Kuliah bronkitis akut

Acute bronchitisProf.dr.Tamsil Syafiuddin, SpP(K)

Departemen Pulmonologi dan Ilmu Kedokteran RespirasiFakultas Kedokteran

Universitas Islam Sumatera Utara2012

CURRICULUM VITAE

N A M A : Prof.Dr.TAMSIL SYAFIUDDIN Sp.P (K)ALAMAT : Jln.KARSA No F 1 KOMPLEKS EKS KOWILHAN I

SEI.AGUL MEDAN 20117PEKERJAAN : Guru Besar FK- UISU / FK- USU Ketua Perhimpunan Dokter Paru Indonesia Sumut

Penasihat Perhimpunan Dokter Paru Indonesia Pusat Anggota Kolegium Pulmonologi Indonesia Anggota Pokja Asma dan PPOK PDPI pusat Assesor Program Pendidikan Dokter Spesialis Paru Indonesia

RIWAYAT PENDIDIKAN : -Dokter Umum FK-USU Medan,1979 -Dokter Spesialis I Paru FK-UI Jakarta, 1990 -Dokter Spesialis II Paru Konsultan Asma/PPOK, 1995

Pendidikan tambahan: - Pelatihan Kanker Paru, TSUKAGUCHI Hospital, Kobe- Japan 1989

- Pelatihan PPOK, AMAGASAKI Hospital, Kobe- Japan 1990 - Pelatihan Respiratory Physiologi, ”JAPAN RESPIRATORY PHYSIOLOGIST

CLUB”, Kyoto- Japan 1990 - Spirometry Training Course, Department of Respiratory Medicine, National University Hospital Singapore, Singapore 1997

-“Workshop of Bronchoscopy and Autofluorecent Bronchoscopy, RS Persahabatan Jakarta, Jakarta September 2005

-“Training of the new interventional technique of bronchosfiberscopy” (Optical Coherence Tommograhy) , Department of Thoracic Surgery, Tokyo Medical University Hospital,Tokyo - Japan 2007

- Workshop on Medical Thoracoscopy, The American College of Chest Physicians-The Indonesian Association of Pulmonologist, RS Persahabatan Jakarta, Jakarta November 1997

- Workshop on Reformation of Higer Education System,HEDS-JICA,Jakarta 1998

-Pulmonary Infections Course, Postgraduate Medical Institute, Singapore General Hospital, Singapore 2001

- Bronchoscopy &Thoracoscopy Workshop, Postgraduate Medical Institute, Singapore General Hospital, Singapore 2005

- Workshop on Transbronchial Lung Biopsy and Trasbronchial Needle Aspiration PDPI Cabang Jakarta, RS Persahabatan Jakarta ,Jakarta Maret 1997 - Workshop on Respiratory Physiology and Its Clinical Application, RS Pusat Angkatan Darat Gatot Subroto Jakarta, Jakarta Juni 1997

Levels of competence

Standar Kompetensi Dokter , Konsil Kedokteran Indonesia, 2012

Standar Kompetensi Dokter , Konsil Kedokteran Indonesia, 2012

Level of competence 4:

• Mampu membuat diagnosis klinik berdasarkan

‘pemeriksaan fisik’ dan ‘pemeriksaan tambahan’

yang diminta oleh dokter (misalnya: pemeriksaan

laboratorum sederhana atau X-ray). • Dokter dapat memutuskan dan mampu menangani

problem itu secara mandiri hingga tuntas.

IDENTIFIKASI MASALAH/ANALISIS:

MASALAH/DATA/KELUHAN:

PEMECAHAN MASALAH/RENCANA(Planning):

KURIKULUM BERBASIS KOMPETENSI (Problem Based Learning)

IDENTIFIKASI MASALAH/ANALISIS:

• Batuk• Sesak napas • Batuk darah• Nyeri dada

• OBSTRUKTIF• INFEKSI • KEGANASAN• PENYAKIT ORGAN LAIN

MASALAH/DATA:

PEMECAHAN MASALAH/RENCANA(Planning):

Daftar keluhan Standar Kompetensi Dokter Indonesia

•DATA LAIN•RENCANA BERIKUT:PF, Ro,PFR

Sesak napas

Batuk

1.Air way sistem: Kelainan obstruktif/Bronkitis akut

2………

Problem Based Learning

1. URTI ?

2. Riwayat sebelumnya?

1 .Pemeriksaan fisik

Tanda obstruktif ?

