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"Latar belakang: Asma dan PPOK merupakan dua penyakit berbeda. Beberapa kelompok pasien, terutama perokok dan usia tua seringkali memiliki gambaran klinis yang mirip dengan asma dan PPOK sehingga diagnosis sulit ditegakkan. Hal ini telah memunculkan suatu entitas klinis baru yang disebut STAP.Tujuan: Mengetahui prevalens dan karakteristik STAP pada pasien asma dan PPOK di RSUP Persahabatan.Metode: Penelitian menggunakan studi potong lintang, dilakukan di Poli Asma-PPOK RSUP Persahabatan Jakarta pada Maret-Agustus 2018. Kriteria GINA/GOLD 2017 yang dimodifikasi digunakan untuk mendiagnosis STAP.Pasien didiagnosis STAP apabila memiliki minimal tiga karakteristik klinis yang mendukung asma dan PPOK.Hasil:Penelitian melibatkan 60 subjek. Prevalens STAP didapatkan 58,3%. Sebanyak 51,4% pasien STAP memiliki jenis kelamin perempuan, 65,7% tidak bekerja, 65,7% berpendidikan tinggi, 54,3% memiliki riwayat merokok dengan median indeks Brinkman 0,5 (0-1536) dan memiliki rerata IMT 24,9±3,8 kg/m². Satu tahun terakhir, median eksaserbasi kelompok STAP adalah 1 (0-10) kali dan median rawat inap di RS adalah 0 (0-1) kali.Uji provokasi bronkus positif ditemukan pada 97,1% pasien STAP.Kesimpulan: Prevalens STAP pada penelitian ini sebesar 58,3%. Kebanyakan pasien STAP adalah perempuan, tidak bekerja, berpendidikan tinggi, memiliki riwayat merokok, indeks Brinkmann yang rendah, IMT normaldan memiliki uji bronkodilator yang positif.

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Asthma and COPD are two different diseases. Some patients, in particular smokers and elderly patients, often have overlapping clinical features of asthma and COPD so that the diagnosis is difficult to establish. This has led to a new clinical entity called ACOS.

Objectives: To determine the prevalence and characteristics of ACOS in patients with asthma and COPD.

Methods: This study was a cross sectional study conducted at Asthma-COPD Polyclinic of Persahabatan Hospital, Jakarta in March-August 2018. ACOS diagnosis was made using the modified 2017 GINA / GOLD criteria. Patients are diagnosed with ACOS if they have at least three clinical characteristics that support asthma and COPD.

Results: The study involved 60 subjects. ACOS prevalence was 58.3%.51.4% of ACOS patients were female, 65,7% did not work, 65,7% were highly educated, 54,3% had a history of smoking with  median Brinkman index 0.5 (0-1536) and had mean BMI of 24,9±3.8 kg/m2.In the past year, median exacerbation of the ACOS group was 1 (0-10) time and median hospitalization was 0 (0-1) times. Positive bronchial challenge test found in 97,1% ACOS patients.

Conclusion: ACOS prevalence in this study was 58,3%. Most of ACOS patients are female, unemployed, highly educated, had history of smoking, low Brinkmann index, normal BMI, had complaint of shortness of breath and had positive bronchial challenge test."

"ABSTRAKLatar belakang: Kapasitas difusi paru berdasarkan karbon ke sirkulasi pulmoner. Nilai DLCO prediksi pada asma cenderung normal atau sedikit monoksida (DLCO) didesain untuk mengukur laju perpindahan gas CO dari alveolus meningkat sedangkan pada PPOK kapasitas difusi cenderung menurun akibat emfisema. Sindrom tumpang-tindih asma-PPOK dinyatakan sebagai entitas yang unik dengan kombinasi karakteristik asma dan PPOK. Tujuan utama penelitian ini adalah mengetahui nilai DLCO pada pasien tumpang tindih asma- PPOK (TAP) di RSUP Persahabatan Jakarta.Metode: Uji DLCO dengan metode napas tunggal dan beberapa pemeriksaan penunjang lainnya telah dilakukan pada 40 pasien yang terdiagnosis sebagai TAP. Diagnosis TAP pada subjek penelitian ditegakkan menggunakan kriteria pedoman GINA/GOLD 2017. Kriteria akseptabilitas dan reprodusibilitas DLCO napas tunggal dinilai menggunakan kriteria dari ATS/ERS 2017. Hasil uji DLCO disajikan dalam nilai mutlak dan nilai persen prediksi.Hasil: Rerata nilai DLCO mutlak dan %DLCO prediksi yang didapatkan dalam penelitian ini adalah 17.98 ± 5.37 mL/menit/mmHg dan 84.16 ± 18.29%. Jika menggunakan persamaan penyesuaian DLCO berdasarkan kadar hemoglobin didapatkan nilai %DLCO prediksi sedikit meningkat dibanding sebelumnya, 85.17 ± 18.04%. Terdapat 10 subjek (25.0%) yang mengalami penurunan nilai DLCO. Enam diantaranya mengalami penurunan ringan dan empat lainnya mengalami penurunan sedang.Kesimpulan : Rerata nilai DLCO pada subjek TAP di RSUP Persahabatan Jakarta dapat diinterpretasikan normal, lebih menyerupai asma dibandingkan PPOK. Hasil ini juga mengindikasikan kebanyakan pasien TAP dalam penelitian ini tidak mengalami penurunan luas permukaan alveolar yang mengganggu proses difusi.

