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"ABSTRAKLatar belakang : Penelitian ini merupakan studi awal untuk mengukur volumeparu pada pasien PPOK stabil di RSUP Persahabatan Jakarta untuk mengetahuiprevalens peningkatan nilai volume paru pada pasien PPOK stabil.Metode : Penelitian ini menggunakan desain studi potong lintang (cross sectionalstudy) pada pasien PPOK stabil yang berkunjung di Poliklinik Asma-PPOKRSUP Persahabatan Jakarta. Dilakukan uji volume paru dengan menggunakan gasdilusi MBNW pada pasien PPOK stabil yang diambil secara konsekutif antarabulan Februari-Maret 2016.Hasil : Uji Spirometri dan Volume paru dilakukan pada 36 subjek didapatkan 3subjek (8.3%) termasuk kedalam PPOK Grup A, 10 subjek (27.8%) PPOK GrupB, 9 subjek (25%) PPOK Grup C dan 14 subjek (8.9%) PPOK Grup D. Usia <60tahun 9 subjek (25%) dan ≥60 tahun 27 subjek (75%). Rerata VEP1 % prediksi47.81%, rerata nilai KRF 2476.39 ml, rerata nilai VR % 76.16%, rerata nilaiVR/KPT 42.03% dan nilai rerata KRF/KPT 59.09%. Peningkatan VR pada GrupPPOK C-D dibanding Grup PPOK A-B, peningkatan juga terjadi pada VR/KPTdan KRF/KPT pada Grup C-D masing-masing 62.9% dan 71.4%. Nilai VR/KPTmempunyai hubungan bermakna dengan skala MmRC, Uji jalan 6 menit daneksaserbasi dalam 1 tahun, namun nilai KRF/KPT berhubungan bermakna denganskala MmRC dan skala CAT.Kesimpulan : Nilai VR/KPT mempunyai hubungan bermakna dengan skalaMmRC, Uji jalan 6 menit dan eksaserbasi dalam 1 tahun, namun nilai KRF/KPTberhubungan bermakna dengan skala MmRC dan skala CAT.

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ABSTRACTBackground: This is a preliminary study to measure lung volume in patients withstable COPD in RSUP Persahabatan Jakarta to determine the prevalence of theincreasing value of the lung volume in patients with stable COPD.Method: This study used a cross-sectional study design of outpatiens with stableCOPD who visited Asthma-COPD clinic Persahabatan Hospital, Jakarta. TheLung volume test using a gas dilution MBNW taken consecutively from Februaryto March 2016.Results: Test Spirometry and Lung volumes performed on 36 subjects. Therewere 3 subjects (8.3%) the COPD group A, 10 subjects (27.8%) COPD Group B,9 subjects (25%) COPD Groups C and 14 subjects (8.9%) COPD Group D. At theage <60 years of 9 there were subjects (25%) and ≥60 years of 27 subjects (75%).The result of FEV1% 47.81%, of FRC 2476.39 ml, of RV% 76.16%, of RV / TLC42.03% and of FRC / TLC 59.09%. The measurement of VR were in Group C-DCOPD, the increase also occurred in RV / TLC and FRC / TLC in Group C-Drespectively 62.9% and 71.4%. Value RV / TLC has a significant relationshipwith the MmRC scale, a 6-minutes walking test and exacerbation within one year,however of FRC / TLC significantly associated with MmRC scale and CAT scale.Conclusion: Value RV / TLC has a significant relationship with the MmRC scale,a 6-minutes walking test and exacerbation within one year, however of FRC /TLC significantly associated with MmRC scale and CAT scale."

