Friday, December 19, 2008

asma

Asthma is a disease channel napas chronicles (chronic), which most often found, particularly in developed countries. The disease usually starts since the children. Cause negative impacts such as children often do not go to school, limiting sports activities, and activities the whole family.
National Asthma Guidelines for Children defines asthma as a collection of signs and symptoms of wheezing / use and / or cough with the following characteristics:

1. arise in episodik and / or chronicles,
2. tend to be on the night / early morning (nokturnal),
3. seasonal
4. the spark of factors including physical activity, and
5. reversibel be (able to recover as usual), either spontaneously or with treatment, and
6. history of asthma or atopi (a contagious tendency allergy) in the other patients / families,
7. while other reasons have been removed.

COPING MECHANISMS occurrence of ASMA

The concept of the latest occurrence of asthma mechanisms, namely asthma is an inflammation of the process (inflammation) chronicles / chronic unique, involving the wall of the channel respiratorik / napas, causing limited air flow, and increase reaktivitas (hiperreaktif / homogenous) napas channel. Hiperreaktivitas this is the beginning of the occurrence of stricture napas channel, as a response to the various stimulative.

Typical illustration of the channel napas inflammation is the activation of cells in the blood cells and form eosinofil, mast cells, makrofag, and limfosit T cells in the mukosa (mucous membrane) and Lumen (estuary) napas channel. This change can happen, even in clinical asmanya not bergejala. Along with the process of inflammation, perlukaan epitel (layer terluar) bronkus (stem lungs) stimulate the repair process napas channel which produces functional and structural changes, known by the term remodelling.
Diagnosis and classification


Diagnosis

Use / recurrent wheezing and / or cough is a recurring chronicles a starting point for making diagnosis. Including the need to consider the possibility of asthma is the children who only shows cough as the only signs, and signs were checked at the time wheezing, shortness and others are not arise.

Difficult asthma diagnosed in children under 3 years. For children who have large (> 6 years) inspection work / function of lungs, should be done. Test your lungs, that functions with a simple peak flow meter, or a more complete with a spirometer. Others can test through provocation bronkus with histamin, metakolin, training (exercise), the air is dry and cold, or with NaCl hipertonis.

Inspection is useful to support the child asthma diagnosis by 3 ways, namely to obtain:

* Variability in the PFR (peak flow rate) or FEV1 (Forced expiratory volume in 1 second) ≥ 15%

The daily variability is the difference in value (increase / decrease) the results of PFR in one day. Rating good can be done with the weekly variability pemeriksaannya held ≥ 2 weeks.

* Reversibilitas in PFR or FEV1 ≥ 15%

Reversibilitas value is the difference (increase) PFR or FEV1 after inhalation bronkodilator.

* The decline ≥ 20% in FEV1 (PC20 or PD20) after provocation bronkus with metakolin or histamin.

The use of peak flow meters are important and necessary effort, because in addition to supporting the diagnosis, also know the success of governance like asthma. If not available, you can use Notes Sheet Daily as an alternative.

In children with signs and symptoms of asthma are clear, and the response to the asthma medication clipping, it does not need further diagnostic examination.
The disease classification Degrees Child Asthma

Can be seen in the table below.
Tata Laksana Asthma Long Term

Destination governance like asthma children in general is to ensure the achievement of the potential flower children grow optimally. In more detail, the goal is to be achieved:

1. Children can be a normal activity, including play and exercise.
2. The least the school attendance figures.
3. Symptoms do not arise day or night.
4. Senormal lungs function test may be, there is no diurnal variation (in 24 hours), which pierce.
5. Ideal for full cloning medicine needs and no attacks.
6. Side effects of drugs that can not be prevented or the least possible, particularly those affecting children to grow flowers.

If the goal is not achieved, then the need to reevaluasi governance laksananya.
Tata Laksana Medikamentosa (with medicines)

Medicine for asthma can be divided into 2 large groups, namely drug pereda (reliever) and drug control (controller).