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ABSTRACTBackground: Diffusing capacity of the lung for carbon monoxide (DLCO) was designed to measure transfer rate of carbon monoxide from alveoli to pulmonary circulation. As we know, DLCO predicted value in asthma proved to be normal or slightly elevated. On contrary it decreased in COPD with emphysematous pattern. Asthma-chronic obstructive pulmonary disease overlap (ACO) declared as a unique entity with combined characteristics between asthma and COPD. The aim of the research is to find out DLCO value of ACO patient in Persahabatan Hospital, Jakarta.Method: We have conducted single-breath DLCO and other required test to 40 patients diagnosed with ACO using GINA/GOLD 2017 guidelines. The acceptability and reproducibility of single-breath DLCO was done according to ATS/ERS 2017 criteria. The result then presented as absolute value and percent predicted value.Results: The mean DLCO of our patient is 17.98 ± 5.37 mL/minute/mmHg with percent predicted value is 84.16 ± 18.29%. Using adjusted DLCO equation for hemoglobin, we found that the value is slightly increased, 85.17 ± 18.04%. However, we found 10 patient (25.0%) with DLCO decrease. Six of them have DLCO predicted value <75% (mild-decrease) and four of them have DLCO predicted value <60% (moderate-decrease).Conclusion: The mean DLCO value of patient with ACO in our hospital can be interpreted as normal, similar with asthma, rather than COPD. It also indicate most of our patient did not have alveolar loss that altering diffusion process."

"Latar belakang: Kapasitas difusi paru berdasarkan karbon  ke  sirkulasi pulmoner. Nilai DLCO prediksi pada asma cenderung normal atau sedikit monoksida (DLCO) didesain untuk mengukur laju perpindahan gas CO dari alveolus meningkat sedangkan pada PPOK kapasitas difusi cenderung menurun akibat emfisema. Sindrom tumpang-tindih asma-PPOK dinyatakan sebagai entitas yang unik dengan kombinasi karakteristik asma dan PPOK. Tujuan utama penelitian ini adalah mengetahui nilai DLCO pada pasien tumpang tindih asma- PPOK (TAP) di RSUP Persahabatan Jakarta.Metode: Uji DLCO dengan metode napas tunggal dan beberapa pemeriksaan penunjang lainnya telah dilakukan pada 40 pasien yang terdiagnosis sebagai TAP. Diagnosis TAP pada subjek penelitian ditegakkan menggunakan kriteria pedoman GINA/GOLD 2017. Kriteria akseptabilitas dan reprodusibilitas DLCO napas tunggal dinilai menggunakan kriteria dari ATS/ERS 2017. Hasil uji DLCO disajikan dalam nilai mutlak dan nilai persen prediksi.Hasil: Rerata nilai DLCO mutlak dan %DLCO prediksi yang didapatkan dalam penelitian ini adalah 17.98 ± 5.37 mL/menit/mmHg dan 84.16 ± 18.29%. Jika menggunakan persamaan penyesuaian DLCO berdasarkan kadar hemoglobin didapatkan nilai %DLCO prediksi sedikit meningkat dibanding sebelumnya. Terdapat 10 subjek (25.0%) yang mengalami penurunan nilai DLCO. Enam diantaranya mengalami penurunan ringan dan empat lainnya mengalami penurunan sedang.Kesimpulan : Rerata nilai DLCO pada subjek TAP di RSUP Persahabatan Jakarta dapat diinterpretasikan normal, lebih menyerupai asma dibandingkan PPOK. Hasil ini juga mengindikasikan kebanyakan pasien TAP dalam penelitian ini tidak mengalami penurunan luas permukaan alveolar yang mengganggu proses difusi

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Background: Diffusing capacity of the lung for carbon monoxide (DLCO) was designed to measure transfer rate of carbon monoxide from alveoli to pulmonary circulation. As we know, DLCO predicted value in asthma proved to be normal or slightly elevated. On contrary it decreased in COPD with emphysematous pattern. Asthma–chronic obstructive pulmonary disease overlap (ACO) declared as a unique entity with combined characteristics between asthma and COPD. The aim of the research is to find out DLCO value of ACO patient in Persahabatan Hospital, Jakarta.

Method: We have conducted single-breath DLCO and other required test to 40 patients diagnosed with ACO using GINA/GOLD 2017 guidelines. The acceptability and reproducibility of single-breath DLCO was done according to ATS/ERS 2017 criteria. The result then presented as absolute value and percent predicted value.

Results: The mean DLCO of our patient is 17.98 ± 5.37 mL/minute/mmHg with percent predicted value is 84.16 ± 18.29%. Using adjusted DLCO equation for hemoglobin, we found that the value is slightly increased, 85.17 ± 18.04%. However, we found 10 patient (25.0%) with DLCO decrease. Six of them have DLCO predicted value <75% (mild-decrease) and four of them have DLCO predicted value <60% (moderate-decrease).

