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Latar belakang : Efek potensial EGFR-TKI terhadap fungsi paru belum diinvestigasi secara mendalam. Penelitian ini bertujuan untuk menilai efek pemberian EGFR TKI terhadap fungsi paru terutama nilai DLCO. Metode : Penelitian berlangsung secara prospektif dari September 2018 hingga Juni 2019 di Rumah Sakit Persahabatan Jakarta. Terdapat 20 subjek adenokarsinoma paru dengan mutasi tunggal di exon 19/21 yang dapat menyelesaikan pemeriksaan DLCO baik sebelum mendapat EGFR TKI dan setelah tiga bulan terapi. Hasil : Penelitian ini mendapatkan peningkatan bermakna nilai rerata KVP prediksi dari 60,6% menjadi 68,25% (p=0,03), nilai rerata VEP1 Prediksi dari 59,7% menjadi 67,05% (p=0,036), nilai rerata DLCO dari 11,55 ml/menit/mmHg menjadi 13,72 ml/menit/mmHg (p=0,004) dan DLCO prediksi dari 53,4% menjadi 63,85% (p=0,03). Peningkatan nilai rerata DLCO prediksi paling besar pada kelompok dengan hasil RECIST partial response yaitu sebesar 16,43% (p=0,056). Kesimpulan : Terapi EGFR TKI selama tiga bulan pada subyek adenokarsinoma paru dengan mutasi tunggal exon19/21 dapat meningkatkan fungsi paru secara bermakna baik nilai KVP prediksi, VEP1 prediksi, DLCO, dan DLCO prediksi.

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Background : The epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are drugs of choice in non-small cell lung cancer possessing EGFR mutation. Its effect on the lung function is not well understood. This study aims to assess lung function using the lung diffusion capacity (DLCO) test in lung cancer patients treated with EGFR-TKIs. ming Method : This prospective study included lung cancer patients treated with EGFR-TKIs at Persahabatan Hospital Jakarta, Indonesia, between September 2018 andGrowt June 2019. The study recruited 20 lung adenocarcinoma patients presented with a single mutation at exon 19 or 21 as subjects in the process. Their DLCO was examined before and three months after receiving EGFR-TKI. Subjects were grouped according to the Response Evaluation Criteria in Solid Tumors (RECIST) assessment. Results: There was an increase in predicted FVC from 60.60% to 68.25% (p=0.03), predicted FEV1 from 59.7% to 67.05% (p=0.036%), DLCO from 11.5 mL/minute/mmHg to 13.72 mL/minute/mmHg (p=0.004), and predicted DLCO from 53.4% to 63.85% (p=0.03) during the therapy. The largest increase of predicted DLCO was shown in RECIST group of partial response (16.43%, p=0.056) Conclusion: This study found an improvement in lung function (predicted FVC, predicted FEV1, DLCO, and predicted DLCO) among lung adenocarcinoma subjects exhibiting single mutation at exon 19 or 21 after three months of EGFR-TKIs treatment.

