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"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. "

"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."

"Penyakit Paru Obstruksi Kronis (PPOK) merupakan penyakit paru yang menetap yang dapat dicegah dan diobati, ditandai dengan adanya keterbatasan aliran udara yang menetap dan bersifat progresif dikarenakan abnormalitas saluran napas dan/atau alveolus yang biasanya disebabkan oleh pajanan gas atau partikel berbahaya. Laporan ini dimaksudkan untuk menganalisis pemberian Asuhan Keperawatan dengan penerapan Model Adaptasi Roy pada pasien kelolaan utama dan 30 pasien resume dengan menggunakan metode studi kasus, laporan tentang penerapan latihan pernapasan untuk mengurangi sesak dan meningkatkan toleransi aktivitas pada pasien PPOK dan penerapan RDOS untuk menilai tanda-tanda distres pernapasan. Hasil menunjukkan masalah keperawatan yang muncul adalah hambatan pertukaran gas, nutrisi kurang dari kebutuhan tubuh, ketiddakberdayaan dan ketidakefektifan manajemen kesehatan. Model Adaptasi Roy dapat diterapkan dalam asuhan keperawatan pada pasien PPOK untuk mampu beradaptasi terhadap penyakitnya.

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Chronic Obstructive Pulmonary Disease (COPD) is a persistent lung disease that can be prevented and treated, characterized by limited persistent and progressive air flow due to airway abnormalities and / or alveoli which is usually caused by exposure to harmful gases or particles. This report aims to analyze the apllication of Roy Adaptation Model to primary care nursing and the 30 patient resumes using case study methods, the application of respiratory training to reduce dispnea and increase activity tolerance in COPD patients and the application of RDOS to assess the signs of respiratory distress. The results showed nursing problems arise were impaired gas exchange, imbalanced nutrition less than body requirements, powerlessness and ineffective health management. Roy  Adaptation Model can be applied in nursing care for patients with COPD  to adapted the ability of their the disease."

"Telah dilakukan penelitian peran n-acetylcysteine (NAC) dosis tinggi jangka pendek pada perubahan klinis dan kadar protein C-reaktif (CRP) penderita penyakit paru obstruksi kronik eksaserbasi akut di RSUD Dr.Moewardi Surakarta. Penelitian ini adalah penelitian eksperimental dengan desain completely randomized experiment. Tujuan penelitian ini adalah untuk mengetahui peran n-acetylcysteine dosis tinggi jangka pendek terhadap perubahan klinis dan nilai CRP penderita PPOK eksaserbasi akut.Kriteria inklusi pada penelitian ini adalah semua penderita PPOK eksaserbasi akut tanpa disertai gagal jantung, penyakit hepar, batu ginjal dan gagal ginjal, kanker paru, infeksi di luar saluran pemapasan, diabetes melitus dan pemakai kortikosteroid oral. Semua penderita dinilai skala klinis dan CRP sebelum dan 5 hari setelah perlakuan. Penilaian skala klinis berupa kesulitan mengeluarkan dahak dan auskultasi paru. Pemeriksaan nilai CRP menggunakan metode kuantitatif high sensity CRP.Subyek penelitian berjumlah 42 orang, secara random dibagi menjadi 3 kelompok yaltu kelompok kontroi, NAC 600 mg dan NAC 1200 mg, masing-masing kelompok terdiri dari 14 orang. Semua subyek penelitian mendapatkan terapi standar berupa aminofilin drip, cefotaxim 1 gram / 12 jam IV, metilprednisolon 62,5 mg / 8 jam IV, nebulizer ipratropium bromida 4x20 µg/hari dan fenoterol 4x200 µg/hari. Penelitian diikuti selama 5 hari dan tiap hari dinilai skala klinis. Data yang diperoleh dianalisis uji beda dengan ANOVA dan uji korelasi dengan uji pearson, dikatakan bermakna bila p < 0,05.Hasil penelitian didapatkan perbedaan penurunan skala klinis antara kelompok kontrol dengan NAC 600 mg 1,21 (p=0,001), kelompok kontrol dengan NAC 1200 mg 3,71 (p=0,000), dan kelompok NAC 600 mg dengan NAC 1200 mg 2,50 (p=0,000). Perbedaan penurunan rata-rata kadar CRP antara kelompok kontrol dengan NAC 600 mg 16,93 (p=0,266), kelompok kontrol dengan NAC 1200 mg 1,95 (p=1,00) dan kelompok NAC 600 mg dengan NAC 1200 mg -14,97 (p=0,39). Lama perawatan di rumah sakit kelompok kontrol adalah 6-14 hari, rata-rata 7 hari (SD 2,287), kelompok NAC 600 6-12 hari, rata-rata 6,71 hari (SD 1,637) dan kelompok NAC 1200 6-10 hari, rata-rata 6,50 hari (SD 1,160). Uji korelasi antara kadar CRP dengan hitung leukosit didapatkan korelasi sedang dan bermakna. (r=0,402; p=0,08), dan korelasi antara kadar CRP dan hitung jenis neutrotil adalah korelasi sedang dan bermakna. (r=0,423; p=0,05). Hasil penelitian di atas menunjukkan perbedaan skala klinis lebih besar pada penderita PPOK eksaserbasi akut dengan pemberian NAC dosis tinggi jangka pendek dibanding tanpa pemberian NAG. Perbedaan nilai CRP tidak lebih besar pada penderita PPOK eksaserbasi akut dengan pemberian NAC dosis tinggi jangka pendek dibanding tanpa pemberian NAC. Perbedaan skala klinis lebih besar pada penderita PPOK eksaserbasi akut dengan pemberian NAC dosis tinggi jangka pendek dibanding dengan pemberian NAC dosis lazim. Perbedaan nilai CRP tidak lebih besar pada penderita PPOK eksaserbasi akut dengan pemberian NAC dosis tinggi jangka pendek dibanding dengan pemberian NAC dosis lazim.Kesimpulan penelitian ini adalah pemberian NAC dosis dosis tinggi jangka pendek dapat memberikan perbaikan klinis pada penderita PPOK ekasaserbasi akut, tetapi tidak terdapat perubahan nilai CRP yang bermakna.