Conclusion: The mean DLCO value of patient with ACO in our hospital can be interpreted as normal, similar with asthma, rather than COPD. It also indicate most of our patient did not have alveolar loss that altering diffusion process."

"[ABSTRAKPenyakit paru obstruktif kronik (PPOK) merupakan penyebab utama morbiditas dan mortalitas di dunia.Beberapa faktor risiko PPOK juga merupakan faktor risiko terjadinya tuberkulosis (TB).Beberapa penelitian di luar ditemukan prevalens TB paru pada pasien PPOK sekitar 2,6% - 10%.Indonesia khususnya di RSUP Persahabatan belum ada data proporsi TB paru pada pasien PPOK.Objektif: tujuan penelitian ini adalah mendapatkan angka proporsi TB paru pada pasien PPOK di RSUP Persahabatan Jakarta.Metode: desain penelitian ini adalah potong lintang. Pasien PPOK (belum diobati dengan obat anti tuberkulosis) yang berkunjung di poliklinik Asma/PPOK RSUP Persahabatan yang memenuhi kriteria inklusi dan eksklusi.Subjek diperiksa dahak BTA dan pemeriksaan Xpert MTB/RIF. Saat pasien berkunjung, dilakukan anamnesis gejala, eksaserbasi, riwayat merokok, penggunaan kortikosteroid (oral atau inhalasi), komorbid, skor CAT, penilaian status gizi, spirometri dan foto toraks. Semua data dilakukan analisis dengan uji chisquare.Hasil: subjek terbanyak adalah laki-laki (97,3%) dengan kelompok usia 60-79 tahun (74,3%), dengan komorbid terbanyak penyakit jantung (41,9%), gejala klinis terbanyak batuk berdahak (81,1%). Berdasarkan derajat PPOK terbanyak adalah GOLD 3 (44,6%) dan frekuensi eksaserbasi tersering 0-1 (78,4%) dengan menggunakan steroid sebanyak 59,5%. Pada penelitian ini didapatkan pemeriksaan dahak BTA positif 1,4% dan Xpert MTB/RIF positif 2,7%, artinya pemeriksaan Xpert MTB/RIF mempunyai angka kepositifan lebih tinggi dibanding dahak BTA. Dalam penelitian ini didapatkan proporsi TB paru pada pasien PPOK sebanyak 2,7%.Dalam Penelitian ini tidak terdapat hubungan bermakna secara statistik antara derajat PPOK, status gizi, penggunaan kortikosteroid, status merokok dengan prevalens TB paru pada pasien PPOK (p > 0,05).Pada penelitian ini didapatkan hubungan bermakna pada frekuensi eksaserbasi PPOK, hasil pemeriksaan dahak BTA dan hasil pemeriksaan Xpert MTB/RIF dengan proporsi TB paru (p < 0,05).Kesimpulan: proporsi TB pada pasien PPOK di RSUP Persahabatan Jakarta adalah 2,7%. Terdapat hubungan yang bermakna secara statistik antara frekuensi eksaserbasi PPOK dengan proporsi TB paru pada pasien PPOK (p = 0,0006). Terdapat hubungan yang bermakna secara statistik antara hasil pemeriksaan dahak BTA dan hasil pemeriksaan Xpert MTB/RIF dengan proporsi TB paru pada pasien PPOK dengan nilai p < 0,05 (p = 0,000).

