Asthma is a chronic inflammatory disease of the airways characterized by recurrent episodes of wheezing, breathlessness, chest tightness, and coughing. The global prevalence of asthma in children is approximately 13% and it places a significant burden on individuals and healthcare systems. Proper management of asthma aims to control symptoms and prevent exacerbations through treatment of airway inflammation and avoidance of triggers.
Asthma is a chronic inflammatory disease of the airways characterized by recurrent episodes of wheezing, breathlessness, chest tightness, and coughing. The global prevalence of asthma in children is approximately 13% and it places a significant burden on individuals and healthcare systems. Proper management of asthma aims to control symptoms and prevent exacerbations through treatment of airway inflammation and avoidance of triggers.
Asthma is a chronic inflammatory disease of the airways characterized by recurrent episodes of wheezing, breathlessness, chest tightness, and coughing. The global prevalence of asthma in children is approximately 13% and it places a significant burden on individuals and healthcare systems. Proper management of asthma aims to control symptoms and prevent exacerbations through treatment of airway inflammation and avoidance of triggers.
Asthma is a chronic inflammatory disease of the airways characterized by recurrent episodes of wheezing, breathlessness, chest tightness, and coughing. The global prevalence of asthma in children is approximately 13% and it places a significant burden on individuals and healthcare systems. Proper management of asthma aims to control symptoms and prevent exacerbations through treatment of airway inflammation and avoidance of triggers.
• Asthma is a disease of airway inflammation characterized by hyperresponsiveness and airflow obstruction that lead to symptoms such as cough and wheezing
Introduction • A chronic inflammatory disorder of the airways • Many cells and cellular elements play a role • Chronic inflammation is associated with airway hyperresponsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing • Widespread, variable, and often reversible airflow limitation
Global Initiative for Asthma (GINA)
Definition of Asthma • Pedoman Nasional Asma Anak 2004
• Asma adalah mengi berulang dan/atau
batuk persisten dengan kharakteristik sebagai berikut: timbul secara episodik, cenderung pada malam/dini hari (nokturnal), musiman, setelah aktivitas fisik, serta terdapat riwayat asma atau atopi lain pada pasien dan/atau keluarganya.
Indonesia (UKK Respirologi IDAI)
• The prevalence of asthma rose steadily from 1980 - late 1990s, when it reached a plateau. • Worldwide prevalence of asthma in children : ±13%.
• USA 2007 : 6.7 million children (9% of children 0- 17 years) had asthma. 12.8 million days of missed school (2003) 198,000 hospitalizations in 2004 (3% of all pediatric admissions). 750,000 emergency department (ED) visits in 2004 (2.8% of all pediatric ED visits).
Epidemiology & Burden of Disease
• The natural history of asthma is variable. • Most individuals who develop chronic asthma, measured by a decrease in lung function and persistence of symptoms, have a genetic predisposition. • In addition, exposure of the airway epithelium to environmental insults in such susceptible individuals contributes to the development, severity, and persistence of asthma.
Natural History Genetic susceptibility Adjuvant factors: Tobacco smoke, Pollutants
• Inherent to asthma is airway inflammation that is mediated by a variety of cell subtypes, resulting in hyperresponsive airways, ultimately limiting airflow and causing variable symptoms.
• Initial airway bronchoconstriction is followed by airway
edema and exaggerated mucus production, accompanied by airway hyperresponsiveness, and followed by chronic changes in the airway epithelium (airway remodeling).
• Current medical management targets various points along this
continuum. However, no clear evidence suggests that early or aggressive treatment with anti-inflammatory medications, such as inhaled corticosteroids, can prevent airway remodeling.
Pathogenesis & Pathophysiology
• Airway inflammation is mediated by a variety of cytokines and chemokines • Chemokines play a key role (cytokines that are specific for chemotaxis in inflammation. and activation of leukocytes). • Cytokines are produced by a number of cell • These proteins recruit types, including lymphocytes, eosinophils, proinflammatory cells, and mast cells. including Th2 lymphocytes, • Proinflammatory cytokines : IL-4, IL-5, mast cells, neutrophils, and and IL-13, produced primarily by the Th2 lymphocytes, are believed to trigger the eosinophils. intense inflammation of allergic asthma. • An imbalance between Th1 and Th2 • Eosinophils and mast cells lymphocytes (specifically, decreased Th1 produce proinflammatory activity with increased Th2 activity) cytokines as well as contributes to chronic inflammatory leukotrienes, which cause asthma. bronchoconstriction.
Cells & Mediators
Asthma Inflammation: Cells and Mediators Environment Genetic susceptibility
P CHRONIC INFLAMMATION A with infiltration of lymphocytes, eosinophils, T mast cells & epithel cells H O Desquamation of epithels, thickening & L O disorganization of tissues of the airway wall (Remodeling) G Y AIRWAY WALL THICKENING Pathophysiology • Initial evaluation should begin with a detailed medical history, including the pattern of symptoms and observed precipitating factors (asthma triggers). • Past medical history should include information about risk factors for asthma (particularly atopy), prior exacerbations, treatments used, and their effects. • A positive family history of parental asthma substantially increases the risk of asthma in a child. • Evaluation also should include an assessment of the impact of asthma on the child and family. • The physical examination of a child who has asthma often yields normal findings, although there may be signs of atopy, such as eczema or allergic rhinitis, which are strongly associated with asthma.
Evaluation • Characterized by intermittent, recurrent symptoms of airway obstruction that is at least partially reversible. • Common symptoms include cough (which may be the only symptom), wheezing, difficulty breathing, and “chest tightness.” • Symptoms often occur or worsen in the presence of common asthma “triggers,” such as exercise, changes in the weather, viral respiratory infections, and exposure to allergens or airway irritants (eg, environmental tobacco smoke).
• Asthma is particularly difficult to diagnose in infants and
toddlers. • Recurrent wheezing episodes are common in young children & many diseases can cause symptoms similar to those seen in asthma.
Diagnosis • Upper airway disease : • Obstruction of the small allergic rhinitis airways: bronchiolitis, sinusitis cystic fibrosis, congestive heart failure, and chronic • Extrinsic or intrinsic lung disease of prematurity. obstruction of the large airways (eg, tracheomalacia, vascular ring, mass, or foreign • Recurrent episodes of body). bronchiolitis may occur in young children and • Recurrent aspiration or sometimes are difficult to gastroesophageal reflux distinguish from asthma.
Differential Diagnosis PNAA, 2004: Entry point diagnosis asma:
Classification of asthma • AVOIDANCE • Education (communication, information, education) • Medication Short term Long term
Goal : optimal growth & development of the child
Management • Minimal (ideally no) chronic symptoms • Minimal (infrequent) exacerbations • No emergency visits • Minimal (ideally no) use of as needed ß2 -agonist • No limitations on activities (exercise) • (Near) Normal lung function • Minimal (or no) adverse effects from medicine
Goal of asthma management
(general) Pengobatan Asma (dahulu) Pengobatan Asma (sekarang) • The prevalence of asthma and the burden of disease remain high, despite efforts to improve public awareness about and medical management of asthma.
• Asthma is a disease of airway inflammation that has a