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Latar Belakang: Gagal ginjal terminal dapat mempengaruhi seluruh sistem dalam tubuh, termasuk sistem respirasi. Penelitian ini bertujuan mengetahui kapasitas difusi paru terhadap karbon monoksida DLCO pada pasien hemodialisis kronik dan menghubungkannya dengan berbagai faktor demografis dan klinis serta spirometri. Metode: Studi potong lintang ini dilakukan pada pasien hemodialisis kronik berusia ge;18 tahun, stabil dalam 4 minggu terakhir, tidak memiliki riwayat penyakit paru dan jantung sebelumnya. Spirometri dan pemeriksaan DLCO dilakukan dalam kurun waktu 24 jam setelah hemodialisis.Hasil: Terdapat 40 subjek yang sebagian besar adalah laki-laki 67,5 , median usia 51 tahun dan bukan perokok 55 . Rerata indeks massa tubuh IMT 22,6 3,9 kg/m2, Hb 9,5 1,3 g/dl, median dialysis adequacy 1,62 dan durasi hemodialisis 31,5 bulan. Penyebab terbanyak gagal ginjal terminal adalah hipertensi 62,5 . Sesak napas dialami oleh 20 subjek. Prevalens penurunan DLCO adalah 52,5 dengan derajat ringan-sedang. Sebanyak 47,5 subjek mengalami restriksi dan 5 mengalami obstruksi pada pemeriksaan spirometri. Terdapat hubungan antara riwayat merokok dan penurunan DLCO dengan odds ratio 4,52 95 IK 1,04 ndash; 19,6 serta antara gangguan restriksi dan penurunan DLCO dengan odds ratio 5,58 95 IK 1,29 ndash; 23,8 . Diperkirakan terdapat gangguan parenkim paru yang menyebabkan restriksi dan menghambat difusi.Kesimpulan: Penurunan kapasitas difusi paru pada pasien hemodialisis kronik cukup sering terjadi meskipun tidak selalu disertai keluhan sesak napas. Faktor risiko penurunan DLCO adalah riwayat merokok dan gangguan restriksi pada spirometri.Kata Kunci: DLCO, hemodialisis, kapasitas difusi paru

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ABSTRACT
Background End stage renal disease affects all systems in human including respiratory system. This study aimed to discover the lung diffusion capacity of carbon monoxide DLCO in chronic hemodialysis patients and to discover its relation to several demographic and clinical factors, as well as spirometry parameters.Method This was a cross sectional study among chronic hemodialysis patients aged ge 18 years old, clinically stable in the last 4 weeks without prior history of lung and cardiac disorder. Spirometry and DLCO examination were performed in the span of 24 hours after hemodialysis.Results There were 40 subjects analyzed. Majority of them were male 67.5 , median age 51 years old and non smoker 55 . Mean Body Mass Index BMI 22.6 3.9 kg m2, Hb 9.5 1.3 g dl, median dialysis adequacy 1.62 and hemodialysis duration of 31.5 months. Hypertension was the most common underlying disease. Some 20 of subject had varying degrees of dyspnea. Prevalence of DLCO reduction was 52.5 with mild to moderate degree. Restrictive spirometry pattern was evident in 47.5 and obstructive pattern in 5 of subjects. There was a significant relation between DLCO reduction with smoking history OR 4.52 95 CI 1.04 ndash 19,6 , also with restrictive disorder OR 5.5 95 CI 1.29 ndash 23.8 . Reduction of DLCO in restrictive subjects was related to the diminished alveolar volume VA . This VA reduction was not compensated by the increase of KCO, therefore we suspect a lung parenchymal disorder that inhibit diffusion. There was no correlation between DLCO reduction with gender, age, BMI, dialysis adequacy, hemodialysis duration, underlying disease and MMRC score. Conclusion Reduction of lung diffusion capacity in chronic dialysis patients is common although not accompanied with dyspnea. Risk factors for DLCO reduction are smoking history and restrictive disorder in spirometry.

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Latar belakang : Airway remodelling pada asma juga melibatkan saluran napas perifer dan diduga dapat mempengaruhi alveoli hingga menyebabkan kelainan di parenkim paru Penelitian ini mencoba menemukan kelainan parenkim paru pada pasien asma melalui pemeriksaan kapasitas difusi dengan DLCO metode napas tunggal. Metode :.Penelitian potong lintang dengan membagi asma berdasarkan derajat keparahannya dalam dua kelompok besar yaitu asma ringan (intermiten dan persisten ringan) dan berat (persisten sedang dan berat). Terdapat 60 subjek yang diambil secara konsekutif dari pasien asma stabil tanpa komorbid dan berobat di Poli Asma- PPOK RSUP Persahabatan dari Bulan Desember 2015-Mei 2016. Hasil : Nilai rerata DLCO/prediksi pada kelompok asma ringan yaitu 92,74±15,70% dan menurun pada kelompok asma berat yaitu 78,41±14,21%. Beberapa nilai spirometri menunjukkan hubungan positif bermakna dengan nilai DLCO/prediksi yaitu : KVP/prediksi, VEP1/prediksi dan FEF25-75%/prediksi dengan nilai p <0,05. Analisis korelasi menunjukkan KVP/prediksi secara nyata dapat mempengaruhi kapasitas difusi pasien asma. Terdapat hubungan bermakna antara kelainan fungsi paru (p 0,004) dan derajat keparahan asma (p 0,000) dengan penurunan nilai DLCO/prediksi (DLCO/prediksi ≤ 75%). Kesimpulan :.Derajat keparahan asma memiliki hubungan dengan kapasitas difusi paru, semakin berat derajat keparahannya maka semakin menurun kapasitas difusi paru. Penurunan kapasitas difusi menunjukkan bahwa kelainan pada asma tidak hanya terjadi di saluran napas tapi juga mungkin melibatkan parenkim paru.