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ABSTRACTChronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality in the world. Some of the risk factors for COPD are also risk factors for tuberculosis (TB). Some studies abroad have found the prevalence of pulmonary tuberculosis in COPD patients were 2.6 - 10%. There are no data on the prevalence of pulmonary tuberculosis patients with COPD in Indonesia, particularly in The Department of Pulmonology PersahabatanHospital, Jakarta. Objective: the purpose of this study is to obtain proportion of pulmonary TB in COPD patients in The Department of Pulmonology Persahabatan Hospital, Jakarta. Methods: this is a cross-sectional study. COPD patients (anti-tuberculosis drugs naive) who visit the Asthma/COPD clinic PersahabatanHospital which meet the inclusion and exclusion criteria. Subjects went through acid-fast bacilli sputum smear and Xpert MTB/RIF examination. On patients visit, symptoms, exacerbations history, history of smoking, use of corticosteroids (oral or inhaled), comorbidities, CAT scores, assessment of nutritional status, spirometry and chest X-ray data had been obtained. All data were analyzed with chi-square test. Results: most subjects were male (97.3%) in the age group 60-79 years (74.3%), with mostly found comorbid was heart disease (41.9%), and mostly found clinical symptoms was productive cough (81.1%). Based on classification of COPD is GOLD 3 (44.6%) and the most exacerbation frequency was 0-1 (78.4%) with 59.5% history of steroid usage. In this study, examination of AFB sputum smear positive 1.4% and the Xpert MTB/RIF positive 2.7%, It shows Xpert MTB/RIF examination has a higher positivity rate than AFB sputum smear. The proportion of pulmonary tuberculosis in patients with COPD was 2.7%. We also found no statistically significant relationship between classification of COPD, nutritional status, use of corticosteroids, smoking status with the proportion of pulmonary tuberculosis in COPD patients (p> 0.05) but we found a significant difference in the exacerbations frequency of COPD, the results of sputum smear examination and the results of Xpert MTB/RIF with proportion of pulmonary TB (p <0.05).Conclusion: the proportion of tuberculosis in patients with COPD in The Department of PulmonologyPersahabatan Hospital Jakarta is 2.7%. There is astatistically significant difference between the frequency of exacerbations of COPD with proportion of pulmonary TB in patients with COPD (p = 0.0006). An association is statistically significant different between the results of sputum smear examination and the results of Xpert MTB/RIF with the proportion of pulmonary tuberculosis in patients with COPD with a value of p <0.05 (p = 0.000)., Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity andmortality in the world. Some of the risk factors for COPD are also risk factors fortuberculosis (TB). Some studies abroad have found the prevalence of pulmonarytuberculosis in COPD patients were 2.6 - 10%. There are no data on the prevalence ofpulmonary tuberculosis patients with COPD in Indonesia, particularly in The Departmentof Pulmonology Persahabatan Hospital, Jakarta. Objective: the purpose of this study is toobtain proportion of pulmonary TB in COPD patients in The Department of PulmonologyPersahabatan Hospital, Jakarta. Methods: this is a cross-sectional study. COPD patients(anti-tuberculosis drugs naive) who visit the Asthma/COPD clinic Persahabatan Hospitalwhich meet the inclusion and exclusion criteria. Subjects went through acid-fast bacillisputum smear and Xpert MTB/RIF examination. On patients visit, symptoms,exacerbations history, history of smoking, use of corticosteroids (oral or inhaled),comorbidities, CAT scores, assessment of nutritional status, spirometry and chest X-raydata had been obtained. All data were analyzed with chi-square test. Results: mostsubjects were male (97.3%) in the age group 60-79 years (74.3%), with mostly foundcomorbid was heart disease (41.9%), and mostly found clinical symptoms was productivecough (81.1%). Based on classification of COPD is GOLD 3 (44.6%) and the mostexacerbation frequency was 0-1 (78.4%) with 59.5% history of steroid usage. In thisstudy, examination of AFB sputum smear positive 1.4% and the Xpert MTB/RIF positive2.7%, It shows Xpert MTB/RIF examination has a higher positivity rate than AFBsputum smear. The proportion of pulmonary tuberculosis in patients with COPD was2.7%. We also found no statistically significant relationship between classification ofCOPD, nutritional status, use of corticosteroids, smoking status with the proportion ofpulmonary tuberculosis in COPD patients (p> 0.05) but we found a significant differencein the exacerbations frequency of COPD, the results of sputum smear examination andthe results of Xpert MTB/RIF with proportion of pulmonary TB (p <0.05). Conclusion:the proportion of tuberculosis in patients with COPD in The Department of PulmonologyPersahabatan Hospital Jakarta is 2.7%. There is a statistically significant differencebetween the frequency of exacerbations of COPD with proportion of pulmonary TB inpatients with COPD (p = 0.0006). An association is statistically significant differentbetween the results of sputum smear examination and the results of Xpert MTB/RIF with the proportion of pulmonary tuberculosis in patients with COPD with a value of p <0.05 (p = 0.000).]"

"Latar Belakang : Merokok masih merupakan masalah kesehatan utama di Indonesia. Merokok menjadi faktor risiko bagi penyakit kanker paru dan PPOK. Hubungan antara kanker paru dan PPOK masih terus dikaji. Komorbiditas PPOK pada kanker paru dapat mempengaruhi proses diagnostik, tatalaksana serta managemen akhir kehidupan pasien kanker paru.Metode : Penelitian ini adalah studi potong lintang analitik yang dilakukan di poliklinik onkologi paru RSUP Persahabatan selama periode Agustus 2018 sampai dengan April 2019 terhadap pasien kanker paru kasus baru yang telah memenuhi kriteria inklusi dan eksklusi.Hasil : terdapat 52 subjek yang diteliti dan didapatkan 76,9% adalah laki-laki dan perokok (71,2%), jenis kanker paru yang paling banyak ditemukan ialah kanker paru karsinoma bukan sel kecil (98,1%), sebagian besar stage 4 (88%) dan tampilan klinis 1 (50%). Prevalens PPOK berdasarkan pemeriksaan spirometri menurut kriteria PNEUMOMOBILE ialah 46,2% dan prevalens emfisema berdasarkan pemeriksaan CT-scan toraks ialah 30,8%.. Subjek kanker paru yang menderita PPOK 91,7% termasuk kedalam obstruksi derajat sedang (GOLD 2) serta memiliki kelainan faal paru campuran obstruksi dan restriksi ( 70,8%). Subjek yang menderita emfisema terbanyak menderita emfisema jenis sentrilobular (43,7%). Terdapat hubungan antara letak lesi sentral terhadap beratnya obstruksi yang diukur melalalui nilai VEP1 pada subjek PPOK dan emfisema.Kesimpulan : PPOK pada kanker paru terutama ditemukan pada laki-laki, perokok serta jenis kanker yang paling banyak diderita ialah adenokarsinoma. Emfisema yang paling banyak diderita ialah jenis sentrilobular yang secara umum banyak didapatkan pada perokok.