"Latar belakang dan tujuan: Penyakit refluks gastroesofagus (PRGE) merupakan salah satu penyebab terbanyak batuk kronik dan menjadi faktor risiko terjadinya eksaserbasi pada penyakit paru obstruktif kronik (PPOK), menurunkan kualitas hidup dan memperparah gejala respirasi dan pencernaan. Total 40 pasien diikutkan pada penelitian ini. Pasien diambil secara konsekutif dari poliklinik asma PPOK di RSUP Persahabatan dimulai dari bulan Mei 2017. Diagnosis PPOK berdasarkan GOLD 2017 yaitu nilai spirometri VEP₁/KVP pasca bronkodilator < 0.7. Diagnosis PRGE menggunakan endoskopi saluran cerna bagian atas apabila ditemukan kerusakan mukosa esofagus. Kriteria eksklusi yaitu eksaserbasi dan kelainan esofagus yang sudah diderita sebelumnya.Metode: Penelitian ini adalah potong lintang pada pasien PPOK stabil yang berkunjung ke poli asma-PPOK di RSUP Persahabatan mulai bulan Juli sampai Nopember 2017. Sebanyak 40 pasien dipilih secara konsekutif sejak bulan Mei 2017. Pemeriksaan berupa wawancara, spirometri dan endoskopi dilakukan pada semua subjek yang memenuhi kriteria inklusi.Hasil: Subjek yang mengikuti penelitian sebanyak 40. Prevalens PRGE pada PPOK adalah 40% (16/40). Tidak ada perbedaan bermakna diantara kedua grup berdasarkan usia, jenis kelamin, Indeks Brinkman (IB) dan Indeks Massa Tubuh (IMT). Keterbatasan aliran udara yang lebih berat dan nilai spirometri pascabronkodilator yang lebih rendah memiliki kecenderungan terjadinya PRGE lebih besar walaupun secara statistik tidak bermakna. Rerata pasien berusia lanjut dan mempunyai riwayat merokok. Eksaserbasi dan skor CAT berhubungan secara bermakna (p < 0.05) dengan kejadian PRGE. Penggunaan obat-obatan PPOK seperti LABA, LAMA dan SABA tidak berubungan bermakna dengan PRGE. Gejala dada terbakar (heartburn) bermakna secara statistik (p < 0.05) sebagai tanda PRGE.Kesimpulan: Prevalens PRGE cukup tinggi pada pasien PPOK dan bahkan lebih tinggi dibandingkan pasien bukan PPOK dengan gejala dispepsia di Jakarta. Dokter harus mempertimbangkan kemungkinan PRGE sebagai salah satu komorbid yang penting pada PPOK. Penelitian kohort dan strategi pencegahan disarankan untuk dilakukan selanjutnya.

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Background/Aim: Gastroesophageal reflux disease (GERD) is one of the most common causes of chronic cough and is a potential risk factor for exacerbation of chronic obstructive pulmonary disease (COPD), decreasing quality of life in COPD patients, aggravating symptoms both respiratory and gastro-intestinal. Total 40 patients were recruited consecutively from the outpatient of Asthma and COPD clinic at Persahabatan hospital Jakarta started from May 2017. The diagnosis of gastroesophageal reflux disease (GERD) was based on the mucosal break on the esophageal lining through endoscopic examination. Exclusion criteria were COPD exacerbation and known esophageal disease.

Methods: This is a cross sectional study among stable COPD patients who visited asthma-COPD clinics at Persahabatan Hospital from July to November 2017. 40 patients were recruited consecutively started from May 2017. Interview, spirometry and endoscopy performed to all subjects who meet the inclusion criteria.

Results: A total 40 subjects were enrolled in our study. Prevalence of GERD in COPD was 40%. There was no significant difference between the two groups regarding age, sex, Index Brinkman (IB) and Body Mass Index (BMI), although in the RE group has a slightly higher BMI. More severe airflow obstruction tends to increase in GERD group although no significant statistical difference Most patients were elderly and smoker/ex. Exacerbation and CAT score were significantly associated with GERD (p<0.05). Post BD spirometry showed greater airway and severe COPD tends to also had GERD similar to results of other studies. Respiratory medication such as ICS + LABA, LAMA and SABA statistically insignificant with GERD. Heartburn as a symptom showed statistically significant to predict GERD (p < 0.05).

Conclusion: Prevalence of GERD was high in COPD patient and even higher than previously reported in general patient with dyspepsia syndrome in Jakarta. Physician should consider GERD as one of the most important comorbidities in COPD. Cohort study and preventive strategy are warranted in the future."

