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Late-Onset Asthma: A Review Moelamsyah, Yandi Noer; Yunus, Faisal; Nurwidya, Fariz; Amien, Bagus Radityo
Jurnal Respirasi Vol. 10 No. 3 (2024): September 2024
Publisher : Faculty of Medicine Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/jr.v10-I.3.2024.272-279

Asthma is a chronic respiratory condition with a growing global prevalence, affecting millions of individuals annually. While asthma can develop at any age, late-onset asthma is a specific phenotype that begins in adulthood, as recognized by the Global Initiative for Asthma (GINA) in its 2024 guidelines. This form of asthma is often associated with several predisposing factors, including gender, obesity, occupational exposure, rhinitis, respiratory infections, smoking, stress, and diminished lung function. Unlike early-onset asthma, which frequently involves a history of allergies, late-onset asthma tends to lack allergic triggers, making it a distinct and challenging form of the disease. Managing late-onset asthma is often more complex, as it typically requires higher doses of corticosteroids and demonstrates a reduced responsiveness to standard steroid treatments. The exact mechanisms and pathophysiological processes contributing to the increased severity and poorer clinical outcomes in late-onset asthma remain largely unclear. This uncertainty often leads to underdiagnosis and inadequate management, further complicating patient care. Phenotypic analysis is recommended to improve treatment outcomes. This includes assessing clinical features and utilizing biomarkers, such as inflammatory markers and immunoglobulin E (IgE) levels, to guide targeted therapy when conventional steroid treatments are insufficient. However, there is a significant need for further research to elucidate the underlying mechanisms of late-onset asthma. This literature review is essential to develop more effective, personalized treatment strategies that can address the unique challenges posed by this asthma phenotype, ultimately leading to better management and improved patient outcomes.

Risk of Developing Chronic Obstructive Pulmonary Disease in Non-Smoking Adults Exposed to Particulate Matter 2.5 Compared to Those Without Exposure Notariza, Kemas Rakhmat; Amien, Bagus Radityo; Susanto, Agus Dwi
Jurnal Respirologi Indonesia Vol 44, No 4 (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.v44i4.478

Background: Chronic obstructive pulmonary disease (COPD) development involves a complex pathway of host and environmental factors. Besides cigarette smoking, previous studies showed exposure to air pollution, such as particulate matter sized 2.5 μm or less (PM2.5), might also have an important role in COPD development because it might lead to airway remodeling and chronic lung inflammation. However, the cause-and-effect relationship between PM2.5 and COPD in non-smoking patients is still unclear.Methods: Literature searches were performed in five online medical databases (PubMed, EMBASE, ScienceDirect, EBSCOhost, and Cochrane Library) and hand-searching in Google Scholar. Filtering literature with the inclusion and exclusion criteria resulted in three relevant articles (1 case-control and 2 cohort studies). Critical appraisal was conducted using the Center of Evidence-Based Medicine (CEBM) worksheet from the University of Oxford for etiologic studies.Results: All three articles were considered valid. The prospective cohort was decided unimportant because of the non-significant adjusted hazard ratio (HR 1.23; 95% confidence interval [CI]=0.50-3.06). The case-control and retrospective studies had important results with adjusted odds ratio of 1.29 (95% CI=1.01-1.65) and 1.69 (95% CI=1.11-2.58), respectively. The relatively low number needed to harm (NNH) of 10-23 indicated that PM2.5 exposure was a meaningful factor for the risk of developing COPD in non-smoker adults. Both articles were considered applicable to our case. Conclusion: Non-smoking adults with exposure to PM2.5, compared to those without exposure, are at higher risk of developing COPD.

