29.Asma Persisten Berat Dengan Eksaserbasi Akut

Asma Persisten Berat dengan Eksaserbasi E ksaserbasi Akut Akut Ivanalia Soli Deo 102012359 B9 FAKULTAS KEDOKTERAN UNIVERSITAS KRISTEN KRIDA WACANA Koe!"on#en$ ivanalia%#eo&'(ail%)o(

Pendahuluan

A!(a A!(a (e*"a (e*"a+an +an "en,a "en,a+i+i- 'an''* 'an''*an an in.la( in.la(a!i a!i +oni! +oni! !al*an !al*an "ena" "ena"a!an a!an ,an' #i/**n'+an #en'an /i"ee!"on!i. +e-ea-a!an alian *#aa ,an' eve!ile #an 'elaa "ena.a!an%1 e!+i"*n a!(a *+an "en,a+i- ,an' #i-a+*-i na(*n a!(a (a!i/ (a!i/ !a,a !a,a (eni( (eni(*l+ *l+an an eea" eea"aa +a!*! +a!*! +e(a-ia +e(a-ian% n% 4eala 4eala !ean'a !ean'an n a!(a a!(a !an'a!an'a evaia!i #ai a+-* +e a+-* ai+ #ala( /al !i.a- ea- #an la(an,a% Sean'an #a"a- -ea#i !an'a- in'an !in'+a- #an !e(*/ !"on-an% Na(*n !eali+n,a #a"a "*la -ea#i !an'a- ea- elan'!*n' la(a !e/in''a !*li- #i-an''*lan'i% Ke(a-ian  "a#a "en#ei-a a!(a "a#a #a!an,a -ea#i +aena "en'oa-an ,an' -i#a+ a#e+*a,an' #i!ea+an ole/ +e-ela(a-an "en#ei-a #a-an' eoa- a-a* +e!ala/an #o+-e  #an -ena'a (e#i! *n-*+ (en'enal !ean'an a!(a a+*- -e*-a(a ,an' ea-% 2 6a#a 6a#a +e!e(" +e!e("a-an a-an +ali +ali ini #i#a"#i#a"-ii +a!*! +a!*! (en'en (en'enai ai !eoan !eoan' ' ana+ ana+ la+i7la la+i7la+i +i  e*!ia 10 -a/*n #iaa +e U4D RS +aena !e!a+ na.a! !ea+ 2 a( ,an' lal*% 6a!ien (e(ili+i ia,a- a!(a !ea+ +e)il% Sea+ 2 (in''* ,an' lal* (en**- I*n,a "a!ien (e(e (e(el l*+ *+an an !al !al**-a( a(ol ol in/a in/ala la!i !i !e-ia !e-ia" " /ai /ai -e-* -e-*-a -a(a (a !aa!aa- eo eola/ la/a' a'a a #an #an (en'ala(i a-*+ ,an' e*lan' !aa- !e#an' -i#* !ean,a+ 28 !e(in''* !e/in''a  "a!ien -i#a+ i!a -i#* #en'an n,en,a+% 6a#a "e(ei+!aan .i!i+ #i#a"a-i "*)a- /an,a #a"a- ei)aa +a-a #en'an -e"a-a7"a-a !iano!i! "eioal in'an +ea#aan !o(nolen !*/* a.eil na.a! 08:(eni- na#i 1208:(eni- -e+anan #aa/ 120:90 ((;' e-a+!i #in#in' #a#a #an /i
1

Pembahasan Anamnesis

Ana(ne!i! #a"a- #ila+*+an +e"a#a "a!ien !e)aa lan'!*n' a"aila +on#i!in,a (e(*n'+in+an na(*n #a"a- #i-an,a+an "*la "a#a oan' -e#e+a- a-a* oan' ,an' (en'an-a "a!ien +e #o+-e% Se!*ai #en'an +a!*! "e-an,aan ,an' #ia*+an #a"a(eli"*-i i#en-i-a! #ii +el*/an *-a(a !ea+ +a"an +el*/an *-a(a (*n)*l +el*/an lain ,an' (*n'+in #ia!a+an ia,a- "en,a+i- ,an' #i#ei-a !aa- ini ia,a- "en,a+i#a/*l* ia,a- "en,a+i- +el*a'a "en'oa-an ,an' !*#a/ #ila+*+an #an +on#i!i !o!ial e+ono(i "a!ien% Un-*+ +el*/an !e!a+ na.a!n,a "el* #i-an,a+an$ a"a+a/ #ia!a+an -e*! (ene*! a"a+a/ #ia!a+an (a+in ea- a-a* (a+in (e(ai+ a"a+a/ a+-ivi-a! =!aa eola/a'a> (e("eea- a!a !e!a+ a-a* (e(i)* -ea#in,a !e!a+ na.a!% Tan,a+an a"a+a/ wheezing   /ilan' -i(*l =i+a /ilan' -i(*l #i-an,a+an -i(*ln,a !aa- a"a> a"a+a/ #i!e-ai #en'an a-*+ =i+a "a!ien (en'el*+an a#an,a a-*+ -an,a+an *'a .e+*en!i ana #a/a+ ,an' #i+el*a+an #an *'a a"a+a/ #i!e-ai #aa/>% Tan,a+an  *'a +e(*n'+inan ia,a- "a"aan ale'en !e"e-i (e(eli/aa ina-an' #i #ala( *(a/ an,a+ +e)oa -e#a"a- a'ian ,an' le(a #i #ala( *(a/ a"a+a/ (en''*na+an +a"e- e*l* !o.a +ain l*#* +a!* +a"*+ an,a+ aan' #i +a(a  -i#* a"a+a/ !e!a+ +aena a*7a*an ="a.*( !"a, "e(*n*/ !ean''a>% 3 Tan,a+an ia,a- /i#*n' in'*!an a-a* (a("a- =/ini-i! ale'i> (a-a 'a-al (ea/ #an eai =+on*n'-ivi-i! ale'i> e+!e( a-o"i a-*+ ,an' !ein' +a(*/ =+oni+> #i!e-ai (en'i .l* e*lan' !a+i- a+ia- "e*a/an (*!i( a-a* "e'an-ian )*a)a !ein' -ean'*n "a#a (ala( /ai ia,a- +el*a'a =ia,a- a!(a ini-i! a-a* ale'i lainn,a #ala( +el*a'a> a"a+a/ "a!ien (eo+o+ oan' lain ,an' (eo+o+ #i *(a/ a-a* lin'+*n'an +ea% Tan,a+an oa- ,an' #i'*na+an "a!ien a"a+a/ a#a beta blocker  a!"iin a-a* !-eoi#%3

Pemeriksaan Fisik 4

6e(ei+!aan .i!i+ ,an' #a"a- #ila+*+an (eli"*-i "e(ei+!aan +e!a#aan  "e(ei+!aan -an#a7-an#a vi-al in!"e+!i "al"a!i "e+*!i #an a*!+*l-a!i% 6e(ei+!aan aal #ila+*+an *n-*+ (enen-*+an +on#i!i "a!ien #an (en)ai i!i+o *n-*+ -ea#in,a 'a'al na.a!% E"i!o#e a+*- a!(a i!a e(*la #en'an !i("-o( ,an' in'an !e"e-i #,!"nea% Den'an o!-*+!i !al*an "ena.a!an ,an' !e(a+in (e(**+ e!"ia-o,