"Latar belakang: Panduan Global Initiative of Chronic Lung Disease (GOLD) 2017 memisahkan derajat spirometrik (GOLD 1234) dari grup ABCD untuk mempertajam diagnosis, prognosis dan pengobatan penyakit paru obstruktif kronik (PPOK). Hipereaktivitas bronkus (HBR) merupakan tanda khas penyakit asma yang juga ditemukan pada PPOK. Penelitian ini bertujuan untuk mengidentifikasi HBR pada pasien PPOK stabil menurut pengelompokkan GOLD 2017.Metode: Penelitian ini merupakan penelitian potong lintang pada 80 subjek PPOK stabil yang berkunjung ke poliklinik asma PPOK RS Persahabatan sejak bulan Mei 2018 hingga Maret 2019. Diagnosis PPOK ditegakkan berdasarkan pemeriksaan spirometri (VEP1/KVP <0.7) pasca uji bronkodilator. Hipereaktivitas bronkus dikonfirmasi menggunakan PC20 (Provocative Concentration 20) pada uji provokasi bronkus menggunakan zat metakolin <4 mg/ml (VEP1 ≥ 20%) yang dilakukan pada semua subjek yang memenuhi kriteria inklusi.Hasil: Prevalens HBR pada PPOK dalam penelitian ini sebesar 73,7% (59/80) dengan proporsi 69,7% (46/66) subjek laki-laki dan 92,9% (13/14) subjek perempuan. Hipereaktivitas bronkus ditemukan paling banyak pada grup PPOK B dan D (27,1% dan 33,9%). Hipereaktivitas bronkus derajat ringan ditemukan paling banyak di grup A dan D (11,25% dan 17,5%) sementara HBR derajat sedang hingga berat ditemukan pada grup B (11,25%). Derajat keterbatasan aliran udara ditemukan paling banyak pada GOLD 2 dan 3 (40,7% dan 44,1%). Hipereaktivitas bronkus derajat ringan ditemukan pada GOLD 2 (20%) sementara HBR derajat sedang hingga berat ditemukan sama pada GOLD 2 dan 3 (16,25%).

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Background: The Global Initiative of Chronic Lung Disease (GOLD) 2017 has separated spirometric grades (GOLD 1234) from the symptom groups (ABCD) to improve diagnosis, outcome and therapy for chronic obstructive pulmonary disease (COPD) patients. Bronchial hyperreactivity (BHR) is thought to be a hallmark of asthma, yet it has been observed to occur in COPD.This study was to identify BHR in stable COPD patients according to GOLD 2017 grouping.

Methods: This cross-sectional study observed 80 stable COPD patients treated at asthma-COPD clinics in Persahabatan Hospital Jakarta, Indonesia between May 2018 and March 2019. Diagnosis of COPD was done by spirometry (post-bronchodilator test FEV1/FVC<0.7). Bronchial hyperreactivity was confirmed by PC20 (Provocative Concentration 20), a bronchial challenge test using methacoline <4 mg/mL (FEV1 drop ≥20%). These were performed in all subjects within the inclusion criteria.

Results: Prevalence of BHR in COPD was 73.7% (59/80), wherein 69.7% (46/66) males and 92.9% (13/14) females were BHR in COPD. Bronchial hyperreactivity was found mostly in Group B and D (27.1% and 33.9, respectively). Mild BHR was found mostly in Group A and D (11.25% and 17.5%, respectively) while moderate to severe BHR were found in Group B (11.25%). Airflow limitation was found mostly in GOLD 2 and 3 (40.7% and 44.1%, respectively). Mild BHR was mostly found in GOLD 2 (20.0%) while moderate to severe BHR were equally found in GOLD 2 and 3 (16.25%, both).

Conclusion: Prevalence of BHR in stable COPD patients was 73.7% and mild BHR was common in stable COPD."

