Penyakit Kronis

• Penyakit Paru Obstruktif Kronik (PPOK)

• PPOK adalah penyakit paru kronik yang ditandai oleh
hambatan aliran udara di saluran napas yang bersifat
progressif nonreversibel atau reversibel parsial. PPOK
terdiri dari bronkitis kronik dan emfisema atau
gabungan keduanya (PDPI, 2003).
• Chronic Obstructive Pulmonary Disease (COPD) is a
preventable and treatable disease that makes it
difficult to empty air out of the lungs (American
Thoracic Society, 2013).
• Chronic bronchitis is a condition of increased
swelling and mucus (phlegm or sputum)
production in the breathing tubes (airways)
(American Thoracic Society, 2013).
• Kelainan saluran napas yang ditandai oleh
batuk kronik berdahak minimal 3 bulan dalam
setahun, sekurang-kurangnya dua tahun
berturut - turut, tidak disebabkan penyakit
lainnya (PDPI, 2013).
 Airway obstruction occurs in chronic bronchitis because the
swelling and extra mucus causes the inside of the breathing
tubes to be smaller than normal.
• Emfisema merupakan uatu kelainan anatomis paru yang
ditandai oleh pelebaran rongga udara distal bronkiolus
terminal, disertai kerusakan dinding alveoli (PDPI, 2013).
• Emphysema a progressive (or increasing) condition of the
lungs that causes shortness of breath and decreased
capacity for physical activity. It is caused by damage to the
small air sacs and small airways in the lungs.
• Emphysema is a condition that involves damage to the walls
of the air sacs (alveoli) of the lung. Normally there are more
than 300 million alveoli in the lung ((American Thoracic
Society, 2013).
• In emphysema, the walls of
some of the alveoli have been
damaged. When this happens,
the alveoli lose their
stretchiness and trap air.
• Since it is difficult to push all of
the air out of the lungs, the
lungs do not empty efficiently
and therefore contain more air
than normal.
• This is called air trapping and
causes hyperinflation in the
lungs.
 Asma adalah gangguan infl amasi kronik jalan napas yang
melibatkan banyak sel dan elemennya.
 Inflamasi kronik tersebut menyebabkan peningkatan
hiperensponsif jalan napas yang menimbulkan gejala
episodik berulang berupa mengi, sesak napas, dada terasa
berat dan batuk terutama malam hari dan atau dini hari.
 Asthma is a common chronic disorder of the airways that is
complex and characterized by variable and recurring
symptoms, airflow obstruction, bronchial
hyperresponsiveness, and an underlying inflammation
• Inflammation has a central role in the pathophysiology of asthma. As
noted in the definition of asthma, airway inflammation involves an
interact ion of many cell types and multiple mediators with the airways
that eventually results in the characteristic pathophysiological features
of the disease: bronchial inflammation and airflow limitation that result
in recurrent episodes of cough, wheeze, and shortness of breath.
• The processes by which these interactive events occur and lead to
clinical asthma are still under investigation. Moreover, although distinct
phenotypes of asthma exist (e.g., intermittent, persistent, exercise-
associated, aspirin-sensitive, or severe asthma), airway inflammation
remains a consistent pattern.
• The pattern of airway inflammation in asthma, however, does not
necessarily vary depending upon disease severity, persistence, and
duration of disease. The cellular profile and the response of the structural
 Bronchoconstriction.
 Airway edema.
 Airway hyperresponsiveness
 Airway remodeling.
• In acute exacerbations of asthma,
bronchial smooth muscle contraction
(bronchoconstriction) occurs quickly to
narrow the airways in response to
exposure to a variety of stimuli including
allergens or irritants.
• Allergen-induced acute
bronchoconstriction results from an IgE-
dependent release of mediators from
mast cells that includes histamine,
tryptase, leukotrienes, and prostaglandins
that directly contract airway smooth
muscle (Busse and Lemanske 2001).
• In addition, other stimuli (including
exercise, cold air, and irritants) can cause
acute airflow obstruction.
 As the disease becomes more persistent and inflammation
more progressive, other factors further limit airflow.
 These include edema, inflammation, mucus hypersecretion
and the formation of inspissated mucus plugs, as well as
structural changes including hypertrophy and hyperplasia of
the airway smooth muscle.
 The degree to which airway hyperresponsiveness
can be defined by contractile responses to
challenges with methacholine correlates with the
clinical severity of asthma.
 The mechanisms influencing airway
hyperresponsiveness are multiple and include
inflammation, dysfunctional neuroregulation, and
structural changes; inflammation appears to be a
major factor in determining the degree of airway
hyperresponsiveness.
• Airway remodeling involves an
activation of many of the structural
cells, with consequent permanent
changes in the airway that increase
airflow obstruction and airway
responsiveness and render the
patient less responsive to therapy
(Holgate and Polosa 2006).
• These structural changes can include
thickening of the sub-basement
membrane, subepithelial fibrosis,
airway smooth muscle hypertrophy
and hyperplasia, blood vessel
proliferation and dilation, and
mucous gland hyperplasia and
hypersecretion (box 2–2).
1. Kebiasaan merokok merupakan satu - satunya penyebab kausal yang
terpenting, jauh lebih penting dari faktor penyebab lainnya.
Dalam pencatatan riwayat merokok perlu diperhatikan :
Riwayat merokok
- Perokok aktif
- Perokok pasif
- Bekas perokok
b. Derajat berat merokok dengan Indeks Brinkman (IB), yaitu perkalian
jumlah rata-rata batang rokok dihisap sehari dikalikan lama merokok
dalam tahun
- Ringan : 0-200
- Sedang : 200-600
- Berat : >600
2. Riwayat terpajan polusi udara di lingkungan dan tempat kerja
3. Hipereaktiviti bronkus
4. Riwayat infeksi saluran napas bawah berulang
• Pada bronkitis kronik terdapat pembesaran kelenjar mukosa bronkus, metaplasia sel
goblet, inflamasi, hipertrofi otot polos pernapasan serta distorsi akibat fibrosis.
• Emfisema ditandai oleh pelebaran rongga udara distal bronkiolus terminal, disertai
kerusakan dinding alveoli. Secara anatomik dibedakan tiga jenis emfisema:
• Emfisema sentriasinar, dimulai dari bronkiolus respiratori dan meluas ke perifer,
terutama mengenai bagian atas paru sering akibat kebiasaan merokok lama
• Emfisema panasinar (panlobuler), melibatkan seluruh alveoli secara merata dan
terbanyak pada paru bagian bawah
• Emfisema asinar distal (paraseptal), lebih banyak mengenai saluran napas distal,
duktus dan sakus alveoler. Proses terlokalisir di septa atau dekat pleura.
• Obstruksi saluran napas pada PPOK bersifat ireversibel dan terjadi karena perubahan
struktural pada saluran napas kecil yaitu : inflamasi, fibrosis, metaplasi sel goblet dan
hipertropi otot polos penyebab utama obstruksi jalan napas.