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Successful Pulmonary Rehabilitation in COPD During COVID-19 Pandemic Era: A Case Report Widjanantie, Siti Chandra; Ayuningtyas, Putu Duhita; Susanto, Agus Dwi
Jurnal Respirologi Indonesia Vol 44, No 2 (2024)
Publisher : Perhimpunan Dokter Paru Indonesia (PDPI)/The Indonesian Society of Respirology (ISR)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36497/jri.v44i2.597

Background: Chronic obstructive pulmonary disease (COPD) patients are at high risk for COVID-19 infection and severe pulmonary complications. Exercise-based pulmonary rehabilitation (PR) in outpatient settings is essential for COVID-19 survivors with COPD comorbidities, providing the most critical patient benefits, but it is challenging during the pandemic.Case: A sixty-four-year-old man with COPD since 2 years ago, a history of COVID-19 one month ago, and Pulmonary Tuberculosis since 1 year ago presented with chief complaints of tiredness, cough, and breathlessness after walking for more than 100 meters. We performed PR, including breathing retraining exercise, chest mobility exercise, active cycle breathing technique (ACBT), posture correction, and aerobic exercise with static ergo-cycle for 8 weeks.Discussion: After 8 weeks of PR, there was a 3% increase in the O2 saturation level from 94-95% room air to 98%, an increase of single breath counting test (SBCT) from 20 to 38 counts, improvement of peak cough flow from 100-110-100 to 420-435-425 L/minute, and peak flow meter from 140-150-145 to 380-400-400 L/minute. Before PR the patient could not perform the sit-to-stand test (STS) and a 6-minute walking test (6MWT), but after 8 weeks of PR, STS was 5 times in 30 seconds, and 6MWT maximum distance was 248 meters. COPD assessment test (CAT) score improved from 23 to 9, and the Modified Medical Research Council (mMRC) dyspnea scale improved from 3 to 2.Conclusion: Eight weeks of pulmonary rehabilitation showed benefits for the patient in reducing dyspnea and improving exercise tolerance and quality of life, especially in hospital-based settings.

Physical Medicine and Rehabilitation Approach of Elderly with Atypical COVID-19 Symptoms Widjanantie, Siti Chandra; Burhan, Erlina; Susanto, Agus Dwi
Surabaya Physical Medicine and Rehabilitation Journal Vol. 6 No. 2 (2024): SPMRJ, AUGUST 2024
Publisher : Faculty of Medicine, Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/spmrj.v6i2.51713

COVID-19 has affected the older population disproportionately. These patients are prone to have more severe COVID-19. Clinical manifestation of COVID-19 in the geriatric can be atypical and differs from the younger population. We report an 80-year-old male with atypical presentation of COVID-19. In this case report, we describe a COVID-19 patient with anorexia and gastrointestinal symptoms. We also describe the multidisciplinary aspect of physical medicine and rehabilitation management of the patient. Clinical manifestations in geriatric with COVID-19 can be atypical. Symptoms experienced may include anorexia and gastrointestinal tract symptoms. A multidisciplinary approach is needed to manage more seniors with COVID-19 and maximize their functional abilities.

Senam Asma Indonesia dalam Perspektif Rehabilitasi Medis Widjanantie, Siti Chandra; Laras, Sekar; Damayanti, Triya; Nusdwinuringtyas, Nury; Yunus, Faisal
Majalah Kedokteran Indonesia Vol 73 No 6 (2023): Journal of The Indonesian Medical Association - Majalah Kedokteran Indonesia, Vo
Publisher : PENGURUS BESAR IKATAN DOKTER INDONESIA (PB IDI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47830/jinma-vol.73.6-2024-1186

“Senam Asma Indonesia” (SAI) is a series of medical knowledge-based structured physical exercises invented by a multidisciplinary team incorporated in the Indonesian Asthma Foundation (YAI) in 1994, taking into account the characteristics of asthma patients adjusted to the severity of the asthma diagnosis with different loads at each stage. The principles for treating asthma are avoidance of triggers, using medication, and maintaining physical fitness. The quality of life (QoL) of asthma patients decreases due to limited daily life activities caused by the respiratory symptoms they suffer. Multifactorial symptoms of asthma such as limited ventilation, gas transfer abnormalities, pulmonary and cardiac blood vessel dysfunction, and dysfunction of extremity muscles, will cause shortness of breath during physical activity or exercise, which is known as Exercise-induced Bronchoconstriction (EIB). Oral steroid therapy given to treat acute exacerbations can cause steroid-induced myopathy and skeletal muscle remodeling, resulting in decreased muscle endurance. SAI consists of a series of movements designed to improve lung function, strengthen respiratory muscles, and improve the quality of life of asthma patients. From a medical rehabilitation perspective, SAI can contribute to optimizing thoracic wall mobility, respiratory control with pursed-lip breathing, relaxation, and improving cardiorespiratory fitness.