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Chronic obstructive pulmonary disease (COPD) is an obstructive airway disorder characterized by slowly progressive and irreversible or only partially reversible. Oxidative stress is increased in patients with COPD, particularly during exacerbations and reactive oxygen species contribute to its pathophysiology. This suggests that antioxidants may be use in the treatment of COPD. Other studies have shown that nacetylcysteine (NAC) has antioxidant and antiinflamatory properties. In vitro, NAC inhibit neutrophil chemotaxis, interleukin (IL)-8 secretion and other pro-inflammmatory mediators such as the transcription nuclear factor (NF)-xB, which is directly correlated with the production of the systemic inflamatory marker C-reactive protein (CRP).The aim of this study was to evaluate the role of high dose-short course n-acetylcysteine in clinical improvement and C - reactive protein's patients with exacerbations of chronic obstructive pulmonary disease. Forty two patients? exacerbations of COPD participated in this study. The subjects were randomly assigned, divided by three treatment groups: placebo (n=14), NAC 600 mg/day (n=14) and NAC 1200 mg/day (n=14), Concomintant use of inhaled p2-agonist and anticholinergics, aminophylline drip, cefotaxim 1g/12h, methyiprednisolon 62,5mg/8h were permitted during the study, while the use of antitussive and mucolitic were prohibited. Clinical symptoms were scored on 2-point scales, difficulty of expectoration and auscultation breath sound. CRP level are determined by high sensitivity C-reactive protein (HS-CRP). All measurements would be taken in baseline and were repeated after 5 days.The results of this study showed that clinical outcomes were improved significantly in patients treated with NAC compared to placebo and clinical outcome of patients treated with NAC 1200 mg/day were more frequently significant than treated with NAC 600 mg/day. There was no significantly reduction in CRP level.The conclusion was treatment with high dose short course NAC improving clinical outcomes in patients? exacerbations of COPD."

