about asthma 2
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AsthmaRetno Ariza S Soemarwoto
Pulmologist
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An imbalance of Th1 and Th2 cells, especially Th2
cells plays an important role in the development of
allergic diseases
Th1IFN-, IL-2
Th2IL-4, 5, 13
Eliminates parasiteAllergic diseases
Eliminates microorganisms and tumors
Auto-immune disease
Transplant rejection
TcCD8+
ThCD4+
BCD19+
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Development of asthma
AsthmaAbnorma
l lung
functions
Genetic &
Environments
& Atopy
Hyper-reactiveness&viral infection
Remodeling &
Histo-pathological
changes
Allergic
rhinitis
Integrated Airway
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Atopy
Kerusakan SN Infeksi SN bawah
Alergen
Perokok pasif
Zat toksik
Persistence Inflammation
Remodeling
Asthma
Perbaikan yang
menyimpang
Risiko
Genetik
Lingkungan
Alergen
Polutan
Stress
Usia
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POTENTIAL BENEFITS
ABORTING THE ALLERGIC
MARCH THE IMMUNOLOGIC BASIS OF LOCAL ALLERGIC
REACTIONSe.g. ATOPIC DERMATITIS.
ALLERGIC RHINITIS and ASTHMA: IS ACTUALLY
A SYSTEMIC DYSREGULATION OFTHE
IMMUNE SYSTEM
ATOPIC
DERMATITIS
ALLERGIC RHINITISBRONCHIAL
ASTHMA
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Allergic reactions
Histamineother mediators
Early phase reaction
(within the first hour)
sneezingrhinorrheanasal pruritusocular pruritus
Late phase reaction
(after several hours)
nasal obstructionswollen eyestiredness, irritabilitysleep disturbance
Attract Eosinophilsand other immune cells
Mast cell
Allergens Adcock I. Clin Exp Allerg Rev 2002; 2: 85-8.
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Environment
al factorsGenetic
factors
Triggers
Viralinfections
Expose to
allergensPollutants
Allergic
inflammation
Clinical
symptoms
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Prevalence of asthma
Based on SKRT 1995 13/1000
Reseach :
In IndonesiaChild 11,5 % Adult 7,7 %
Wang et al 2001
Rhinitis 5,1%
Non rhinitis 0,75 %
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asthma triggers
Debu, asap, polusi udara
Flu
Binatang berbulu (anjing, kucing, burung), kecoa
Pollen dari pohon, rumput
Bau menyengat
Perubahan cuaca, udara yg sangat dingin
Aktivitas berat, menangis, tertawa, teriak
Aspirin atau obat lain
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How is asthma diagnosed?
Based on a physical examination,
personal history, and lung function
tests
Typical asthma symptoms such as
wheezing or coughing,
the personal historyallergies or a
familial tendency towards asthma.
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intermittent
moderatepersistentmild
persistent
severepersisten
t
immunotherapy
oral or MDI bronchodilator
MDI LABA + Steroid
allergen and irritant avoidance
Treatment of asthma
MDI steroid or
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Asthma treatment
Based on severity spirometry
Allergen avoidance
Gradation of severity: Mild short acting bronchodilator
Moderate to severe bronchodilator &antiinflammation
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Spirometry
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Peak flow meter
http://www.vitalitymedical.com/vitalitymedical.storefront/455c7fc1004c182e2719424d362305fc/Product/View/HDN755_ea -
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Nebulizer
http://www.vitalitymedical.com/isroot/Stores/VitalityMedical/picxl/DEV5650D.jpg -
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To use M D I
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