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The Delay in The Diagnosis of Lung Cancer Due to Misdiagnosis as Pulmonary Tuberculosis Jatu Aviani; Satria Maulana EH; Ita Haryatie; Farih Raharjo; Yusup Subagio Sutanto; Ana Rima Setijadi
Jurnal Respirologi Indonesia Vol 37, No 4 (2017)
Publisher : Perhimpunan Dokter Paru Indonesia (PDPI)/The Indonesian Society of Respirology (ISR)

Background: Lung cancer and pulmonary tuberculosis (TB) are global health problem. Similarity of symptoms of both made misdiagnose of lung cancer as TB and treated with Anti Tuberculosis Treatment (ATT). Evaluation of ATT often inaccurate, causing late diagnosis of lung cancer. This study aimed is to determine the lung cancer percentage with delayed diagnosis due giving of ATT for >1 month. Methods: A prospective descriptive study was performed from January 2014-February 2016 in Dr. Moewardi Hospital, Surakarta taken from the patient's medical record. Results: As much 293 patients with lung cancer consisted of 188 males (64.4%) and 105 females (35.8%) with the average age was 57 years old. The types of the lung cancer were non-small cell lung carcinoma (NSCLC) consisted of adenocarcinoma 195 subjects (66.6%), squamous cell carcinoma 65 subjects (22.2%), large cell carcinoma 23 subjects (7.8%) and neuroendocrine carcinoma 4 subjects (1.4%). The stages of the NSCLC were stage I (0%), II (0%), IIIa (0%), IIIb (11.7%) and IV (88.3%). Among 293 lung cancer patients, 89 subjects (30.4%) were diagnosis as pulmonary TB. Two subjects (2.2%) of 89 subjects were truly pulmonary TB while the rest 87 subjects were not pulmonary TB and had ATT for average 12 weeks with the longest period was 16 weeks. The ATT duration >1 month was 76.4%. Conclusions: Percentage of lung cancer patients with ATT before being referred to dr. Moewardi hospital were 30.4% of 293 lung cancer patients while 68 subjects (76.4%) of whom had received ATT >1 month. (J Respir Indo. 2017; 37(4): 288-92)

Comparison of Eutectic Mixture of Local Anesthesia Cream and Subcutaneous Lidocaine to Reduce Chest Tube Removal Pain and Willingness to Repeat Procedure Roman Diaz; Yusup Subagio Sutanto; Ahmad Farih Raharjo
Jurnal Respirologi Indonesia Vol 42, No 2 (2022)
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.v42i2.297

Background:. Patients with chest tube have allodynia (pain from stimuli that is normally painless) and hyperalgesia (increased sensitivity to pain). Anesthetics has not been used routinely when removing chest tubes assuming that the procedure is brief and that the pain is short-lived, even though it could be the most painful part of chest tube procedures.Objective: This study compared the effectiveness of local anesthetic EMLA cream and subcutaneous infiltration of lidocaine to reduce pain of chest tube removal, 10 minutes after, and it’s effect on the patient's willingness to repeat the procedure.Method: A quasi-experimental clinical trial conducted on 28 patients undergoing chest tube removal at dr. Moewardi from September 2020. The EMLA group (n = 14) received 2 grams of topical EMLA cream applied 2 hours before chest tube removal. The lidocaine group (n = 14) received subcutaneous infiltration of 2% lidocaine 5 minutes before chest tube removal. Pain was measured by VAS pain before, during, and 10 minutes after the chest tube was removed, followed by filling out a willingness to repeat procedure questionnaire.Results: Topical EMLA cream was comparable to 2% lidocaine infiltration for reducing pain during chest tube removal (p = 0.679) and 10 minutes thereafter (p = 0.833). EMLA cream did not increase the patient's willingness to repeat the procedure (p = 0.815)Conclusion: Topical EMLA cream able to replace the subcutaneous infiltration of 2% lidocaine as a local anesthetic for chest tube removal but does not increase the patient's willingness to repeat the procedure.

Combined Upper Limb Exercise and Creatine Monohydrate Supplementation Improved Musculoskeletal Function in NSCLC Patients Muhammad Addinul Huda; Ana Rima Setijadi; Reviono Reviono; Farih Raharjo; Yusup Subagio Sutanto
Jurnal Respirologi Indonesia Vol 42, No 4 (2022)
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.v42i4.310

