PEMBAHASAN EPIDEMIOLOGI PENYAKIT TIDAK MENULAR “PENYAKIT PARU OBSTRUKSI KRONIS (PPOK)” A. Defini Definisi si Peny Peny!i !i"" O#s"$ O#s"$%!s %!sii K$&ni K$&niss PPOK ' *eny!i" !$&nis s%$n n*s yn+ 'i"n'i 'en+n ,#"n i$n %'$ !%s%sny %'$ e!s*i$si 'n #e$sif" *$&+$esif ,#" (se,!in , se,!in se,!in ,e,#%$%!) (Ris!es's (Ris!es's-/10). -/10). Peny!i" Peny!i" P$% O#s"$%!"if O#s"$%!"if K$&ni! (PPOK) yn+ yn+ 'i!en 'i!en 'en+ 'en+n n OPD OPD (Chronic ' Chronic Obstructive Obstructive Pulmonary Pulmonary Disease Disease) ' *eny!i" yn+ 'i"n'i 'en+n ,#"n i$n %'$ %' $ n*s yn+ #isny *$&+$esif 'n #e$%#%n+n 'en+n $es*&n inf,si !$&ni! 'i s%$n n*s 'n *$% "e$'* *$"i!e "% +s yn+ #e$2%n3 #e$#y. P$&+$esif $"iny *eny!i" ini #e$n+s%n+ se%,%$ i'%* 'n se,!in ,e,#%$%! se2$ ,#" '$i "%n !e "%n. Ge4 %", PPOK ' ses! n*s- #"%! !$&nis "% *$&'%!si '! 'n $i5y" "e$**$ 'en+n f!"&$ $esi!& (PDPI- /11 'n GOLD- /11). Peny!i" Peny!i" P$% P$% O#s"$% O#s"$%!si !si K$&nis K$&nis ,e$%* ,e$%*!n !n *eny!i" *eny!i" !$&nis !$&nis yn+ yn+ 'i"n' 'i"n'ii 'en+n #"%! *$&'%!"if 'n "e$4'iny s"$%!si s%$n nfs se!i*%n *eny!i" ini #e$sif" !$&nis 'n ,e$%*!n +#%n+n '$i e,fise,- #$&n!i&i"is !$&ni!- "e"*i ', !e'n "e$"en"% "e$4'i *e$#%$%!n '$i f%n+si *e$nfsn (T#$ni R#/1/). PPOK ' s%"% *eny%,#"n ,ene"* *' s%$n *e$nfsn yn+ 'ise##!n &e e,fise, 'n #$&n!i"is !$&ni (K&es I$in"&- /16). B. D" D" s%$7ei s%$7ei "en"n "en"n+ + Peny!i" Peny!i" O#s" O#s"$%! $%!si si K$&ni K$&niss D" 8HO "%n //1 ,en%n4%!!n ,en%n4%!!n n+! ,&$"i"s ,&$"i"s PPOK ' 6-9: 'n ,en'%'%!i %$%"n !ee,*" *enye## !e,"in 'i '%ni- 'i In'&nesi- PPOK '
1
s s"% '$i 1/ *enye## !e,"in %",. D" B'n Kese"n D%ni (8HO),en%n4%!!n #5 *' "%n 1;;/ PPOK ,ene,*"i %$%"n !e<= se#+i *enye## %", !e,"in 'i '%ni- se'n+!n *' "%n // "e ,ene,*"i %$%"n !e<0 se"e *eny!i" !$'i&7s!%e$ 'n !n!e$ (8HO-//). Di A,e$i! Se$i!" 'i#%"%!n 'n se!i"$ 0 4%" US> ', se"%n %n"%! ,enn++%n+i *eny!i" ini- 'en+n 4%, *sien se#ny! 1= 4%" &$n+ 'n e#i '$i 1// $i#% &$n+ ,enin++. Hsi s%$7ei *eny!i" "i'! ,en%$ &e Di$e!"&$" ?en'e$ PPM @ PL 'i $%, s!i" *$&*insi 'i In'&nesi (?5 B$"- ?5 Ten+- ?5 Ti,%$- L,*%n+'n S%,"e$ Se"n) *' "%n //6- ,en%n4%!!n PPOK ,ene,*"i %$%"n *e$", *eny%,#n+ n+! !es!i"n (0:)- 'ii!%"i s, #$&n!i (00:)- !n!e$ *$% (0/:) 'n inny (:) (De*!es RI- //6). Men%$%" RISKESDAS "%n /10 P$e7ensi PPOK "e$"in++i "e$'*" 'i N%s Ten++$ Ti,%$ (1/-/:)- 'ii!%"i S%5esi Ten+ (9-/:)- S%5esi B$"- 'n S%5esi Se"n ,sin+<,sin+ =- *e$sen se'n+!n %n"%! 'i!i,n"n "i,%$ sen'i$i se#ny! -9 :. . C!"&$ *enye## Peny!i" O#s"$%!si K$&nis C!"&$ *enye## Peny!i" O#s"$%!si K$&nis ,ei*%"i . C!"&$ *e4,% (H&s") C!"&$ ,n%si '*" 'i*en+$%i &e *en+e"%n 'n *e$i!% ,n%sise*e$"i !e#isn ,e$&!&!. #. C!"&$ +en A+en ', Peny!i" P$% O#"$%s!si K$&nis ini ' "<" 'n *&%"n
