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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 364 Documents
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Non-Genetic Risk Factors for First-Line Anti-Tuberculosis Drug-Induced Liver Injury in Active Pulmonary Tuberculosis Patients: A Systematic Review and Meta-Analysis Ilham, Ahmad Fadhil; Felim, Ris Raihan; Akbar, Fadhian; Burhan, Erlina
Jurnal Respirologi Indonesia Vol 45 No 3 (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.v45i3.693

Abstract

Background: Tuberculosis is still one of the leading causes of poor health and death worldwide. Drug-induced liver injury (DILI) is an important and serious side effect of anti-tuberculosis treatment and can cause non-adherence of patients to the treatment. To reduce the possibility of patients developing DILI, the risk factors must be identified. Methods: This systematic review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. Inclusion and exclusion criteria were used to screen and filter the articles that were obtained from literature searching performed through several journal databases. The extracted data were analyzed qualitatively and quantitatively. The quality of each study was also assessed using the modified Newcastle Ottawa Scale (NOS). The protocol for this systematic review has been registered with PROSPERO CRD42022384892. Results: The results showed that, of the 13 studies analyzed qualitatively, 11 studies with a total of 4,920 patients were selected for quantitative analysis. The factors analyzed and the results were female gender (OR=1.10; 95% CI=0.72-1.67; P=0.65), age over 40 years (OR=1.60; 95% CI=1.04-2.46; P=0.03), body mass index less than 18.5 kg/m2 (OR=0.96; 95% CI=0.52-1.79; P=0.9), active smoking (OR=0.71; 95% CI=0.34-1.49; P=0.36), frequent alcohol intake (OR=1.44; 95% CI=0.61-3.42; P=0.41), hepatitis B (OR=3.42; 95% CI=1.72-6.79; P<0.001]), and hepatitis C (OR=12.87; 95% CI=6.67-24.86; P<0.00001]). Conclusion: In conclusion, the evidence from this review suggests that older age, hepatitis B, and hepatitis C are significant risk factors thought to increase the incidence of DILI in active pulmonary tuberculosis patients taking first-line anti-tuberculosis regimens.
ALK and PD-L1 Expression in Non-Small Cell Lung Cancer through Immunohistochemical Assays in Indonesia Syahruddin, Elisna; Sayekti, Mutia A.; Yuliyanti, Sayekti; Thabrany, Hasbullah; Nurmadani, Labbaika
Jurnal Respirologi Indonesia Vol 45 No 3 (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.v45i3.794

Abstract

Background: Advanced therapies for non-small cell lung carcinoma (NSCLC), such as targeted therapy and immunotherapy, are available; however, their use depends on biomolecular testing. In the Indonesian context, EGFR testing is covered by the national health insurance (JKN). According to the Indonesian Clinical Guideline for Lung Cancer, if the EGFR test is negative, further testing, including ALK and PD-L1 immunohistochemistry, is required. Nevertheless, the JKN does not currently cover ALK and PD-L1 IHC tests, which restricts access to the appropriate therapies. This study aims to determine the positivity rates of ALK and PD-L1 IHC tests. Method: This study employs a cross-sectional approach to analyze 2,553 ALK and PD-L1 IHC tests conducted from 2019 to 2023, sourced from four major provinces in Indonesia Results: The positivity of ALK IHC tests is 8% with a median age of 52 years. The positivity rate for PD-L1 IHC in all patients is 49%, while based on the tumour proportion score (TPS), TPS ≥50% is 17% and TPS 1-49% is 32%. ALK positivity correlates with age and female gender (P<0.001 and P=0.006). Conversely, PD-L1 positivity was significantly associated with cancer type (P=0.008). Conclusion: ALK positivity in NSCLC in Indonesia is relatively high (8%), with a relatively young median age of 52 years and is predominantly found in females. PD-L1 positivity does not significantly differ by gender and age, but positively correlates with adenocarcinoma cancer type.
Prognosis in Thymoma Patients with Myasthenia Gravis Undergoing Video-Assisted Thoracoscopic Surgery (VATS) Thymectomy: An Evidence-Based Case Report Mety, Susan Hendriarini; Permadijana, Diajeng; Ramli, Muhammad Syawal Satria
Jurnal Respirologi Indonesia Vol 45 No 3 (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.v45i3.814

