CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD ) adalah :

▪ Penyakit umum yg bisa dicegah dan diobati, ditandai dengan gejala

respirasi yang menetap dan adanya hambatan aliran udara karena ketidak
normalan pada jalan napas dan atau alveoli karena paparan bahan bahan
partikel atau gas yang beracun.
▪ Keluhan yang umum meliputi sesak, batuk dan produksi sputum, keluhan ini
mungkin tidak dilaporkan penderita.

Global Initiative for Chronic Obstructive Lung Disease (GOLD) Guidelines, 2019 Available from http://www.goldcopd.com/
▪ COPD is currently the fourth leading cause of death in the
world.
▪ COPD is projected to be the 3rd leading cause of death by
2020.
▪ More than 3 million people died of COPD in 2012
accounting for 6% of all deaths globally.
▪ Globally, the COPD burden is projected to increase in
coming decades because of continued exposure to COPD
risk factors and aging of the population.

▪ 1. Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the
Global Burden of Disease Study 2010. Lancet 2012; 380(9859): 2095-128.
▪ 2. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 2006; 3(11): e442.
© 2019 Global Initiative for Chronic Obstructive Lung Disease
 ETIOLOGY
SMOKIND -POLLUTANS
HOST FACTORS

PATHOBIOLOGY
IMPAIRED LUNG GROWTH
ACCELERATED DECLINE
LUNG INJURY
LUNG & SYTEMIC INFLAMMATION

PATHOLOGY
SMALL AIRWAY DISORDERS
OR ABNORMALITIES
EMPHSYEMA
SYTEMIC EFFECTS

AIRFLOW CLINICAL
MANIFESTATIONS
LIMITATION
SYMPTOMS
PERSISTENT
leading to airflow limitation & AIRFLOW
EVACERBATIONS
COMORBIDITIES
clinical manifestations LIMITATION

© 2019 Global Initiative for Chronic Obstructive Lung Disease

 SMALL AIRWAY DISEASE PARENCHYMAL DESTRUCTION
Airway inflammation Loss of alveolar attachments
Airway fibrosis, luminal plugs Decrease of elastic recoil
Increased airway resistance

Global Initiative for Chronic Obstructive Lung Disease (GOLD) Guidelines, 2011. Available from http://www.goldcopd.com/
 FEV1 progression over time

© 2019 Global Initiative for Chronic Obstructive Lung Disease

Global Initiative for Chronic Obstructive Lung Disease (GOLD) Guidelines, 2011, Available from http://www.goldcopd.com/
 INFLAMASI BERPERAN UTAMA PADA
PATOGENESA COPD

Asap rokok

genetika Inflamasi paru

LUNG INFLAMMATION
Inflammatory cells
Inflammatory mediators
Oxidative stress
proteases

Perubahan anatomi
▪ Typically smokers - mean 20 cigs/day for 20 years
▪ Usually present in 5th decade of life with
productive cough or acute chest illness – when the
disease is far advanced
▪ DOE usual until 6th or 7th decade
▪ Patients who are dyspnea give up activities
▪ wheezing accompanying dyspnea may lead to
erroneous diagnosis of asthma
▪ Sputum production initially only in AM
▪ daily volume rarely exceeds 60 ml
▪ usually mucoid
▪ Acute exacerbations characterized by increased cough,
purulent sputum, wheezing, dyspnea, sometimes fever
▪ Interval between exacerbations grows shorter with disease
progression
▪ A condition of the lung characterized by
abnormal, permanent enlargement of
airspaces distal to the terminal
bronchiole,
▪ accompanied by the destruction of their
walls, and without obvious fibrosis
▪ Cough productive of sputum on
most days during at least three
consecutive months for more than
two successive years.
▪ More profound hypoxemia at rest
▪ Elevated PaCO2 with chronic
respiratory acidosis
▪ Cor pulmonale with right heart
failure
COPD has significant extrapulmonary

(systemic) effects including:

▪ Weight loss
▪ Nutritional abnormalities
▪ Skeletal muscle dysfunction
COPD patients are at increased risk for:
▪ Myocardial infarction.
▪ Osteoporosis.
▪ Respiratory infection.
▪ Diabetes.
▪ Lung cancer.
 ▪ Definition and Overview

▪ Diagnosis and Initial Assessment

▪ Evidence Supporting Prevention &

Maintenance Therapy

▪ Management of Stable COPD

▪ Management of Exacerbations

▪ COPD and Comorbidities

© 2019 Global Initiative for Chronic Obstructive Lung Disease

 RISK FACTORS
SYMPTOMS HOST FACTORS
SHORT OF BREATH TOBACCO
CHRONIC COUGH OCCUPATION
SPUTUM INDOOR/OUTDOOR
POLUTION

SPIROMETRY
REQUIRED
TO ESTABLISH
DIAGNOSIS
 Spirometry should be
performed after the
administration of an
adequate dose of a short-
acting inhaled
bronchodilator to minimize
variability.

A post-bronchodilator
FEV1/FVC < 0.70 confirms
the presence of airflow
limitation that is not fully
reversible.

