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INDONESIA
Jurnal Respirologi Indonesia
Published by Perhimpunan Dokter Paru Indonesia
ISSN : 08537704     EISSN : 26203162     DOI : -
Core Subject : Health,
Health Professions Medicine & Pharmacology
Jurnal Respirologi Indonesia (JRI) is an online and printed scientific publication of the Indonesian Society of Respirology (ISR). The journal is published thrice-monthly within a year (January, April, July and October). The journal is focused to present original article, article review, and case report in pulmonary and critical care medicine.
Arjuna Subject : -
Articles 11 Documents
 1   2 
Search results for , issue "Vol 44, No 2 (2024)" : 11 Documents clear
C-Arm Fluoroscopy-Guided Bronchoscopic Biopsy for Diagnosing Aspergilloma With Massive Hemoptysis After Pulmonary Tuberculosis: A Case Report Wikamto, Rifka; Ardana, I Dewa Putu; Suhendro, Suhendro
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.v44i2.529

Abstract

Background: Aspergilloma usually develops in the pulmonary cavity that already exists, including tuberculosis. The most frequent symptom is hemoptysis. Diagnosis of proven fungal infection requires a tissue sample obtained from a disease location to be subjected to histological examination or culture. A specimen taken using bronchoscopy alone is quite challenging because of its location. In this case, a C-arm fluoroscopy-guided bronchoscopic biopsy may be a solution to get specimens for a proven diagnosis.Case: A 53-year-old male presented to the emergency department following a massive hemoptysis with a previous history of tuberculosis. Chest radiography revealed opacity and hilar restriction in the left upper lobe. A chest CT scan without contrast revealed suspected aspergilloma. The patient underwent a C-arm fluoroscopy-guided bronchoscopy for a biopsy sample. The biopsy sample referred to Aspergillus niger.Discussion: Aspergillus sp. leads to parenchymal damage and causes several symptoms, mostly hemoptysis. Aspergilloma usually develops in the pulmonary cavity that already exists, including those from tuberculosis. The diagnostic effectiveness of bronchoscopy guided by C-arm fluoroscopy for peripheral lung lesions has consistently improved.Conclusion: Aspergilloma usually develops in the pulmonary cavity that already exists, including tuberculosis. The patient came to the emergency department with massive hemoptysis and met all the criteria for diagnosis of proven fungal infection. The diagnosis was made by analyzing biopsy samples, which was taken by C-arm fluoroscopy-guided bronchoscopy.
Extraction of Foreign Body in Left Main Bronchus with Flexible Optical Bronchoscopy in Asymptomatic Needle Aspiration Patient: A Case Report Antika, Puspa; Jito, Anggar
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.v44i2.526

Abstract

Background: Foreign body aspiration is one of the most common respiratory and airway emergencies. The incidence is higher in children and obstruction occurrences are common. The late complications might be fatal when ignored. Bronchoscopy as a gold standard modality in diagnosing and treating this condition, now is widely available, and the emerging flexible optic bronchoscopy (FOB) is more commonly used.Case: A ten-year-old girl with a history of needle aspiration arrived at the ER with an asymptomatic condition. Further investigations reveal leucocytosis and a metal-needle-shaped foreign body found approximately in the left main bronchus via chest x-ray and CT scan. Bronchoscopy with FOB was performed under general anesthesia and LMA and successfully evacuated the needle although the pin had infiltrated the mucosal wall.Discussion: Asymptomatic foreign body aspiration is nearly at the same rate as symptomatic one. Management of difficulties and complications increases the longer the foreign body infiltrates the respiratory tract. Early diagnosis with chest x-ray and CT scan is necessary. Prompt and urgent evacuation of the foreign body is required. The use of FOB is associated with a higher success rate and lower complications. FOB is the best modality choice in this case.Conclusion: The foreign body in the respiratory tract may be asymptomatic. Early and proper diagnosis must be worked out as early management of asymptomatic foreign body aspiration. Early FOB can be used as a modality of choice in this case, preventing further damage to the respiratory tract.
Pneumomediastinum and Spontaneous Subcutaneous Emphysema in COVID-19 Patients Using High-Flow Nasal Cannula (HFNC) Suhadayanti, Rizki; Fatoni, Arie Zainul; Jaya, Wiwi; Asmoro, Aswoco Andyk
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.v44i2.448