2

#i!-e!!-e(a!*+ e-a+!i "en''*naan o-o- a#o(en !ea+-* e+!"ia!i #an -i#a+ i!a  ei)aa !a-* a-a* #*a +a-a i!a #i-e(*+an% 6e(ei+!aan -an#a7-an#a vi-al (eli"*-i$ -e+anan #aa/ na#i .e+*en!i na"a! #an !*/* a#an% Tan#a vi-al i!a (en*n*++an -a+i+a#ia #an /i"e-en!i% 6ea+ .lo a-e /a*!la/ #i"ei+!a !ea'ai -an#a vi-al "a#a ana+7ana+ ,an' +oo"ea-i.% ?i+a -i#a+  #iei "en'oa-an o!-*+!i !al*an na.a! ,an' la(a #an *!a/a *n-*+ ena.a! ,an' (enin'+a- i!a (en,ea+an a#i+a#ia /i"oven-ila!i #an )a#ioe!"ia-o, ae!-% 6a#a in!"e+!i #ili/a- a"a+a/ en-*+ #a#a !i(e-i! -e-in''al "a#a 'ea+an na"a! #an a"a+a/ -a+ea -ele-a+ #i-en'a/% ;i#*n' on''a (*l*- /en#a+n,a #i"ei+!a ila a#a !*(a-an% ?i+a #i"el*+an !"*-*( #a"a- #i"ei+!a *n-*+ (en)ai a#an,a !el a#an' -e*-a( eo!ino.il #an a+-ei% 6e/a-i+an a"a+a/ a#a (a!!a -*(o e#e(a "enin''ian -e+anan vena *'*lai! #an "e(e!aan +elena 'e-a/ enin'% 6a#a "al"a!i #ila+*+an "eaaan *n-*+ (eli/a- a#an,a a!a n,ei -*(o:enolan  "en,e("i-an:"eleaan !ela i'a #an "e'ea+an -/oa+!% 6a#a "e(ei+!aan a*!+*l-a!i #i#en'a+an a"a+a/ a#a *n,i "a-olo'i!% 6a#a  "en#ei-a

a!(a

a+an

#i#a"a-+an

*n,i

wheezing %

B*n,i

wheezing   #a"a-

#i+al!i.i+a!i+an (ena#i #*a ,ai-* lo+al #an (ea-a% Wheezing  ,an' -ea#i lo+al a-a* !e-e("a- (*n'+in #i!ea+an ole/ o!-*+!i !e"e-i "a#a +a!ino(a on+*! #an  en#a a!in' a-a* !-eno!i! ,an' (ene-a" !i.a- wheezing n,a (ono-onal% Se#an'+an wheezing ,an' -e!ea l*a! #a"a- #i!ea+an ole/ on)/i-i! +oni+ e(.i!e(a a-a*  "en,a+i- "a* o!-*+-i. +oni+% Wheezing   ,an' !i.a-n,a in-e(i-en =(i!aln,a /an,a  "a#a (ala( /ai:#ini /ai> (en'aa/ +e a!(a !e#an'+an ila -ea#i "a#a a+*  eain' (*n'+i( e#e(a "a* a-a* a!"ia!i% W/ee
Ui .aal "a* #i+ea+an *n-*+ (enen-*+an #eaa- o!-*+!i (enilai /a!il  "ovo+a!i on+*! (enilai /a!il "en'oa-an #an (en'i+*-i "ealanan "en,a+i-% 6e(ei+!aan .aal "a* ,an' "en-in' "a#a a!(a iala/ 6EFR = peak expiratory flow rate> FEV1 (forced expiratory volume 1 second) FVC (forced vital capasity) FEV1:FVC% Ui .aal "a* -i#a+ !elal* (*#a/ #ila+*+an -e*-a(a "a#a ana+ #iaa/ *(* 57@ -a/*n% Seai+n,a -ia" ana+ #en'an a!(a #i *i .aal "a*n,a "a#a -ia"

3

+*n*n'an% “Peak flow meter a#ala/ ,an' "alin' !e#e/ana !e#an'+an #en'an !"io(e-e (e(ei+an #a-a ,an' lei/ len'+a"% FVC 6EFR #an a!io FEV1:FVC e+*an'  15 #ai nilai no(aln,a% 6e"anan'an a+-* e+!"ia!i "a+!a ia!an,a #i-e(*+an ala*"*n 6EFR #an FEV1:FVC /an,a e+*an' !e#i+i-% In.la!i elei/an ,an' ia!an,a '-eli/a- !e)aa +lini! a+an #i'a(a+an !ea'ai (enin''in,a i!i -o-al "a* =TLC> i!i +a"a!i-a! e!i#* .*n'!ional #an i!i e!i#*% Di l*a !ean'an .aal "a* -e!e*- *(*(n,a a+an +e(ali no(al +e)*ali "a#a a!(a ,an' ea-%

Gambar 1. Gambaran Tes Fungsi Faal Paru ada Penderita Asma

!. Pemeriksaan "arah, E#siin#$il dan Uji Tuber%ulin

6a#a "e(ei+!aan #aa/ ,an' *-in #i/aa"+an eo!ino.il (enin''i !e#an'+an le*+o!i- #a"a- (enin''i a-a* no(al ala*"*n -e#a"a- +o("li+a!i a!(a% 6a#a anali!a 'a! #aa/ -e#a"a- /a!il alian #aa/ ,an' vaiael a+an -e-a"i ila -e#a"a "enin''ian 6aCO2 (a*"*n "en**nan "; (en*n*+an -en#en!i "o'no!i! ,an'  **+% ;i"ona-e(ia +a#an'7+a#an' 6N (enin''i *(la/ #ia-a! 15%000:((3 (enan#a+an -e#a"a- ,a in.e+!i% 6a#a "e(ei+!aan .a+-o ale'i -e#a"a- I'E ,an' (enin''i "a#a a+-* !ean'an #an (en**n "a#a a+-* "en#ei-a ea! #ai !ean'an% 6e(ei+!aan -e! +*li- *n-*+ (en)ai .a+-o ale'i #en'an ea'ai ale'enn,a #a"a- (eni(*l+an ea+!i ,an' "o!i-i. "a#a -i"e a!(a a-o"i+% 6e(ei+!aan eo!ino.il #ala( #aa/ !e)e- /i#*n' #an #a/a+ #a"a- (en*nan' #ia'no!i! a!(a% Eo!ino.il #a"a- #i-e(*+an #ala( #aa/ -e"i !e)e- /i#*n' #an !"*-*(% Dala( !"*-*( #a"a- #i-e(*+an Ki!-al C/a)o-7Le,#en #an !"ial C*!/(an%

Bila

a#a

in.e+!i

(*n'+in

a+an

#i#a"a-+an

"*la

le+o!i-o!i!