Bronchial Artery Embolization in Hemoptysis Audina, Dea Putri; Isbaniah, Fathiyah; Soehardiman, Dicky; Darwis, Andi; Amien, Bagus Radityo
Jurnal Respirasi Vol. 11 No. 2 (2025): May 2025
Publisher : Faculty of Medicine Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/jr.v11-I.2.2025.174-182

Hemoptysis, characterized by bleeding from the lower airways, is classified as mild, moderate, or massive, with massive hemoptysis carrying a mortality rate of 6.5–38%. Tuberculosis (TB) remains the most common cause globally. Management strategies include invasive and noninvasive options, with bronchial artery embolization (BAE) emerging as a cornerstone of noninvasive treatment since its introduction in the 1970s. Bronchial artery embolization provides rapid bleeding control and high success rates for both short- and long-term outcomes. Despite these advantages, recurrence rates range widely from 10–55%, often due to incomplete embolization, vessel recanalization, and collateral vessel development. The procedure employs embolic agents such as polyvinyl alcohol (PVA) particles, gelatin sponges, and tris-acryl gelatin microspheres, with minimal complications such as spinal cord infarction or broncho-esophageal fistulas. Diagnostic tools like computed tomography (CT) and bronchoscopy complement BAE by localizing the bleeding sites, stabilizing the airway, and aiding in definitive management. Bronchoscopy serves diagnostic and therapeutic purposes, employing techniques such as vasoconstrictor instillation, laser therapy, and balloon tamponade to control bleeding. Bronchial artery embolization is particularly effective for patients with life-threatening or recurrent hemoptysis who are unsuitable for surgery, often acting as a bridge to elective interventions. This literature review highlighted the pathophysiology, diagnostic modalities, BAE techniques, outcomes, and challenges involved in managing hemoptysis, emphasizing the role of BAE as a vital, minimally invasive therapeutic option.

Prevalence and Affecting Factors of Arrhythmias in Stable Chronic Obstructive Pulmonary Disease at a Tertiary Hospital in Indonesia Gozali, Achmad; Wicaksono, Muhammad Bimo Adi; Yunus, Faisal; Ratnawati, Ratnawati; Basalamah, Muhammad Abbas; Amien, Bagus Radityo
Jurnal Respirasi Vol. 11 No. 2 (2025): May 2025
Publisher : Faculty of Medicine Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/jr.v11-I.2.2025.131-139

Introduction: Chronic obstructive pulmonary disease (COPD) represents an increasing global health burden. Among its significant comorbidities, cardiovascular complications, particularly arrhythmias, are of significant concern. Chronic obstructive pulmonary disease and arrhythmias share common risk factors, including advanced age and smoking. This study investigated the prevalence and contributing factors of arrhythmias in stable COPD patients. Methods: This cross-sectional study was conducted among stable COPD patients attending the Asthma-COPD Clinic at Persahabatan National Respiratory Referral Hospital, Jakarta, Indonesia, from January to April 2018. The inclusion criteria encompassed a clinical diagnosis of COPD and voluntary participation with written informed consent. Each participant underwent laboratory evaluation, electrocardiography (ECG), blood pressure measurement, and a structured interview. Patients were excluded if they had experienced acute COPD exacerbations during the assessment, had a history of other chronic lung diseases, suffered a recent myocardial infarction, had structural heart disease, were diagnosed with fibrillation, or declined to participate. Results: The prevalence of arrhythmias in stable COPD patients was 24.1%. The types included sinus bradycardia (2.41%), premature atrial contractions/PACs (3.61%), premature ventricular contractions/PVCs (8.43%), and sinus tachycardia (9.64%). The majority of arrhythmic patients were males, with an average age of 68 years old. These patients also had a history of heart disease, exhibited severe COPD symptoms, and demonstrated significant airflow obstruction (average pCO₂ of 36 mmHg). Conclusion: Decreased chloride levels were associated with an increased incidence of arrhythmias. However, no significant associations were observed with airflow limitation, sex, age, bronchodilator use, or arterial blood gas parameters.

Pregnancy-Related Disorders and Intrauterine Impaired Lung Development Zulhadji, Harry Agustio; Yunus, Faisal; Rasmin, Menaldi; Saroyo, Yudianto Budi; Amien, Bagus Radityo
Jurnal Respirasi Vol. 10 No. 2 (2024): May 2024
Publisher : Faculty of Medicine Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/jr.v10-I.2.2024.178-185

