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"Asma merupakan penyakit saluran napas kronik yang merupakan masalah kesehatan dunia. Adanya perubahan gaya hidup, kerusakan lingkungan, meningkatnya paparan polusi dan alergen berdampak pada kesehatan sistem pernapasan, mengakibatkan angka kejadian asma semakin meningkat. Ekstrak etanol patikan kebo (Euphorbia hirta) diketahui mengandung antiinflamasi, salah satunya adalah β-amyrin, yang secara turun-temurun dipakai untuk mengurangi keluhan batuk pada asma.Oleh karena itu peneliti ingin melihat apakah herbal patikan kebo benar mempercepat pengurangan keluhan gejala asma bila ditambahkan pada pengobatan penderita asma persisten sedang. Studi awal ini melibatkan 20 orang responden yang dibagi dalam 2 kelompok yaitu kelompok perlakuan dan kelompok plasebo, masing-masing 10 orang. Kelompok perlakuan mendapat kapsul ekstrak patikan kebo 2 x 2 kapsul / hari yang mengandung 385 mg tiap kapsulnya selama 8 minggu.Hasil studi secara statistik ditemukan adanya kecenderungan perbaikan nilai skor asma kontrol test (ACT). Ditemukan peningkatan yang tidak bermakna dari nilai arus puncak ekspirasi (APE) maupun penurunan jumlah eosinofil sputum.

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Asthma is a chronic respiratory disease which has become a global health issue. Effect of lifestyle changes, environmental degradation, pollution and allergen exposure on the health of the respiratory system, have led to the increasing incidence of asthma. Ethanolic extract of patikan kebo (Euphorbia hirta) is known to have an antiinflamatory effect due to one of its active compound, β-amyrin. Patikan kebo has been used for generations to reduce cough in asthma.Therefore, we wanted to see whether or not the addition of patikan kebo in treatment of moderate persistent allergic asthma can accelerate the reduction of asthma symptoms. This is a preliminary study, consisted of 20 subjects divided into 2 groups: the treatment group and the placebo group, 10 people each. The treatment group received extract capsules patikan kebo extract capsules at 2 x 2 capsules / day containing 385 mg per capsule for 8 weeks.The study shows a statistically significant trend toward improved asthma control test (ACT) scores. There is no significant increase of peak expiratory flow or decrease in the number of sputum eosinophils."

"Bronchial asthma : a guide for practical understanding and treatment, sixth edition, is a fully updated version of a widely respected classic on the diagnosis and management of asthma. Discussing the disorder in all relevant patient groups, including a variety of patient subpopulations, this invaluable title continues to emphasize the definition, medications, and practical use of asthma treatment plans. Importantly, this comprehensive reference also discusses the common side effects found in the full range of medications used for asthma treatment. "

"Terapi penyakit asma dengan inhaled corticosteroid (ICS) dosis tinggi yang berjangka panjang berpotensi menimbulkan efek samping. Salah satu pendekatan yang dapat dilakukan adalah menggunakan senyawa turunan tumbuhan sebagai alternatif. Fisetin merupakan senyawa flavonoid yang menunjukkan berbagai efek farmakologis. Hambatan utama keberhasilan terapi dengan fisetin adalah bioavailabilitas yang rendah dan lipofilisitas yang tinggi. Beberapa pendekatan digunakan untuk meningkatkan bioavailabilitas obat dengan lipofilisitas tinggi, yaitu menggabungkan obat ke dalam matriks lipid. Solid lipid microparticles (SLM) adalah metode mikroenkapsulasi obat ke dalam lipid yang memungkinkan pelepasan obat terkendali, peningkatkan stabilitas obat, dan tetap aman bagi tubuh. Penelitian ini bertujuan untuk mendapatkan formulasi solid lipid microparticle fisetin dry powder inhalation fisetin berbasis lipid Glyceryl tristearate serta surfaktan Poloxamer 188 dan Tween 80 sebagai obat terapi inhalasi penyakit asma. Pada penelitian ini, peneliti telah mengamati variasi kandungan obat, konsentrasi surfaktan, dan kecepatan putar. Serbuk inhalasi menghasilkan ukuran 1,2 – 4 µm dan menunjukkan 34% antiinflamasi pada konsentrasi 1.000 ppm. Selain itu, persentase yield formulasi berada dalam rentang 81 – 96%, drug loading 2 – 5%, dan entrapment efficiency 82 – 87%. Profil pelepasan menunjukkan sistem pelepasan sustained release. Formulasi yang terbaik adalah FIS6 dengan variasi kandungan obat, surfaktan, dan kecepatan putar paling tinggi.