yn+ "e$'*" ', s* $&!&! 'n *&%si %'$. 2. C!"&$ in+!%n+n P&%si %'$ "e$'i$i '$i *&%si 'i ', $%n+n (indoor ) se*e$"i s* $&!&!s* !&,*&$- #$i!e" #"% #$- s* !y% #!$- s* " ny,%! #!$- 'n in<in)- *&%si 'i %$ $%n+n ( outdoor )- se*e$"i +s #%n+ in'%s"$i- +s #%n+ !en'$n #e$,&"&$- 'e#% 4nn- !e#!$n %"n- +%n%n+ ,ee"%s'n in<in- 'n *&%si 'i "e,*" !e$4 (#n !i,i- 'e#%3" i$i"si- 'n +s #e$2%n). P4nn yn+ "e$%s ,ene$%s &e +s 'n #n !i,i si in'%s"$i ,e$%*! f!"&$ $isi!& in PPOK. Pe$n *&%si %$ $%n+n (outdoor polution) e#i !e2i 'i#n'in+!n s* $&!&!. Se'n+!n *&%si ',
$%n+n (indoor polution) yn+ 'ise##!n &e #n #!$ #i&,ss yn+ 'i+%n!n %n"%! !e*e$%n $%, "n++ ,e$%*!n f!"&$ $isi!& inny. Ri5y" infe!si #e$" se,s n!Fn! #e$%#%n+n 'en+n *en%$%nn f *$%. D. Ke&,*&! yn+ #e$isi!& "e$!en Peny!i" O#s"$%!si K$&nis . Pe$&!&! PPOK #e$!e,#n+ *' ,*i$ 1: *e$&!&!. U,%$ *e$", !i ,e$&!&! 4%, #"n+ $&!&! yn+ 'iis* ', se"%n- se$" s""%s "e$#$% *e$&!&! ,e,*$e'i!si!n ,&$"i"s !i#" PPOK. In'i7i'% yn+ ,e$&!&! ,en+,i *en%$%nn *' CE1 'i,n !i$
*e$nfsn- 'n +e4<+e4 s,. H ini ,en+!i#"!n *en%$%nn f%n+si *$% (K,n+$- /1/). Pe,*$n s* $&!&! *' n! 'en+n i#% yn+ ,e$&!&!
0
,enye##!n *en%$%nn *e$"%,#%n *$% n!. I#% ,i yn+ "e$**$ 'en+n s* $&!&! 4%+ '*" ,enye##!n *en%$%nn f%n+si 'n *e$!e,#n+n *$% 4nin se,s +es"si. #. Msy$!" 'e$ *e$!&"n O$n+ yn+ "in++ 'i !&" !e,%n+!inn %n"%! "e$!en PPOK e#i "in++i '$i*' &$n+ yn+ "in++ 'i 'es. H ini #e$!i"n 'en+n !&n'isi "e,*" yn+ #e$#e' n"$ !&" 'n 'es. Di !&" "in+!" *&%si %'$ e#i "in++i 'i#n'in+!n 'i 'es 2. Be$",#ny %si D, *e$4nn *eny!i" PPOK '*" ,en+%# !$!"e$ny- ,isny *' ,s #yi "i,#% s, #$&n!i- *' %si 0/<6/ "%n "i,#% #$&n!i"is !$&nis 'n *' %si n4%" "i,#% e,fise,. Se,!in #e$",# %si se,!in #es$ $isi!& ,en'e$i" PPOK '. Pe!e$4 ",#n+ C!"&$ *e!e$4n #e$%#%n+n e$" 'en+n %ns%$ e$+i 'n i*e$$e!"i7i"s #$&n!%s. Dn %,%,ny *e!e$4 ",#n+ e,s "% #"% #$- in'%s"$i +es 'n !e$,i! yn+ #e$'e#% !n e#i ,%' "e$!en PPOK e. S""%s e!&n&,i yn+ $en'
S""%s s&si&e!&n&,i ,e$%*!n f!"&$ $isi!& %n"%! "e$4'iny PPOK !e,%n+!inn #e$!i"n 'en+n *&%si- 7en"isi yn+ "i'! 'e!%" *' $%, "in++- +ii #%$%! "% f!"&$ in yn+ #e$!i"n 'en+n s&si&e!&n&,i. f. Gene"i!