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Background: Smoking is one of risk factors in both of lung cancer and chronic obstructive pulmonary disease (COPD). Comorbidity of COPD among lung cancer patients generally influenced outcome of their quality of life, diagnostic procedures, treatments, and end of life managements.

Methods:This analytical cross-sectional study involved newly diagnosed lung cancer cases admitted to the oncology clinics of Persahabatan Hospital Jakarta, Indonesia between August 2018 and April 2019. Patients who met the study criteria were consecutively included. Spirometric evaluation of airway obstruction and COPD was based on PNEUMOBILE and GOLD criteria. Radiological evaluation of emphysema was based on thorax CT-scan.

Results:Subjects were 52 lung cancer patients and most of them were males (76.9%) and smokers (71.2%). Most of them were diagnosed as non-small cell lung cancer (NSCLC) (98.1%), were in end-stage of the disease (88.0%) and were in performance status of 1 (50.0%). The prevalence of COPD and emphysema was 46.2% and 30.8%, respectively. Most of the COPD subjects (91.7%) experienced moderate airway obstruction (GOLD 2), along with mixed obstruction-restriction spirometric results (70.8%). Centrilobular emphysema was common (43.7%) radiological finding in this study. Degree of obstruction by spirometry (VEP1)and detection of central tumor lesion by thorax CT-scan in COPD and emphysema subjects was found to be correlated.

Conclusion:COPD in lung cancer was found in males, smokers, and NSCLC patients. Centrilobular emphysema was commonly found in this study, particularly in smoker sub-group."

"ABSTRAKLatar belakang: Penyakit Paru Obstruksi Kronik (PPOK) merupakan penyebab utama angka kesakitan dan kematian di seluruh dunia termasuk di Indonesia. Hasil Riset Kesehatan Dasar (RISKESDAS) tahun 2013 menunjukkan bahwa prevalens PPOK di Indonesia sebanyak 3,7% dan menduduki peringkat ke-6 dari 10 penyebab kematian di Indonesia. Penelitian ini merupakan studi awal untuk mengetahui prevalens PPOK di RSUP Persahabatan.Metode: Penelitian ini menggunakan desain studi potong lintang dengan metode consecutive sampling pada pasien PPOK yang berkunjung di RSUP Persahabatan Jakarta pada bulan April-September 2018. Diagnosis PPOK dilakukan dengan menggunakan COPD Diagnostic Questionnaire (CDQ) dan pemeriksaan spirometri.Hasil: Subjek penelitian sebanyak 875 subjek. Sampel akan dilakukan penapisan awal menggunakan CDQ dengan skor nilai ≥19,5 sebanyak 332 subjek. Hasil pemeriksaan spirometri pada 332 subjek sebelum pemberian bronkodilator inhalasi menunjukkan bahwa sebanyak 83 subjek (25%) memiliki hasil VEP1/KVP <70% dan 249 subjek (75%) memiliki hasil VEP1/KVP ≥70%. Hasil pemeriksaan spirometri setelah pemberian bronkodilator inhalasi menunjukkan bahwa sebanyak 78 subjek (94%) memiliki hasil VEP1/KVP <70% yang berarti menderita PPOK dan 5 subjek (6%) memiliki hasil VEP1/KVP ≥70% yang berarti tidak menderita PPOK sehingga prevalens PPOK adalah 8,9% dari keseluruhan sampel. Gejala klinis pada pasien PPOK antara lain batuk (43,6%), terdapat dahak (50%), dan sesak (39,7%). Hasil uji statistik menunjukkan bahwa faktor yang berhubungan dengan PPOK dalam penelitian ini adalah umur (nilai-p = 0,040), lama merokok (nilai-p = 0,012), jumlah rokok yang dihisap per hari (nilai-p = 0,000) dan derajat berat merokok (nilai-p = 0,000) sedangkan faktor yang tidak berhubungan adalah jenis kelamin (nilai-p = 0,585) dan indeks massa tubuh (nilai- p = 0,953).Kesimpulan: Prevalens PPOK di rumah sakit Persahabatan Jakarta adalah 8,9%. Gejala klinis pada pasien PPOK antara lain batuk, terdapat dahak dan sesak. Hasil uji statistik menunjukkan bahwa faktor yang berhubungan dengan PPOK dalam penelitian ini adalah umur, lama merokok, jumlah rokok yang dihisap per hari dan derajat berat merokok sedangkan faktor yang tidak berhubungan adalah jenis kelamin dan indeks massa tubuh.

