Asthma

Retno Ariza S Soemarwoto

Pulmologist
 An imbalance of Th1 and Th2 cells, especially Th2
cells plays an important role in the development of
allergic diseases
• Eliminates parasite
• Eliminates micro
• Allergic diseases
organisms and tumors
•……
• Auto-immune disease
• Transplant rejection
•……

Th2
IL-4, 5, 13

Th1
IFN-γ, IL-2

Tc Th B
CD8+ CD4+ CD19+
 Integrated Airway
Development of asthma

Allergic
rhinitis
Asthma
Abnorma
l lung
functions
Genetic &
Environments
Hyper-reactiveness & Atopy
&viral infection ……
Remodeling & ……
Histo-pathological
changes
 Lingkungan
Risiko
• Alergen Usia Genetik
• Polutan
• Stress

Atopy

• Infeksi SN bawah
Kerusakan SN • Alergen
• Perokok pasif
• Zat toksik

Perbaikan yang • Persistence Inflammation

menyimpang • Remodeling

Asthma
 POTENTIAL BENEFITS
ABORTING THE ALLERGIC
MARCH
 THE IMMUNOLOGIC BASIS OF LOCAL ALLERGIC
REACTIONS e.g. ATOPIC DERMATITIS. ALLERGIC
RHINITIS and ASTHMA: IS ACTUALLY A
SYSTEMIC DYSREGULATION OFTHE IMMUNE
SYSTEM
ALLERGIC RHINITIS
ATOPIC BRONCHIAL
DERMATITIS ASTHMA
 Allergic reactions
Histamine Attract Eosinophils
other mediators and other immune cells

Mast cell
Early phase reaction Late phase reaction
(within the first hour) (after several hours)

 sneezing  nasal obstruction

 rhinorrhea  swollen eyes
 nasal pruritus  tiredness, irritability
 ocular pruritus  sleep disturbance

Allergens Adcock I. Clin Exp Allerg Rev 2002; 2: 85-8.

 Clinical
symptoms
Allergic Triggers
inflammation Viral
infections
Expose to
allergens
Pollutants
Genetic Environment
……
factors al factors
 Prevalence of asthma
Based on SKRT 1995 13/1000
Reseach :
 In Indonesia
Child 11,5 % Adult 7,7 %
 Wang et al 2001
Rhinitis 5,1%
Non rhinitis 0,75 %
 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
 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 history→ allergies or a
familial tendency towards asthma.
 Treatment of asthma

severe
moderate persisten
mild persistent t
persistent

intermittent MDI steroid or

MDI LABA + Steroid
allergen and irritant avoidance
oral or MDI bronchodilator

immunotherapy
 Asthma treatment
Based on severity → spirometry
Allergen avoidance
Gradation of severity:
 Mild → short acting bronchodilator
 Moderate to severe → bronchodilator &
antiinflammation
Spirometry
Peak flow meter
Nebulizer
To use M D I