 "oli(o.on*+le*!% Ui -*e)*lin "en-in' *+an !aa +aena #i In#one!ia (a!i/

4

 an,a+ -*e)*lo!i! -e-a"i *'a +aena +ala* a#a -*e)*lo!i! #an -i#a+ #ioa-i a!(an,a "*n (*n'+in !*+a #i+on-ol%

&. F#t# '#ntgen T#raks

6e(ei+!aan ini "el* #ila+*+an #an "a#a .o-o a+an -a("a+ )oa+an "a* ,an' (enin'+a-% ;i"ein.la!i -e#a"a- "a#a !ean'an a+*- #an "a#a a!(a +oni+% A-ele+-a!i! *'a !ein' #i-e(*+an% Se-ia" ana+ "en#ei-a a!(a ,an' e+*n*n'  "e-a(a +alin,a "el* #i*a- .o-o on-'en "a*n,a% Fo-o ini #i*a- -e*-a(a *n-*+  (en,in'+i+an +e(*n'+inan a#an,a "en,a+i- lain% Fo-o "el* #i*lan' ila a#a in#i+a!i (i!aln,a #*'aan a#an,a "ne*(onia a-a* "ne*(o-oa+!% Ron-'en .o-o !in*!  "aana!ali! "el* *'a ila a!(an,a !*li- -e+on-ol%

Gambar !. Reversible Hyperinflation dengan Asma

4. Uji (ulit Alergi dan )mun#l#gi

6e(ei+!aan ini #ila+*+an #en'an )aa 'oe!an a-a* -*!*+% a!in'7(a!in' )aa (e("*n,ai +e*n-*n'an #an +e*'iann,a% Alle'en ,an' #i'*na+an a#ala/ alle'en ,an' an,a+ #i#a"a- #i #aea/n,a% ;a!il "o!i-i. /a*! #i)o)o++an #en'an +ea#aan "en#ei-a !e/ai7/ai% Bila a#a /**n'an ,an' ela! a* *i +*li- -e!e* ea-i% Ke#*a )aa *i +*li- ale'i -e!e*- #a"a- (e(ei+an /a!il "o!i-i. "al!* #ala(  "e!en-a!e +e)il #an (e("*n,ai +oela!i ,an' ai+ #en'an I'E ,an' ee#a% 6el* #iin'a- a/a ea+!i ini #a"a- #i-e+an #en'an "e(eian an-i/i!-a(in%

5

6e(ei+!aan I'E a-a* +ala* (*n'+in I'E !"e!i.i+ #a"a- (e("e+*a#ia'no!i! #an (enen-*+an "en'elolaann,a% Te-a"i ila -i#a+ #a"a- #i-e(*+an +elainan ini #ia'no!i! a!(a el*( #a"a- #i!in'+i+an% Ui ale'i +*li- e'*na *n-*+  (en*n*++an alle'en ,an' "o-en!ial !ea'ai "en)e-*!% ;a!il *i ale'i +*li- /a*! #i/**n'+an #en'an +ea#aan +lini! #an ila )o)o+ i-*la/ alle'en "en)e-*! ,an' !e!*ai%

*#rking "iagn#sis+ Asma Persisten Berat Eksaserbasi Akut 1. "e$inisi dan (lasi$ikasi Asma

I!-ila/ a!(a ea!al #ai +a-a ,*nani ,an' a-in,a -ean'a/7en'a/% A!(a (e*"a+an !*a-* 'an''*an in.la(a!i "a#a alan na"a! ,an' #i"ean+an ole/ an,a+  !el +/*!*!n,a !el (a!- e*!ino.il li(.o!i-T (a+o.a' ne*-o.il #an !el7!el e"i-el% 6a#a in#ivi#* ,an' "e+a in.la(a!i ini (en,ea+an e"i!o#e e*lan' (en'i !*li ena"a! !e!a+ #a#a #an a-*+ -e*-a(a #i (ala( /ai% E"i!o#e ini ia!an,a #i!e-ai #en'an o!-*+!i alian *#aa -e-a"i evaia!i ,an' !ein' eve!iel ai+ !e)aa !"on-an a-a*"*n #en'an "enan'anann,a% 5@ San'a- !*+a (e(e#a+an !a-* eni! a!(a #en'an a!(a ,an' lain%% #a/*l* #ie!a+an a!(a ale'i+ =e+!-in!i+> #an non7ale'i+ =in-in!i+>% Na(*n +la!i.i+a!i -e!e*- "a#a "a+-e+n,a -i#a+ (*#a/ #an !ein' "a!ien (e("*n,ai +e#*a !i.aale'i+ #an non ale'i+% Se/in''a ) Connel #an ;ol'a-e (e(a'i a!(a #ala( 3 +a-e'oi ,ai-* a!(a e+!-in!i+ a!(a in-in!i+ #an a!(a ,an' e+ai-an #en'an  "en,a+i- "a* +oni+%@ Selan*-n,a "en#ei-a a!(a #i+la!i.i+a!i+an (ena#i a!(a in-e(i-en in'an ='eala -ea#i +*an' #ai !e(in''* !e+ali #en'an .*n'!i "a* no(al a-a* (en#e+a-i no(al #ian-aa e"i!o#e !ean'an> a!(a "e!i!-en in'an ='eala (*n)*l lei/ #ai !e+ali #ala( !e(in''* #en'an .*n'!i "a* no(al a-a* (en#e+a-i no(al #ian-aa e"i!o#e !ean'an> a!(a "e!i!-en (o#ea- ='eala (*n)*l !e-ia" /ai #en'an +e-ea-a!an alan na"a! in'an /in''a (o#ea-> a!(a "e!i!-en ea- ='eala (*n)*l -ia" /ai #an (en''an''* a+-ivi-a! /aian -e#a"a- 'an''*an -i#* +aena -ean'*n (ala( /ai #an +e-ea-a!an alan na"a!> #an a!(a ea- : !-a-*! a!(a-i+*! ='eala #i!-e!! ea- /in''a -i#a+ i!a -i#* +e-ea-a!an alan na"a! ,an' +*an' e!"on -e/a#a" on+o#ila-o in/ala!i #an #a"a- (en'an)a( n,aa>% 3 !lobal "nitiative for   #sthma =4INA> (en'a*+an +la!i.i+a!i a!(a "e!i!-en in'an !e#an' #an ea-% @

6

Tabel 1. (lasi$ikasi Asma Berdasarkan ani$estasi (linis enurut Global   Initiative for Asthma -G)A/