Reliever, often called the attack drug, used to ease symptoms of asthma attack or if are arising. When the attacks go away and have no more symptoms, the medication is not used again.

Controller, often called preventive medicine, is used to overcome the problem of basic asthma, which chronicles respiratorik inflammation (chronic inflammation napas channel). Thus, the use of drugs is continuously in the relatively long period of time, depending on the degree of asthma, and responnya the treatment / prevention. Controller given on Episodik Asthma, and Asthma Persisten.
Rarely asthma Episodik

Episodik rarely enough asthma treated with reliever form bronkodilator (dilate bronkus / stem-new lungs) beta agonis sniffs (inhaler / spray) work short (short acting β2-agonist, Saba) or groups xantin work quickly, when symptoms occur / attack.

Obstacles to the use of the spray is expensive and the price is not available in all places. In addition, the use of inhaler (Metered Dose Inhaler / MDI or Dry Powder Inhaler / DPI), this requires the correct use of the technique (for most children), and need tools (for a small child / baby). When the drug sniff is not there, then given a beta agonis per oral (medicine drinking).

Use of xantin work quickly (teofilin) as increasingly less bronkodilator role in the governance like asthma, because the limit of securing (the margin of safety) narrow. However, given in the beta agonis oral medication is not always there, it can use teofilin consider the potential side effects. Furthermore, can be found in Appendix 3.
Most asthma Episodik



If the use of beta agonis sniff is more than 3x per week (without the use of the measure before physical activity), or the attacks are / weight occur more than once a month, then use as anti-inflammation of the (controller) is required, namely low-dose steroid sniffs. Steroid drugs are often used on children is budesonid, that is used as a standard.

Low-dose steroid sniff is equivalent to 100-200 mg / day budesonid (50-100 mg / day flutikason) for children aged less than 12 years, and 200-400 mg / day, to budesonid children aged above 12 years old. At doses of 100-200 mg / day has not reported any long-term side effects.

In accordance with the basic mechanism which is inflammation of asthma / inflammation chronicles, controller form of anti-inflammation need time to work therapy. Assessment is done after 6-8 weeks, the time needed to control inflamasinya. If still no response (there are symptoms of asthma or sleep disturbance or activity a day-to-day), then proceed with the second stage, namely, increasing the dose of steroid pull up to 400 mg / day, including in the governance persisten like asthma. Furthermore, can be found in annex 3.

Principles of treatment is: if the governance of a degree of disease like asthma is in accordance with the guidelines, but still not good response in 6-8 weeks, the degrees of governance like to move more weight (step-up). Conversely, if asmanya restrained in 6-8 weeks, the degree to switch to a more lightweight (step-down). If possible, pull discontinued steroid use.

Note: before doing step-ups, should be evaluated (1) implementation of deterrence spark, (2) how the use of drugs, and (3) of the broadcaster difficult to control asthma (such as rinitis and Sinusitis).
Asthma Persisten



How the steroid sniffs whether starting from high to low doses during the symptoms are still restrained, or vice versa starting from low to high dose until symptoms can be managed, depending on the case. In certain circumstances, especially in children with severe disease, it is recommended to use high doses first, with oral steroid short term (3-5 days). Next dose steroid sniffs revealed until the smallest dose that is optimal.

After giving a low dose of steroid sniff does not have a good response, needed an alternative to replacement therapy, namely increasing the dose of steroid into the medium or remain low dose steroid sniffs plus EARNINGS (long acting beta-2 agonist) or the teophylline added slow release (TSR) or added anti-leukotriene receptor (ALTR). Medium dose is equivalent to 200-400 mol l / day budosenid (100-200 mol l / day flutikason) for children aged less than 12 years, and 400-600 mol l / day budosenid (200-300 mol l / day flutikason) for children aged at over 12 years.

