olycythemia 'increase (B)s*
)yanosis )or pulmonale 'enlargement of right side of
heart*
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0
Harrowing of airwa tarting w bronchi
smaller airwas
airflow resistance
work of breathing
-poventilation G 'I2
retention hpo7emiaG hpercapnea
*'roni& Bron&'itis
Pat'op'ysio!ogy ..
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*'roni& Bron&'itis?
Diagnosti& 7ests
*;Js (*ulmonar ;unction Jests) ;K' ;orced vital capacit ;8K! ;orcible e7hale in ! second ;8K!;K' ? </0$
ALs (Arterial lood Las analsis) *a'I2
*aI2 '' ('ell lood 'ounts) -ct
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..mp'ysema? Pat'op'ysio!ogy
tructural changes
-perinflation of
alveoli estruction of alveolar
G alveolar"capillar
walls
mall airwas narrow
3ung elasticit
decreases
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Abnormal distension
of air spaces
Actual cause is
unknown ungkin ok ada
Pores of Kohn (ada
hubungan dari alvke alv g lain)
mp'ysema? Pat'op'ysio!ogy
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.. Ast'ma
(eversible inflammation +obstruction
%ntermittent attacks #udden onset
aries from person to person #everity can vary from shortness of
breath to death
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Ast'ma
riggers Allergens
"xercise
(espiratory infections
Drugs and food additives
ose and sinus problems "(D /astro "sophageal (eflux Disorder
"motional stress
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!. welling of mucus
membranes
(edema)
2. pasm of smoothmuscle in
bronchioles ncreased airwa
resistance
+. ncreased mucus
gland secretion
Ast'ma? Pat'op'ysio!ogy
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Ast'ma? ar!y *!ini&a! anifestations
"xpiratory + inspiratory whee0ing Dry or moist non-productive cough
)hest tightness
Dyspnea
Anxious +Agitated
&rolonged expiratory phase %ncreased respiratory + heart rate
Decreased &"1( /&ulmo. "xpi2tory 1low (ate3
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Pencetus Asthma