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Long-term high-dose inhaled corticosteroid (ICS) for asthma therapy has the potential to cause side effects. One approach that can be taken is to use plant-derived compounds as an alternative. Fisetin is a flavonoid compound that exhibits various pharmacological effects. The main obstacle to successful therapy with fisetin is its low bioavailability and high lipophilicity. Several approaches are used to increase the bioavailability of drugs with high lipophilicity is to incorporate the drug into the lipid matrix. Solid lipid microparticles (SLM) is a method of microencapsulating drugs into lipids that allows the drug to be released slowly, improves drug stability, and remains safe for the body. This study has obtained a fisetin SLM formulation as dry powder inhalation with Glyceryl Tristearate as lipid as well as Poloxamer 188 and Tween 80 as the surfactants. The dry powder inhalation is in the form of inhaled therapy drugs for asthma. This study also observes variations in drug content, surfactant concentration, and rotational speed. The inhalation powder has a particle size ranged 1,2 – 4 µm and showed 34% anti-inflammatory at a concentration of 1,000 ppm. In addition, the yield is in the range of 81 – 96%, drug loading is 2 – 5%, and entrapment efficiency is 82 – 87%. The winning profile shows the sustain release pulmonary drug delivery profile. The best formulation is FIS6 with the highest variation of drug, surfactant, and rotational speed."

"[Prevalensi asma di Indonesia cukup tinggi (4,5%) dan beban yang diakibatkannya menyebabkan konsekuensi sosial ekonomi. Peningkatan risiko terjadinya efek samping yang mengiringi pengobatan jangka lama pada asma mendorong pengembangan modalitas terapi lain salah satunya adalah akupunktur tetapi belum ada penelitian akupunktur pada asma yang menilai efeknya pada derajat keterkontrolan asma menggunakan alat ukur yang valid. Penelitian ini bertujuan mengetahui efektivitas terapi kombinasi akupunktur tanam benang dan medikamentosa terhadap derajat keterkontrolan asma menggunakan skor ACT, pengaruhnya terhadap perubahan faal paru dan efek samping yang dapat timbul pada tindakan akupunktur tanam benang pada pasien asma bronkial derajat persisten sedang yang terkontrol sebagian dan tidak terkontrol. Uji klinis acak dan tersamar ganda dengan pembanding dilakukan pada 52 penderita asma bronkial derajat persisten sedang yang terkontrol sebagian dan tidak terkontrol yang dialokasikan secara acak menjadi kelompok terapi kombinasi akupunktur tanam benang dan medikamentosa (kelompok kasus) atau kelompok terapi medikamentosa (kelompok kontrol). Hasil penelitian menunjukkan perbedaan bermakna perubahan skor ACT dan persentasi perubahan nilai APE sebelum dan sesudah perlakuan lebih tinggi pada kelompok kasus dibanding kelompok kontrol (p < 0,05). Persentasi perubahan nilai VEP1, KVP dan VEP1/KVP sebelum dan sesudah perlakuan lebih tinggi pada kelompok kasus dibanding kelompok kontrol namun perbedaan tersebut tidak bermakna secara statistik (p > 0,05). Kesimpulan penelitian adalah terapi kombinasi akupunktur tanam benang dan medikamentosa lebih efektif dibanding terapi medikamentosa saja dalam meningkatkan derajat keterkontrolan asma pada pasien asma bronkial derajat persisten sedang yang terkontrol sebagian dan tidak terkontrol.;Asthma prevalence in Indonesia is quite high (4,5%) and the resulting burden caused socio-economic consequences. An increased risk of side effects that accompany long term treatment of asthma encourage the development of other therapeutic modalities one of which is acupoint catgut embedment but there is no studies of acupuncture in asthma that assess its effect on the degree of asthma control using a valid measurement tools. The aim of this study was to establish the effectiveness of acupoint catgut embedment combined with medical treatment on asthma control using Asthma Control Test (ACT), to establish its effect on measurement result of lung function and to monitor the side effects that may occur. This study is a randomized, double-blind and controlled clinical trial involving 52 patients with partially controlled and uncontrolled moderate persistent bronchial asthma that are allocated into groups of catgut embedding method combined with medication (case group) and group of medication (control group). The results showed a statistically significant difference in the change of ACT scores and PEF before and after treatment higher in case group compared to control group (p < 0,05). The change of FEV1, FVC and FEV1/FVC before and after treatment were higher in case group compared to control group but the differences were not statistically significant (p > 0,05). The conclucion of this study is acupoint catgut embedment combined with medical treatment is more effective than medication treatment alone in improving asthma control in patients with partially controlled and uncontrolled moderate persistent bronchial asthma., Asthma prevalence in Indonesia is quite high (4,5%) and the resulting burden caused socio-economic consequences. An increased risk of side effects that accompany long term treatment of asthma encourage the development of other therapeutic modalities one of which is acupoint catgut embedment but there is no studies of acupuncture in asthma that assess its effect on the degree of asthma control using a valid measurement tools. The aim of this study was to establish the effectiveness of acupoint catgut embedment combined with medical treatment on asthma control using Asthma Control Test (ACT), to establish its effect on measurement result of lung function and to monitor the side effects that may occur. This study is a randomized, double-blind and controlled clinical trial involving 52 patients with partially controlled and uncontrolled moderate persistent bronchial asthma that are allocated into groups of catgut embedding method combined with medication (case group) and group of medication (control group). The results showed a statistically significant difference in the change of ACT scores and PEF before and after treatment higher in case group compared to control group (p < 0,05). The change of FEV1, FVC and FEV1/FVC before and after treatment were higher in case group compared to control group but the differences were not statistically significant (p > 0,05). The conclucion of this study is acupoint catgut embedment combined with medical treatment is more effective than medication treatment alone in improving asthma control in patients with partially controlled and uncontrolled moderate persistent bronchial asthma.]"