"ABSTRAKLatar Belakang: Eksaserbasi pada PPOK mempunyai kontribusi yang besar terhadap derajat keparahan dan progresivitas PPOK. Identifikasi faktor-faktor yang berhubungan dengan eksaserbasi PPOK banyak diteliti di luar negeri. Dengan mempertimbangkan terdapatnya perbedaan karakteristik pasien di Indonesia, maka perlu dilakukan penelitian tentang faktor-faktor yang berhubungan dengan eksaserbasi pada pasien PPOK di Indonesia.Tujuan: Mengetahui prevalensi eksaserbasi pada pasien PPOK di RSCM selama kurun waktu 1 Januari 2010 sampai dengan 31 Desember 2012 serta untuk mengidentifikasi faktor-faktor yang berhubungan dengan eksaserbasi pasien-pasien PPOK yang berobat di RSCM baik rawat jalan maupun rawat inap.Metode: Penelitian ini merupakan studi dengan desain potong lintang pada pasien PPOK yang berobat di RSCM selama tahun 2010–2012. Data klinis dan penunjang selama perawatan diperoleh dari rekam medis. Analisis bivariat dilakukan pada variabel kelompok usia, riwayat merokok, komorbiditas, derajat PPOK, riwayat pengobatan dengan kortikosteroid, dan frekuensi eksaserbasi dalam satu tahun sebelumnya.Variabel yang memenuhi syarat akan disertakan pada analisis multivariat dengan regresi logistik.Hasil: Sebanyak 184 pasien diikutsertakan dalam penelitian ini. Didapatkan prevalensi eksaserbasi PPOK sebesar 70,7%. Derajat PPOK , riwayat perokok, frekuensi eksaserbasi satu tahun sebelumnya, pengobatan kortikosteroid sistemik, dan komorbid merupakan variabel yang berbeda bermakna pada analisis bivariat. Faktor risiko independen yang bermakna pada analisis multivariat adalah frekuensi eksaserbasi PPOK dalam satu tahun sebelumnya ≥ 2 kali (OR 27,39; IK 95% 3,30 sampai 227,29; p = 0,002), perokok aktif (OR 5,11; IK 95% 1,07 sampai 24,35; p = 0,041), PPOK derajat III dan IV (OR 4,71; IK 95% 1,59 sampai 13,97; p = 0,005), dan komorbid dengan nilai Charlson Comorbid Index lebih dari dua (OR 4,09; IK 95% 1,37 sampai 12,18; p = 0,011). Sedangkan pengobatan dengan kortikosteroid sistemik merupakan faktor proteksi terhadap eksaserbasi PPOK (OR 0,12; IK 95% 0,03 sampai 0,54; p = 0,006).Simpulan: Prevalensi eksaserbasi pasien PPOK di RSCM pada tahun 2010 sampai dengan 2012 adalah 70,7%. Faktor risiko eksaserbasi PPOK adalah frekuensi eksaserbasi PPOK pada satu tahun sebelumnya lebih dari sama dengan dua kali, perokok aktif, PPOK derajat III dan IV serta komorbid dengan Charlson Comorbid Index . Sedangkan pengobatan dengan kortikosteroid sistemik merupakan faktor proteksi terhadap eksaserbasi PPOK.

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ABSTRACTBackground. Exacerbation in chronic obstructive pulmonary disease (COPD) contributes greatly to the severity and progression of COPD. Identification of factors associated with exacerbation of COPD has widely studied abroad with varying results. Due to difference in patient characteristic, it is necessary to study on the factors associated with exacerbation of COPD in Indonesia.Aim.To determine the prevalence of COPD exacerbations in RSCM during 2010 until 2012. And to identify factors associated with exacerbation of COPD patients who seek treatment at Cipto Mangunkusumo Hospital, both inpatient and outpatient.Methods. This study was a cross sectional study design in COPD patients who seek treatment at CiptoMangunkusumo Hospital, both inpatient and outpatient, during 2010-2012. Clinical data, supportive data, and outcome (exacerbation or stable) data during treatment were obtained from medical records. Bivariate analyses were performed on age, history of smoking, comorbidity, severity of COPD, history corticosteroids treatment, and frequency of exacerbations in the previous year. Variables that were eligible would be included in the multivariate analysis in the form of logistic regression.Results. A total of 184 patients enrolled in this study. Prevalence of COPD exacerbation was 70.7%. Severity of COPD, history of smoking, frequency of previous exacerbations, history of systemic corticosteroid treatment, and comorbidity were variables found to be significantly different in bivariate analysis. Independent risk factors that were found to be significant in multivariate analysis were ≥ 2 times of COPD exacerbation in the previous year (OR 27.39; 95% CI 3.30 to 227.29; p = 0.002), current smoker (OR 5.11; 95% CI 1.07 to 24.35; p = 0.041), grade III and IV of COPD (OR 4.71; 95% CI 1.59 to 13.97; p = 0.005), and comorbid with charlson comorbid index value more of two (OR 4.09; 95% CI 1.37 to 12.18; p = 0.011). While treatment with systemic corticosteroid is protective factor against COPD exacerbations (OR 0.12; 95% CI 0.03 to 0.54; p = 0.006).Conclusion. The prevalence of COPD exacerbations in RSCM during 2010 to 2012 is 70.7%. Risk factors for COPD exacerbation are more than or equal to two times of COPD exacerbation in the previous year, current smokers, grade III and IV of COPD and comorbid with charlson comorbid index value more of two. While treatment with systemic corticosteroid is protective factor against COPD exacerbations."