Hubungan Kualitas Hidup Terkait Kesehatan dengan Tingkat Keparahan Sesak pada Lansia Penyintas COVID-19 di Indonesia Widjanantie, Siti Chandra; Susanto, Andri; Alwin, Wanarani; Ilyas, Muhammad
Majalah Kedokteran Indonesia Vol 74 No 4 (2024): Journal of The Indonesian Medical Association - Majalah Kedokteran Indonesia, Vo
Publisher : PENGURUS BESAR IKATAN DOKTER INDONESIA (PB IDI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47830/jinma-vol.74.4-2024-1355

Introduction: COVID-19 is a disease that can severely reduce life quality, particularly in the aged population. The research aim was to establish the correlation between health-related life quality and dyspnea severity within aged COVID-19 survivors.Method: The cross-sectional study was conducted on older COVID-19 survivors at Persahabatan Hospital, Jakarta. The use of WhatsApp® video call and Zoom® video conference applications for audio and video evaluation in data collection. The European Quality of Life-5Dimensions-5L (EQ-5D-5L) and the European Quality of Life-Visual Analog Scale (EQ-VAS) were used to assess health-related quality of life. Modified Borg and modified Medical Research Council (mMRC) dyspnea scale were used to assess dyspnea severity. The data were analyzed using correlation test. Results: Based on 44 data collected, it was found that seven (15.9%) of the participants experienced mild breathlessness, while three patients (6.8%) had severe level of dyspnea on the modified Borg dyspnea scale assessment. The mMRC dyspnea scale assessment indicated that over nine patients (20.4%) had mMRC value greater than one. The study found a significant correlation (p less than 0.01) between the EQ-5D-5L and the modified Borg Dyspnea Scale, particularly in the areas of anxiety or depression (r=0.52), self-care (r=0.51), mobility (r=0.42), and EQ-VAS (r=-0.53). The EQ-5D-5L and the mMRC dyspnea scale showed a significant correlation (p less than 0.01), particularly in relation to usual activities (r=0.69), self-care (r=0.62), and mobility (r=0.65), as well as EQ VAS (r=-0.58).Conclusion: Moderate positive correlations existed between life quality issues including self-care, anxiety, depression and dyspnea severity .

Respiratory Rehabilitation for A Loss to Follow-Up Pulmonary Tuberculosis Patient with Bilateral Hydropneumothorax: A Case Report Isdyanta, Rezky Achmad; Widjanantie, Siti Chandra
Respiratory Science Vol. 5 No. 2 (2025): Respiratory Science
Publisher : Indonesian Society of Respirology (ISR)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36497/respirsci.v5i2.147

Background: Tuberculosis (TB) is a preventable and treatable disease. However, without treatment, mortality from TB is 50%, whereas with treatment, 85% of people with TB can be cured. Incomplete treatment of pulmonary TB can lead to various complications, one is hydropneumothorax, which is an abnormal picture of air and fluid in the pleural cavity. Complications of this condition can lead to long-term impairment of lung function with varying degrees of severity. Pain and shortness of breath are clinical features that interfere with daily activities and are associated with a decreased quality of life. Pulmonary rehabilitation is a crucial component in managing respiratory diseases, including pneumothorax, which aims to restore respiratory muscle strength, optimize lung expansion, and prevent complications such as atelectasis, pleural adhesions, or chronic respiratory insufficiency. Case: A 26-year-old woman presented to the emergency department with moderate dyspnea. She was diagnosed with loss to follow-up (LTFU) TB with bilateral hydropneumothorax and malnutrition. She was in the third month of a four-drug anti-TB regimen and had a chest tube with water shield drainage (WSD) placed in both the right and left chest walls. The rehabilitation problems in these patients are dyspnea, pain in the chest tube insertion area, immobilization, and partial dependency. Discussion: A pulmonary rehabilitation program was initiated during hospitalization and continued in the outpatient rehabilitation clinic, including energy conservation techniques, breathing exercises, relaxation, splinted cough, chest wall mobilization, respiratory muscle stretching, and laser therapy for pain management. Barthel Index (BI) shows improvement from 10 to 45 due to pain reduction. Visual Analog Scale (VAS) 7-8 to 5, allowing the patient to use her right upper extremity for daily activities. Conclusion: Pulmonary rehabilitation is a cost-effective therapy that can improve symptoms and quality of life in patients with post-TB hydropneumothorax. It also reduces spasms, dyspnea, and pain.