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ABSTRACTBackground: Chronic Obstructive Pulmonary Disease (COPD) is the main cause of morbidity and mortality rates in the world including in Indonesia. The result of Riset Kesehatan Dasar (RISKESDAS) in 2013 showed the prevalence of COPD in Indonesia was 3.7% and was ranked 6th from 10 causes of death in Indonesia. This study is the preliminary study to determine of prevalence of COPD in Persahabatan Hospital.Method: This is a cross sectional study design with consecutive sampling method in COPD patient who visited to the Persahabatan Hospital Jakarta in April- September 2018. COPD diagnosed by using COPD Diagnostic Questionnare (CDQ) and spirometry examination.Result: Study subject were 875 subject. The sample will be screened preliminary by using CDQ whom get score ≥ 19.5 only 332 subject. The results of spirometry tests on 332 subject before inhaled bronchodilators showed that 83 subject (25%) had results VEP1/KVP <70% which meant diagnose COPD and 249 subject (75%) had results VEP1/KVP ≥70% which means not diagnose COPD. The results of spirometry after inhaled bronchodilators showed that as many as 78 subject (94%) had results VEP1/KVP <70% which meant diagnose COPD and 5 subject (6%) had results VEP1/KVP ≥70%, which means not diagnose COPD so that the prevalence of COPD is 8.9% from all the sample. There were some of symptoms of COPD patients reported such as daily coughing (43,6%), coughing with phlegm (50%), and wheezing (39,7%). Statistical test results indicate that factors associated with COPD in this study are age, duration of smoking, number of cigarettes smoked per day and the degree of smoking-free while the unrelated factors are gender and Body Mass Index."

"Latar belakang dan tujuan: Sindrom metabolik merupakan penyakit komorbid yang sering ditemui pada pasien PPOK. Keadaan inflamasi sistemik diperkirakan mempengaruhi keadaan PPOK dan sindrom metabolik. Keterbatasan aktivitas, disfungsi otot rangka, dan penggunaan steroid juga merupakan penyebab penting sindrom metabolik pada PPOK. Sindrom metabolik pada PPOK dapat meningkatkan angka kematian dan kesakitan yang disebabkan oleh penyakit kardiovaskular. Penelitian ini bertujuan untuk mengetahui prevalens sindrom metabolik pada PPOK stabil. Metode : Penelitian ini merupakan penelitian potong lintang yang dilakukan di poliklinik asma ndash; PPOK Rumah sakit umum pusat Persahabatan pada bulan Mei - November 2017 untuk melihat kejadian sindrom metabolik pada pasien PPOK. Enam puluh empat pasien PPOK di ambil untuk ikut dalam penelitian ini secara consecutive sampling. Pada semua pasien dilakukan wawancara, pemeriksaan antopometri, pemeriksaan fisis dan pemeriksaan laboratorium. Hasil : Sebanyak 64 pasien ikut serta dalam penelitian ini dengan subjek terbanyak laki-laki 95,3 . Usia rerata subjek adalah 65,81 9,38. Prevalens sindrom metabolik pada pasien PPOK sebesar 15,6 dengan GOLD 1 sebesar 20 , GOLD 2 sebesar 30 , GOLD 3 sebesar 40 dan GOLD 4 sebesar 10 . Ditemukan hubungan bermakna antara status gizi dengan kejadian sindrom metabolik pada PPOK stabil. Tidak ditemukan hubungan bermakna antara jenis kelamin, usia, status merokok, hambatan aliran udara dan penggunaan kortikosteroid inhalasi dengan kejadian sindrom metabolik pada pasien PPOK stabil. Kesimpulan : Prevalens sindrom metabolik pada pasien PPOK dalam penelitian ini adalah sebesar 15,6 terutama ditemukan pada GOLD 3.

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Background: Metabolic syndrome is a common comorbid disease in COPD patients. Systemic inflammatory conditions can affect the condition of COPD and metabolic syndrome. Activity limitations, skeletal muscle dysfunction, and steroid use are also important causes of metabolic syndrome in COPD. The metabolic syndrome in COPD can increase mortality and morbidity caused by cardiovascular disease. The aim of this study is to reveal the prevalence of metabolic syndrome in stable COPD patients. Methods: This study is a cross sectional study among stable COPD who visit asthma - PPOK clinic in Persahabatan Hospital from May to November 2017 to get the incidence rate of metabolic syndrome in stable COPD patients. Sixty-four COPD patients were taken to participate in the study on a consecutive sampling basis. All patients were interviewed, antropometric, physical and laboratory examination were done. Results: A total of 64 patients participated in this study Males = 61, Female = 3 with mean age of the subjects was 65.81 9.38. Prevalence of metabolic syndrome in COPD patients was 15.6 with GOLD 1 by 20 , GOLD 2 by 30 , GOLD 3 by 40 and GOLD 4 by 10 . There was a significant association between nutritional status and the incidence of metabolic syndrome in stable COPD. There was no significant association between sex, age, smoking status, airflow resistance and the use of inhaled corticosteroid with the incidence of metabolic syndrome in stable COPD patients. Conclusion: The prevalence of metabolic syndrome in COPD patients in this study is 15.6 especially in GOLD 3."