"Latar Belakang: Penyakit Paru Obstruktif Kronik (PPOK) berkontribusi terhadap masalah kesehatan yang bermakna selama penyelenggaraan haji. Kementerian Kesehatan RI mendokumentasikan PPOK sebagai penyebab ketiga terbesar perawatan jemaah haji yaitu sebesar 7,2% pada tahun 2010. Identifikasi individu yang berisiko lebih tinggi untuk mengalami eksaserbasi akut PPOK selama pelaksanaan haji menjadi penting. Oleh karenanya, penggunaan skor CAT dalam memprediksi risiko eksaserbasi akut pada populasi khusus ini perlu diteliti lebih lanjut. Tujuan: Mengevaluasi skor CAT sebagai prediktor kejadian eksaserbasi akut pada jemaah haji dengan PPOK. Metode: Penelitian kohort prospektif ini dilakukan pada jemaah haji Embarkasi Provinsi DKI Jakarta tahun 2012. Sebelum keberangkatan, subyek diminta mengisi CAT dan diberikan kartu pencatatan harian untuk mencatat gejala eksaserbasi akut selama pelaksanaan haji. Kartu serupa juga diberikan pada dokter kelompok terbang (kloter) mereka. Saat kedatangan di tempat disembarkasi, subyek diwawancarai dan dilakukan pemeriksaan kesehatan serta pengumpulan kartu pencatatan harian dari pasien maupun dokter kloter. Eksaserbasi akut ditentukan dari kartu pencatatan harian dan buku kesehatan haji yang dibawa oleh tiap jemaah. Hasil: Sebanyak 61 pasien PPOK direkrut dengan subyek laki-laki sejumlah 57 orang (93,4%) dan rerata usia 58,8±8,5 tahun. Eksaserbasi akut terjadi pada 35 pasien (57,4%). Skor CAT berkisar antara 0–25 dengan rerata 8,2±5,5. Persentase kelompok kategori CAT rendah (skor<10) sebesar 63,9% sementara 36,1% memiliki kategori CAT sedang-berat (skor CAT 10-30). Didapatkan Risiko Relatif sebesar 1,33 (IK95% 0,875–2,020), Nilai Duga Positif: 0,68 (IK95% 0,47–0,84), dan AUC 0,773 (IK95% 0,647-0,898). Median skor CAT 9 (nilai minimum 1; maksimum 25) untuk kelompok eksaserbasi akut dan median 4 (nilai minimum 0; maksimum 17) untuk kelompok tidak eksaserbasi akut yang bermakna secara statistik (p<0.0001, Uji Mann-Whitney). Simpulan: Terdapat peningkatan kejadian eksaserbasi akut pada jemaah haji dengan CAT kategori sedang-berat dibandingkan kelompok CAT kategori ringan namun belum terlihat perbedaan risiko yang bermakna pada penelitian ini dan skor CAT memiliki kemampuan untuk memprediksi terjadinya eksaserbasi akut.

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Background: COPD contributes to significant health problems during pilgrimage for moslems. Indonesian Ministry of Health COPD as the third leading causes of hospitalization pilgrims with percentage of 7.2% in 2010. Identifying individuals with higher risk to have acute exacerbation during the pilgrimage is essential. Therefore, the use of CAT scores in predicting the risk of acute exacerbation in this special population merits further investigation.

Objective: To evaluate CAT score as predictor of acute exacerbation event in pilgrims with COPD.