Efek Program Telerehabilitasi Paru pada Penyintas COVID-19: Penilaian Status Fungsional Menggunakan 30-Second Sit-To-Stand Test Widjanantie, Siti Chandra; Maylani, Lina; Ilyas, Muhammad; Nusdwinuringtyas, Nury; Susanto, Agus Dwi
Majalah Kedokteran Indonesia Vol 73 No 5 (2023): Journal of The Indonesian Medical Association - Majalah Kedokteran Indonesia, Vo
Publisher : PENGURUS BESAR IKATAN DOKTER INDONESIA (PB IDI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47830/jinma-vol.73.5-2023-1224

Introduction: Long COVID is a persistent symptom among COVID-19 survivors. Fatigue and other symptoms related to respiratory or non-respiratory cause disturbance of patient functional status. Pulmonary telerehabilitation program after hospitalization was needed to optimize patients’ functional status. Assessment of functional status using 30-Second Sit-To-Stand Test (30s-STST) was easily to apply. The aim of this study was to know the changes of functional status in COVID-19 survivors after pulmonary telerehabilitation program.Method: This study was analytic experimental with one group pre-test and post-test design, conducted in Persahabatan Hospital from August to September 2020. The COVID-19 patient’s discharge records were recruited consecutively, 24 patients were eligible for this study to get pulmonary telerehabilitation program for four weeks. The patients were evaluated with 30s-STST twice, at discharge (baseline) and four weeks after discharge.Result: Participants consist of 19 men (79,2%) and 5 women (20,8%). The result of thirty second-STST before and after four weeks pulmonary telerehabilitation program result was 7,75 ± 2,19 dan 13,70 ± 4,23 times. There was a strong positive correlation (significant) between 30s STST result before and after program (r = 0,757, p less than 0,01).Conclusion: There was functional status improvement in COVID-19 survivors after pulmonary telerehabilitation for four weeks, evaluated with 30s-STST.

Combined Institutional and Telerehabilitation Programs for A Post-Tuberculosis Lung Disease Patient with Low Cardiorespiratory Endurance: A Case Report Widjanantie, Siti Chandra; Agustin, Heidy; Handayani, Diah; Burhan, Erlina; Susanto, Agus Dwi
Jurnal Respirologi Indonesia Vol 45 No 4 (2025)
Publisher : Perhimpunan Dokter Paru Indonesia (PDPI)/The Indonesian Society of Respirology (ISR)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36497//jri.v45i4.719

Background: Post-tuberculosis lung disease (PTLD) can lead to long-term respiratory issues and impaired lung function, which can impact quality of life. Pulmonary rehabilitation (PR) is a personalized strategy designed to address these problems and improve overall well-being. It is administered by a diverse team of experts. Case: A 28-year-old female patient with a history of tuberculosis (TB) presented with breathing difficulty. The physical examination revealed decreased chest expansion, shoulder asymmetry, a slight forward neck, and a rounded shoulder. The radiologic findings and bronchoscopy showed PTLD, atelectasis in several parts of the right lung, and regional destruction of the right lung. Discussion: The patient underwent pulmonary rehabilitation (PR), which included endurance exercises, strength training, several types of breathing exercises, breath-stacking exercises, thoracic expansion exercises, physical agents for rehabilitation modalities, education on posture correction, and energy conservation in daily activities. The patient was also monitored remotely through telerehabilitation from home. There were significant improvements in pulmonary function tests. Measurement of FVC, FEV1, the six-minute walking test (6MWT), and the PCF after two weeks of follow-up. After eight weeks of training, there were improvements in cardiopulmonary endurance, muscle endurance, and reduced dyspnea. Conclusion: Comprehensive pulmonary rehabilitation programs, including a combination of institutional and telerehabilitation synchronous approaches, can help improve cardiopulmonary endurance, muscle strength-endurance, and the overall patient's functional life who was suffering from chronic respiratory diseases, such as post-TB sequelae.