When treatment with a second layer for 6-8 weeks, there are still symptoms of asthma, it can be given an alternative to the third layer, which can increase the dose kortikosteroid up with the high dose, or a fixed dose of the medium added with PROFIT, or TSR, or ALTR. The definition of high dose is equivalent to> 400 mol l / day budesonid (> 200 mol l / day flutikason), for children aged less than 12 years, and> 600 mol l / day budesonid (> 300 mol l / day flutikason) for children aged above 12 years old.

The addition of the steroid PROFIT sniffs can be proven to improve FEV1, reduce symptoms of asthma, and improve the quality of life. When the dose steroid sniffs reached> 800 mg / day but did not achieve a response, the new steroid use oral (systemic). So the use of oral kortikosteroid as a controller (control) is the last road. This step is taken only when the danger of asmanya greater than the danger of side effects of drugs. As the initial dose, oral steroid can be given 1-2 mg / kgBB / day. Dose and then lowered to the smallest dose given the lapse of the day in the morning. Systemic side effects of steroid can be found in the annex 4.

Giving antileukotrien (zafirlukas) dikontraindikasikan aberration in the liver. Giving anti-drug histamin new generation of non sedatif (for example setirizin and ketotifen), should be considered in children with asthma who accompanied rinitis.
How medicine Giving



Ways of asthma drugs should be adjusted to the age of the children, because of differences in the ability to use tools inhalation. Training needs to be done correctly and repeatedly.
The use of perenggang (spacer) to reduce deposisi (cumulation) drugs in the mouth (orofaring), thereby reducing the amount of drugs consumed, and reduce systemic effects. Deposisi (storage) in the lungs, even better, so the effect is obtained terapetik (treatment) is good. Sniff drugs in the form of dry powder (DPI = Dry Powder Inhaler) as Spinhaler, Diskhaler, Rotahaler, Turbuhaler, Easyhaler, Twisthaler need inspiration (efforts to attract / breathe napas) strong. Generally, this form is recommended for school age children.
Prevention and Early Intervention



Prevention and early action should be the main objective in dealing with children's asthma. Controlling the environment, the provision of exclusive breastfeeding at least 6 months, tergiversation food alergenik potential (capable of allergic reaction), reduction of Exposure to house dust mite and rontokan fur, proven to reduce the manifestation of food allergy, and dermatitis atopik especially in infants, also asthma.

Antihistamin the use of non sedatif (do not cause drowsiness) as ketotifen and setirizin reported long-term can prevent asthma in children with dermatitis atopik. However, medicines are not useful as a drug of asthma (controller),
Allergy and Environmental Factors (Avoiding fuse)



While this has been a lot of evidence that allergy is one of the important factors for development of asthma. 75-90% at least five children asthma has proven allergy, both in developing countries and developed countries. Atopi (trend has one or several types of large groups of allergy) is a real risk factor for menetapnya hiperreaktivitas asthma symptoms bronkus and. There is a relationship between allergens Exposure (spark allergic) with sensitisasi. Exposure to high associated with increased symptoms of asthma in children.

Controlling the environment must be made for each child's asthma. Avoidance of cigarette smoke is an important recommendation. Families with children's asthma is recommended not keep furry animals, like cats, dogs, birds. Repair ventilation room, deterrence and humidity room for children who need to be sensitive to house dust and tungaunya.

It should be noted that children often suffer from asthma and allergic rinitis / or Sinusitis, which make asmanya unruly. Detection and diagnosis second difference is that followed by adekuat therapy will improve symptoms asmanya.