!. Eidemi#l#gi

A!(a (e*"a+an !ala/ !a-* "en,a+i- +oni+ ,an' !ein' #an #i"e+ia+an #i#ei-a ole/ !e+i-a 300 *-a oan' #i #*nia% Di"e+ia+an 10712 oan' #ea!a #an 15 ana+7ana+ ,an' (en#ei-a a!(a% A!(a #a"a- #i#ei-a ole/ !e-ia *!ia% 6a#a ana+7 ana+ a!io la+i7la+i "en#ei-a a!(a #*a +ali #ian#in'+an #en'an "ee("*an na(*n (ena#i !a(a "a#a *!ia #ea!a% Di In#one!ia "evalen!i a!(a el*( #i+e-a/*i !e)aa  "a!-i% ;a!il "eneli-ian "a#a ana+ !e+ola/ *!ia 1371 -a/*n #en'an (en''*na+an +*e!ione ISAAC ("nternational $tudy on #sthma and #llergy in %hildren) -a/*n 1995 (ela"o+an "evalen!i a!(a !ee!a 21 !e#an'+an "a#a -a/*n 2003 (enin'+a- (ena#i 52%  ;a!il !*ve, a!(a "a#a ana+ !e+ola/ #i eea"a +o-a #i In#one!ia =e#an 6ale(an' ?a+a-a Ban#*n' Se(aan' o',a+a-a alan' #an Den"a!a> (en*n*+an "evalen!i a!(a "a#a ana+ SD =@ !a("ai 12 -a/*n> e+i!a an-aa 37 @ !e#an'+an "a#a ana+ S6 #i ?a+a-a 6*!a- !ee!a 5% Be#a!a+an 'a(aan -e!e*- -eli/a- a/a a!(a -ela/ (ena#i (a!aa/ +e!e/a-an (a!,aa+a,an' "el* (en#a"a- "e/a-ian !ei*!% 3

7

&. Eti#l#gi@

Ran'!an'an ,an' #a"a- (en)e-*! !ean'an a!(a #a"a- #i+elo("o++an #ala( -**/ +a-e'oi e!a$ ale'eni+ .a(a+olo'i+ lin'+*n'an "e+eaan in.e+!i  e/**n'an #en'an ola/a'a #an e(o!ional% Ale'en "a#a a!(a ale'i+ e'an-*n'  "a#a e!"on I'E ,an' #i+on-ol ole/ li(.o!i- T #an B #an #ia+-iva!i ole/ in-ea+!i an-i'en #en'an i+a-an !el (a!-  I'E% Sea'ian e!a ale'en a!(a -e!ea ole/ *#aa #an *n-*+ (en'/a!il+an !-a-*! !en!i-ivi-a! (e(*-*/+an a+-* ,an' )*+*" la(a% Se-ela/ -ea#i !en!i-i!a!i "a!ien #a"a- (ena("a++an e!"on ,an' /ea-  a/+an +on-a+ #ala( /i-*n'an (eni- #a"a- (en'/a!il+an e+!a!ea!i !i'ni.i+an "a#a  "en,a+i- ini% A!(a ale'i+ ia!an,a (*!i(an "alin' an,a+ #i-e(*+an "a#a ana+7 ana+ #an #ea!a (*#a% Se#an'+an ,an' *+an (*!i(an #a"a- #i-i(*l+an #ai ale'i -e/a#a" *l* !e"i/an +*li- ina-an' +*-* #e* a(* #an an-i'en lin'+*n'an lain ,an' a#a !e)aa +on-in,*% Ran'!an'an .a(a+olo'i! *'a #a"a- (en,ea+an a!(a% Oa- ,an' "alin' !ein' e/**n'an #en'an .a!e a+*- a!(a a#ala/ a!"iin =NSAID>
8

 "o"*la!i !e)aa *(*( #a"a- (en'ala(i 'an''*an "ena"a!an "a!ien #en'an a!(a #an "en,a+i- "ena"a!an ,an' lain #a"a- -e"en'a*/ lei/ **+% 6e+eaan !e!eoan' i!a #i/**n'+an "*la #en'an -ea#in,a a!(a !ea #ai /a!il la"oan #i+e-a/*i a/a !-*+!i !al*an "ana"a!an a+*- #an +oni!  e+ai-an #en'an "a"aan !e*(la/ e!a !en,aa ,an' #i'*na+an #ala( ea'ai (a)a( in#*!-i =*(*(n,a !en,aa #en'an ea- (ole+*l -in''i>% Sen,aa #en'an  ea- (ole+*l -in''i (eni(*l+an a!(a #en'an (en'/a!il+an ea+!i i(*nolo'i! !e#an'+an !en,aa #en'an ea- (ole+*l en#a/ (e*"a+an !en,aa ,an' (e(ili+i e.e+ +on!-i+-o on+*!% In.e+!i !al*an na"a! (e*"a+an an'!an'an ,an' "alin' !ein' (eni(*l+an e+!a!ea!i a+*- "a#a a!(a% Vi*! !al*an na"a! #an *+an a+-ei a-a* ale'i -e/a#a" (i+oo'ani!(e a#ala/ .a+-o e-iolo'i ,an' "alin' *-a(a% 6a#a ana+ ,an' (a!i/ +e)il "en,ea in.e+!i ,an' "alin' "en-in' a#ala/ vi*! "ena"a!an !in!i!ial #an vi*! "aain.l*en
4. Pat#$isi#l#gi Asma5@

Se"e-i -ela/ #i+e(*+a+an a/a an,a+ .a+-o ,an' (e("en'a*/i -ea#in,a a!(a !e/in''a el*( a#a "a-o'ene!i! ,an' #a"a- (enean'+an !e(*a  "ene(*an "a#a "en,a+i- a!(a% Ta("ilan .i!iolo'i! #an +lini! a!(a ea!al #ai in-ea+!i an-aa ain'an #en'an !el a#an' ,an' ein.il-a!i "a#a e"i-el "e(*+aan !al*an na"a! (e#ia-o a#an' #an !i-o+in% Sel ,an' (e(ili+i "eanan ,an' "en-in' #ala( e!"on a#an' a#ala/ !el (a!- eo!ino.il li(.o!i- #an !el e"i-el !al*an na"a!% Sel (a!- #a"a- -ean'!an' ole/ ea'ai "en)e-*!an (i!aln,a ale'en in.e+!i exercise& #an lain7lain%

9

Se-ia" eni! !el -e!e*- #a"a- (en'el*a+an (e#ia-o #an !i-o+in *n-*+  (en'ini!ia!i #an (en'a("li.i+a!i in.la(a!i a+*- #an *'a "e*a/an "a-olo'i! #ala(  an'+a "anan'% e#ia-o ,an' #ile"a!+an (en'/a!il+an ea+!i a#an' ,an' )e"a#an /ea- #an (eni(*l+an +on!-i+!i on+*! +on'e!-i va!+*la "e(en-*+an e#e(a (enin'+a-+an "o#*+!i (*+*! #an (en'/a(a- -an!"o- (*+o!iliai!% Rea+!i )e"a- -e!e*- #a"a- #ii+*-i #en'an ea+!i ,an' +oni!% Eo!ino.il (e(ili+i "ean ,an' "en-in' #ala( +o("onen in.il-a-i.% In-ele*+in =IL> 5 (en!-i(*la!i "ele"a!an !el7!el ini +e #ala( !i+*la!i #an e-a/an% ?i+a -ela/ -ea+-iva!i !el7!el ini (ena#i !*(e +a,a le*+o-ien #an (ele"a!+an "o-ein 'an*le #an a#i+al ea! #eiva- o+!i'en (a("* (e*!a+ e"i-el !al*an na"a! +e(*#ian (a!*+ +e l*(en on+ial #ala( en-*+ a#an Ceola% Di!a("in' (en'/ilan'+an .*n'!i !aa #an !e+e-oi +e*!a+an -e!e*- (ean'!an'  "en'el*aanan !i-o+in +e(o-a+-i+ ,an' (eni(*l+an "ea#an'an lei/ lan*-%

