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Abstrak :
Latar belakang: Penelitian ini bertujuan untuk mengetahui proporsi hiperinflasi paru pada pasien asma persisten di Rumah Sakit Persahabatan Jakarta.Metode: Penelitian ini menggunakan desain potong lintang kemudian dilakukan analisis deskriptif. Penelitian dilakukan di klinik Asma RSUP Persahabatan dari bulan September-November 2016. Empat puluh lima subjek dengan consecutive sampling dan dilakukan wawancara, pemeriksaan fisis, foto toraks, spirometri dan multiple breath N2-washout MBW . Hiperinflasi paru pada penelitian ini ditentukan berdasarkan peningkatan volume residu/ kapasitas paru total VR/KPT di atas batas atas nilai normal.Hasil: Proporsi hiperinflasi paru pada pasien asma persisten di RSUP Persahabatan Jakarta adalah 17,8 8 dari 45 subjek . Nilai tengah VR dalam mililiter adalah 1230 570-2860 . Nilai tengah KRF dalam mililiter adalah 1730 970-3990 . Nilai tengah KPT dalam mililiter adalah 3310 2490-6350 . Rerata rasio VR/KPT adalah 36,39 SD 8,86 . Rerata rasio KRF/KPT adalah 52,86 SD 6,85 . Terdapat hubungan yang bermakna antara nilai VEP1 dengan hiperinflasi paru pada asma persisten. Penurunan VEP1 0,05 .Kesimpulan: Proporsi hiperinflasi paru pada pasien asma persisten di RSUP Persahabatan Jakarta adalah sebesar 17,8 . Hiperinflasi paru pada asma persisten berhubungan dengan derajat obstruksi saluran napas.Kata kunci: hiperinflasi paru, asma persisten, multiple breath N2-washout

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Background The aim of the study is to discover the proportion of lung hyperinflation in patient with persistent asthma in Persahabatan Hospital Jakarta.Method A cross sectional study with descriptive analysis was done in Asthma clinic Persahabatan Hospital from September to November 2016. Forty five subjects were recruited consecutively. Interview, physical examination, chest x ray CXR , spirometry and multiple breath N2 washout MBW were performed. Lung hyperinflation was defined as a residual volume total lung capacity RV TLC above the upper limit of normal.Result The proportion of lung hyperinflation in patients with persistent asthma was 17,8 8 of 45 subjects . Median RV in milliliter is 1230 570 2860 . Median functional residual capacity FRC in milliliter is 1730 970 3990 . Median TLC in milliliter is 3310 2490 6350 . Mean RV TLC ratio is 36,39 SD 8,86 . Mean FRC TLC ratio is 52,86 SD 6,85 . There was a significant correlation between forced expiratory volume in 1 second FEV1 value with lung hyperinflation with the decline of FEV1 0,05 .Conclusion The proportion of lung hyperinflation in patient with persistent asthma in Persahabatan Hospital Jakarta was 17,8 . Lung hyperinflation in persistent asthma associated with the degree of airway obstruction.