Some research found that many babies wheezing with asthma do not continue to be on the children and teenagers, they. The existence of asthma on parents, and dermatitis (skin disease eczema) in children with atopik on one of the indicators of the occurrence of asthma later in the day. When there are two things, the possibility of a greater asthma.
Tata Laksana Asthma Attack



GINA governance like to share a two asthma attacks, like governance at home and in hospitals. Procedures like in the home by children asthma (or parents) in their own homes. This can be done by those who have undergone previous therapy with regular, and have enough education. Inhalation form of therapy early beta agonis short work until three times in one hour. Then the children or their families are asked to assess the response of determining the degree assault, to be followed up according to rank. However, for the conditions in our countries, the initial therapy in the home such as the significant risk, and the ability to do the assessment also still in question. With such reasons, then, when after the inhalation one does not have a good response, the doctor recommended to seek help.
Other drugs for Asthma Attack

* Magnesium Sulphate

In the research multisenter, giving intravenous magnesium sulphate (Doofus) in the hospital have the same effectiveness of beta agonis.

* Mukolitik

Giving mukolitik (for example Bisolvon syrup) in asthma attacks can only be given, but must be careful in children with cough reflex that is not optimal. Giving mukolitik by inhalation (sniff) do not have a significant effect, but must be careful on the weight of asthma attacks.

* Antibiotics

Giving antibiotics in asthma is not recommended, because most of the pencetusnya not a bacterial infection, but infection with the virus. In certain circumstances, antibiotics can be given, namely the infection napas suspected because the bacteria, or suspected Sinusitis that accompany asthma.

* Medicine for sedation (have the effect of making drowsiness)

Provision of sedation medication in asthma attacks is not recommended, because the press everywhere.

* Anti histamin (anti-allergy)

Anti histamin not given in asthma attacks, because they do not have a meaningful effect, could even aggravate the situation.

TERAPI inhalation

Asthma treatment aims to stop the asthma attack as soon as possible, and prevent the next attack, or when the attacks arise again, serangannya not heavy. To achieve these objectives, need to bronkodilator given the drugs at the time of the attack, and anti-inflammation drugs as drug usage to reduce the inflammation that arises.

Giving medicine in asthma can be through various ways, namely parenteral (through Doofus), per oral (tablets drunk), or by inhalation. Giving per inhalation is the drug directly into the channel napas pull through. In asthma, the use of drugs by inhalation can reduce the side effects that often occur in the per parenteral or oral, because the doses are very small compared to other types.

To get the optimal benefits of drugs, medicines, which must be given by inhalation can be reached at work in the channel napas. Drugs used usually in the form of aerosols, the suspension of particles in the gas.
Special types of inhalation



Giving the aerosol idel with tools that are simple, easy to carry, not expensive, are selective channel napas reached the bottom, only slightly behind in the channel napas above, and can be used by children, the disabled, and parents. However, the ideal situation can not be fully achieved.

Here are some tools inhalation therapy:

* Metered Dose Inhaler (MDI)

1. MDI without Spacer
2. MDI with Spacer

Spacer (station equipment) will increase the distance between the mouth with a tool, so the speed at the time These aerosols to be reduced. This reduces settling in orofaring (channel napas above). This form of spacer tube (80 ml volume can be) with a length of 10-20 cm, or other form of a cone with a volume of 700-1000 ml. The use of the spacer is very beneficial to the child.

* Dry Powder Inhaler (DPI)

The use of drugs dry powder (dried powder) on the DPI requires a strong pull. In a small child, this is difficult. In a larger children, the use of the drug powder can be more easily, because it needs less coordination than MDI. Deposisi (storage) of drugs in the lungs, higher than the MDI and more constant. So it is recommended given to the child above 5 years old.

* Nebulizer

Tool nebulizer medicines that can change the shape of a solution aerosols continuously, with the energy that comes from the air dipadatkan, or Ultrasonic waves. Dihirup aerosols that are formed by people or through the mouth piece sungkup.
Bronkodilator provided with a nebulizer to give effect bronkodilatasi meaningful without causing side effects. The results of treatment with a nebulizer more depending on the type of nebulizer, which is used. There is a nebulizer, which produces aerosol particles continuously, there is also the aerosol can be regulated so that only arise when people do inhalation, so many wasted tdak drugs.
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