Background: Lung cancer is a chronic respiratory disease that causes muscle dysfunction. Giving creatine monohydrate supplementation combined with exercise has efficacy in increasing lean body mass (LBM), muscle strength, and physical function. This study aims to analyze the effect of a combination of creatine monohydrate supplementation and upper limb exercise on skeletal muscle dysfunction in NSCLC patients.Methods: A quasi-experimental study with a pretest-posttest study on NSCLC patients given epidermal growth factor receptor (EGFR) – tyrosine kinase inhibitors (TKIs) from outpatient at RSUD Dr. Moewardi Surakarta in September - October 2021. The combination group of creatine monohydrate supplementation with upper limb exercise (n=15), the group with creatine monohydrate supplementation only (n=16), and the control group (n=15). Lean body mass in kilograms and percentages, 6-minute walk test (6MWT), and quality of life were assessed after 8 weeks of treatment.Results: The increase in LBM in the combination group was 4.22±1.81kg and 6.38±2.48% (P=0.0001). The combination groups have a greater increase in the 6MWT was 104±20.07 meters. The increase in quality of life in the combined creatine monohydrate supplementation group with upper limb exercise was 20.80±10.75. Changes in the value of LBM, 6MWT, and quality of life (QoL) in the creatine monohydrate supplementation combined with upper limb exercise were significantly different compared to the creatine monohydrate supplementation only group and the control groups.Conclusion: There is a greater effect of giving a combination of creatine monohydrate supplementation and upper limb exercise on LBM, 6MWT, and QoL in NSCLC patients.

Lidocaine Nebulization Compared to Lidocaine Spray in Decreasing Pain, Cough and Breathless in Flexible Fiber Optic Bronchoscopy Vita Ovaria; Yusup Subagio Sutanto; Ahmad Farih Raharjo
Jurnal Respirologi Indonesia Vol 42, No 4 (2022)
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.v42i4.368

Background: Flexible optical fiber bronchoscopy (FFB) is a visual airway tract examination for diagnostic and therapeutic purposes. This procedure often causes discomfort for patients, such as cough, breathlessness and pain. Lidocaine is a topical anesthetic premedication used in bronchoscopy. This study compared the use of lidocaine nebulization and lidocaine spray in inhibiting pain, cough and breathlessness in complexity of flexible fiber optic bronchoscopy.Methods: Pretest and posttest control group clinical study was conducted in patients prior to bronchoscopy at RSUD Dr. Moewardi from February to March 2020. The samples were taken by consecutive sampling technique, then randomly assigned into either lidocaine spray or nebulization. Cough and pain were assessed with VAS score while breathlessness was assessed with Borg score. The data were analyzed statically by using Chi-square test with P<0.05 was considered significantResults: Cough scores were -17.78±11.66 for nebulization and -8.33±6.18 for spray (P=0.005). Pain score were -16.67±11.38 and -9.44±7.25 for nebulization and spray respectively (P=0.045). Borg score obtained the scores for nebulization and 0.06±0.42 for spray (P=1.000).Conclusion: Both lidocaine nebulization and spray were effective in decreasing breathlessness during bronchoscopy. However, lidocaine nebulization was more effective in decreasing cough and pain.

Delayed Treatment and Adverse Effects of Drug Resistance Tuberculosis Impact on Outcome, Survival and Quality of Life Linda Soebroto; Reviono Reviono; Yusup Subagio Sutanto; Farih Raharjo; Jatu Aphridasari
Jurnal Respirologi Indonesia Vol 43, No 1 (2023)
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.v43i1.259

Background: Global TB Report 2020 states that 78% of tuberculosis patients experience drug resistancy with a global treatment success rate of 57%. Drug resistance tuberculosis (DR TB) patients whom experience side effects such as arthralgia and hyperuricemia with inadequate treatment will affect the treatment result.Methods: Retrospective cohort study to DR TB patients who underwent treatment from January 2015 to August 2020 at RSUD dr. Moewardi Surakarta. Survival analysis using Kaplan Meier method and Cox regression test for the effect of risk factors on the safety and survival of TB RO patients. Quality of life analysis using Mann Whitney test.Results: From 372 patients, delayed treatment factor (OR=2.906; 95% CI=1.890-4.469; P≤0.001) and arthralgia factor (OR=1.775; 95% CI=1.148-2.744; P=0.010) were variables that had a significant effect on recovery of DR TB patients. Delayed treatment and arthralgia have risk (2,906 times and 1.775 times) for non-recovered DR TB patients. Delayed treatment factor with HR=14.772 (95% CI=13.381-16.163), arthralgia with HR=15.170 (95% CI=13.960-16.379), and anemia with HR=15.304 (95% CI=14.074-16.535; P=0.002) affect on the survival of DR TB patients. Anemia affect on the quality of life DR TB patients.Conclusion: Delayed treatment for more than 14 days and arthralgia that is not treated adequately can affect the recovery of DR TB patients. The survival and quality of life of DR TB patients can be increased by monitoring the time of taking medication, monitoring side effects of drugs such as arthralgia, and adequate nutritional intake so that anemia does not occur.