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Latar belakang: Pasien asma persisten berisiko mengalami penyakit jamur paru, termasuk aspergilosis bronkopulmoner alergika (ABPA) dan aspergilosis paru kronik (APK). Deteksi IgG spesifik Aspergillus metode enzyme-linked immunosorbent assay (ELISA) merupakan pemeriksaan mikologi yang direkomendasikan untuk diagnosis APK. Metode baru yang lebih praktis adalah immunochromatography test (ICT) Aspergillus, tetapi data hasil pemeriksaan tersebut masih terbatas di Indonesia. Penelitian ini bertujuan untuk mengetahui nilai diagnostik ICT Aspergillus dibandingkan dengan metode ELISA pada pasien asma persisten. Metode: Uji diagnostik dilakukan untuk mengetahui nilai diagnostik ICT Aspergillus dibandingkan dengan IgG spesifik Aspergillus metode ELISA. Bahan klinis berasal dari serum pasien asma persisten di RSUP Persahabatan pada tahun 2021 yang memenuhi kriteria inklusi. Deteksi antibodi kedua metode tersebut dilaksanakan di laboratorium Departemen Parasitologi FKUI untuk mengetahui proporsi, sensitivitas, spesifisitas, nilai duga positif dan negatif. Hasil: Deteksi antibodi spesifik Aspergillus kedua metode dilakukan terhadap 50 serum pasien. Proporsi hasil positif ICT Aspergillus 16%, sedangkan ELISA 32%. Nilai diagnostik ICT Aspergillus dibandingkan ELISA menunjukkan sensitivitas 25%, spesifisitas 88,24%, nilai duga positif 50%, dan nilai duga negatif 71,43%. Kesimpulan: Pemeriksaan ICT Aspergillus belum dapat direkomendasikan sebagai pemeriksaan standar diagnosis APK pada pasien asma persisten karena memiliki sensitivitas rendah ......Introduction: Patients with persistent asthma are at risk of developing pulmonary mycoses, including allergic bronchopulmonary aspergillosis (ABPA) and chronic pulmonary aspergillosis (CPA). Aspergillus immunochromatography test (ICT) is a new practical method to detect Aspergillus-specific antibodies, but data on ICT results are still limited in Indonesia. This study aims to determine the diagnostic value of Aspergillus ICT compared to ELISA in persistent asthma patients. Methods: Diagnostic tests were carried out to determine the diagnostic value of Aspergillus ICT. The antibody detection on the sera of persistent asthma patients at Persahabatan General Hospital in 2021 who met inclusion criteria was carried out in the laboratory of Parasitology Department, FMUI to determine the proportion, sensitivity, specificity, positive and negative predictive values. Results: Detection of Aspergillus-specific antibodies was performed on 50 patient sera using ICT and ELISA. The proportion of positive results for Aspergillus ICT revealed 16%, while the ELISA 32%. The diagnostic value of Aspergillus ICT compared to ELISA showed a sensitivity of 25%, specificity of 88.24%, a positive predictive value of 50%, and a negative predictive value of 71.43%. Conclusion: Aspergillus ICT could not be recommended as a standard examination for CPA diagnosis in persistent asthma patients due to its low sensitivity.

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Latar Belakang Asma persisten banyak terjadi pada anak di bawah usia tiga hingga enam tahun. Karakteristik pada anak dengan asma persisten cukup bervariasi sehingga menyebabkan anak rentan mengalami kondisi yang tidak terkendali jika tidak segera ditangani. Di Indonesia, belum ada data yang menggambarkan karakteristik anak dengan asma persisten dan faktor-faktor yang memengaruhi derajat kendalinya. Metode Desain penelitian potong lintang dilakukan terhadap 81 anak berusia 6-18 tahun dengan asma persisten yang melakukan kontrol ke RSCM dalam rentang tahun 2019-2023. Pemilihan sampel dan pengambilan data dilakukan menggunakan rekam medis milik RSCM Kiara dengan metode total sampling. Hasil Asma persisten yang tidak terkendali terjadi pada 53 subjek (65.4%). Sebagian besar subjek berada dalam rentang usia 6-11 tahun (61.7%), berjenis kelamin laki-laki (55.6%), terpapar oleh alergen (72.8%), faktor lingkungan (34.6%), memiliki komorbiditas (88.9%), berada dalam kelompok gizi baik (43.2%), patuh terhadap pengobatan (74.1%), dan menggunakan terapi pengendali jenis metered dose inhaler (84.0%). Dari hasil analisis bivariat dan regresi logistik, tidak ada karakteristik yang menunjukkan hubungan signifikan terhadap derajat kendali asma. Kesimpulan Terdapat 65.4% anak dengan asma persisten yang tidak terkendali. Tidak ada karakteristik yang berhubungan signifikan dan berperan sebagai prediktor independen dengan derajat kendali asma. ......Introduction Persistent asthma often occurs in children under the age of three to six years. The characteristics of children with persistent asthma are quite varied, making children vulnerable to experiencing uncontrollable conditions if not treated immediately. In Indonesia, there is no data that describes the characteristics of children with persistent asthma and the factors that influence the level of control. Method A cross-sectional research design was carried out on 81 children aged 6-18 years with persistent asthma who underwent control at RSCM in the period 2019-2023. Sample selection and data collection were carried out using medical records belonging to RSCM Kiara using the total sampling method. Results Persistent uncontrolled asthma occurred in 53 subjects (65.4%). Most of the subjects were in the age range of 6-11 years (61.7%), male (55.6%), exposed to allergens (72.8%), environmental factors (34.6%), had comorbidities (88.9%), were in the healthy weight group (43.2%), adherent to treatment (74.1%), and used metered dose inhaler control therapy (84.0%). From the results of bivariate analysis and logistic regression, there were no characteristics that showed a significant relationship to the level of asthma control. Conclusion There are 65.4% of children with persistent uncontrolled asthma. There were no characteristics that were significantly related and acted as independent predictors with the level of asthma control.

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

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