Gambar &. Pat#$isi#l#gi Asma

5. ani$estasi (linis5@

4eala #an -an#a +lini! !an'a- #i"en'a*/i ole/ ea- in'ann,a a!(a ,an' #i#ei-a% Bi!a !aa !eoan' "en#ei-a a!(a /a("i7/a("i -i#a+ (en*n*++an 'eala ,an' !"e!i.i+ !a(a !e+ali #i lain "i/a+ a#a *'a ,an' !an'a- ela! 'ealan,a% 4eala #an -an#a -e!e*- an-aa lain$ Ba-*+ na.a! !e!a+ =#i!"nea> -elei/ "a#a !aa(en'el*a+an na.a! =e+!"ia!i> wheezing   =(en'i> na.a! #an'+al #an )e"a- on+/i e-a+!i #in#in' #a#a "ena.a!an )*"in' /i#*n' =(en*n*++an -ela/ #i'*na+ann,a !e(*a o-o-7o-o- an-* "ena.a!an #ala( *!a/a (en'a-a!i !e!a+ ,an' -ea#i> a-*+ #an "a#a !ea'ian "en#ei-a a#a ,an' (ea!a n,ei #i #a#a% 4eala7'eala -e!e*-i#a+ !elal* #i*("ai e!a(aan%

10

Ana+ #en'an a!(a in'an (en'ala(i ea'ai .e+*en!i e+!a!ea!i =+e+a(*/an> !a("ai #*a +ali !e(in''* #en'an "en**nan an'+a alian e+!"ia!i  "*n)a+ -i#a+ lei/ #ai 20 #an ee!"on -e/a#a" "en'oa-an on+o#ila-o #ala( 272 a(% Ana+ #en'an a!(a in'an (e("*n,ai -in'+a- +e/a#ian #i !e+ola/ ,an'  ai+ -oean!i -e/a#a" ola/a'a ,an' ai+ #an -i#*n,a -i#a+ a-a* !e#i+i- -e'an''* ole/ a!(a% 6en#ei-a ini -i#a+ (en#ei-a /i"ein.la!i #a#aH "a#a #a!an,a o-'en #a#an,a no(al% Ui .*n'!i "a* #a"a- (en*n*++an "en,*(a-an alan na"a! in'an ,an' eve!iel #en'an !e#i+i- a-a* -an"a "ena(a/ vol*(e "a*% Ana+ #en'an a!(a !e#an' (e("*n,ai 'eala ,an' lei/ !ein' #ai"a#a (ee+a ,an' (en#ei-a a!(a in'an #an lei/ !ein' (en#ei-a a-*+ #an (en'i in'an #ian-aa !ean'an ,an' lei/ ea-% A!en!i !e+ola/ (*n'+in -e'an''* -olean!i -e/a#a" ola/a'a a+an e+*an'an +aena a-*+ #an (en'i #an +e(*n'+inan -i#* ana+ "a#a (ala( /ai +*an' -e*-a(a !ela(a e+!a!ea!i% Tan#a7-an#a "en,*(a-an alan na.a! "a#a *i .i!iolo'i! lei/ (en)olo+ #ai"a#a +elo("o+ in'anHvol*(e "a* !e(a+in e-a(a/% 6a#a a!(a ea- 'eala7'eala ,an' -i(*l (a+in an,a+ an-aa lain !il ent  chest  !iano!i! 'an''*an +e!a#aan /,"ein.la!i #a#a -a+i+a#i ei)aa +a-a "e  +a-a #a"a- #i!e-ai a-*+ #en'an !"*-*( +en-al #an "ena.a!an )e"a- #an'+al% 6en#ei-a a+an -a("a+ 'eli!a/ ena.a! #en'an (en''*na+an o-o-7o-o- -a(a/an #en'an -an#a7-an#a !iano!i! !en-al #an "*l!*! "aa#o+!*!% Ana+ #en'an a!(a ea(en#ei-a (en'i /aian ,an' ela! #an +*(a-n,a lei/ !ein' #an lei/ ea-% ee+a (e(el*+an aa- ina" e*lan' #an #a"a- +e/ilan'an *(la/ /ai !e+ola/ ,an' )*+*" -i#*n,a !ein' -e'an''* ole/ a!(a #an (e("*n,ai -olean!i -e/a#a" ola/a'a ,an' ele+% ee+a (en#ei-a #e.o(i-a! #a#a !ea'ai a+ia- /i"e.en-ila!i +oni!%

6. Penatalaksanaan 6.1

Penatalaksanaan 0erangan 'ingan dan 0edang 

6enan'anan aal -e/a#a" "a!ien a#ala/ "e(eian 7a'oni! !e)aa ne*li!a!i% 4aa( .i!iolo'i! #a"a- #i-a(a/+an #ala( )aian ne*li!a!i% Ne*li!a!i !e*"a #a"a- #i*lan' #*a +ali la'i #ala( !elan' 20 (eni-% 6a#a "e(eian +e-i'a #a"a- #i-a(a/+an oa- an-i+oline'i+% Beea"a "eneli-i (en'an*+an "e(eian oa- an-i+oline'i+ e!a(a7!a(a #en'an 7a'oni! "a#a !aa- !ean'an !e#an' #an  ea-%

11

6a#a !ean'an in'an i+a #en'an !e+ali ne*li!a!i "a!ien (en*n*++an e!"on! ,an' ai+ =)o("le-e e!"on!e> ea-i #eaa- !ean'ann,a in'an% 6a!ien #io!eva!i !ela(a 172 a( i+a e!"on! -e!e*- e-a/an =+lini! -e-a" ai+> "a!ien #a"a- #i"*lan'+an% an' /a*! #iin'a- a#ala/ "a!ien /a*! #ie+ali oa on+o#ila-o =/i*"an a-a* oal> ,an' #iei+an -ia" 7@ a(% 6a#a +ea#aan -e-en-* !e"e-i i+a "en)e-*! !ean'ann,a a#ala/ vi*! #an a#a ia,a- !ean'an a!(a !e#an':ea- (a+a #a"a- #i-a(a/+an !-eoi# oal an'+a "en#e+:!/o-)o*!e =375 /ai>% 6a#a ana+ a!(a e"i!o#i) !ein' #an a!(a "e!i!-en oa- )on-olle ="en'en#ali> /a*! -e-a" #iei+an "a#a !aa- "a!ien "*lan'% 6a#a !ean'an !e#an' i+a #en'an "e(eian ne*li!a!i #*a a-a* -i'a +ali  "a!ien /an,a (en*n*++an e!"on! "a!ial =in)o("le-e e!"on!> +e(*n'+inan #eaa- !ean'ann,a !e#an'% Un-*+ i-* "el* #inilai *lan' #eaa-n,a !e!*ai "e#o(an #i a-a!% ?i+a !ean'ann,a (e(an' -e(a!*+ !ean'an !e#an' ei+an o+!i'en 2 l:(eni- +e(*#ian "a!ien #o!eva!i #an #i-an'ani #i *an' aa- !e/ai% 6a#a +ea#aan !ean'an !e#an' !eai+n,a #i"a!an' al* "aen-eal *n-*+ "e!ia"an #a*a-% 6a#a +ea#aan ala- ne*li ,an' #i/**n'+an #en'an !"a)e%

6.!