"ABSTRAK Latar belakang : Penelitian ini merupakan studi awal untuk mengukur kapasitasdifusi paru DLCO-SB ipada pasien PPOK di RSUP Persahabatan Jakarta untukmengetahui 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 RSUPPersahabatan Jakarta. Dilakukan uji spirometri dan DLCO pada pasien PPOKyang diambil secara konsekutif antara bulan Mei-Juli 2015. Komorbiditas jugadicatat.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, 21subjek (32,3%) PPOK grup C dan 18 subjek (27,7%) PPOK grup D. rerata usia64,15 (45-89) tahun;rerata VEP1% 46,05%, rerata nilai DLCO 19,42ml/menit/mmHg dan rerata DLCO % adalah 72.00%. prevalens penurunanDLCO pasien PPOK adalah 56,92% (37/65 subjek) sedangkan 28 subjek dengannilai DLCO normal. Ditemukan 15 subjek (23,07%) dengan penurunan ringan, 18subjek (27.69%) penurunan sedang dan 4 subjek (6,15%) dengan penurunan berat.Ditemukan 47 subjek (72,3%) memiliki komorbid. Terdapat hubungan bermaknaantara grup PPOK, derajat spirometri, VEP1, IMT dan komorbiditas dengan nilaihasil uji DLCO. Tidak terdapat hubungan bermakna antara nilai DLCO denganjenis kelamin, umur, riwayat merokok, Indeks Brinkmann, obstruksi-restriksi danlama terdiagnosis PPOK.Kesimpulan : Proporsi penurunan nilai DLCO pada pasien PPOK adalah 56,92%. Terdapat hubungan bermakna antara grup PPOK, derajat spirometri,VEP1, IMT dan riwayat TB dengan nilai hasil uji DLCO. Tidak terdapathubungan bermakna antara nilai DLCO dengan jenis kelamin, umur, riwayatmerokok, Indeks Brinkmann, obstruksi-restriksi, komorbid dan lama terdiagnosisPPOK.ABSTRACT Background and the aim of study : This is a preliminary study to measureDLCO-SB in COPD patients in Persahabatan Hospital. The aim of the study is toknow the magnitude of disturbance in diffusing capacity of the lung in COPDpatients.Methods : This was a cross sectional study in which COPD patients attending COPD-Asthma clinic in Persahabatan Hospital Jakarta were performed spirometryand DLCO-SB consecutively between May 2015?July 2015. Comorbiditiesconditions were also recorded.Results : Spirometry and DLCO-SB measurement were conducted on 65 COPDsubjects 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 FEV1% was46.05%, 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 inCOPD patients was 56.92% (37 subjects) While 28 subjects were normal. Therewere 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 grupCOPD, GOLD COPD grade, VEP1, BMI and comorbidities with magnitude ofdecreasing DLCO value. There was no correlation between DLCO value with sex,smoking history, Brinkmann index, age, obstruction-mix criteria, length of COPDperiod. Conclusion : The proportion of decreasing in DLCO in COPD patients are56.92%. There is significant correlation among the group of COPD, GOLDCOPD grade, VEP1, BMI and previous TB history with magnitude of decreasingDLCO value. There is no correlation between DLCO value with sex, smokinghistory, brinkmann index, age, obstruction-mix criteria, comorbidities and lengthof COPD period. ;Background and the aim of study : This is a preliminary study to measureDLCO-SB in COPD patients in Persahabatan Hospital. The aim of the study is toknow the magnitude of disturbance in diffusing capacity of the lung in COPDpatients.Methods : This was a cross sectional study in which COPD patients attending COPD-Asthma clinic in Persahabatan Hospital Jakarta were performed spirometryand DLCO-SB consecutively between May 2015?July 2015. Comorbiditiesconditions were also recorded.Results : Spirometry and DLCO-SB measurement were conducted on 65 COPDsubjects 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 FEV1% was46.05%, 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 inCOPD patients was 56.92% (37 subjects) While 28 subjects were normal. Therewere 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 grupCOPD, GOLD COPD grade, VEP1, BMI and comorbidities with magnitude ofdecreasing DLCO value. There was no correlation between DLCO value with sex,smoking history, Brinkmann index, age, obstruction-mix criteria, length of COPDperiod. Conclusion : The proportion of decreasing in DLCO in COPD patients are56.92%. There is significant correlation among the group of COPD, GOLDCOPD grade, VEP1, BMI and previous TB history with magnitude of decreasingDLCO value. There is no correlation between DLCO value with sex, smokinghistory, brinkmann index, age, obstruction-mix criteria, comorbidities and lengthof COPD period. ;Background and the aim of study : This is a preliminary study to measureDLCO-SB in COPD patients in Persahabatan Hospital. The aim of the study is toknow the magnitude of disturbance in diffusing capacity of the lung in COPDpatients.Methods : This was a cross sectional study in which COPD patients attending COPD-Asthma clinic in Persahabatan Hospital Jakarta were performed spirometryand DLCO-SB consecutively between May 2015?July 2015. Comorbiditiesconditions were also recorded.Results : Spirometry and DLCO-SB measurement were conducted on 65 COPDsubjects 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 FEV1% was46.05%, 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 inCOPD patients was 56.92% (37 subjects) While 28 subjects were normal. Therewere 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 grupCOPD, GOLD COPD grade, VEP1, BMI and comorbidities with magnitude ofdecreasing DLCO value. There was no correlation between DLCO value with sex,smoking history, Brinkmann index, age, obstruction-mix criteria, length of COPDperiod. Conclusion : The proportion of decreasing in DLCO in COPD patients are56.92%. There is significant correlation among the group of COPD, GOLDCOPD grade, VEP1, BMI and previous TB history with magnitude of decreasingDLCO value. There is no correlation between DLCO value with sex, smokinghistory, brinkmann index, age, obstruction-mix criteria, comorbidities and lengthof COPD period. "

