Asma, Gangguan Perilaku dan Gangguan Neuro Anatomi

Asma, Gangguan Perilaku dan Gangguan Neuro Anatomi 

Tidak hanya pada dewasa, asma atau alergi adalah penyakit kronik juga banyak terjadi pada anak ternyata beresiko terjadi gangguan tumbuh dan berkembangnya anak.  Asma sebagai salah satu manifestasi alergi, tidak hanya hanya mengganggu sistem pernapasan tetapi juga mengganggu berbagai orang dan sistem tubuh. Gangguan neurologi dan gangguan perilaku juga banyak terjadi pada penderita asma. Ternyata penderita asma mengalami berbagai gangguan penyerta yang sering diabaikan dan dianggap gangguan yang terpisah. Sehingga penanganan gangguan penyerta khususnya gangguan pewrilaku dan gangguan neuroanatomi lainnya juga sering dilakukan terpisah.

Angka kejadian asma terus meningkat tajam beberapa tahun terahkir. Penyakit asma terbanyak terjadi pada anak dan berpotensi mengganggu tumbuh dan berkembangnya. Asma adalah salah satu manifestasi alergi. Alergi dapat menyerang semua organ dan fungsi tubuh tanpa terkecuali. Selain gangguan pulmonal gangguan yang menyertai adalah gangguan organ tubuh lain, gangguan pertumbuhan, perkembangan, perilaku dan permasalahan kesehatan lainnya. Tetapi permasalahan tersebut  belum banyak terungkap dan diperhatikan. Gangguan tersebut tampaknya sangat penting dan sangat berpengaruh terhadap kehidupan anak penderita asma yang sudah banyak mengalami gangguan sistem pernapasan. Selama ini yang diungkapkan tentang asma mungkin hanya seputar patofisiologi, manifestasi klinis, pengobatan dan pencegahan.

Asma adalah penyakit yang mempunyai banyak faktor penyebab. Yang paling sering karena faktor atopi atau alergi. Penyakit ini sangat berkaitan dengan penyakit keturunan. Bila salah satu atau kedua orang tua,  kakek atau nenek anak menderita astma bisa diturunkan ke anak.  Faktor-faktor penyebab dan pemicu asma antara lain debu rumah dengan tungaunya, bulu binatang, asap rokok, asap obat nyamuk, dan lain-lain.  Beberapa makanan penyebab alergi makanan seperti susu sapi, ikan laut, buah-buahan, kacang juga dianggap berpernanan penyebab asma. Polusi lingkungan berupa peningkatan penetrasi ozon, sulfur dioksida (SO2), nitrogen oksid (NOX), partikel buangan diesel, partikel asal polusi (PM10) dihasilkan oleh industri dan kendaraan bermotor.  Kondisi lain yang dapat memicu atau memperberat timbulnya asma adalah aktifitas, penyakit infeksi, emosi atau stres

Ternyata penderita asma mengalami berbagai gangguan penyerta yang sering diabaikan dan dianggap gangguan yang terpisah. Sehingga penanganan gangguan penyerta tersebut juga sering dilakukan terpisah. Bila hal ini terjadi sering terjadi kesalahan dalam mengidentifikasi penyebab dan penanganan gangguan asma dan gangguan penyertanya. Padahal bila penanganan penyebab asma diidentifikasi dan dihindari dapat memperbaiki berbagai gangguan penyerta yang ada secara bersamaan

Gangguan Perilaku

Tak terkecuali ternyata otak ataupun susunan saraf pusat ternyata dapat terganggu oleh reaksi alergi atau asma. Reaksi alergi dengan berbagai manifestasi klinik ke sistem susunan saraf pusat dapat mengganggu neuroanatomi dan neurofungsional, Selanjutnya akan mengganggu perkembangan dan perilaku pada anak. Beberapa gangguan perilaku yang pernah dilaporkan pada penderita alergi juga pernah dilaporkan pada penderita asma.  Banyak penelitian juga menyebutkan gangguan perilaku seperti gangguan emosi, gangguan konsentrasi, agresif, gangguan tidur dan gangguan perilaku buruk lainnya sering menyertai penderita asma pada usia anak. Pada tes kepribadian dapat terlihat bahwa pasien-pasien asma lebih bersifat mengutamakan tindakan fisik, lebih sulit menyesuaikan diri dalam lingkungan sosial, dan mempunyai mekanisme defensif yang kurang baik.