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ABSTRACT
Background: Airway remodelling in asthma which is involved small airway is thought can affect until alveoli and cause abnormalities in the lung parenchyma This study tries to find lung parenchymal abnormalities in patients with asthma through the examination diffusion capacity with a single breath DLCO method . Methods : A cross-sectional study by dividing asthma based on the degree of severity into two major groups, namely mild asthma ( intermittent and mild persistent ) and severe ( persistent moderate and severe ). The amount of each group is 30 subjects , which is taken consecutively from stable asthma patients without comorbid who is seeking treatment Persahabatan Hospital at December 2015 - May 2016 Results : The average value of DLCO /predictions in mild asthma group is 92,74 ± 15,70% and decreased in the severe asthma group is 77,45 ± 16,78%. Some spirometry values showed significant positive correlation with the value of DLCO /prediction , namely : KVP /prediction , VEP1 /prediction and FEF25-75 % / prediction with p < 0.05 . Corellation analysis showed KVP / prediction could dramatically affect the diffusion capacity of asthmatic patients . There is a significant relationship between abnormalities in lung function ( p 0,004) and severity of asthma ( p 0.000 ) with a corresponding decrease DLCO / prediction (DLCO / prediction ≤ 75 % ) Conclusion : The severity of asthma has a relationship with the diffusion capacity of the lungs, increased severity will decrease the diffusion capacity in asthma patient. Decreasing diffusion capacity showed that abnormalities in asthma not only occur in the respiratory tract but also in the lung parenchyma;

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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, 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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ABSTRACT
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.

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Latar belakang : Penelitian ini merupakan studi awal untuk mengukur kapasitas difusi paru DLCO-SB ipada pasien PPOK di RSUP Persahabatan Jakarta untuk mengetahui prevalens penurunan nilai DLCO pada pasien PPOK. Metode : Penelitian ini menggunakan desain studi potong lintang (cross sectional study) pada pasien PPOK yang berkunjung di Poliklinik Asma-PPOK RSUP Persahabatan Jakarta. Dilakukan uji spirometri dan DLCO pada pasien PPOK yang diambil secara konsekutif antara bulan Mei-Juli 2015. Komorbiditas juga dicatat. Hasil : Uji Spirometri and DLCO dilakukan pada 65 subjek didapatkan 7 subjek (10,8%) termasuk kedalam PPOK Grup A, 19 subjek (29,2%) PPOK Grup B, 21 subjek (32,3%) PPOK grup C dan 18 subjek (27,7%) PPOK grup D. rerata usia 64,15 (45-89) tahun;rerata VEP 1 % 46,05%, rerata nilai DLCO 19,42 ml/menit/mmHg dan rerata DLCO % adalah 72.00%. prevalens penurunan DLCO pasien PPOK adalah 56,92% (37/65 subjek) sedangkan 28 subjek dengan nilai DLCO normal. Ditemukan 15 subjek (23,07%) dengan penurunan ringan, 18 subjek (27.69%) penurunan sedang dan 4 subjek (6,15%) dengan penurunan berat. Ditemukan 47 subjek (72,3%) memiliki komorbid. Terdapat hubungan bermakna antara grup PPOK, derajat spirometri, VEP 1 , IMT dan komorbiditas dengan nilai hasil uji DLCO. Tidak terdapat hubungan bermakna antara nilai DLCO dengan jenis kelamin, umur, riwayat merokok, Indeks Brinkmann, obstruksi-restriksi dan lama terdiagnosis PPOK. Kesimpulan : Proporsi penurunan nilai DLCO pada pasien PPOK adalah 56,92%. Terdapat hubungan bermakna antara grup PPOK, derajat spirometri, VEP 1 , IMT dan riwayat TB dengan nilai hasil uji DLCO. Tidak terdapat hubungan bermakna antara nilai DLCO dengan jenis kelamin, umur, riwayat merokok, Indeks Brinkmann, obstruksi-restriksi, komorbid dan lama terdiagnosis PPOK.ABSTRACT