"ABSTRAKLatar belakang: Penyakit paru obstruktif kronik merupakan penyebab utama morbiditas dan mortalitas di dunia. Penyakit komorbid pada PPOK berkontribusi terhadap rendahnya status kesehatan, mempengaruhi lama perawatan bahkan kematian. Osteoporosis merupakan komorbid yang cukup sering ditemukan pada PPOK. Di Indonesia khususnya di RSUP Persahabatan belum ada data prevalens osteoporosis pasien PPOK stabil.Objektif: Tujuan penelitian ini adalah mendapatkan angka prevalens osteoporosis pada pasien PPOK stabil di RSUP Persahabatan Jakarta.Metode: Disain penelitian ini adalah potong lintang. Pasien PPOK stabil yang berkunjung di poliklinik Asma/PPOK RSUP Persahabatan yang memenuhi kriteria inklusi dan eksklusi. Subjek diperiksa densitas mineral tulang menggunakan dual energy x-ray absorptiometry (DXA) dan diperiksa kadar vitamin D darah. Saat pasien berkunjung, dilakukan anamnesis gejala, eksaserbasi, riwayat merokok, penggunaan kortikosteroid (oral atau inhalasi), komorbid, penilaian status gizi. Selanjutnya dilakukan analisis dengan uji statistik.Hasil: Subjek terbanyak adalah laki-laki (90,6%) dengan kelompok usia 65-75 tahun (53,1%), riwayat merokok terbanyak (84,4%). Berdasarkan derajat PPOK terbanyak adalah GOLD II (46,9%) dan grup B (50%) dengan menggunakan kortikosteroid sebanyak (65,7%). Pada penelitian ini didapatkan prevalens osteoporosis sebesar 37,5%, artinya lebih dari sepertiga pasien mengalami osteoporosis. Dalam Penelitian ini tidak terdapat hubungan bermakna secara statistik antara grup PPOK, derajat PPOK, jenis kelamin, riwayat merokok, riwayat kortikosteroid, usia, kadar 25-OHD, faal paru dengan terjadinya osteoporosis pada pasien PPOK stabil (p>0,05). Pada penelitian ini didapatkan hubungan bermakna pada IMT yang rendah sebagai faktor risiko osteoporosis pada PPOK stabil (p<0,001).Kesimpulan: Prevalens osteoporosis pada pasien PPOK stabil di RSUP Persahabatan Jakarta adalah 37,5%. Terdapat hubungan yang bermakna secara statistik antara IMT dengan osteoporosis pada pasien PPOK stabil (p<0,001).

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ABSTRACT

Background: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality in the world. Comorbid diseases in COPD contributing to low health status, affecting the duration of treatment and even death. Osteoporosis is a quite often comorbid that found in COPD. In Indonesia, particularly in Persahabatan Hospital there are no data of prevalence on osteoporosis in patient with stable COPD.

Objective: The purpose of this research is to get the prevalence?s data of osteoporosis in patients with stable COPD at Persahabatan Hospital-Jakarta.

Method: The studie?s design was cross-sectional. Patients with stable COPD who came to the Asthma/COPD policlinic at Persahabatan Hospital-Jakarta who meet the criteria of inclusion and exclusion. Subjects had an examined of bone mineral density using dual energy x-ray absorptiometry (DXA) and had an examined of vitamin D blood level. At the time of visit, conducted anamnesis of symptoms, exacerbations, history of smoking, used of corticosteroid (oral or inhaled), comorbid, assessment of nutritional status. Then we did statistical test for analysis.

Results: Subjects were dominated with male (90.6%) in the age group 65-75 years old (53.1%), and smoking history (84.4%). The most degree of COPD of the subject were GOLD II (46.9%) and group B (50%) that using corticosteroid (65.7%). In this study we found prevalence of osteoporosis was 37.5%, meaning that approximately more than one third of the patients have had osteoporosis. There were no statistically significant relationship between COPD group, the degree of COPD, sex, smoking history, history of corticosteroid, age, levels of 25-OHD, pulmonary function with the occurrence of osteoporosis in patients with stable COPD (p>0.05). We found a significant relationship on low BMI as a risk factor for osteoporosis in stable COPD (p<0.001).

Conclusion: The prevalence of osteoporosis in patients with stable COPD in Persahabatan Hospital-Jakarta is 37.5%. There are a statistically significant relationship between BMI with osteoporosis in patients with stable COPD (p <0.001)."

"Latar belakang: Inflamasi pada Penyakit Paru Obstruktif Kronik (PPOK) dominan disebabkan oleh neutrofil namun inflamasi dikarenakan eosinofil juga dapat terjadi pada PPOK. PPOK eosinofilik jika ditemukan eosinofil di sputum ≥3%. Peningkatan eosinofil dapat dideteksi di darah dan sputum. Metode: penelitian ini menggunakan potong lintang dengan menggunakan data primer di poli asma dan PPOK RS Rujukan Respirasi Nasional dari Juni 2019 sampai September 2019. Pemilihan subjek dilakukkan secara consecutive sampling dan dilakukan wawancara, pemeriksaan uji faal paru, pemeriksaan sputum dan darah eosinofil.Hasil: total 74 sampel yang datang ke poli asma dan PPOK RS Rujukan Respirasi Nasional Persahabatan terdapat 7 sampel sputum yang tidak terdapat leukosit dan hanya epitel sehingga didapatkan 67 sampel yang dianalisis (61 laki-laki dan 6 perempuan). Pasien dalam penelitian ini memiliki  rata-rata  usia 66,7±8,6 tahun. Pasien didominasi oleh pasien perokok dan bekas perokok sebesar 62 pasien (92,5%). Indeks Brinkman terbanyak adalah IB sedang dan berat sebanyak 48 pasien (71,6%). Derajat hambatan aliran jalan napas paling banyak pada GOLD III dan IV (68,7%). Median eosinofil darah pasien pada penelitian ini sebesar 280 sel/μL dengan rentang 0-1300 dan median eosinofil sputum 4% dengan rentang 0-47. Korelasi darah dan sputum pada penelitian ini sebesar 0,43 Kesimpulan: penelitian ini menggambarkan korelasi positif dengan kekuatan lemah antara eosinofil darah dan sputum pada pasien PPOK stabil