"Latar belakang: Asma merupakan penyakit ditandai peradangan saluran napas kronik. Satu dari tiga kasus tidak memberikan respon adekuat. Modalitas alternatif terapi  asma adalah magnesium inhalasi. Inhalasi magnesium memiliki efek samping sistemik minimal. Oleh karena itu, peran magnesium inhalasi perlu diteliti lebih lanTujuan: Penelitian bertujuan untuk mengetahui efektivitas dan keamanan pemberian magnesium inhalasi pada pasien dewasa mengalami  asma akut.Metode: Penelusuran literatur dilakukan dua peneliti independen melalui: PubMed/ MEDLINE, Google Scholar, ProQuest, dan Cochrane dengan kata kunci “magnesium inhalasi” dan “serangan asma” dalam bahasa Inggris dan Indonesia. Pencarian manual dan snowballing dilakukan di portal data nasional. Studi yang dimasukkan adalah uji acak terkontrol mengenai perbandingan magnesium inhalasi dengan terapi standar pada serangan asma akut. Penilaian efektivitas berdasarkan parameter readmisi, tanda vital, perbaikan klinis, serta fungsi paru, sedangkan keamanan berdasarkan parameter efek samping. Protokol telaah sistematis didaftarkan pada PROSPERO.Hasil: Lima artikel diikutsertakan dalam telaah sistematis. Dua artikel diikut-sertakan menilai aspek  readmisi. Tiga studi  menilai hubungan magnesium terhadap tanda vital pasien. Dua studi menilai tingkat keparahan penyakit dan perbaikan klinis. Studi menunjukkan tidak terdapat hubungan bermakna pemberian magnesium inhalasi pada aspek readmisi pasien (RR 1; IK 95% 0.92 - 1,08; p= 0,96), dan saturasi oksigen (MD  1,82; IK 95%: -0.89 - 4.53; p= 0.19). Ada penurunan bermakna laju napas pasien  (MD -1,72; IK 95% -3,1 -0.35; p= 0.01), dan perbaikan gejala pada pasien  (RR 0.29; IK95% 0.18 - 0.47; p <0.001). Ada peningkatan bermakna efek samping pasien magnesium inhalasi (HR 1.56; IK 95% 1.05 – 2.32; p= 0.32). Efek samping relatif ringan  berupa hipotensi dan rasa mual. Kesimpulan: Magnesium inhalasi memperbaiki  klinis pasien asma terutama gejala, laju napas, dan fungsi paru.  Magnesium inhalasi dikatakan aman jika diberikan pada pasien, namun hati-hati penggunaan pada pasien hipotensi.

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Background:  Asthma is a disease characterized by chronic airway inflammation. Asthma occurs to many people worldwide. One third of asthmatic case did not respond adequately to standard therapy (Short Acting Beta Agonist, Anticholinergic, Corticosteroid). One of alternative treatment of asthma is inhaled magnesium.  Theoretically, inhaled magnesium is thought to have less systemic side effect and could act directly to respiratory tract. However, the role of inhaled magnesium therapy is not established yet.

Objective: This review is made to evaluate the effectiveness and safety of nebulized magnesium in adult with acute asthma attack.

Methods: Literature search was conducted by two independent investigators through online databases: PubMed/MEDLINE, Cochrane, ProQuest, and Google scholar using the keywords “inhaled magnesium” and “asthma” in English and Indonesian. Manual searches and snowballing were carried out through national data portals and medical faculty e-libraries. Journal articles included in this study are randomized controlled trials that observed inhaled magnesium in adult with acute asthma attack. All the protocol of this systematic review has been registered in PROSPERO.

Result: There are five articles included in this review. Two of them evaluate the effect of magnesium in term of readmission, three of the studies measures effect of magnesium in vital sign, and two of them evaluate the effect of magnesium in term of severity of asthma There is no significant difference in readmission rate and oxygen saturation in magnesium group compared to control (RR 1; 95% CI 0.92 to 1,08; p= 0,96 and MD 1,82; 95% CI -0.89 to 4.53; p= 0.19, respectively). There is significant reduction of respiratory rate and clinical severity in magnesium (MD -1,72; 95% CI   -3,1 to 0.35; p= 0.01, RR 0.29; 95% CI 0.18 to 0.47; p <0.001, respectively). There was a higher risk of side effect in magnesium group (HR 1.56; 95%CI 1.05 to 2.32; p= 0.03). However, the side effect is relatively mild such as hypotension and nausea.

Conclusion: Inhaled magnesium improves clinical outcome for patient with asthma attack especially lung function, improvement of clinical outcome, and lung function. Moreover, Inhaled magnesium is considered safe to be given to asthmatic patient. However, the inhaled magnesium is given with caution in patient with hypotension."