Methods: This propective cohort study was conducted to pilgrims from DKI Jakarta Province in 2012. Prior to departure, subjects were asked to complete CAT and given diary card to record any symptoms of exacerbation during pilgrimage. Similar observation card were also given to their pilgrims groups’ doctors. On arrival at disembarkation point, subjects underwent interview and health examination while diary cards were collected from both patients and their doctors. Acute exacerbation were determined from the diary cards and individual health record book carried by every pilgrim.

Results: Sixty one COPD patients were recruited comprising 57 male subjects (93.4%) and mean age for this study is 58.8 ± 8.5 years. Acute exacerbation occurred in 35 patients (57.4%). CAT scores range from 0–25 with a mean of 8.2±5.5. Percentage of low CAT category group (score <10) was 63.9% while the 36.1% of subjects were in medium to high CAT category group (score 10-30). Relative Risk for acute exacerbation was 1.33 (95% CI 0.875 – 2.020), Positive Predivetive Value: 0.68 (95%CI 0.47–0.84), and AUC 0.773 (95% CI 0.647-0.898) and median CAT scores were 9 (minimum value 1; maximum 25) for acute exacerbation group and 4 (minimum value 0; maximum 17) for and non acute exacerbation group which was statistically significant (p<0.0001, Mann-Whitney U test).

Conclusion: An increasead numbers of acute exacerbation was observed in moderate-severe category CAT score compared to those in mild category nevertheless a significant risk difference was not demonstrated in this study and CAT score has the ability to predict acute exacerbation."

"Penyakit paru obstruksif kronik PPOK merupakan penyakit paru dengan karakteristik hambatan aliran udara yang progresif, karena peningkatan reaksi peradangan kronik berlebihan pada saluran napas dan parenkim paru. Stres oksidatif terutama akibat pajanan rokok dalam jangka waktu lama berperan sentral pada patogenesis PPOK. Beta karoten suatu karotenoid punya peran pada stres oksidatif dengan kemampuan mereduksi paling tinggi dan lebih efisien mengikat radikal yang berasal dari dalam dinding liposom pada kompartemen lipofilik dinding sel. Di Indonesia bahan makanan sumber β-karoten mudah didapat. Penelitian ini bertujuan mencari hubungan antara kadar β-karoten dan MDA serum pada penderita PPOK. Penelitian pontong lintang ini mengikutsertakan 47 penderita PPOK melalui metode consecutive sampling. Data sosio-demografi, riwayat merokok, asupan β-karoten secara FFQ semikuantitatif diperoleh dengan wawancara. Data skor CAT, kekerapan kekambuhan dan uji fungsi paru terbaru didapatkan dari rekam medik. Dilakukan pengukuran IMT, kadar MDA serum dengan spektrofotometri dan β-karoten serum dengan HPLC. Subjek paling banyak berusia 60-74 tahun, bekas perokok, dengan IMT normal. Asupan dan kadar ?-karoten serum rendah pada sebagian besar 63,8 subjek. Kadar MDA serum cenderung lebih tinggi daripada orang sehat, menandakan adanya penngkatan stres oksidatif pada penderita PPOK. Tidak didapatkan adanya korelasi antara kadar β-karoten dan MDA serum.

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Chronic obstructive pulmonary disease COPD is a lung disease, characterized by progressive air flow resistance, which increase chronic inflammatory reactions of the airways and lung parenchyma. A history of exposure to risk factors, especially smoking, for long term contribute to the central role of oxidative stress in the pathogenesis of COPD. Beta carotene as one of the antioxidants may play a role in oxidative stress among COPD patients, carotene's food source is abandon in Indonesia. This cross sectional study aimed to investigate relationship between levels of serum carotene and MDA in COPD patients. Consecutive sampling was applied to recruit 47 COPD subjects, who mainly subjects elderly with history of heavy smoking. Socio demographic data, smoking history, intake of carotene by semiquantitative FFQ was obtained by interview. CAT score, frequency of exacerbations and lung function tests were obtained from medical records. Nutritional status by BMI, concentration of carotene by HPLC and MDA serum by spectrophotometry were assessed. More than 50 subjects'carotene intake and serum level were lower than reference. Serum MDA level was higher than healthy person's, indicating an increase oxidative stress among COPD patients. There was no correlation between serum carotene and MDA levels. "