2. Spirometri/PFR?

3. Radiologi?

Definition

Infection of the lower respiratory tract Generally follows an upper respiratory tract

infection From viral or bacterial infection Airways become inflamed; irritated Mucus production increases

20.6.2000 10

Adult bronchitis

Acute inflammation of the mucous membranes of the trachea and bronchi (duration < 4 weeks)

– productive cough– upper respiratory tract symptoms– general symptoms (in 10 - 50%)

Assessment

Fever Tachypnea Mild dyspnea Pleuritic chest pain (possible) Cough with clear to purulent sputum

production Diffuse rhonchi and crackles

20.6.2000 12

Aetiology of acute bronchitis

• Common respiratory tract viruses (80%)• Bacteria (in about 20% of cases): – Pneumococci ( in 2 - 30%)?– Haemophilus ( in 2 - 8%)?– Mycoplasma (in 0.5 - 11%)– Chlamydia (in 0 -18%)– (Pertussis (in 0 - 7%))

20.6.2000 13

Diagnosis of acute bronchitis

The aim is to

• identify, among all patients with cough, those with other illnesses needing specific treatment (e.g. pneumonia, sinusitis, asthma)

• identify, among all patients with bronchitis, those who would benefit from antibiotics

Diagnostic Evaluation

Chest x-ray -rule out pneumonia Films show no evidence of lung infiltrates

20.6.2000 15

When is chest x-ray needed?• patient is particularly unwell• patient is particularly prone to pneumonia due to

underlying disease, age or alcoholism• history of pneumonia within the preceding year• upper respiratory tract symptoms absent• patient requests x-ray (pneumonia can not be excluded

on clinical symptoms and findings only)

20.6.2000 16

(Differential) diagnosis• History (e.g. asthma)• Health status (general condition, auscultation) • X-ray (to exclude pneumonia)• CRP (high CRP refers to bacterial aetiology or pneumonia)• Sinus ultrasound (to exclude sinusitis)• Antibody testing (of a few representative patients if

needed to establish an epidemic)• Easy access to a follow-up visit (inform your

assistants!)

Pharmacologic Interventions

1. Bronchodilators• Reduce brochospasm• Promote sputum expectoration

2. Oral antibiotics3. Symptom management for fever and cough

20.6.2000 18

Treatment of acute bronchitis

First choice: no antibiotics!Factors supporting antibiotic treatment:• CRP > 50 mg/l• patient is particularly unwell or becoming so• pyrexia of over week’s duration or patient pyrexial

following a period of apyrexia• epidemiological state• patient is immunocompromised

20.6.2000 19

Antimicrobial therapy of acute bronchitis 1

• First choice:– in most cases good effect on pneumococci is

sufficient– penicillin resistance in pneumococci in Finland is

low (R < 1%) (A) – penicillin V: 1-1.5 mega units 8 hourly for 5 – 7 days – for patients with penicillin allergy a first -

generation cephalosporin

20.6.2000 20

Antimicrobial therapy of acute bronchitis 2

• Other choices:– probable mycoplasma or chlamydia infection:• doxycycline 100-150 mg daily for 5 – 7 days• a macrolide: erythromycin 500mg 3 - 4 times daily,

roxithromycin 150 mg twice daily, klarithromycin 250mg twice daily or azithromycin 250 mg daily for 5 –7 days

– underlying chronic lung disease: • amoxicillin, sulphatrimethoprim

20.6.2000 21

Symptomatic treatment of acute bronchitis

”Symptomatic treatment assists the patient to cope with his/her symptoms and thus aims at reducing the unnecessary use of antimicrobial agents”

• no benefit is gained on cough with codeine, or dextromethorphan as compared with a placebo,

• ...but cough improves considerably even during a placebo-treatment

• patient often presents with additional symptoms, which can be eased with antihistamines, anticholinergic and/or sympatomimetic agents, but their benefit remains controversial!

20.6.2000 22

Quality criteria to develop treatment

• as a general rule a young, or middle-aged, previously well patient with bronchitis not to be prescribed antibiotics, at least not at the first consultation.

• if antibiotics are considered for the treatment of bronchitis, CRP is to be determined first

• follow-up appointment arrangements to be patient friendly

Therapeutic Intervention

Chest physiotheraphy to mobilize secretions Hydration to liquefy secretions

Nursing Interventions

1. Encourage mobilization of secretion Ambulation Coughing exercises Deep breathing exercises

2. Adequate fluid intake• To liquefy secretions• Prevent dehydration caused by fever and

tachypnea

Nursing Interventions

1. Encourage mobilization of secretion Ambulation Coughing exercises Deep breathing exercises

2. Adequate fluid intake• To liquefy secretions• Prevent dehydration caused by fever and

tachypnea

Nursing Interventions

3. Encourage rest4. Avoid bronchial irritants 5. Eat nutritious foods to facilitate recovery 6. Instruct patient to comply taking medications7. Caution the patient on using OTCs

medications

Syafiuddin San : You are the Inspiring womanImah San : You are the Wind beneath my wings

Arigatoo gozaimasu