Penatalaksanaan 0erangan Berat 

6a#a !ean'an ea- o+!i'en !elal* #iei+an ai+ #en'an +an*la /i#*n' a-a* !*n'+*" *n-*+ (en'a-a!i #an (en)e'a/ /i"o+!e(ia% O+!i'en #a"a- #iei+an #ala( #o!i! -in''i 7@L:(eni- "a#a "en#ei-a ea-% In/ala!i a'oni! β2 !aa- ini (e*"a+an  "ili/an "e-a(a% Diei+an !al*-a(ol 2%575(' a-a* -e*-alin 2%575(' !e)aa ne*li!a!i #a"a- #i*lan' !e-ia" 20 (eni- #ala( 1 a(% Bila ne*li 7 !e("o- "e+ali #*lan' !a("ai 20 (eni#ala( 1 a(% Ine+!i a'oni! β2 a-a* !i("a-o(i(e-i+ lainn,a !al*-a(ol -e*-alin a-a* o!i"enalin #a"a- #iei+an 0%571(l !*+*-an #i*lan' !e-ela/ 30 (eni-% A#enalin 1:1000 (e*"a+an oa- (*a/ #an !elal* -e!e#ia #a"a- #iei+an !e)aa !*+*-an 0%270%5)) ia!an,a 0%3)) #a"a- #i*lan' !a("ai 273 +ali #en'an in-eal 307@0 (eni-% Ine+!i a'oni! β2 #an *'a a#enalin #iei+an /a*! #en'an !an'a- /a-i7/a-i% Seali+n,a -i#a+ #iei+an "a#a "en#ei-a #en'an /i"e-en!i /i"e-ioi# +elainan an-*n' #an *!ia lan*- a-a* *(* lei/ #ai 0 -a/*n% A(ino.ilin ine+!i #iei+an #en'an #o!i! 57@ (':+' ea- a#an #ien)e+an #ala(

12

la*-an #e+!-o!e 5 !a(a an,a+ #iei+an !e)aa in-avena !ea'ai ol*! "ela/an7 la/an #ala( a+-* 10715 (eni- a-a* #ala( in.*! 100)) #e+!-o!e 5 NaCl 09 #ala( a+-* 20 (eni-% Do!i! #iei+an !e"a*/n,a a"aila #ala( 12 a( !eel*(n,a -ela/ (en#a"a- a(ino.ilin% I"a-o"i*( o(i# #a"a- #i'*na+an !en#ii (a*"*n #ala( +o(ina!i #en'an a'oni! β2 (elal*i in/ala!i #en'an ne*la!i "ena(a/an ini -i#a+ #i"el*+an ila e!"on! #en'an a'oni! β2 !*#a/ )*+*" ai+% Ko-i+o!-eoi# !i!-e(i+ #o!i! -in''i /a*! !e'ea #iei+an "a#a "en#ei-a a!(a a+*- ea-% S-eoi# "ili/an a#ala/ ,an'  e+ea )e"a- /i#o+o-i!on 200(' in-avena a-a* (e-il"e#ni!on ine+!i a-a* -ale307@0(' a-a* +e#*an,a% Se-ela/ #ila+*+an "en'oa-an aal #en'an on+o#ila-o #an !-eoi# -e/a#a"  "en#ei-a #ila+*+an "e(an-a*an (en'enai +lini! !e-ia" 15 (eni- !e-ela/ 30 (eni#ila+*+an eval*a!i% A"aila -i#a+ -ea#i "eai+an !a(a !e+ali -e/a#a" -ea"i aal a-a* (ala/ (e(**+ (a+a "en#ei-a lan'!*n' #iaa- ina" !ea'ai !-a-*! a!(a-i+*!% 6en#ei-a ,an' (en*n*+an "eai+an na(*n -i#a+ a#e+*a- #i*lan'  "e(eian on+o#ila-o #an o!eva!i #ilan*-+an !ela(a @0 (eni-% Bila !e-ela/ @0 (eni- +on#i!in,a (ene-a" a-a* (ala/ (e(**+ lan'!*n' #iaa- ina"% 6eai+an a#e+*a- ila +ea#aan +linni! no(al% 6en#ei-a #en'an "eai+an a#e+*a- #io!eva!i la'i !ela(a @0 (eni- #an +e(*#ian "en#ei-a #a"a- #i"*lan'+an% 6.&

Penatalaksanaan 0tatus Asmatikus  6en#ei-a !-a-*! a!(a-i+*! ,an' #iaa- ina" #i *an'an !e-ela/ #i+ii( #ai

U4D #iei+an o+!i'en +e(ali% A'oni! 2 #ilan*-+an #en'an "e(eian in/ala!i ne*la!i 1 #o!i! !e-ia" a( +e(*#ian #a"a- #i"eaan' "e(eiann,a !e-ia"  a(  ila !*#a/ a#a "eai+an ,an' ela!% Sea'ai al-ena-i. lain #a"a- #iei+an #ala(  en-*+ in/ala!i #en'an ne*/ale:vol*(a-i) a-a* !e)aa ine+!i% Bila -ea#i  "e**+an #iei+an #i" !al*-a(ol a-a* -e*-alin% A(io.ilin #iei+an (elal*i in.*!:#i" #en'an #o!i! 0%570%9 (':+'BB:a(% 6e(eian "e #i" #i#a/*l*i #en'an  "e(eian !e)aa ol*! a"aila el*( #iei+an% Ko-i+o!-eoi# #o!i! -in''i in-avena #iei+an !e-ia" 27 a( -e'an-*n'  ea-n,a +ea#aan !e-a +e)e"a-an e!"on!% 6e"aa- "ili/an a#ala/ /i#o+o-i!on 2007 00(' #en'an #o!i! +e!el**/an 17':2 a(% Se#iaan lain ,an' *'a #a"a#iei+an !ea'ai al-ena-i. a#ala/ -ia(inolon 070(' #e+!a(e-a!on:e-a(e-a!on 5710('% Dala( /al ini -i#a+ -e!e#ian,a +o-i+o!-eoi# in-avena #a"a- #iei+an +o-i+o!-eoi# "eoal ,ai-* "e#ni!on a-a* "e#ni!olon 307@0(':/ai% I"-o"i*(  o(i# #a"a- #iei+an ai+ !en#ii (a*"*n #ala( +o(ina!i #en'an a'oni! 2