"Penyakit Paru Obstruktif Kronik PPOK adalah penyakit akibat stres oksidatif penyebab menurunnya fungsi paru sehingga mempengaruhi kualitas hidup penderitanya.Tes baku untuk mengukur kualitas hidup PPOK adalah COPD AssessmentTest CAT . Vitamin C sebagai antioksidan banyak terdapat di cairan pelapis epitel paru. Penelitian ini bertujuan mengetahui korelasi antara kadar vitamin C serum dan skor CAT pada PPOK. Penelitian potong lintang ini dilakukan di RSUP Persahabatan,Jakarta Timur, melibatkan 47 subjek dengan metode consecutive sampling. Data karakteristik subjek dan asupan vitamin C secara FFQ semikuantitatif didapatkan melalui wawancara. Data klasifikasi klinis, fungsi paru, komorbid, skor CAT didapatkan dari rekam medis dan wawancara. Status gizi ditentukan berdasarkan Indeks Masa Tubuh IMT , dan kadar vitamin C serum dengan spektrofotometer. Semua subjek laki-laki, rerata usia 66,6 tahun, sebagian besar bekas perokok berat dengan fungsi paru rendah. Status gizi kurang pada 25 subjek, skor CAT kategori ringan, asupan vitamin C cukup, dan kadar vitamin C rendah. Tidak didapatkan korelasi antara kadar vitamin C serum dan skor CAT.

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COPD is a disease due to oxidative stress causing low pulmonary function, resulting in low quality of life. A standard test to measure the quality of life in COPD is COPD Assessment Test CAT . Vitamin C as antioxidant is widely available in the pulmonary epithelial fluid. This study aimed to investigate the correlation between serum vitamin C level and CAT score in COPD. This cross sectional study was conducted at Persahabatan Hospital, East Jakarta, involving 47 subjects using consecutive sampling method. Interview was used to assess subjects rsquo characteristics and vitamin C intake using semi quantitative FFQ. Clinical classification, lung function, comorbidity, and CAT scores were gathered from medical records or interview. BMI was used to determine nutritional status, while vitamin C serum level was assessed using spectrophotometry. All subjects were male, mean age was 66.6 years, mostly ex heavy smokers, with decreased lung function, and 25 were undernourished. Vitamin C intake was sufficient, but low in serum vitamin C level and CAT score. There was no correlation between serum vitamin C levels and CAT score. "

"Latar Belakang: Perubahan sistemik pada PPOK menyebabkan terjadinya disfungsi otot yang berhubungan dengan penurunan fungsi keseimbangan. Gangguan keseimbangan menimbulkan konsekuensi terhadap kejadian jatuh. Penambahan latihan keseimbangan pada PPOK dapat meningkatkan fungsi keseimbangan, namun belum menjadi standar tatalaksana pada program rehabilitasi PPOK. Latihan ketahanan dengan menggunakan jentera dan sepeda statis menunjukkan adanya peningkatan nilai uji fungsi keseimbangan pasien PPOK, namun belum ada penelitian yang membandingkan antara kedua latihan tersebut dalam meningkatkan fungsi keseimbangan pasien PPOK. Tujuan: Menilai efek latihan jentera dan latihan sepeda statis selama delapan minggu terhadap perbaikan fungsi keseimbangan pasien PPOK.Metode. Uji klinis teracak terhadap pasien PPOK stabil grup A,B,C dan D pada usia 55-80 tahun. Subjek dibagi dalam dua kelompok, yaitu kelompok jentera dan kelompok sepeda statis. Kedua kelompok mendapat program rehabilitasi paru selama delapan minggu. Dilakukan evaluasi fungsi keseimbangan dengan menggunakan Berg Balance Scale BBS pada awal penelitian, 4 dan 8 minggu setelah mulai penelitian. Hasil: Terdapat 16 subjek PPOK yang menyelesaikan penelitian. Didapatkan peningkatan yang signifikan secara statistik pada nilai BBS baik pada latihan jentera maupun pada latihan sepeda statis setelah delapan minggu latihan dengan nilai akhir BBS 51,88 dan 50,25 secara berurutan. Tidak didapatkan perbedaan yang bermakna secara statistik antara selisih peningkatan nilai BBS latihan jentera dan latihan sepeda statis dengan nilai tengah 3,00 dan 3,50 secara berurutan. Kesimpulan: Nilai BBS menunjukkan perbaikan bermakna secara statistik baik pada latihan jentera maupun sepeda statis. Tidak terdapat perbedaan efek yang bermakna secara statistik antara latihan pada kedua kelompok tersebut.