Abstract

Background: Thymoma, a tumor in the anterior mediastinum, is common in adults and often linked with myasthenia gravis (MG). Thymectomy is recommended for MG patients with thymoma and traditionally done via median sternotomy, which is invasive. Minimally invasive methods like video-assisted thoracoscopic surgery (VATS) offer benefits like less blood loss and quicker recovery. However, more extensive studies are needed to confirm long-term oncological outcomes. Methods: A literature search was conducted using PubMed, Cochrane, and Scopus databases focused on terms related to thymoma, myasthenia gravis, VATS thymectomy, and survival. Duplicates were excluded, and studies were selected based on criteria. The selected studies were then critically appraised for validity, importance, and applicability. Results: Three manuscripts are selected for this case report. He et al showed that the cumulative CSR in the VATS group (26.7%) was significantly higher than the transsternal group (P=0.026). Maggi et al reported that the VATS group is significantly correlated with CSR (P=0.0349). Meanwhile, Tian et al showed there was no significant difference in the level of CSR (32.7% vs. 36.7%; P=0.622) between the VATS and trans-sternal groups. Tian et al also showed that survival results in the VATS group were higher than in the trans-sternal group, but it was not statistically significant (P=0.109). Conclusion: The prognosis of thymoma patients with MG who undergo thymectomy using the VATS method is not significantly different compared with the trans-sternal method.
Chronic Respiratory Symptoms among TB Survivors in a High-TB Burden Setting in Indonesia: A Preliminary Study Dewi, Intan Mauli Warma; Fauziyyah, Raden Nabilah Putri; Wanda, Dananfi; Kulsum, Iceu Dimas; Lestari, Bony Wiem; Soeroto, Arto Yuwono
Jurnal Respirologi Indonesia Vol 45 No 3 (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.v45i3.844

Abstract

Background: Tuberculosis (TB) affects over 10 million people worldwide and causes more than 1.4 million deaths in 2019. Despite improvements in TB treatment, many TB survivors experience ongoing health problems. Post-TB lung disease (PTLD) affects 30-60% of treated patients, leading to chronic respiratory impairments and reduced quality of life. Data on PTLD in Indonesia, a country with a high TB burden, are still scarce. We conducted a preliminary study in Bandung to estimate the burden of respiratory health problems among those who completed TB treatment. Methods: Adults aged 18 years or older with a history of TB treatment and a minimum of 6 months since treatment completion were screened at two primary healthcare centres in Bandung municipality. Data on demographics, previous TB history, and clinical symptoms were collected. Results: From 133 identified TB survivors, 61 eligible patients were interviewed. Persistent respiratory symptoms, such as cough or shortness of breath, were observed in 6 (9.8%) patients. Among these patients, some had abnormal chest x-ray and/or negative Gene Xpert MTB/RIF results. Conclusion: Even after completing treatment, nearly 1 in 10 TB survivors experienced chronic respiratory symptoms. Greater efforts and awareness are needed to improve post-TB wellbeing, especially in high-burden settings like Indonesia.
Exploring How Albumin Supplementation Affects Serum Albumin Levels, CD8+ Lymphocyte Counts, and Interferon Gamma In Rifampicin-Resistant TB Patients Yusdianto, Adrian; Chozin, Iin Noor; Sartono, Teguh Rahayu; Tantular, Rezki; Chilmi, Syahrul; Setijowati, Nanik
Jurnal Respirologi Indonesia Vol 45 No 3 (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.v45i3.874

