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Abstrak :
Parameter yang menilai derajat asma dan asma kontrol saling tumpang tindih secara bermakna. Walaupun terjadi korelasi antar parameter namun tidak ada satu komponen tunggal yang dapat secara akurat mengklasifikasikan setiap individu penyandang asma. Beberapa alat ukur berupa kuesioner yang telah divalidasi, seperti Asthma Control Test ( ACT ), Asthma Control Scoring System ( ACS ) dan Asthma Control Questionnaire (ACQ ) telah dipublikasi saat ini, namun belum dilakukan perbandingan antar kuesioner tersebut. Asthma Control Test adalah suatu kuesioner yang berisi 5 pertanyaan dan dapat diisi sendiri oleh penyandang asma. Lima pertanyaan tadi mencakup frekuensi gejala, pembatasan aktiviti, penggunaan obat pelega, dan persepsi sendiri mengenai kontrol asma. Asthma Control Scoring System adalah suatu kuesioner yang sifatnya kuantitatif dan berisi 3 parameter yaitu gejala klinis, fungsi paru ( VEP1 ) dan persen eosinofil pada sputum induksi. Khusus parameter eosinofil disebut sebagai parameter opsi pada kuesioner ini. Kantrol asma dihitung berdasarkan skor 0-100% untuk tiap pertanyaan. Tujuan penelitian adalah untuk menilai hubungan antara ACT dan ACS pada penderita asma persisten baik sebelum dan sesudah pemberian kortikosteroid inhalasi. Disain penelitian yang digunakan adalah kohort dan pengumpulan sampel dilakukan secara quota di poli paru RSUD Dr Moewardi, Surakarta. Jumlah sampel yang diteliti sebesar 32 orang yang seluruhnya tergolong dalam asma persisten. Janis kelamin laki-laki sebanyak 11 orang (34%) dan perempuan 21 orang (66% ). Sampel yang termasuk derajat asma persisten ringan sebesar 17 orang ( 53% ), asma persisten sedang 14 orang ( 44%) dan asma persisten berat 1 orang (3% ). Tidak ada korelasi antara skor ACS dengan skor kategori ACT sebelum pemberian kortikosteroid inhalasi dengan koefisien kesepakatan (x) : 0, 06, p : 0, 86. Sebaliknya, korelasi antara skor ACS dengan skor kategori ACT sesudah pemberian kortikosteroid inhalasi menunjukkan korelasi sedang yang bermakna (K: 0,56; p : 0,001 ). Perbedaan rata-rata skor ACT balk sebelum dan sesudah pemberian kortikosteroid inhalasi adalah bermakna ( p : 0,001 ), sedangkan hasil yang sama juga diperlihatkan pada perbedaan rata-rata skor ACS baik sebelum dan sesudah pemberian kortikosteroid inhalasi ( p : 0,001 ). Cut off point ACS sesudah pemberian kortikosteroid inhalasi sebesar 60%. Kesimpulan : Hasil menunjukkan bahwa terdapat korelasi sedang dan bermakna pada penilaian skor ACS dan skor ACT sesudah pemberian kortikosteroid inhalasi pada cut off point ACS sebesar 60%.

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The individual parameters to define asthma severity and asthma control overlap significantly. Although correlation exists between the various parameters, no single component can accurately classify the entire individual. Validated measures, such as ACT, ACS, ACQ, for assessing asthma control are now available, but no comparison between the existing measures has been performed. Asthma Control Test is a five item self administered survey, scored from 0-5 points and only assessed asthma control from symptom frequency, activity limitation, rescue medication and self-perception of control. Asthma Control Scoring System is a quantitative measure of asthma control incorporating 3 parameters (respiratory symptoms, FEV, and percentage eosinophit in induced sputum as an option parameter). Asthma score is quantified based on 0-100% for each component. The purposes of this study were to assess the correlation between ACT and ACS in persistent asthmatic patients either before of after inhaled corticosteroid (ICS) treatment. The study design was cohort study and the sample was collected by quota sampling. A total of 32 patients (male 11 persons (34%) and female 21 persons (66%)) which was diagnosed as persistent asthma fulfilled the criteria of this study. Samples were categorized as mild persistent asthma (53%), moderate persistent asthma (44%) and severe persistent asthma (3%). The correlation of ACS score based on ACT category score before ICS showed no agreement (agreement coefficient (K: 0,06) ; p : 0,86 ). In contrary, the correlation of ACS score based on ACT category score after ICS showed significantly moderate agreement ( K : 0,56 ; p : 0,001 ). The mean difference of ACT score before and after treatment showed significant level (p: 0,001). Likewise, the mean difference of ACS score before and after treatment showed significant level (p: 0,001). Cut off point of ACS score after inhaled corticosteroid was 60%. Conclusion: The result showed that there was a moderate correlation statistically significant agreement between ACS and ACT assessment when ACS score of 60% was used as the cut off point.