"Pendahuluan: Neutrofil merupakan sel inflamasi yang diyakini berperan pada patogenesis Penyakit Paru Obstruktif Kronik (PPOK). Telah terdapat bukti korelasi antara hambatan aliran udara pada pasien PPOK dengan kadar neutrofil sputum. Penelitian beberapa tahun terakhir membuktikan nilai rasio neutrofillimfosit (RNL) dan protein C-reaktif (CRP) dari darah perifer berpotensi menjadi petanda inflamasi sistemik, tidak terkecuali PPOK. Beberapa penelitian membuktikan nilai RNL dan CRP lebih tinggi pada pasien dengan PPOK dibanding orang normal. Begitu pula saat kondisi eksaserbasi, nilai RNL dan CRP lebih tinggi daripada kondisi stabil. Selain itu terdapat bukti korelasi antara hasil spirometri dengan nilai RNL dan CRP. Hasil beberapa penelitian yang telah dilakukan sejauh ini menunjukkan bahwa nilai RNL dan CRP dapat menjadi suatu penilaian yang layak diperhatikan dalam PPOK. Tujuan: Memperoleh data mengenai nilai RNL dan CRP pada pasien PPOK eksaserbasi dan stabil di Rumah Sakit Umum Pusat Persahabatan. Metode: Analisis observasional kohort prospektif di RS Persahabatan, Jakarta Indonesia sebanyak 31 sampel dari Juli 2018 hingga Desember 2018. Kami mengikutsertakan 31 pasien PPOK eksaserbasi untuk dilakukan pemeriksaan spirometri dan pemeriksaan darah dan membandingkan hasil pemeriksaan pasien yang sama pada kondisi stabil.Hasil: Petanda inflamasi yang diperiksa pada penelitian ini RNL dan CRP keduanya menunjukkan penurunan kadar pada kondisi stabil, bertutut-turut dari 7,95 ± 6,8 menjadi 4,6 ± 5,5 dan 43,4 ± 71 menjadi 12,2 ± 18,5 dengan nilai p < 0,01. Didapatkan pula korelasi negatif yang bermakna antara RNL dan nilai VEP1/KVP pada kondisi eksaserbasi. Nilai CRP menunjukkan korelasi negatif hanya dengan VEP1 pada saat eksaserbasi. Di samping itu, terdapat pula subjek penelitian dengan nilai CRP yang sangat tinggi pada saat eksaserbasi, meninggal dunia dalam kurun waktu dua bulan setelah eksaserbasi. Kesimpulan: Nilai RNL dan CRP pada subjek dengan PPOK lebih tinggi pada kondisi eksaserbasi dan mungkin dapat menggambarkan status eksaserbasi pada pasien PPOK.