Abstract

Background: Drug-resistant tuberculosis (DR-TB) remains a global health threat, with increasing cases unresponsive to rifampicin therapy. Diagnosing rifampicin-resistant TB (RR-TB) requires a multidisciplinary approach, in which markers such as interferon-gamma (IFN-ɣ) are useful for diagnosis, monitoring, therapy evaluation, and prognosis. Hypoalbuminemia commonly accompanies TB patients, evidenced by weight loss and reduced serum albumin levels. TB infection stimulates cytokine production, which suppresses albumin synthesis and regulation, affecting both prognosis and treatment success, particularly in RR-TB. This study aimed to evaluate the role of albumin supplementation in improving serum albumin levels, CD8+ lymphocyte counts, and IFN-ɣ levels in RR-TB patients. Methods: This true experimental study with a pre- and post-test control group design was conducted at Saiful Anwar Hospital. Thirty subjects were recruited: 10 healthy individuals (control group), 10 RR-TB patients receiving albumin supplementation (egg white extract) for 30 days (RR-TB + Albumin), and 10 RR-TB patients without supplementation (RR-TB only). Peripheral blood samples were collected before and after anti-TB drug (ATD) and albumin administration. Flow cytometry was used for analysis. Data were analyzed using SPSS and Partial Least Squares (PLS) analysis. Results: Significant differences in albumin and IFN-ɣ levels were observed between the control and RR-TB groups before supplementation. No significant differences were found in CD8+ lymphocyte counts (P=0.402) or IFN-ɣ levels (P=0.390) between supplemented and non-supplemented RR-TB patients. However, albumin levels (P=0.003) and body weight (P=0.014) increased significantly in the supplemented group. Conclusion: Albumin supplementation significantly increases serum albumin levels and body weight in RR-TB patients, but does not significantly affect CD8+ lymphocyte counts or IFN-ɣ levels.
Associated Risk Factors for Depression in MDR-TB Patients Receiving Cycloserine Therapy at dr. Soebandi Regional Hospital Maulidiyah, Najma; Wisudanti, Desie Dwi; Rachmawati, Dwita Aryadina; Komariah, Cicih; Raharjo, Angga Mardro
Jurnal Respirologi Indonesia Vol 45 No 3 (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.v45i3.883

Abstract

Background: The most common psychological disorder in cycloserine treatment is depression. The purpose of this study was to identify the risk factors associated with depression in MDR-TB patients receiving cycloserine therapy at dr. Soebandi Regional Hospital. Data were obtained from medical records and the Depression Anxiety Stress Scales (DASS-42) questionnaire from 89 MDR-TB patients at dr. Soebandi Regional Hospital in 2022-2024. Methods: Data analysis was performed using the Lambda and Somers’ tests, followed by multivariate analysis using ordinal logistic regression. Results: Out of a sample of 89 patients, 27 (30.3%) experienced depression, with the majority experiencing moderate-level depression (18%). The bivariate test results showed that the variables that significantly influenced the level of depression were gender (P=0.011), education (P=0.000), occupation (P=0.037), BMI (P=0.000), and comorbidities (P=0.029). Multivariate tests showed that three variables had a significant effect (P<0.05) on the level of depression: gender (P=0.047), occupation (P=0.001), and comorbidities (P=0.011). The top two dominant risk factors affecting the level of depression are occupation (OR=17.12) and comorbidities (OR=9.14). Conclusion: Occupation and comorbidities are the risk factors that most influence the level of depression in MDR-TB patients receiving cycloserine.
Path Analysis in PLS for Assessing the Impact of Metabolic Syndrome on Pulmonary Fibrosis in a Rat Model Yaman, Muli; Djajalaksana, Susanthy; Putra, Ngakan Putu Parsama; Yudhanto, Hendy Setyo
Jurnal Respirologi Indonesia Vol 45 No 3 (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.v45i3.889