Background and the aim of study : This is a preliminary study to measure DLCO-SB in COPD patients in Persahabatan Hospital. The aim of the study is to know the magnitude of disturbance in diffusing capacity of the lung in COPD patients. Methods : This was a cross sectional study in which COPD patients attending COPD-Asthma clinic in Persahabatan Hospital Jakarta were performed spirometry and DLCO-SB consecutively between May 2015?July 2015. Comorbidities conditions were also recorded. Results : Spirometry and DLCO-SB measurement were conducted on 65 COPD subjects of which 7 subjects (10.8%) were COPD Group A, 19 subjects (29.2%) were Group B, 21 subjects (32.3%) were COPD group C and 18 subjects (27.7%) were COPD group D. The mean age was 64.15 (45-89); mean FEV 1 % was 46.05%, mean DLCO measured was 19.42 ml/min/mmHg and the mean DLCO% was 72.00%. The prevalence of decreasing in diffusing capacity of the lung in COPD patients was 56.92% (37 subjects) While 28 subjects were normal. There were 15 subjects (23.07%) with mild decrease in DLCO, 18 subjects (27.69%) were moderate decrease and 4 subjects (6.15%) with severe decrease. 47 subjects (72.3%) had comorbid conditions. There was significant correlation between grup COPD, GOLD COPD grade, VEP 1 , BMI and comorbidities with magnitude of decreasing DLCO value. There was no correlation between DLCO value with sex, smoking history, Brinkmann index, age, obstruction-mix criteria, length of COPD period. Conclusion : The proportion of decreasing in DLCO in COPD patients are 56.92%. There is significant correlation among the group of COPD, GOLD COPD grade, VEP 1 , BMI and previous TB history with magnitude of decreasing DLCO value. There is no correlation between DLCO value with sex, smoking history, brinkmann index, age, obstruction-mix criteria, comorbidities and length of COPD period. ;Background and the aim of study : This is a preliminary study to measure DLCO-SB in COPD patients in Persahabatan Hospital. The aim of the study is to know the magnitude of disturbance in diffusing capacity of the lung in COPD patients. Methods : This was a cross sectional study in which COPD patients attending COPD-Asthma clinic in Persahabatan Hospital Jakarta were performed spirometry and DLCO-SB consecutively between May 2015?July 2015. Comorbidities conditions were also recorded. Results : Spirometry and DLCO-SB measurement were conducted on 65 COPD subjects of which 7 subjects (10.8%) were COPD Group A, 19 subjects (29.2%) were Group B, 21 subjects (32.3%) were COPD group C and 18 subjects (27.7%) were COPD group D. The mean age was 64.15 (45-89); mean FEV 1 % was 46.05%, mean DLCO measured was 19.42 ml/min/mmHg and the mean DLCO% was 72.00%. The prevalence of decreasing in diffusing capacity of the lung in COPD patients was 56.92% (37 subjects) While 28 subjects were normal. There were 15 subjects (23.07%) with mild decrease in DLCO, 18 subjects (27.69%) were moderate decrease and 4 subjects (6.15%) with severe decrease. 47 subjects (72.3%) had comorbid conditions. There was significant correlation between grup COPD, GOLD COPD grade, VEP 1 , BMI and comorbidities with magnitude of decreasing DLCO value. There was no correlation between DLCO value with sex, smoking history, Brinkmann index, age, obstruction-mix criteria, length of COPD period. Conclusion : The proportion of decreasing in DLCO in COPD patients are 56.92%. There is significant correlation among the group of COPD, GOLD COPD grade, VEP 1 , BMI and previous TB history with magnitude of decreasing DLCO value. There is no correlation between DLCO value with sex, smoking history, brinkmann