Referat Batuk Nurfitri

REFERAT
BATUK PADA ANAK

Pembimbing:
dr. Pulung. M. Silalahi, SpA

Penulis:
Nurfitri Azhri Miranti (1102012204)
KEPANITERAAN KLINIK ILMU KESEHATAN ANAK

FAKULTAS KEDOKTERAN UNIVERSITAS YARSI
RUMAH SAKIT BHAYANGKARA TK. I RADEN SAID SUKANTO
Definition
• Cough is a protective function of the

human respiratory system.
• This reflex aims to help clear the
respiratory tract of large mucus, irritants,
particles and microbes
Epidemiology
Episodes of cold cough diseases in toddlers

in Indonesia are estimated to be 3-6 times
per year (an average of 4 times per year),
meaning that an average toddler gets a cold
cough attack 3-6 times a year
Anatomy
Upper Respiratory Tract Lower Respiratory Tract
Physiology of Cough
Mechanism of Cough
• Phase Irritation
• Phase of Inspiration
• Compression phase
• Expiration phase
Clasification
Duration
Acute Chronic
Etiology
• Iritating • Obstructive disease • Infection
– Ciggarates – Chronic Bronchitis – Acute laryngitis
– Smoke – Athsma – Acute bronchitis
– SO2 – Emphysema – Pneumonia
– Cystic Fibrosis – Pleuritis
• Mechanics – Bronchiectasis – Pericarditis
– Bronchopulmonary
secretion restriction • Restrictive disease • Tumor
– Respiratory tract – Pneumoconiosis – Larynx tumor
corpus allienum – Collagen disease – Pulmonary tumor
– Postnasal drip – Granulomatous • Psychogenic
– Aspiration disease
Pneumonia
Pneumonia is usually caused by viruses or
bacteria.
Pneumonia is classified based on presence
or absence of an alarm, the pull of the
lower chest wall into and respiratory
frequency, and with specific treatment for
each degree of disease
Mild pneumonia
In addition to coughing or difficulty
breathing, there is only a quick
breath.
Quick breath:
- in children aged 2 months - 11
months: ≥ 50 times / minute
- - in children aged 1 year - 5 years:
≥ 40 times / minute
Severe pneumonia
Cough and or difficulty breathing plus at
least one of the following:
– Head nodded
– Respiratory nostril
– Pull the lower chest wall inside
– Photo chest shows a picture of pneumonia
(broad infiltrates, consolidation, etc.)
• In addition can also be obtained the
following signs:
• Rapid breathing:
• Voice whining (grunting) in young infants
• At auscultation sounded:
– Crackles (ronki)
– Decreased breathing sound
– Bronchial breathing sound
Asma
• Asthma is a chronic inflammatory state

with reversible airway constriction.
• Characteristic signs of recurrent
episodes of wheezing, often with a cough
that indicates response to bronchodilator
and anti-inflammatory drugs
• episodes of cough and / or repeated
wheezing
• hyperinflation of the chest
• pull the lower chest wall into
• expiration extends with audible
wheezing sound good response to
bronchodilators
Croup
• Croup (viral laringotracheobronkitis)
causes obstruction / blockage of
the upper respiratory tract, if
severe, can be life-threatening.
• Most severe occurs in infancy.
• Croup is caused by various
respiratory viruses.
• Lightweight croup is indicated by:
– fever
– hoarseness
– cough barking
– stridor that only sounds when the child is
restless.
• Heavy croup is characterized by:
– Stridor sounds even though the child is calm
– Breath quickly and
– pull the lower chest wall inside.
Bronkiolitis
• Bronchiolitis is a viral-induced lower
respiratory tract infection.
• characterized by respiratory tract
obstruction and wheezing.
• The most common cause is Respiratory
syncytial virus.
• wheezing, which does not improve with
three doses of fast bronchodilators
• expiratory effort hyperinflation of chest
wall, with hipersonor on percussion pull
the lower chest wall into
• crackles or ronchi on auscultation of the
chest
• difficulty eating, feeding or drinking.
Aspirasi Benda Asing
• Foreign bodies are usually caught in the
bronchus (most commonly on the right lung) and
may cause collapse or consolidation of the distal
site of the blockage.
• The most common early symptom is choking
within a few days or weeks later the child exhibits
persistent wheezing symptoms, chronic cough or
pneumonia that does not respond to therapy.
• Small sharp objects can get caught in the larynx
and cause stridor or wheezing.
Pertusis
• Severe pertussis occurs in young infants who
have never been immunized.
• After an incubation period of 7-10 days, the child
develops a fever, usually accompanied by cough
and nasal secretions that are clinically
indistinguishable from common coughs and colds.
• At 2 weeks, a paroxysmal cough is recognized as
pertussis. Cough may last up to 3 months or
more.
• Infectious children for 2 weeks to 3 months after
the onset of the disease.
• Paroxysmal cough followed by the sound
of whoop during inspiration, often
accompanied by vomiting
• No or complete child is immunized against
pertussis
• Young infants may not be accompanied
with whoop, but cough is followed by
cessation of breath or cyanosis, or
breathing ceases without coughing
• Check the child for signs of pneumonia
and ask about seizures.
Tuberkulosis
• In general, children infected with
Mycobacterium tuberculosis are not
shows tuberculosis (TB) disease.
• The only evidence of infection is a
positive tuberculin (Mantoux) test.
• The risk of being infected with TB germs
increases when the child is living in a
home with a smear positive tuberculosis
TB patient.
• In children, cough is not a major
symptom.
• The exact diagnosis of TB is established
by the discovery of M. tuberculosis on
sputum or gastric flushing, cerebrospinal
fluid, pleural fluid, or tissue biopsy.
• The difficulty of making a definitive
diagnosis in children is due to two things,
namely the least amount of germs
(paucibacillary) and the difficulty of
taking sputum specimens.
Patients with a score of ≥ 6 (equal to or greater than 6) should be
treated as TB patients and receive treatment with anti-
tuberculosis (OAT)
Diagnosis
• Anamnesis
The duration Frequency