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Background: Systemic changes in COPD result in muscle dysfunction that associated with decreased balance function. Impaired balance has consequences for falling events. The addition of balance exercises to COPD can improve balance function, but it has not yet become the standard treatment for COPD rehabilitation programs. Endurance exercises using treadmill and static cycle show an increase in balance function test of COPD patients, but no studies have compared the two exercises in order to improve the balance function of COPD patients.

Aim: To assess the effects of treadmill and static cycle exercise for eight weeks on improving balance function of COPD patients. Method. Randomized Clinical trials of stable COPD patients on A, B, C and D group at age 55 80 years. Subjects were divided into two groups, treadmill and static cycle group. Both groups received pulmonary rehabilitation program for eight weeks. Evaluation of balance function using Berg Balance Scale BBS at the beginning of the study, 4 and 8 weeks after the study.

Results: There were 16 subjects of COPD who completed the study. There was a statistically significant increase in the value of BBS in both treadmill and static cycle group after eight weeks of exercise with a final BBS score of 51.88 and 50.25 respectively. There was no statistically significant difference between the improvement value of BBS in treadmill and static cycle exercise with median values of 3.00 and 3.50 respectively.

Conclusion: The BBS score showed statistically significant improvements in treadmill and static cycles exercise. There was no statistically significant different effect of exercises in both groups. "

"Penyakit paru obstruktif kronik (PPOK) merupakan salah satu penyakit yang menjadi masalah di Indonesia. PPOK ditandai oleh hambatan aliran udara di saluran napas yang disebabkan oleh kelainan saluran napas atau kelainan anatomis paru atau kombinasi dari keduanya. Salah satu komplikasi yang dapat terjadi pada penderita PPOK yaitu kurangnya asupan oksigen pada waktu malam hari. Keadaan tersebut akan semakin diperberat apabila penderita PPOK juga menderita gangguan tidur Obstructive Sleep Apnea (OSA). OSA adalah gangguan tidur yang disebabkan penyumbatan saluran napas dan menyebabkan jeda sementara saat napas minimal 10 detik. Pada penelitian ini, peneliti menggunakan seleksi fitur Information Gain untuk mencari fitur-fitur yang berpengaruh terhadap risiko terjadinya OSA pada pasien PPOK. Setelah proses seleksi fitur selesai, peneliti menggunakan metode Random Forest untuk mengklasifikasi pasien PPOK yang beresiko tinggi terkena OSA dan yang berisiko rendah terkena OSA. Sampel pada penelitian ini merupakan 111 pasien PPOK yang berada di RS Cipto Mangunkusumo. Dari hasil penelitian ini, nilai akurasi terbaik didapat saat penggunaan 4 fitur terbaik dari keseluruhan fitur (10% fitur dari keseluruhan fitur) sebesar 85.71% dengan sensitifitas dan spesifisitas berturut-turut sebesar 71.43% dan 92.86%. Fitur yang memiliki rangking terbaik adalah lingkar pinggang.

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Chronic obstructive pulmonary disease (COPD) is one of the epidemic diseases in Indonesia. The characters of COPD can be seen from airway abnormalities, anatomical abnormalities of the lungs, or the combination of both. One complication that can occur in patients with COPD is lack of oxygen intake at night. This situation will be further aggravated if COPD patients also suffer from Obstructive Sleep Apnea (OSA). OSA is a sleep disorder caused by airway obstruction, and causes a temporary pause when breathing for at least 10 seconds.

In this study, we used Information Gain feature selection to determine which features that affect the risk of OSA in COPD patients. After the feature selection process was completed, we used the Random Forest Classifier method to classify who has the high risk and who has the low risk of developing OSA in COPD patients. The sample in this study consist of 111 COPD patients with 34 features who hospitalized in Cipto Mangunkusumo Hospital.

From experimental result, the best accuracy are obtained by 4 features (10% of total features) i.e 85.71% with sensitivity and specificity are 71.43% and 92.86% respectively. The feature with highest ranking is waist size."