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%).
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. |
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