Defisiensi 1<n"i"$i*sin ' s"%
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n"i"$i*sin 'i A,e$i! Se$i!" ' !%$n+ '$i*' s"% *e$"%s. 1<n"i"$i*sin ,e$%*!n ini#i"&$ *$&"ese yn+ 'i*$&'%!si 'i "i 'n #e!e$4 ,en+ini#isi neutrophil elastase 'i *$%. Defisiensi 1<n"i"$i*sin yn+ #e$" ,enye##!n
e,fise, *' %,%$ $"<$" 0 "%n #+i #%!n *e$&!&! 'n 6/ "%n #+i *e$&!&!. +. ?enis !e,in (!i !i)
L!i<!i
,e,ii!i $isi!& "e$!en PPOK 'ise##!n &e $&!&!
'n
*e!e$4nny. E. ?enis *eny!i" *$% O#s"$%!si K$&nis . E,fise, ( PPOK Ti*e A ) E,fise, ' s%"% *ee#$n !n"&n+ %'$ !e2i (7e&i) 'i*$%<*$%yn+ 'ise$"i 'en+n !e$%s!n *' 'in'in+ny. D, !e'n n&$,se!%,*%n 7e&i yn+ #e$%#%n+n !es%$n nfs !e2i (#$&n!i&i),e,#en"%! s"$%!"%$ yn+ !%" 'n ,en4+ s%$n *e$nfsn "e"* "e$#%!. P' e,fise,- 'in'in+ 7e&i ,en+,i !e$%s!n sein++ #$&n!i&i !ein+n s"$%!"%$ *enyn++ny. Den+n 'e,i!in- *' s" %'$ 'i!e%$!n- #$&n!i&i !n ,en+e$%". S"$%!"%$ s%$n %'$ ,enye,*i" 'n sif"ny ,ene"*. #. B$&n!i"is K$&nis (PPOK Ti*e B) A' #"%! ,en%n yn+ ,ene"*- yn+ 'ise$"i 'en+n *e,#en"%!n '! 'n #%!n ,e$%*!n !i#" '$i *enye## yn+ se2$ ,e'is 'i!e"%i (,isny !n!e$ *$%<*$%). P' s%$n %'$ !e2i "e$4'i *e,#en"%!n 4$in+n *$%"- *e,#en+!!n *isn- *eny%,#"n *$si &e en'i$ 'n
!e4n+ *' &"& *&&sny. Penye,*i"n ini #e$sif" se,en"$. A'ny #n< #n i$i"n ,enye##!n *e$'n+n *' 7e&i. ?i! s%"% *e$'n+n #e$n+s%n+ ,- #is "e$4'i !e$%s!n yn+ ,ene"*. P' 7e&i yn+ ,e$'n+ !n "e$!%,*% se
Ri5y" A,i Peny!i" O#s"$%!si K$&nis ) T* *$e *"&+enesis P' "* ini *en'e$i" "e "e$**$ s* $&!&! 'n *&%si %'$ yn+ in se, <1/ "%n- se"e i"% ,%n2% +e4 1)
B"%! $in+n 'ise$"i '!
)
Nye$i !e* 'n *ie!
0)
D! #e$5$n i4% 'i!$en!n nn
6)
Men+i3 #en+e!