Abstrak :
Latar belakang: Tungau debu rumah TDR merupakan alergen hirup yang penting pada asma alergik. Namun, penelitian diagnostik molekuler menggunakan Imunoglobulin E IgE spesifik akibat sensitisasi alergen TDR dihubungkan dengan derajat keparahan asma alergik belum pernah dilakukan di Indonesia. Tujuan: Mengetahui perbedaan kadar IgE spesifik serum kuantitatif akibat sensitisasi alergen Dermatophagoides D. pteronyssinus, D. farinae dan Blomia B. tropicalis pada asma alergik intermiten dan persisten. Metode: Desain penelitian potong lintang pada pasien asma alergik dewasa yang diundang untuk pemeriksaan IgE spesifik serum dan merupakan bagian dari penelitian payung di Divisi Alergi dan Imunologi Klinik, RS Cipto Mangunkusumo. Derajat keparahan asma ditentukan berdasarkan kriteria Global Initiative on Asthma GINA 2015 dan dikelompokkan menjadi intermiten dan persisten. Pemeriksaan IgE spesifik serum kuantitatif menggunakan metode multiple allergosorbent test Polycheck Allergy, Biocheck GmbH, Munster, Germany . Alergen TDR yang diperiksa adalah D. pteronyssinus, D. farinae, dan B. tropicalis. Perbedaan antara dua kelompok dianalisis dengan uji Mann-Whitney. Hasil: Sebanyak 87 subyek dilibatkan dalam penelitian ini; 69 79,3 subyek adalah perempuan. Rerata usia pasien adalah 40,2 tahun. Enam puluh tiga 72,4 pasien menderita asma dan rinitis alergik. Sebanyak 58 66,7 pasien asma persisten. Gambaran sensitisasi alergen TDR adalah 62,1 D. farinae; 51,7 D. pteronyssinus dan 48,3 B.tropicalis. Median kadar IgE spesifik secara bermakna lebih tinggi pada asma persisten dibandingkan asma intermiten untuk alergen D. farinae 1,30 vs. 0,0 kU/L; p=0,024 dan B. tropicalis 0,57 vs. 0,0 kU/L; p=0,015 . Kadar IgE spesifik D. pteronyssinus lebih tinggi pada asma persisten dibandingkan intermiten 0,67 vs. 0,00 kU/L; p=0,066. Kesimpulan:Gambaran sensitisasi alergen secara berurutan didapatkan D. farinae 62,1, D. pteronyssinus 51,7 dan B. tropicalis 48,3 . Kadar IgE spesifik akibat sensitisasi D. farinae dan B. tropicalis lebih tinggi secara bermakna pada pasien asma persisten dibandingkan asma intermiten. Kadar IgE spesifik akibat sensitisasi D. pteronyssinus lebih tinggi pada pasien asma persisten dibandingkan asma intermiten, tetapi secara statistik tidak bermakna.

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Introduction House dust mites HDM are an important inhalant allergen in allergic asthma. However, molecular diagnostic study using specific IgE level induced by HDM allergens associated with asthma severity has not been done in Indonesia. Objective To investigate the difference of serum quantitative specific IgE levels induced by Dermatophagoides D. pteronyssinus, D. farinae and Blomia B. tropicalis sensitization in intermittent and persistent allergic asthma. Method This was a cross sectional study on adult allergic asthma patients who were invited for serum specific IgE testing. This study was a part of a larger research within the Division of Allergy and Immunology, Cipto Mangunkusumo Hospital. Asthma severity was defined based on Global Initiative on Asthma GINA 2015 criteria and were grouped as intermittent or persistent. Quantitative specific IgE testing was done on blood serum using a multiple allergosorbent test Polycheck Allergy, Biocheck GmbH, Munster, Germany . The HDM allergens tested were D. pteronyssinus, D. farinae, and Blomia tropicalis. Difference between two groups were analyze using Mann Whitney test. Results A total of 87 subjects were enrolled in this study 69 79.3 were women. Mean patients rsquo age was 40, 2 years. Sixty three 72.4 patients had asthma and allergic rhinitis. Fifty eight 66.7 patients were classified as persistent asthma. The prevalence of sensitization was 62.1 D. farinae, 51.7 D. pteronyssinus, and 48.3 Blomia tropicalis. The median of specific IgE levels is significantly higher in persistent asthma compares to intermittent asthma induced by D. farinae median 1.30 vs. 0.0 kU L p 0.024 and B. tropicalis median 0.57 vs. 0.0 kU L p 0.015 sensitization. Level of Specific IgE D. pteronyssinus is also to be higher in persistent asthma than the level measured in intermittent asthma 0.67 vs. 0.00 kU L p 0.066. Conclusion Sensitization of HDM allergens is shown to be highest for D. farinae 62.1 , followed by D. pteronyssinus 51, 7 and Blomia tropicalis 48, 3 . Specific IgE level induced by D. farinae and Blomia tropicalis sensitization are significantly higher in patients with persistent compares to intermittent asthma, whereas specific IgE level induced by D. pteronyssinus sensitization to be higher in persistent asthma although not statistically significant.