Abstract

Background: Spontaneous pneumothorax, pneumomediastinum, and subcutaneous emphysema are rare complications that occur without mechanical ventilation, namely 0.81% of all COVID-19 patients. During the COVID-19 pandemic, high-flow nasal cannulas (HFNC) were used to support respiratory failure in critically ill patients. However, there have been no clinical trials explaining its safety and effectiveness. Hypoxemic normocapnic respiratory failure is an indicator of HFNC use. This study reports a case of associated spontaneous subcutaneous pneumomediastinum and emphysema in a COVID-19 patient using HFNC.Case: A 30-year-old male patient came to the hospital with a chief complaint of increasingly severe shortness of breath and confirmed COVID-19. Physical examination revealed a good airway, spontaneous breathing with a frequency of 28 times/minute; SpO2 of 97% with HFNC Flow 60 and FiO2 60%; blood pressure of 102/69 mmHg; and heart rate of 65 beats per minute. On the second day of treatment in the ICU, the patient did not experience desaturation or hypotension. Patent airway, spontaneous breathing, and oxygenation initiated using NRM 10lpm with a target SpO2 of 97%, RR at 30-32x/minute. On the fifth day, desaturation and hypotension were no longer observed.Discussion: Real-Time Reverse Transcriptase (RT)–PCR Diagnostic Panel detects SARS-CoV-2 in respiratory samples. Chest CT scans show viral pneumonia. Subcutaneous emphysema (SE) and pneumomediastinum cause breathing issues. Severe COVID-19 is treated with antivirals, vitamins, and oxygen therapy. Pneumomediastinum or subcutaneous emphysema may occur due to prolonged non-invasive ventilation but is generally self-limited.Conclusion: Clinical improvement was found in COVID-19 patients with pneumomediastinum and spontaneous subcutaneous emphysema using HFNC.
Interventional Approach on Lung Abscess Audina, Dea Putri; Agustin, Heidy; Reisa, Tina
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.v44i2.440

Abstract

Lung abscess is a necrotic liquefaction process containing necrotic debris or fluid from the lung parenchyma tissue, creating a cavity of more than 2 cm caused by bacterial infection. The most common etiology of lung abscess is oral aspiration. With a high incidence of tuberculosis in Indonesia, Mycobacterium tuberculosis may also cause cold abscesses, although rarely reported. Several things can increase the risk of developing a lung abscess, such as oral aspiration, sepsis, and history of previous lung infection. The treatment for lung abscess was classified into two groups, the pharmacology group which uses antibiotics including clindamycin, ampicillin-sulbactam, moxifloxacin, carbapenem, and piperacillin-tazobactam; and the other group is non-pharmacology therapy including drainage which is indicated for patient with a size cavity of more than 6 cm. There are several options for drainage such as percutaneous or endoscopic drainage. Bronchoscopy may serve as a diagnostic and also intervention tool in lung abscess.
Non-Severe COVID-19 Complicated by Deep Vein Thrombosis (DVT) Rajabto, Wulyo; Priantono, Dimas
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.v44i2.263

Abstract

Background: Coronavirus Disease 2019 (COVID-19) displays various symptoms ranging from asymptomatic to life-threatening. Patients may present with typical respiratory infections or atypical symptoms. Non-severe COVID-19 encompasses mild and moderate cases, characterized by the absence of criteria for severe or critical illness, with mild cases not showing evidence of viral pneumonia or hypoxia and moderate cases maintaining SpO2 levels of at least 90% on room air.Case: We presented a COVID-19 case with the chief complaint of unilateral leg swelling. A 48-year-old male was admitted with the chief complaint of cramps and swelling of the left leg. He had a history of fever, cough, nausea, and vomiting. Laboratory studies showed elevated D-dimer. Doppler ultrasound shows signs of both proximal and distal deep vein thrombosis.  CT pulmonary angiography excluded pulmonary embolism while the lung window image supported the diagnosis of COVID-19 pneumonia. Polymerase chain reaction (PCR) obtained from nasopharyngeal and oropharyngeal swabs confirmed COVID-19 infection.Discussion: We treated the patient with parenteral anticoagulation followed by direct oral anticoagulant upon discharge. The swelling improved as well as the patient’s clinical status. Thromboembolic complications have been credited as the culprit of high mortality in COVID-19. Systemic activation of coagulation in pulmonary and peripheral circulation contributed to life-threatening thrombotic complications. Our patient presented with COVID-19-associated proximal and distal DVT without pulmonary embolism.Conclusion: Prompt diagnosis of COVID-19 infection and acute DVT improves patient care. The hallmark of the management of VTE in COVID-19 patients is treatment with therapeutic dose parenteral anticoagulation followed by oral anticoagulant.
Mepolizumab’s (Anti-Interleukin-5) Role in Severe Asthma: A Literature Review Atikanur, Atikanur; Wijaya, Dewi; Esha, Indi; Simanjuntak, Arya Marganda
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.v44i2.494