Jumlah serangan alergi yang dilaporkan oleh pasien ternyata berhubungan dengan meningkatnya kecemasan, depresi, kesulitan berkonsentrasi, dan kesulitan menyesuaikan diri dengan lingkungan sosial.

Reichenberg K mengadakan pengamatan pada anak penderita asma usia 7-9 tahun, didapatkan gangguan emosi dan gangguan perilaku lainnya. Jill S Halterman, dari the University of Rochester School of Medicine di Rochester, New York, melaporkan penderita asma di usia sekolah lebih sering didapatkan perilaku sosial yang negatif seperti mengganggu, berkelahi atau melukai teman lainnya. 

Sebaliknya juga didapatkan perilaku pemalu dan mudah cemas. Bahkan peneliti terbaru lainnya mengungkapkan bahwa penderita asma berpotensi untuk terjadi gangguan kejiwaan, seperti depresi dan sebagainya.  Didapatkan penelitian yang mengejutkan yang dilakukan Croen. Maternal asma atau asma saat kehamilan ternyata bisa meningkatkan resiko terjadinya autis pada anak yang dilahirkan. Penelitian ini dilakukan terhadap 88.000 anak pada tahun 1995 – 1999 di North California

Gangguan neurologi

Asma dengan berbagai mekanisme yang berkaitan dengan gangguan neuroanatomi susunan saraf pusat dapat menimbulkan beberapa manifestasi klinis seperti sakit kepala, migrain, vertigo, kehilangan sesaat memori.

Strel’bitskaia seorang peneliti mengungkapkan bahwa pada penderita asma didapat gangguan aktifitas listrik di otak, meskipun saat itu belum bisa dilaporkan kaitannya dengan manifestasi, mengungkapkan bahwa asma dan ADHD ternyata berkaitan dengan riwayat asma dan adhd pada orang tua dan keluarga.  klinik. Asma juga sering dikaitkan dengan gangguan neurologi seperti migrain.

Siniatchkin M melaporkan penderita asma disertai migrain pada anak juga berkaitan dengan gejala asma dan migrain pada salah satu orang tua. Storfer  tahun 2000, melaporkan dalam pengamatan pada 2.720 anak penderita alergi dan asma terdapat kecenderungan terjadi myopia 2 kali lebih besar. Sehingga anak alergi atau asma 2 kali lebih besar untuk memakai kaca mata sejak usia muda. Yang menarik dari penelitian tersebut juga didapatkan bahwa pada kelompok asma dan alergi didapatkan tingkat kecerdasan yang lebih tinggi. Penderita asma sering dikaitkan dengan gangguan ADHD.

Penelitian menunjukkan angka rerata kejadian ADHD lebih tinggi terjadi pada wanita penderita asma. Biederman, mengungkapkan kaitan kormobiditias  dan riwayat keluarga antara ADHD dan asma antara anak dan orang tua. Berbagai penelitian gangguan neurologi pada asma dan alergi telah banyak dilaporkan.

Banyak laporan penelitian yang juga mengungkapkan bahwa pada penderita asma juga disertai gangguan tidur. Gangguan biasanya ditandai dengan awal jam tidur yang larut malam, tidur sering gelisah, sering mengigau, menangis dan berteriak. Tengah malam sering  terjaga tidurnya hingga pagi hari atau mimpi buruk pada malam hari

Tampaknya banyak fakta dan penelitian yang ternyata mengungkapkan bahwa penderita asma selain mengalami gangguan pada penyakit di paru-parunya juga mengalami manifestasi lain pada gangguan beberapa organ tubuh dan gangguan perilaku. Meskipun demikian beberapa fenomena tersebut masih harus memerlukan penelitian lebih lanjut. Melihat demikian kompleksnya masalah kesehatan yang mungkin bisa terjadi maka tindakan pencegahan asma sejak dini bahkan sejak di dalam kandungan harus mulai dilakukan.