13

!e)aa in/ala!i ne*li!a!i "ena(a/an ini -i#a+ #i"el*+an ila "e(eian a'oni! 2 !*#a/ (e(ei+an /a!il ,an' ai+% 6.4

Penatalaksanaan ain De/i#a!i /en#a+n,a #inilai !e)aa +lini! "el* *'a "e(ei+!aan ele+-oli-

!e*( #an "enilaian a#an,a a!i#o!i! (e-aoli+% Rin'e la+-a- #a"a- #iei+an !ea'ai -ea"i aal *n-*+ e/i#a!i #an "a#a +ea#aan a!i#o!i! (e-aoli+ #iei+an na-i*(  i+aona-% *+oli-i+ #an e+!"e-oan! #a"a- #iei+an ala*"*n (an.aa-n,a #ia'*+an "a#a "en#ei-a #en'an o!-*+!i alan na"a! ea- e+!"e+-oan !e"e-i oa a-*+ /i-an #an 'li!eil '*ai+ola- #a"a- #iei+an% De(i+ian *'a (*+oli-i+   o(e+!in (a*"*n N7a!e-il!i!-ein% An-iio-i+ #iei+an +ala* ela! a#a -an#a7-an#a in.e+!i !e"e-i #e(a( !"*-*( "**len #en'an ne*-o.il le*+o!i-o!i!% Oa-7oaa-an !e#a-i. (e*"a+an in#i+a!i +on-a +e)*ali #i *an' "eaa-an in-en!i.% Se#an'+an an-i/i!-a(in -i#a+  -e*+-i e(an.aa- #ala( "en'oa-an a!(a a+*- ea- (ala/an #a"a- (en,ea+an  "en'ei+an #a/a+ ,an' (en'a+ia-+an !*(a-an on+*!% 6.5

Penatalaksanaan 2angka Panjang  6a#a "ena-ala+!anaan a!(a "e!i!-en -e#a"a- #*a al-ena-ive ,ai-* #en'an

(en''*na+an !-eoi# /i*"an #o!i! (e#i*( #en'an (e(ei+an *#eno!i#e 2007 00*':/ai *#e!oni#e =1007200*':/ai .l*-i+a!on> *n-*+ ana+ e*!ia +*an' #ai 12 -a/*n 007@00*':/ai *#e!oni# =2007300*':/ai .l*-i+a!on> *n-*+ ana+ e*!ia #i a-a! 12 -a/*n% Selain i-* #a"a- #i'*na+an al-ena-i. "en''an-i #en'an (en''*na+an !-eoi# /i*"an #o!i! en#a/ #i-a(a/ #en'an LABA =Lon' A)-in' 72 A'oni!-> a-a* #i-a(a/+an T/eo"/,lline Slo Relea!e =TSR> a-a* #i-a(a/+an An-i7Le*+o-iane Re)e"-o =ALTR>% A"aila #en'an "en'oa-an -e!e*- !ela(a @7 (in''* -e-a" -e#a"a- 'eala a!(a (a+a #a"a- #iei+an al-ena-i. la"i! +e-i'a ,ai-* #a"a- (enin'+a-+an #o!i! +o-i+o!-eoi# !a("ai #en'an #o!i! -in''i "a#a "e(eian 00*':/ai*#e!oni# =200*':/ai .l*-i+a!on> *n-*+ ana+ e*!ia +*an' #ai 12 -a/*n #an@00*':/ai  *#e!oni# =300*':/ai .l*-i+a!on> *n-*+ ana+ e*!ia #i a-a! 12-a/*n a-a* -e-a" #o!i! (e#i*( #i-a(a/+an #en'an LABA a-a* TSR a-a* ALTR% 6ena(a/an LABA "a#a !-eoi# /i*"an -ela/ an,a+ #i*+-i+an +ee/a!ilann,a ,ai-* #a"a- (e("eai+i FEVI (en**n+an 'eala a!(an,a #an (e("eai+i +*ali-a! /i#*"n,a% A"aila #o!i! !-eoi# /i*"an !*#a/ (en)a"ai 00*':/ai na(*n -e-a" -i#a+  (e("*n,ai e!"on! (a+a a* #i'*na+an !-eoi# oal =!i!-e(i+>% ?a#i "en''*naan

14

+o-i+o!-eoi# oal !ea'ai )on-olle ="en'en#ali> a#ala/ alan -ea+/i !e-ela/  "en''*naan !-eoi# /i*"an a-a* al-ena-i. #i a-a! -ela/ #ialan+an% Lan'+a/ ini #ia(il /an,a ila a/a,a #ai a!(an,a lei/ e!a #ai"a#a a/a,a e.e+ !a("in' oa-% Un-*+ !-eoi# oal !ea'ai #o!i! aal #a"a- #iei+an 172(':+'BB:/ai% Do!i! +e(*#ian #i-**n+an !a("ai #o!i! -e+e)il ,an' #iei+an !elan' /ai "a#a "a'i /ai% 6en''*naan !-eoi# !e)aa !i!-e(i+ /a*! e/a-i7/a-i +aena (e("*n,ai e.e+  !a("in' ,an' )*+*" ea-% 6a#a "e(eian an-ile*+o-ien

=

"ena/ #ila"o+an

a#an,a

 "enin'+a-an en "en''*naann,a #a"a- #i"e-i(an'+an "a#a ana+ #en'an a!(a -i"eini-i! /an,a *n-*+ (enan''*lan'i ini-i!n,a% 6a#a !aa- ini "en''*naan +o-o-i.en !ea'ai oa- "en'en#ali =)on-olle> "a#a a!(a ana+ -i#a+ la'i #i'*na+an +aena -i#a+ (e("*n,ai (an.aa- ,an' ea-i% A"aila #en'an "e(eian !-eoi# /i*"an #i)a"ai .*n'!i "a* ,an' o"-i(al a-a* "eai+an +lini! ,an' (an-a" !ela(a @7 (in''* (a+a #o!i! !-eoi# #a"a#i+*an'i e-a/a" /in''a #i)a"ai #o!i! -e+e)il ,an' (a!i/ i!a (en'en#ali+an a!(an,a% Se(en-aa i-* "en''*naan 7a'oni! !ea'ai oa- "ee#a -e-a" #i-e*!+an%

15

Gambar 4. Alur Penatalaksanaan 2angka Panjang Asma 3. Pen%egahan

Sean'an e+!a!ea!i a+*- a!(a #a"a- #i)e'a/ #en'an (en'/in#ai .a+-o   "en)e-*! a!(a ,an' -e'an-*n' "a#a "en,ea a!(a (a!in'7(a!in' "a!ien% I#en-i.i+a!i #an "en'/in#aan ale'en #i *(a/ #an -e("a- +ea /a*! !ei!a (*n'+in #ila+*+an% 6en'/in#aan ,an' ena7ena -e/a#a" "a"aan -*n'a* #e* *(a/ /ean7/ean "eli/aaan #an .a+-o "e+eaan e/**n'an #en'an "eai+an n,a-a "a#a 'eala7'eala "ena"a!an .*n'!i "a*7"a* #an /i"ee!"on!ivi-a! !al*an na"a!% e(*an' /ean "eli/aaan -e*-a(a +*)in' #ai #ala( *(a/ a+an !an'ae.e+-i. ila #i!e-ai "e(e!i/an #an "en)*)ian *(a/ *n-*+ (en'/ilan'+an ale'en