)
Ses! n*s
#) T* P"&+enesis P' "* ini *en'e$i" "e ,en+,i PPOK 'i,n 'i"n'i 'en+n ses! n*s yn+ #e$" "i,#% *' s" is"i$" yn+ ,e$%*!n *e"%n4%! 'ny !e++n *e$n*sn !%" yn+ 'ise$"i 'en+n 'ny *eny!i" e,fise, 'n #$&n!i"is !$&nis. 2) T* Ps2 P"&+enesis Pen'e$i"
yn+
,en+,i
PPOK
,es!i*%n
"e
,e!%!n
*en+"n !n "e"*i *eny!i" ini #e$sif" *$&+$essif (se,!in ,
=
se,!in ,e,#%$%!). G. Pen2e+n Peny!i" O#s"$%!si K$&nis Pen2e+n *eny!i" P$% O#s"$%!si K$&nis ,en%$%" fi7e e7e *$e7en"i&n 1) Pen2e+n "* 5 (*$i,&$'i *$e7en"i&n) Pen2e+n *$i,&$'i yi"% %*y *en2e+n *' &$n+<&$n+ yn+ #e%, ' f!"&$ $esi!& PPOK- ,ei*%"i ,en2i*"!n in+!%n+n yn+ #e$si 'n #e$*e$i!% i'%* se" se*e$"i "i'! ,e$&!&!. ) Pen2e+n *$i,e$ ( *$i,$y *$e7en"i&n ) Pen2e+n *$i,e$ ,e$%*!n %*y %n"%! ,e,*e$"n!n &$n+ yn+ se" +$ "e"* se" "% ,en2e+ &$n+ yn+ se" ,en4'i s!i". T%4%n '$i *en2e+n *$i,e$ ' %n"%! ,en+%$n+i insi'ensi *eny!i" 'en+n 2$ ,en+en'i!n *enye##<*enye## *eny!i" 'n f!"&$
'i+n&sis 'ini 'n *e,#e$in *en+"n. Un"%! ,ene"*!n 'i+n&sis 'ini PPOK *' *sien ' 'en+n *e,e$i!sn f *$%- $'i&&+is- nisis +s '$- 'n 'efisiensi AAT. A'*%n *e,#e$in *en+"n "e$'* *en'e$i"
PPOK
,ei*%"i
#$&n!&'i"&$-
!&$"i!&s"$e$&i'-
n"i#i&"i!-
*e,#e$in &!si+en 'n *e,#e'n.
6) Pen2e+n Te$sie$ T%4%n *en2e+n "e$"ie$ ' %n"%! ,en+%$n+i !e"i'!,,*%n 'n ,en+'!n $e#ii"si. Pen2e+n "e$"ie$ ,ei*%"i ) Re#ii"si Psi!is Re#ii"si *si!is #e$"%4%n ,e,#e$i!n ,&"i7si *' *en'e$i" %n"%! '*" ,ene$i, !eny"n #5 *eny!i"ny "i'! '*" 'ise,#%!n #!n !n ,en+,i !e2e,sn- "!%" 'n 'e*$esi "e$%", s" e!sse$#si. Re#ii"si *si!is 4%+ #e$"%4%n ,en+%$n+i #!n ,en+in+!n *e$sn "e$se#%". #) Re#ii"si Pe!e$4n Re#ii"si *e!e$4n 'i!%!n %n"%! ,enye$s!n *e!e$4n yn+ '*" 'i!%!n *en'e$i" ses%i 'en+n +e4 'n f%n+si *$% *en'e$i". Di%s!n ,en+in'$i *e!e$4n yn+ ,e,ii!i $isi!& "e$4'i *e$#%$%!n *eny!i". 2) Re#ii"si Cisi! Pen'e$i" PPOK !n ,en+,i *en%$%nn !e,,*%n !"i7i"s fisi! se$" 'ii!%"i &e +n++%n *e$+e$!n yn+ ,en+!i#"!n !&n'isi in!"if 'n #e$!i$ 'en+n !e'n yn+ "i'! "e$!&n'isi. T%4%n $e#ii"si fisi! yn+ %", ' ,e,%"%s!n $n"i "e$se#%"
9
sein++ *en'e$i" "e"* !"if.
DACTAR PUSTAKA
R#- T#$ni. (/10). Ilmu Penyakit Paru. ?!$" . T$ns Inf& Me'i I$in"&- K&es. (/16). Epidemiologi Penyakit Menular dan Tidak Menular Bn'%n+ Af#e". KEPMENKES. (2008). PEDOM!" PE"#E"D!$I!" PE"%!&IT P!'( O)ST'(&TI* &'O"I& ME"TE'I &ESE+!T!" 'EP()$I& I"DO"ESI! ""*33555.#"!s#y.+&.i'35*<2&n"en"3%*&'s3/1/3/3KEPMENKES<1/
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