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Introductions: Although COPD has been believed to be characterized by respiratory disease, currently limited study conducted to evaluate inflammation markers and exacerbation rate in COPD by noninvasive method. We observed the COPD severity, future exacerbation by using peripheral blood test. We did a prospective cohort study to observe the alteration of Neutrophyl-Lymphocyte Ratio (NLR) and C-reactive protein (CRP) in COPD patients to find any possible correlation with COPD exacerbation status.

Aims: To study the value of NLR and CRP of COPD patients during exacerbation and stable in Persahabatan Hospital, Jakarta.

Methods: Starting from July to December 2019, a prospective cohort study was performed with blood and pulmonary function test in 31 COPD patients in two different conditions: during exacerbation and stable. The mean of both inflammation markers was compared and correlated them with pulmonary function test.

Results: Both inflammation markers NLR and CRP value decreased during stable condition (from 7,95 ± 6,8 to 4,6 ± 5,5 and 43,4 ± 71 to 12,2 ± 18,5) with p < 0,01 respectively. In addition, we also found a significant inverse correlation between NLR and FEV1/FVC during exacerbation but not during the stable condition, and CRP showed inverse correlation only with FEV1 during exacerbation. Another interesting finding was subject with very high CRP whose value remained above nomal limit during stable, died within 2 month after exacerbation.

Conclusions: NLR and CRP in COPD patients increased during exacerbation and may reflect lung function and exacerbation status in COPD patient."

"[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).]"

"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."

"Praktik residensi keperawatan medikal bedah yang dilakukan selama dua semester telah memberikan asuhan keperawatan pada pasien dengan gangguan respirasi, melakukan implementasi evidence based nursing dan dan proyek inovasi serta pengabdian masyarakat yang dilakukan di RSUP Fatmawati dan RSUP Persahabatan. Peran pemberian asuhan keperawatan pada kasus kelolaan utama yaitu PPOK eksaserbasi grup D dan 30 pasien resume menggunakan teori keperawatan self care Orem, teori ini digunakan karena masalah respirasi adalah masalah kronik, teori ini dapat diimplentasikan oleh perawat spesialis untuk meningkatkan perawatan diri pasien (self care) sesuai dengan kemampuannya untuk dapat meningkatkan kualitas hidup pasien. Implementasi EBN berupa balloon blowing exercise terbukti mampu mengurangi keluhan sesak napas pada pasien CLRD, mudah dilakukan, tidak memerlukan waktu lama, murah dan tidak menimbulkan efek samping. Penerapan proyek inovasi pengembangan self management: written action plan dengan media booklet terbukti dapat meningkatkan manajemen diri pasien PPOK. Booklet dapat membantu baik keluarga maupun pasien PPOK dalam mengetahui kondisi PPOK pasien serta melakukan manajemen yang tepat sesuai dengan kondisi pasien. Pengabdian masyarakat berupa edukasi kepada pasien TB Paru tentang TB Paru dan manajemen terapi pengobatannya terbukti dapat meningkatkan pengetahuan pasien, hal ini kemudian diharapkan dapat menurunkan angka putus obat pasien TB Paru.

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The medical surgical nursing residency practice which was carried out for two semesters has provided nursing care to patients with respiratory disorders, implemented evidence based nursing and and innovation projects as well as community service carried out at Fatmawati Hospital and Friendship Hospital. The role of providing nursing care in the main managed cases, namely COPD exacerbation group D and 30 patients resumed using Orem's self care nursing theory, this theory is used because respiratory problems are chronic problems, this theory can be implemented by specialist nurses to improve patient self care according to its ability to improve the patient's quality of life. The implementation of EBN in the form of balloon blowing exercise is proven to be able to reduce complaints of shortness of breath in CLRD patients, is easy to do, does not take long, is inexpensive and does not cause side effects. The implementation of self-management development innovation projects: written action plans with booklet media has been proven to improve COPD patient self-management. Booklets can help both families and COPD patients in knowing the patient's COPD condition and carrying out appropriate management according to the patient's condition. Community service in the form of educating pulmonary TB patients about pulmonary TB and management of treatment therapy has been proven to increase patient knowledge, this is then expected to reduce the dropout rate of pulmonary TB patients."