Penanganan

  • Berpindah dokter ahli atau spesialis lainnya. Faktanya gangguan penyerta tersebut seringkali ditangani secara terpisah oleh banyak dokter dengan keahlian berbeda dan dianggap sebagai kejadian yang tidak berkaitan dengan gangguan asmanya. Misalnya seorang asma dengan disertai gangguan migrain, sering sakit kepala, sinusitis, amandel membesar,  gangguan berat badan kurang, gangguan kulit, sering sakit perut, tidak bisa diam, gangguan konsentrasi secara bersamaan dan gangguan perilaku. Seringkali gangguan asma ditangani dokter dokter paru, sinusitis dan amandel membesar diperiksakan dokter THT, gangguan kenaikklan berat badan ditangani dokter gizi, gangguan pencernaan dikonsultasikan ke ahli gastroentrologi, gangguan kulit dibawa ke dokter kulit. Gangguan migrain dan sakit kepala dikonsultasikan ke dokter saraf dan gangguan perilaku ke psikiater atau ke dokter tumbuh kembang. Memang tidak salah bila melakukan konsultasi ke berbagai dokter ahli tersebut. Tetapi saat berbagai gangguan tersebut dianggap sebagai gangguan terpisah maka seringkali terjadi kesalahan dalam diagnosis dan penanganannya.
  • Tes alergi yang sering mengacaukan. Untuk memastikan penyebab alergi makanan, Gold Standart atau standar baku emas diagnosis alergi makanan adalah DBPCFC (Double Blind Placebo Chalenge Food Control). Tetapi karena relatif rumit timbul beberapa modifikasi Chalenge test atau eliminasi provokasi makanan yang kelihatan mudah tetapi sulit ini seringkali tidak pernah dilakukan oleh klinisi dan sebagian ahli alergi untuk memastikan penyebab alergi makanan.Kesalahan tersering dalam melakukan pencarian penyebab alergi makanan pada asma adalah kesalahan dalam melakukan interpretasi tes alergi. Tes kulit alergi hanya bisa mendeteksi reaksi alergi tipe cepat seperti debu, tungau atau mungkin sebagian kecil makanan. Sebagian besar penyebab alergi makanan tidak bisa terdeteksi dengan tes alergi. Sedangkan tes lainya seperti bioresonansi, tes IgE4 (dikirim ke Amerika), tes bandul, tes mata, tes rambut sampai saat ini tidak direkomendfasikan oleh berbagai institusi alergi Internasional karena tidak terbukti manfaat dan kebenarannya secara ilmiah. Karena saat dilakukan tes alergi, makan sering hasilnya negatif. Maka makanan langsung diabaikan sebagai penyebab. Hal inilah yang menjadikan bahwa makanan diabaikan sebagai penyebab dalam memperberat kekambuhan Asma
  • Alergi Makanan Sering Dibaikan Alergi Makanan sering dilaporkan sebagai penyebab pada kekambuhan asma. Tetapi faktanya makanan sering diabaikan sebagai penyebab kekambuhan asma. Bila penderita asma  mengalami hipersensitif sdaluran cerna dengan gejala mudah mual dan muntah, Gastroesofageal refluk, Irritabel Bowel Syndrome, nyeri perut berulang, konstipasi dan gangguan saluran cerna lainnya maka makanan harus dicurigai sebagai penyebab utama. Ternyata saat dilakukan intervensi eliminasi provokasi makanan gangguan asma membaik disertai perbaikan pada gejala penyertanya khususnya gangguan perilaku dan gannguan neuroanatomi lainnya.

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