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Background: Dominant Chronic Obstructive Pulmonary Disease (COPD) inflamation is neutrofil but eosinofilic inflammation for COPD can be occurred. Eosinopilic COPD is defined by increament of eosinophils in sputum ≥3%. Increament of eoshinophils can be shown in blood and sputum

Method: this study use cross sectional method from primary data at asma and PPOK clinic in National Referal Rspuratory Persahabatan Hospital. Subject were taken to participate in study in consecutive sampling basis and all patients were interviewed, lung function test and blood and sputum eoshinophils

Results: Total 74 patient have been recruited who came to asma and PPOK klinik in National Referal Respiratory Persahabatan Hospital. Seven sputum sample is not have the leukocyt but ephitel only. Total patients are 67 (61 male dan 6 female). The mean of age from this study is 66,7±8,6 years old. Most of pasien is smokers and former smoker about 62 patients (92,5%). Brinkman index from this study dominating moderate and severe about 48 patients (71,6%). Airflow limitations from this study are GOLD III and IV (68,7%). Median of blood eoshinophils of this study is 280 cells/μL (0-1300). Median of sputum eoshinophils in this study is 4% (0-47). Correlations of blood and sputum eoshinophils from this study is 0,43

Conclusion: this study shown positive correlations with weak power between blood and sputum eoshinophils."

"Latar Belakang: Komorbiditas depresi pada PPOK dapat memengaruhi kepatuhan pengobatan, hospitalisasi dan kualitas hidup. Salah satu target tatalaksana PPOK adalah meningkatkan kualitas hidup penderitanya. Pasien PPOK dengan gangguan depresi memiliki kualitas hidup yang buruk dibandingkan pasien PPOK tanpa gangguan depresi. Untuk itu perlu diketahui perbedaan rerata skor kualitas hidup pasien PPOK dengan gangguan depresi dan pasien PPOK tanpa gangguan depresi. Metode: Penelitian potong lintang deskriptif-analitik pada 40 pasien PPOK dengan gangguan depresi dan 40 pasien PPOK tanpa gangguan depresi di klinik Asma/PPOK RSUP Persahabatan menggunakan Mini-International Neuropsychiatric Interview International Classification Of Diseases (MINI ICD 10) dan instrumen World Health Organization Quality Of Life (WHOQOL)-BREF. Hasil: Terdapat perbedaan median skor kualitas hidup pada pasien PPOK dengan gangguan depresi dan pasien PPOK tanpa gangguan depresi berdasarkan domain kesehatan fisik (p = 0,005), domain relasi sosial (p < 0,001) dan domain lingkungan (p = 0,005). Tidak terdapat perbedaan median skor kualitas hidup berdasarkan domain kesehatan psikologis ( p = 0,421) namun rerata skor domain kesehatan psikologis pasien dengan PPOK lebih rendah dibanding pasien tanpa gangguan depresi. Simpulan: Pasien PPOK dengan gangguan depresi cenderung memiliki rerata skor kualitas hidup yang lebih rendah pada domain kesehatan fisik, kesehatan psikologis, relasi sosial, dan lingkungan dibandingkan pasien PPOK tanpa gangguan depresi.

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Background: Comorbid depression in COPD affects patient’s medical adherence, hospitalization and quality of life. One of the COPD management is improving the patient’s quality of life. COPD patients who have depression disorder have lower quality of life scores compared to COPD patients who do not have depression disorder. We investigated the difference quality of life scores in COPD patients who have depression disorder and COPD patients who do not have depression disorder.

Methods: The study was cross-sectional descriptive-analytic in 40 COPD patients who have depression disorder and 40 COPD patients who do not have a depression disorder in the Asthma and COPD Clinic RSUP Persahabatan using the Mini-International Neuropsychiatric Interview International Classification Of Diseases (MINI ICD 10) and World Health Organization Quality Of Life (WHOQOL)-BREF.

Results: There is a score difference between COPD patients who have depression disorder and COPD patients who do not have depression disorder based on physical health domain (p = 0.005), social relationship domain (p < 0.001) and environment domain (p = 0.005). There is no score difference between COPD patients who have depression disorder and COPD patients based on psychological domain (p = 0,421). COPD patients who have depression disorder have lower mean score compared to COPD patients who do not have depression based on psychological domain.

Conclusion: COPD patients who have depression disorder tend to score lower quality of life in the domains of physical health, psychological health, social relationships, and environment than COPD patients who do not have depression disorder."