The Effect of Inhaled Ipratropium Bromide as a Premedication For Bronchoscopy on Dyspnea, Cough, and Tracheobronchial Secretion Safina Mutmainnah; Yusup Subagio Sutanto; Jatu Aphridasari; A. Farih Raharjo
Jurnal Respirologi Indonesia Vol 43, No 4 (2023)
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.v43i4.256

Background: Bronchoscopy is a minimally invasive procedure used for diagnostic examination and intervention of the airways. Patient comfort and cooperation during bronchoscopy are very important because they affect the success and outcome. The sympathetic anticholinergic effect of ipratropium bromide can improve procedure tolerance and airway visualization. This study was conducted to analyze the effect of inhaled ipratropium bromide as a bronchoscopy premedication for the assessment of dyspnea, cough, and tracheobronchial secretion.Methods: This was a clinical study with a quasi-experimental pretest-posttest control group design in pulmonary patients who underwent bronchoscopy at Dr. Moewardi General Hospital Surakarta in October 2021 using consecutive sampling. The subjects of the study were divided into an intervention group with inhaled ipratropium bromide and a control group without inhaled ipratropium bromide. The Borg scale of dyspnea and the visual analog scale (VAS) score of cough were assessed before and after bronchoscopy in both groups. The grading of tracheobronchial secretion was assessed during bronchoscopy.Results: Thirty-six pulmonary patients who underwent bronchoscopy were included in this study. The intervention group showed a lower Borg scale (0.28±0.57) and VAS score (3.22±8.54), lower tracheobronchial secretion grading, and there was a significant difference compared to the control (P≤0.05).Conclusion: There was a significant difference in the Borg scale of dyspnea, VAS score of cough, and the grading of tracheobronchial secretion in patients undergoing bronchoscopy as an effect of ipratropium bromide inhalation.

Comparison of NEWS, SIRS, and qSOFA Score as Predictors of Mortality and Length of Stay in Patients Pneumonia with Sepsis Harsini Harsini; Aditya Alfarizi; Jatu Aphridasari; A Farih Raharjo; Reviono Reviono
Jurnal Respirologi Indonesia Vol 44, No 1 (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.v44i1.505

Background: Pneumonia is a major health problem in all age groups and often related with sepsis. In 2021, Surviving Sepsis Campaign Guidelines mentioned several clinical scoring systems to identify patients with potentials of developing sepsis, such as systemic inflammatory response syndrome (SIRS), national early warning score (NEWS), quick sequential organ failure assessment (qSOFA) and sequential organ failure assessment (SOFA). The guideline stated that there is no gold standard for diagnosing sepsis, contradicting The Sepsis-3 Guideline in 2016 that mentioned SOFA score as a gold standard for diagnosing sepsis.Methods: Subjects were all patients with pneumonia and sepsis who were treated in Dr.Moewardi Hospital within 1 January to 31 December 2022. Data from subjects’ medical records were collected to assess their NEWS, SIRS, qSOFA, and SOFA score on the day of admission. Since evaluation of SOFA score needs a number of components requiring laboratory results and takes longer time so they made a simpler tool called qSOFA to avoid delayed treatment of the patients.Results: NEWS is more consistent with SOFA compared to SIRS and qSOFA (Kappa value = 0.726 vs 0.320 vs 0.22; respectively). NEWS, SIRS, and qSOFA were all significantly correlated with mortality (P<0.001) with NEWS having the strongest correlation (r=0.482 vs 0.216 vs 0.175; respectively). Only NEWS showed significant correlation with the length of stay (r=0.129; P<0.001).Conclusion: NEWS was the most consistent score to SOFA compared to SIRS and qSOFA. NEWS was also the best predictor for mortality and was the only score correlated with length of hospital stay.

Diagnostic Performance of Cardiopulmonary Exercise Testing (CPET) in Chronic Obstructive Pulmonary Disease (COPD) at a Tertiary Hospital in Indonesia Musdalifah Musdalifah; Hendrastutik Apriningsih; A. Farih Raharjo
Jurnal Respirologi Indonesia Vol 46 No 2 (2026)
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.v46i2.1078

Background: Chronic obstructive pulmonary disease (COPD) remains a major global health burden. Spirometry as the diagnostic gold standard, still has limitations for functional assessment. The existence of cardiopulmonary exercise testing (CPET) provides a comprehensive evaluation of integrated cardiopulmonary and metabolic responses during exercise and may improve diagnostic and management decisions in COPD. This study determined the diagnostic quality of CPET parameters for COPD. Methods: This observational analytic cross-sectional study used paired spirometry and CPET data from medical records at Universitas Sebelas Maret Hospital. Thirty-seven eligible records were analyzed after obtaining ethics approval. CPET parameters included maximal oxygen uptake (VO2max), respiratory exchange ratio (RER), and the slope of the ratio between minute ventilation volume and carbon dioxide production volume (VE/VCO2 slope). Discrimination was assessed using AUC, diagnostic performance was assessed using the chi-square test, and correlation with obstruction severity was assessed using the GOLD classification, with a value of P<0.05 being significant. Results: Of 37 subjects, 62.2% had COPD. COPD status was significantly associated with older age and smoking (both P<0.05). VO2max (sensitivity 73.9%; specificity 78.6%; AUC=0.795; P=0.002), RER (sensitivity 78.3%; specificity 78.6%; AUC=0.846; P=0.001), and VE/VCO2 slope (sensitivity 78.3%; specificity 71.4%; AUC=742; P=0.003) showed useful discrimination. Among CPET parameters, RER correlated significantly with obstruction severity by GOLD (P<0.05), while VO2max and VE/VCO2 slope did not (P>0.05), though trends were worse with more severe disease. Conclusion: The integration of CPET with spirometry provides a more comprehensive approach to the diagnosis and management of COPD.

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