Rehabilitation Management for Sarcopenia in Chronic Obstructive Pulmonary Disease: A Literature Review Widjanantie, Siti Chandra; Lestari, Fiona; Nusdwinuringtyas, Nury; Susanto, Agus Dwi
Respiratory Science Vol. 4 No. 3 (2024): Respiratory Science
Publisher : Indonesian Society of Respirology (ISR)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36497/respirsci.v4i3.136

Chronic obstructive pulmonary disease (COPD) is a prevalent and debilitating chronic respiratory condition that not only affects the lungs but has far-reaching systemic consequences; one such consequence is the heightened risk of developing sarcopenia, a condition characterized by progressive loss of skeletal muscle mass and strength. Recent studies have highlighted the significant prevalence of sarcopenia among COPD patients, with rates ranging from 7.9% to 66.7%. This association underscores the importance of early identification and intervention to mitigate the adverse outcomes related to both conditions. Managing COPD patients with sarcopenia is fraught with challenges, primarily due to the multifaceted nature of both conditions. Sarcopenia exacerbates the decline in respiratory function and physical performance in COPD patients, complicating treatment and management strategies. The complexity is further amplified by the need for personalized treatment plans that address these conditions' pulmonary and musculoskeletal aspects. Precise assessment and re-evaluation are essential to ensure optimal outcomes and enhance physical and functional well-being. Rehabilitation for COPD patients with sarcopenia involves a multidisciplinary approach, focusing on exercise training, nutritional support, and pulmonary interventions. Pulmonary rehabilitation programs, tailored to individual patient needs and capabilities, have shown promise in improving exercise capacity, functional performance, and overall health status, thereby enhancing the quality of life for these patients. In this literature review, we will discuss the elevated risk of sarcopenia in COPD patients, highlight the significance of rehabilitation management, and emphasize the pivotal role of precise assessment and re-evaluation in optimizing the care provided to this population.

Successful Pulmonary Rehabilitation in COPD During COVID-19 Pandemic Era: A Case Report Widjanantie, Siti Chandra; Ayuningtyas, Putu Duhita; Susanto, Agus Dwi
Jurnal Respirologi Indonesia Vol 44 No 2 (2024)
Publisher : Perhimpunan Dokter Paru Indonesia (PDPI)/The Indonesian Society of Respirology (ISR)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36497/jri.v44i2.597

Background: Chronic obstructive pulmonary disease (COPD) patients are at high risk for COVID-19 infection and severe pulmonary complications. Exercise-based pulmonary rehabilitation (PR) in outpatient settings is essential for COVID-19 survivors with COPD comorbidities, providing the most critical patient benefits, but it is challenging during the pandemic.Case: A sixty-four-year-old man with COPD since 2 years ago, a history of COVID-19 one month ago, and Pulmonary Tuberculosis since 1 year ago presented with chief complaints of tiredness, cough, and breathlessness after walking for more than 100 meters. We performed PR, including breathing retraining exercise, chest mobility exercise, active cycle breathing technique (ACBT), posture correction, and aerobic exercise with static ergo-cycle for 8 weeks.Discussion: After 8 weeks of PR, there was a 3% increase in the O2 saturation level from 94-95% room air to 98%, an increase of single breath counting test (SBCT) from 20 to 38 counts, improvement of peak cough flow from 100-110-100 to 420-435-425 L/minute, and peak flow meter from 140-150-145 to 380-400-400 L/minute. Before PR the patient could not perform the sit-to-stand test (STS) and a 6-minute walking test (6MWT), but after 8 weeks of PR, STS was 5 times in 30 seconds, and 6MWT maximum distance was 248 meters. COPD assessment test (CAT) score improved from 23 to 9, and the Modified Medical Research Council (mMRC) dyspnea scale improved from 3 to 2.Conclusion: Eight weeks of pulmonary rehabilitation showed benefits for the patient in reducing dyspnea and improving exercise tolerance and quality of life, especially in hospital-based settings.

Rehabilitasi Jantung Pasca Percutaneous Coronary Intervention and Coronary Artery Bypass Surgery Billy, Matthew; Widjanantie, Siti Chandra
Majalah Kedokteran Indonesia Vol 69 No 12 (2019): Journal of The Indonesian Medical Association - Majalah Kedokteran Indonesia, V
Publisher : PENGURUS BESAR IKATAN DOKTER INDONESIA (PB IDI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47830/jinma-vol.69.12-2019-163

Berbagai panduan menyarankan pentingnya rehabilitasi jantung. Program ini diberikan untuk pasien dengan infark miokardium, terlebih lagi pasca tindakan jantung seperti percutaneous coronary intervention (PCI) ataupun coronary arter bypass grafting (CABG).

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