"Latar belakang dan tujuan: Penyakit kardiovaskular merupakan komorbid yang sering terjadi dan menjadi penyebab kematian pada pasien penyakit paru obstruktif kronik (PPOK). Penyakit kardiovaskular menjadi salah satu faktor prediksi tahan hidup pasien PPOK. Pemeriksaan echocardiography merupakan pemeriksaan yang akurat dan menyediakan informasi untuk evaluasi fungsi jantung.Tujuan penelitian ini adalah untuk mengetahui fungsi jantung pasien PPOK berdasarkan temuan echocardiography di RSUP Persahabatan Jakarta.Metode: Penelitian ini merupakan penelitian potong lintang terhadap pasien PPOK stabil yang berkunjung ke poli asma-PPOK di RSUP Persahabatan.Penelitian dilakukan dari Januari-Juni 2017. Subjek yang memenuhi kriteria akan dilakukan anamnesis, spirometri dan echocardiography.Hasil: Sebanyak 70 pasien ikut serta dalam penelitian ini dan dilakukan echocardiography. Usia rerata subjek adalah 65,68 ± 7,65. Subjek terbanyak adalah laki-laki (95,7%). Pada penelitian ini ditemukan 5,7% subjek memiliki gagal jantung kiri, 11,4% memiliki gagal jantung kanan, 30% hipertensi pulmoner, 8,6% mengalami dilatasi ventrikel kanan dan 11,4% mengalami pembesaran ventrikel kiri. Analisis statistik menemukan hubungan bermakna antara tricuspid annular plane excursion(TAPSE) dengan eksaserbasi pada PPOK(p<0,05). Terdapat hubungan yang bermakna antara indeks massa tubuh (IMT) dengan kontraksi ventrikel kanan, hipertensi pulmoner dan dilatasi ventrikel kanan. Tidak ditemukan hubungan yang bermakna antara derajat keparahan PPOK dengan dimensi, tekanan dan kontraksi jantung.Kesimpulan: Prevalens gangguan fungsi jantung tinggi pada pasien PPOK dan memiliki hubungan dengan eksaserbasi pada PPOK. Pasien dengan fungsi paru rendah memiliki kecenderungan untuk memilki gangguan di jantung.

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Background/Aim: Cardiovascular disease is a frequent comorbidity and cause of death in chronic obstructive pulmonary disease (COPD). Cardiovascular disease is one of predictive of survival in COPD. Echocardiography provides accurate and rapid information to evaluate cardiac function. The aim of this study is to elucidate the cardiac function based on echocardiography findings in stable COPD patients in the Persahabatan Hospital Jakarta.Methods: This study is a cross sectionalstudy among stable COPD patients who visit asthma-COPD clinics in Persahabatan Hospitals from January to June 2017. Interview, spirometry dan echocardiography perform to all subject who meet the ctiteria.Results: A total 70 subject with COPD perform echocardiography with mean ages 65,68 ± 7,65. Most of subject were men (95,7%). In this study found 5,7% subjects with left ventricle failure, 11,4% with right ventricle failure, 30% with pulmonary hypertension, 8,6% with right ventricle dilatation and 11,4% left ventricle hypertrophy. Statistic analysis have found significant association between tricuspid annular plane systolic excursion (TAPSE) and exacerbation in COPD patient (p<0,05). In this study found significant relationship between body mass index (BMI) and right ventricle contraction, pulmonary hypertension and right ventricle dilatation. There were no significant relationship between COPD severity and cardiac dimension, pressure and contraction.Conclusion: Prevalence of cardiac function abnormality were high in COPD patient and have relationship with exacerbation of COPD. Patient with lower lung function tender to have cardiac problem."

"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."