16

,an' (*n'+in -e-in''al ,an' i!a -e-a" ea#a "a#a +on!en-a!i ,an' )*+*" *n-*+  (ean'!an' a!(a #ala( a+-* ,an' la(a% . (#mlikasi

Bila !ean'an a!(a !ein' -ea#i #an -ela/ elan'!*n' la(a (a+a a+an -ea#i e(.i!e(a #an (en'a+ia-+an "e*a/an en-*+ -oa+! ,ai-* -oa+! (e(*n'+*+ +e #e"an #an (e(anan'% 6a#a .o-o on-'en -oa+! -eli/a- #ia.a'(a le-a+ en#a/ 'a(aan an-*n' (en,e("i- )oa+an /il*! +ii #an +anan e-a(a/% en-*+ #a#a *n' #a"a- #inilai #ai "eai+an "e-*(*/ann,a%an' -*a% 6a#a a!(a +oni+ #an ea- #a"a- -ea#i en-*+ #a#a **n' #aa #an -a("a+ !*l+*! ;ai!on% 9 Bila !e+e- an,a+ #an +en-al !ala/ !a-* on+*! #a"a- -e!*(a- !e/in''a #a"a- -ea#i a-ele+-a!i! "a#a lo*! !e'(en ,an' !e!*ai% Bila a-ele+-a!i! elan'!*n' la(a

#a"a-

e*a/

(ena#i

on+ie+-a!i!

#an

ila

a#a

in.e+!i

-ea#i

 on+o"ne*(onia% Sean'an a!(a ,an' -e*! (ene*! #an eea"a /ai !e-a ea#an -i#a+ #a"a- #ia-a!i #en'an oa-7oa-an #i!e*- !-a-*! a!(a-i+*!% Bila -i#a+  #-olon' #en'an !e(e!-in,a #a"a- (en,ea+an 'a'al "ena"a!an 'a'a+ an-*n'  a/+an +e(a-ian%1 . Pr#gn#sis5

6o'no!i! an'+a "anan' a!(a ana+ "a#a *(*(n,a ai+% !ea'ian e!a  a!(a ana+ /ilan' a-a* e+*an' #en'an e-a(a/n,a *(*% Se+i-a 50 a!(a e"i!o#i) aan' !*#a/ (en'/ilan' "a#a *(* 1071 -a/*n #an /an,a 15 ,an' (ena#i a!(a +oni+ "a#a *(* 21 -a/*n% D*a "*l*/ "e!en a!(a e"i!o#i) !ein' !*#a/ -i#a+ -i(*l "a#a (a!a a+il ali @0 -e-a" !ea'ai a!(a e"i!o#i) !ein' #an !i!an,a !ea'ai a!(a e"i!o#i) aan'% ;an,a 5 #ai a!(a +oni+:"e!i!-en ,an' #a"a- (en'/ilan' "a#a *(* 21 -a/*n 20 (ena#i a!(a e"i!o#i) aan'% Se)aa +e!el**/an #a"a- #i+a-a+an 070 a!(a ana+ ila #ii+*-i !a("ai #en'an *(* 21 -a/*n a!(an,a !*#a/ (en'/ilan'% 6o'no!i! **+ i+a ana+ #iaa -ela(a- !aa-ea#i !ean'an a!(a ea-%

17

(esimulan

A!(a (e*"a+an "en,a+i- #en'an +aa+-ei!-i+ (enin'+a-n,a ea+!i -a+ea #an  on+*! ole/ ea'ai (a)a( "en)e-*! #i!e-ai #en'an -i(*ln,a "en,e("i-an l*a! !al*an na"a! a'ian aa/% Ran'!an'an ,an' #a"a- (en)e-*! !ean'an a!(a an-aa lain$ ale'eni+ .a(a+olo'i+ lin'+*n'an "e+eaan in.e+!i e/**n'an #en'an ola/a'a #an e(o!ional% 6a-o.i!iolo'i a!(a -e+ai- #en'an -ea#in,a "o!e! a#an' ,an' +e(*#ian #en'an )e"a- (eni(*l+an +on!-i+!i on+*! +on'e!-i va!+*la  "e(en-*+an e#e(a (enin'+a-+an "o#*+!i (*+*! #an (en'/a(a- -an!"o(*+o!iliai!%% 6ena-ala+!anaan a!(a #i-**+an *n-*+ (ee#a+an "en,e("i-an alan na"a! !e)e"a- (*n'+in (en'*an'i /i"o+!e(ia (en'e(ali+an .*n'!i "a* +e +ea#aan no(al !e)e"a-n,a #an *n-*+ (en)e'a/ +e+a(*/an% "a$tar Pustaka

1% Lon'o DL Ka!"e DL ?a(e!on ?L e- al%  'arrisons principle of internal  medicine% 2n# E#% USA$ )4a7;illH 2012% 2% Ba+-a I S*a!-i+a IK% 4aa- #a*a- #i i#an' "en,a+i- #ala(% ?a+a-a$ E4CH 2000% 3% Ren''ani! I% Dia'no!i! #an -a-ala+!ana a!(a on+ial Nove(e 200% aala/ +e#o+-ean in#one!ia% olume 5% No% 11% % Se-ia-i S 6*na(a!ai D Rinal#i I Rani-,a R 6i-o,o CW% Li(a "*l*/ (a!ala/ +e!e/a-an #i i#an' il(* "en,a+i- #ala(% E#i!i 1% ?a+a-aH FKUIH 200%/%20275% 5% S-a. "en'aa il(* +e!e/a-an ana+ FKUI% Il(* +e!e/a-an ana+% E#i!i 11% ?a+a-aH In.o(e#i+aH 200%/%119722% @% S*n#a* ; S*+a(-o% B*+* aa il(* "en,a+i- #ala($ a!(a on+ial% ?ili# I% E# 5% ?a+a-a$ In-ena 6*li!/in'H 2009%/071% % S*"i,an-o B% Ta-ala+!ana !ean'an a!(a "a#a ana+% Dala($ De"a-e(en il(* +e!e/a-an ana+ FKUI% E#i!i 1% ?a+a-aH Balai "enei- FKUIH 200%/%@079% % 6*a#ian-o A Sa("*na B% Ke#a*a-an (e#i+$ "e#o(an "ena-al+!anaan  "a+-i!% ?a+a-a$ Bina*"a A+!aaH2000% 9% 6e/i("*nan Do+-e 6a* In#one!ia% A!(a $ 6e#o(an Dia'no!i! #an 6ena-ala+!aan #i In#one!ia% Balai 6enei- FKUI $ ?a+a-a 200%

18