of cough of cough
Times of The trigger

attack factor
Diagnosis
Radiology Bronchoscopy
Hipersensitivity
test reaction Spirometry
Complication
Respiratory Pneumothoraks
Musculosceletal Bone fracture, ruptur m, rectus

abdominalis
cardiovascular Bradiaritmia, Subconjungtiva bleeding,

nasal bleeding
Central Nervous System Cough Syncope
etc Insomnia, vomitus, penurunan nafsu

makan
Therapy
Non
Farmacology
Farmacology
Non Farmacology
Avoiding Environmental
cough trigger control
Sufficient
hydration
Farmakologi
Primary Simptomatic
Treatment Treatment
Primary Treatment
Antibiotik Bronkodilator
Kortikosteroid
Antitusif
• Pressing the cough reflex.

• Used in unproductive airway
disorders and cough due to
respiratory tract irritation
Antitusif
Sentral Perifer
Narkotik Anestesi
Non
Demulcent
Narkotik
Antitusif Sentral
• Withstand coughing by raising the
threshold of stimulation.
• Narcotics: analgesic, antitussive
• Example: Codeine
• Side effects: central airway
suppression, constipation, nausea
and vomiting, addictive effects
• Non Narcotics: no addictive effects
and analgesic effects.
• Examples: dextromethorphan,
Butamirat citrate, Noskapin,
Difenhidramin.
Antitusif Perifer
• Reduces local irritation of the
airways, by performing direct or
indirect anesthesia on the
peripheral irritant receptors of the
airways.
• Local anesthetic agents:
benzocaine, benzylalcohols,
phenols
• Reduce cough due to irritant
fracture receptors in the pharynx
• Not significant in overcoming cough
in lower airway abnormalities.
• Demulcent
• Works on the pharyngeal mucosa
that serves to prevent dryness of the
mucous membranes.
• Subjectively can provide repair and
safe use
Mukokinesis
• Drugs used to treat mucostasis

• Mucostasis is a pathological fluid
retention of pathologic pathways
Mukokinesis
Diluent Surfactan Mucolitic

• Diluent works in thinning sputum
• Surfactants work on the mucus
surface and decrease the mucus
stickiness of the epithelium.
• Mucolytics function in breaking the
molecular chains of the mucoprotein
thereby decreasing the viscosity of
the mucus.
• Thiol Group: Acetylcysteine
• Increase the number of bronchial
secretions
• Proteolytic enzymes: Tripsin,
chemotrypsin, streptokinase
• Reduces the viscosity of mucus
More effective when given with
purulent sputum.
Ekspektoran
• Stimulates discharge of bronchial
fluid by gastric vascular reflex
mechanisms:
– Ammonium chloride
– Potassium yodida
– Guaifenesin
– Citric
– Ipekak
Diluent Menambah jumlah cairan mukus
Surfaktan Menurunkan efek perlengketan oleh mukus
Mukolitik Memecah rantai molekul mukoprotein

Bronkomukotropik Obat yang secara langsung merangsang
sekresi cairan dan glukoprotein kelenjar
bronkus
Bronkomeik Mengeluarkan cairan dari mukosa dengan

proses osmotik atau iritasi
Ekspektorans Obat yang merangsang pengeluaran

cairan dan glikoprotein kelenjar bronkus
secara refleks
Mukoregulator Obat yang merubah sekresi

kelenjarbronkusmenjadi kurang kental
Bromheksin Meningkatkan jumlah sputum dan

menurunkan viskositasnya
Mediator otonom Perangsangan simpatomimetik atau

reseptorlain yang secara langsung
mengakibatkan sel kelenjar

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REFERAT

BATUK PADA ANAK

KEPANITERAAN KLINIK ILMU KESEHATAN ANAK

• Cough is a protective function of the

Episodes of cold cough diseases in toddlers

• Asthma is a chronic inflammatory state

The duration Frequency

Times of The trigger

Musculosceletal Bone fracture, ruptur m, rectus

cardiovascular Bradiaritmia, Subconjungtiva bleeding,

Central Nervous System Cough Syncope

etc Insomnia, vomitus, penurunan nafsu

• Pressing the cough reflex.

• Drugs used to treat mucostasis

Diluent Surfactan Mucolitic

Mukolitik Memecah rantai molekul mukoprotein

Bronkomeik Mengeluarkan cairan dari mukosa dengan

Ekspektorans Obat yang merangsang pengeluaran

Mukoregulator Obat yang merubah sekresi

Bromheksin Meningkatkan jumlah sputum dan

Mediator otonom Perangsangan simpatomimetik atau

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