© 2019 Global Initiative for Chronic Obstructive Lung Disease

 ▪ Definition and Overview

▪ Diagnosis and Initial Assessment

▪ Evidence Supporting Prevention &

Maintenance Therapy

▪ Management of Stable COPD

▪ Management of Exacerbations

▪ COPD and Comorbidities

© 2019 Global Initiative for Chronic Obstructive Lung Disease

 Prevention & Maintenance Therapy

▪ Smoking cessation is key. Pharmacotherapy and

nicotine replacement reliably increase long-term
smoking abstinence rates.
▪ The effectiveness and safety of e-cigarettes as a
smoking cessation aid is uncertain at present.
▪ Pharmacologic therapy can reduce COPD
symptoms, reduce the frequency and severity of
exacerbations, and improve health status and
exercise tolerance.
 Prevention & Maintenance Therapy

▪ Influenza vaccination decreases the incidence of

lower respiratory tract infections.
▪ Pneumococcal vaccination decreases lower
respiratory tract infections.
▪ Pulmonary rehabilitation improves symptoms,
quality of life, and physical and emotional
participation in everyday activities.
▪ In patients with severe resting chronic hypoxemia,
long-term oxygen therapy improves survival.
 ▪ Definition and Overview

▪ Diagnosis and Initial Assessment

▪ Evidence Supporting Prevention &

Maintenance Therapy

▪ Management of Stable COPD

▪ Management of Exacerbations

▪ COPD and Comorbidities

© 2019 Global Initiative for Chronic Obstructive Lung Disease

 Mengurangi gejala klinis
COPD

Berdasarkan strategi GOLD

2019 terapi pemeliharaan
COPD terfokus pada dua
tujuan utama :
Menurunkan risiko
kejadian ekaserbasi
COPD Assessment Test (CATTM)

© 2019 Global Initiative for Chronic Obstructive Lung Disease

Modified MRC dyspnea scale

© 2019 Global Initiative for Chronic Obstructive Lung Disease

ABCD assessment tool

C D
A B

© 2019 Global Initiative for Chronic Obstructive Lung Disease

 GROUP C GROUP D

GROUP A GROUP C

© 2019 Global Initiative for Chronic Obstructive Lung Disease

 GROUP C GROUP D
LAMA OR
LAMA LAMA + LABA OR
ICS + LABA

GROUP A GROUP C

A BROCHODILATOR LABA OR LAMA

© 2019 Global Initiative for Chronic Obstructive Lung Disease

Pharmacological therapy

© 2019 Global Initiative for Chronic Obstructive Lung Disease

Pharmacological therapy

© 2019 Global Initiative for Chronic Obstructive Lung Disease

▪ Following implementation of therapy, patients should be reassessed
for attainment of treatment goals and identification of any barriers
for successful treatment (Figure 4.2).
▪ Following review of the patient response to treatment initiation,
adjustments in pharmacological treatment may be needed.

© 2019 Global Initiative for Chronic Obstructive Lung Disease

 © 2019 Global Initiative for Chronic Obstructive Lung Disease
© 2017 Global Initiative for Chronic Obstructive Lung Disease
Non-Pharmacological Treatment

▪ Education and self-management

▪ Physical activity
▪ Pulmonary rehabilitation
programs
▪ Exercise training
▪ Self-management education
▪ End of life and palliative care
▪ Nutritional support
▪ Vaccination
▪ Oxygen therapy
© 2019 Global Initiative for Chronic Obstructive Lung Disease
 ▪ Definition and Overview

▪ Diagnosis and Initial Assessment

▪ Evidence Supporting Prevention &

Maintenance Therapy

▪ Management of Stable COPD

▪ Management of Exacerbations

▪ COPD and Comorbidities

© 2019 Global Initiative for Chronic Obstructive Lung Disease

▪ An exacerbation of COPD is defined as an acute worsening of
respiratory symptoms that results in additional therapy.

▪ Exacerbations of COPD can be precipitated by several factors. The

most common causes are respiratory tract infections.

▪ The goal for treatment of COPD exacerbations is to minimize the

negative impact of the current exacerbation and to prevent
subsequent events.

▪ Short-acting inhaled beta2-agonists, with or without short-acting

anticholinergics, are recommended as the initial bronchodilators to
treat an acute exacerbation.
1

4
COPD exacerbations lead to:
Decline in lung function

Increased symptoms
(breathlessness)

Worsening health status

Increased risk
of hospitalisation

Increased risk of
4,5
mortality
.
Chest 2003;124:459–467; 5. Soler-Cataluna JJ, et al. Thorax 2005;60:925–931.
Symptoms

Exacerbations

Exacerbations
Deterioration
Exacerbations

End of Life
▪ COPD exacerbations are defined as an acute worsening
of respiratory symptoms that result in additional therapy.

▪ They are classified as:

▪ Mild (treated with short acting bronchodilators only,

SABDs)
▪ Moderate (treated with SABDs plus antibiotics and/or
oral corticosteroids) or
▪ Severe (patient requires hospitalization or visits the
emergency room). Severe exacerbations may also be
associated with acute respiratory failure.

© 2019 Global Initiative for Chronic Obstructive Lung Disease

Pharmacological treatment
The three classes of medications most commonly used for COPD
exacerbations are:
▪ Bronchodilators
it is recommended that short-acting inhaled beta2-agonists, with or without
short-acting anticholinergics.
▪ Corticosteroids
systemic glucocorticoids in COPD exacerbations shorten recovery time and
improve lung function (FEV1). They also improve oxygenation, the risk of
early relapse, treatment failure, and the length of hospitalization.
▪ Antibiotics

© 2019 Global Initiative for Chronic Obstructive Lung Disease

BRONCODILATORS LABAS
LAMAS
LABA + LAMA

CORTICOSTEROID- LABA + ICS

CONTAINING REGIMENS LABA + LAMA + ICS
ANTI-INFLAMMATORY
(NON-STEROID) ROFLUMILAST

ANTI-INFECTIVES VACCINES
LONGTERM MACROLIDES
N- ACETYLCYSTEIN
MUCOREGULATORS
CARBOCYSTEIN

SMOKING CESSATION
VARIOUS OTHERS
REHABILITATION
LUNG VOLUME REDUCTION
© 2017 Global Initiative for Chronic Obstructive Lung Disease