index, age, obstruction-mix criteria, comorbidities and length of COPD period. ;Background and the aim of study : This is a preliminary study to measure DLCO-SB in COPD patients in Persahabatan Hospital. The aim of the study is to know the magnitude of disturbance in diffusing capacity of the lung in COPD patients. Methods : This was a cross sectional study in which COPD patients attending COPD-Asthma clinic in Persahabatan Hospital Jakarta were performed spirometry and DLCO-SB consecutively between May 2015?July 2015. Comorbidities conditions were also recorded. Results : Spirometry and DLCO-SB measurement were conducted on 65 COPD subjects of which 7 subjects (10.8%) were COPD Group A, 19 subjects (29.2%) were Group B, 21 subjects (32.3%) were COPD group C and 18 subjects (27.7%) were COPD group D. The mean age was 64.15 (45-89); mean FEV 1 % was 46.05%, mean DLCO measured was 19.42 ml/min/mmHg and the mean DLCO% was 72.00%. The prevalence of decreasing in diffusing capacity of the lung in COPD patients was 56.92% (37 subjects) While 28 subjects were normal. There were 15 subjects (23.07%) with mild decrease in DLCO, 18 subjects (27.69%) were moderate decrease and 4 subjects (6.15%) with severe decrease. 47 subjects (72.3%) had comorbid conditions. There was significant correlation between grup COPD, GOLD COPD grade, VEP 1 , BMI and comorbidities with magnitude of decreasing DLCO value. There was no correlation between DLCO value with sex, smoking history, Brinkmann index, age, obstruction-mix criteria, length of COPD period. Conclusion : The proportion of decreasing in DLCO in COPD patients are 56.92%. There is significant correlation among the group of COPD, GOLD COPD grade, VEP 1 , BMI and previous TB history with magnitude of decreasing DLCO value. There is no correlation between DLCO value with sex, smoking history, brinkmann index, age, obstruction-mix criteria, comorbidities and length of COPD period.

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Latar belakang: Diabetes melitus DM tipe 2 merupakan masalah kesehatan dunia. Gangguan DM tipe 2 ditandai dengan peningkatan kadar gula darah secara kronik dan dapat menimbulkan komplikasi baik makro maupun mikrovaskuler. Paru sebagai salah satu organ yang memiliki komponen mikrovaskuler dapat terdampak komplikasi mikrovaskuler DM tipe 2 berupa gangguan kapasitas difusi.Metode: Penelitian studi potong lintang pada subjek DM tipe 2, dewasa, rawat jalan, tanpa kelainan paru berat, gagal ginjal terminal, ataupun gagal jantung kronik yang didapat secara konsekutif dan menjalani proses wawancara, pemeriksaan fisis, laboratorium, spirometri dan uji DLCO.Hasil: Didapatkan total subjek sebanyak 35 orang. Karakteristik subjek DM tipe 2 yang ditemukan adalah rerata usia 57,88 tahun, usia >40 tahun 88,6 , perempuan 54,3 , IMT kategori overweight-obesitas 85,7 , lama menderita DM tipe 2 6,5 memiliki risiko penurunan nilai DLCO sebesar 21 kali daripada nilai HbA1c ABSTRACT Background Type 2 DM has become worldwide health problem. It is characterized with chronic hyperglycemia and causing both macro and microvascular complication. Lung as a microvascular contained organ may be affected by type 2 DM microvascular complication in result lung capacity disorder.Method Cross sectional study in type 2 DM, adult, outpatient basis, without overt lung disorder, terminal kidney failure nor cardiovascular disorder. Subject undergone consecutive sampling, interview session, physical examination, laboratory test, spirometry and DLCO test.Result There were 35 subject in total with characteristic mean age 57.88 y.o, age 40 y.o 88.6 , female 54.3 , BMI overweight obesity 85.7 , duration of type 2 DM 6,5 has 21 time risk to have decreasing DLCO value compare to subject with HbA1c