Various pregnancy-related disorders are known to affect fetal lung development negatively. During pregnancy, chronic nutrition and/or oxygen limitation is known to impede lung maturation and induce airway and lung abnormalities. Structural abnormalities and reduced lung function may be evident immediately after birth, persist, or develop with age. The expansion of the fetal lung, fetal breath movements, fetal lung growth, alveolarization, blood-air barrier, extracellular matrix (ECM), airways, surfactant system, and lung immune function are all affected by nutritional limitations during pregnancy. Gestational hypoxia disrupts fetal lung development, which manifests as morphological and functional pulmonary abnormalities. Additionally, intrauterine growth restriction (IUGR), preeclampsia (PE), exposure to air pollution, and smoking are known to interfere with embryonic lung development. Birth defects, such as bronchopulmonary dysplasia, as well as chronic obstructive pulmonary disease (COPD), can be caused by abnormalities in pregnancy. Adequate nutrition, avoidance of smoking, and watchful monitoring and intervention during pregnancy should be promoted to prevent chronic lung disease of the newborn, child, and adult.

Risk of Developing Chronic Obstructive Pulmonary Disease in Non-Smoking Adults Exposed to Particulate Matter 2.5 Compared to Those Without Exposure Notariza, Kemas Rakhmat; Amien, Bagus Radityo; Susanto, Agus Dwi
Jurnal Respirologi Indonesia Vol 44 No 4 (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.v44i4.478

Background: Chronic obstructive pulmonary disease (COPD) development involves a complex pathway of host and environmental factors. Besides cigarette smoking, previous studies showed exposure to air pollution, such as particulate matter sized 2.5 μm or less (PM2.5), might also have an important role in COPD development because it might lead to airway remodeling and chronic lung inflammation. However, the cause-and-effect relationship between PM2.5 and COPD in non-smoking patients is still unclear.Methods: Literature searches were performed in five online medical databases (PubMed, EMBASE, ScienceDirect, EBSCOhost, and Cochrane Library) and hand-searching in Google Scholar. Filtering literature with the inclusion and exclusion criteria resulted in three relevant articles (1 case-control and 2 cohort studies). Critical appraisal was conducted using the Center of Evidence-Based Medicine (CEBM) worksheet from the University of Oxford for etiologic studies.Results: All three articles were considered valid. The prospective cohort was decided unimportant because of the non-significant adjusted hazard ratio (HR 1.23; 95% confidence interval [CI]=0.50-3.06). The case-control and retrospective studies had important results with adjusted odds ratio of 1.29 (95% CI=1.01-1.65) and 1.69 (95% CI=1.11-2.58), respectively. The relatively low number needed to harm (NNH) of 10-23 indicated that PM2.5 exposure was a meaningful factor for the risk of developing COPD in non-smoker adults. Both articles were considered applicable to our case. Conclusion: Non-smoking adults with exposure to PM2.5, compared to those without exposure, are at higher risk of developing COPD.

Pulmonary Hypertension: Understanding the Underlying Anatomy and Physiology of Pulmonary Circulation Amien, Bagus Radityo; Putra, Andika Chandra
Jurnal Respirologi Indonesia Vol 45 No 2 (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.v45i2.779

The circulatory system has a vital role in fulfilling oxygen demand in tissues and maintaining homeostasis. There are two types of circulatory systems in our body, the systemic and pulmonary circulation. Pulmonary circulation, the critical pathway of blood oxygenation through heart-lung-pulmonary vascular interaction, remains poorly understood despite its central role in the various pulmonary vascular diseases. One of the most prevalent pulmonary vascular diseases is pulmonary hypertension (PH), which is characterized by high mortality and disease progression. A thorough understanding of the physiologic structure and function of pulmonary circulation is essential for diagnosing and treating patients with PH. Pulmonary blood flow is determined by pulmonary vascular pressure (PVP) and pulmonary vascular resistance (PVR). Lung volume, neural factors (sympathetic and parasympathetic nervous systems), humoral factors (vasoconstrictor and vasodilator), and alveolar hypoxia play an important role in regulating PVR. Alveolar hypoxia triggers hypoxic pulmonary vasoconstriction to maintain the ventilation-perfusion ratio balance. High PVR increases pulmonary arterial pressure (Pa), which is the main pathophysiology of PH. In addition, endothelial dysfunction and vasoactive imbalance also contribute significantly to the pathogenesis of the disease.

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