Abstract

Background: Metabolic syndrome (MetS) is characterized by obesity, dyslipidemia, hyperglycemia, and insulin resistance, which are associated with increased risk for pulmonary fibrosis. This study investigates the impact of MetS on pulmonary fibrosis in a rat model using Partial Least Squares (PLS) path analysis. Methods: Sprague Dawley rats were fed a high-fat, high-fructose diet for 37 weeks to induce MetS. Key metabolic parameters, including body weight, lipid profiles, fasting blood glucose, fibrosis markers and Aschroft scores, were assessed. PLS path analysis was conducted to explore the relationships between these variables and their influence on pulmonary fibrosis. Results: PLS path analysis identified a strong correlation between increased body weight and MetS development (path coefficient=0.977). Dyslipidemia, characterized by elevated triglycerides and reduced HDL cholesterol, was also associated with MetS. A novel association was found between glucose dysregulation and pulmonary fibrosis (R2=0.908; path coefficient=0.947), suggesting that hyperglycemia contributes to lung fibrosis. Reduced PPARγ expression was associated with insulin resistance and inflammation, implicating it in fibrotic processes. Conclusion: This study highlights the role of metabolic disturbances in promoting pulmonary fibrosis in MetS. PLS path analysis effectively identified key metabolic pathways, suggesting potential targets for therapeutic intervention to mitigate MetS effects and prevent fibrosis. Further research is warranted to explore these pathways and develop targeted therapies.
Effect of Balloon Inflation Exercise on Lung Function, Resilience, and Quality of Life in Patients Stable Copd RS UNS Pratiwi, Atmasari; Apriningsih, Hendrastutik; Setijadi, Ana Rima; Adhiputri, Artrien; Rahardjo, A. Farih
Jurnal Respirologi Indonesia Vol 45 No 3 (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.v45i3.492

Abstract

Background: His WHO data for 2019 puts him third in COPD deaths, at about 3.23 million. Decreased respiratory function is one of the symptoms of COPD that causes respiratory arrest that impacts quality of life. Pulmonary rehabilitation in COPD patients is a means of controlling and reducing symptoms and optimizing functional function.Method: Experimental study with pre-test and post-test groups design. The number of study participants was 30 stable COPD outpatient in group B and E of the Respiratory Clinic of the UNS Hospital during the period of February 2023 by targeted sampling. The control group (n = 15) received standard care and the treatment group (n=15) received standard care plus additional balloon-inflation exercises for 6 weeks. Comparisons between pretest and posttest groups were made on %VEP1 score, breathlessness symptoms, CAT questionnaire, exercise capacity, and EID.Result: Increased values of %VEP1 (p=0.001), decreased Borg scale (p=0.001), decreased CAT score (p = <0.001), and physical activity performance (p = 0.001) versus his EID (p = <0.001) increase.Conclusion: Inflating the balloon affects %VEP1, Borg scale, CAT score, training capacity increase, and EID values. Balloon blowing exercise increases the %VEP1 value, lowers the Borg scale, lowers the CAT score, increases exercise capacity, and EID.Keywords: %VEP1, Borg scale, training capacity, CAT, EID
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

Abstract

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.
Analysis of Risk Factors for Loculated Pleural Effusion in Patients with Tuberculous Pleural Effusion at dr. Zainoel Abidin Hospital Purqan, Muhammad; Arliny, Yunita; Priyanto, Herry; Yanifitri, Dewi Behtri; Yanti, Budi
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.v45i4.822

Abstract

Background: Loculated pleural effusion is an effusion that has a lenticular configuration with smooth borders and is relatively homogeneous and can cause atelectasis in the surrounding lung tissue and is a result of excessive inflammation. Tuberculous pleural effusion is characterized by chronic accumulation of fluid and inflammatory cells in the pleural cavity. If not treated appropriately, a loculated pleural effusion can be life-threatening. This study aims to assess risk factors for loculated pleural effusion in TB pleural effusion patients. Method: This is an observational, analytical research with a cross-sectional design. The research sample was taken based on a consecutive sampling technique from TB pleural effusion patients treated at dr. Zainoel Abidin Hospital, Banda Aceh, from January 2024 to April 2024. Results: This study shows a relationship between age, kidney failure and diabetes mellitus on the incidence of loculated pleural effusion in TB pleural effusion patients (P<0.05). Age ≥46 years old has a 12.57 times risk, kidney failure 5.50 times and DM 14.5 times against the incidence of loculated pleural effusion. Gender, anemia, human immunodeficiency virus (HIV), pleural fluid analysis results and positive culture did not correlate with loculated pleural effusion (P>0.05). Conclusion: Age, kidney failure and diabetes mellitus are risk factors for loculated pleural effusion. The increase in age-related risk is associated with chronic inflammation, called inflammaging. Increasing age is also associated with changes in the composition and function of lung cells, making the clearance of pathogens difficult. Intense inflammation and difficulty in clearing pathogens also contribute to the association of kidney failure and diabetes mellitus with loculated pleural effusion.

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