Abstract

One type of asthma that is difficult to treat is severe asthma, which is asthma that is uncontrolled even when the patient is taking medication or trigger factors. It can be treated with the finest therapy but will worsen if high-dose treatment is discontinued. Age, gender, obesity, hypersensitivity, and immunological factors are all directly related to the onset of asthma. A complicated illness, severe asthma has many clinical symptoms and treatment choices. Chronic airway inflammation and lung tissue remodeling are its defining features. This literature review aims to describe how mepolizumab works in patients with severe asthma. Mepolizumab mainly inhibits the IL-5 cytokine from binding to IL-5 receptor subunits through the nanomolar potential, which inhibits IL-5 from binding to receptors on the surface of eosinophils. In contrast to the placebo group, patients on mepolizumab had an average 50% decrease from the baseline Prednisone dosage. With Mepolizumab, the yearly exacerbation rate was 1.44 RR, while it was 2.12 RR with placebo. The injection of monoclonal antibodies, such as mepolizumab, as a form of therapy in addition to treating severe eosinophilic asthma is advised by the GINA guideline for 2022. Mepolizumab's mode of action blocks IL-5 from binding to receptors on eosinophil surfaces, which lowers eosinophil recruitment, activation, production, growth, and survival, as well as eosinophil-mediated inflammation.
C-Reactive Protein and Procalcitonin as Markers for Post-Bronchoscopic Complications: A Literature Review Indriani, Sri Indah; Yovi, Indra; Syaf, Syarlidina; Simatupang, Elvando Tunggul Mauliate
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.v44i2.638

Abstract

In the respiratory system, bronchoscopy is a basic procedure utilized for both diagnostic and therapeutic purposes. Despite being a generally safe procedure, bronchoscopy can result in complications that range in severity from moderate to severe. Pulmonary infection is among the potential complications that can happen after a bronchoscopy procedure. An incidence of 0.2% to 5.2% has been described typically for complications such as empyema, lung abscess, and pneumonia that may develop after bronchoscopy procedures. Although these complications are uncommon, their prognosis can be quite bad. The risk of pulmonary infection, specifically pneumonia, has been related in several studies to sepsis and mortality in patients enduring bronchoscopy procedures. The initiation of the infection exposure process into the lung can be assisted through a variety of factors, including the underlying diagnosis and the type of intervention performed during the bronchoscopy procedure. A critical complication that needs additional consideration is the potential transmission of infection through bronchoscopy procedures. It is beneficial to consider prophylactic antibiotics before a procedure due to the possibility that infectious agents will be transferred from one patient to another. Antibiotic prophylaxis may involve the utilization of C-reactive protein (CRP) and Procalcitonin (PCT) testing as determining parameters. Serial PCT and CRP 24–96 hours post-bronchoscopy procedure might help to determine one of the post-bronchoscopy complications.
Persistent Air Leak Anggita, Dwi; Wiriansya, Edward Pandu; Santoso, Arif; Putrawan, Harry Azka
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.v44i2.432

Abstract

In cases of pneumothorax in the chest tube, the presence of air in the pleural cavity that lasts more than 5 to 7 days can be suspected as a persistent air leak (PAL), especially if an increased amount of air is obtained accompanied by the appearance of bubbles in the water seal drainage (WSD) system. This is the most common complication after surgery (8–26%), although it can be primary spontaneous pneumothorax (PSP) (26%) or secondary spontaneous pneumothorax (SSP) (39%). One condition that often causes difficulties in PAL therapy is infection due to direct contact with the fistula. The presence of PAL is associated with higher morbidity and mortality, prolonged chest tube inserted, and longer hospitalization. Observations of air production in PAL are expected to occur spontaneously within 4 days, if the leak persists, pleurodesis is recommended. If it was possible, surgery is needed to close the leak. Bronchoscopy treatment is only recommended in special circumstances where surgery is contraindicated or the patient refuses the surgical procedure.
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

Abstract

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.
Non-Invasive Respiratory Support Strategy in Adults with Acute Respiratory Failure Soebekti, Wahyu; Zulfikar, Teuku; Priyanto, Herry
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.v44i2.650

Abstract

Patients with acute respiratory failure wil sometimes need invasive mechanical ventilation (IMV). High-demand events such as a pandemic will render the already limited bed in the ICU unavailable for another patient who also needs IMV. Acute respiratory failure can be divided into two categories: hypoxemic respiratory failure and hypercapnic respiratory failure. Non-invasive strategies presently available for treatment of acute respiratory failure are non-invasive ventilation (NIV), continuous positive airway pressure (CPAP), and high flow nasal oxygen (HFNO). Strong evidence has been present for the use of NIV in acute exacerbations of COPD, cardiogenic pulmonary edema, and ARF in immunocompromised patients, while in hypoxemic respiratory failure, there is low to moderate certainty of evidence pointing to the benefit of CPAP and HFNO. Correctly and selectively using these non-invasive strategies can reduce mortality and prevent intubation.

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