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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 360 Documents
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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.
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.
Update on the Global Initiative for Chronic Obstructive Lung Disease (GOLD 2023) Adrianison, Adrianison; Simbolon, Rohani Lasmaria; Simatupang, Elvando Tunggul Mauliate
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.v44i1.451

Abstract

The overall increase in morbidity and mortality associated with chronic obstructive pulmonary disease (COPD) is inextricably linked to the concept of Global Initiative for Chronic Obstructive Lung Disease (GOLD) updates. An element of every GOLD update is directed toward policymakers, healthcare professionals, and people in general in order to evaluate the immediate and prolonged consequences of COPD. At this time, international interest is focused on the acceleration of the GOLD 2022 update to GOLD 2023 in an effort to enhance clinical management approaches for COPD, including individualized and comprehensive COPD treatment. The GOLD 2023 update will encompass the following aspects: definition and taxonomy, screening and case identification, diagnosis pathway, pharmacological and non-pharmacological approaches to managing stable COPD, and exacerbation management, as discussed in this review. GOLD 2023 explains that the diagnosis of emphysema has been classified as a pathologic diagnosis, in comparison with GOLD 2022. In the meantime, the clinical and epidemiological diagnosis of COPD is chronic bronchitis. The risk factor for tobacco smoke, which was once thought to be the primary cause of COPD, is described in GOLD 2023, together with the most recent taxonomy that has been developed to identify additional contributing components. The word "GET", which refers to the interaction of three risk factors-gene (G), environment (E), and lifetime (T)-that can cause lung damage and accelerate the aging or development of the lungs, is also linked to the most recent taxonomy of COPD. The switch from the "ABCD" approach to the "ABE" method for diagnosis and management of stable COPD is another significant modification included in the GOLD 2023 update. The number of COPD cases worldwide is expected to rise in the upcoming years as an outcome of long-term exposure to risk factors. Consequently, with the goal of increasing patient survival rates, GOLD 2023 highlights the significance of screening and early case discovery through the provision of non-pharmacological care.
Overview of Peak Expiratory Flow Rate in Elementary School Students in the Coastal Area of Hutumuri Village Lutfhi, Muhammad; Tentua, Vebiyanti; Devi, Cokorda Istri Arintha
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.v44i1.466

Abstract

Background: Respiratory diseases are the most common cause of death in children, in this case most of them are obstructive disorders. Peak expiratory flow (PEF) is a tool for detecting airway obstruction, which the value is influenced by host and environmental factors. Examination of PEF aims to describe the condition of the large-calibre airway. A decrease in PEF values indicates an expiratory airways resistance. This study aimed to determine how the condition of pulmonary physiology in children living in the coastal area, with peak expiratory flow parameters in elementary school students in coastal areas, area of Hutumuri Village.Methods: The design used in this study was descriptive quantitative with cross-sectional method. This study took variables in the group of children aged 8-13 years, the group of children with weight between 15-36 kg, height of 118-139 cm, the group of children with a hobby of swimming, the group of children with a history of respiratory disease. The sampling technique used was total sampling with a total of 215 respondents in four elementary schools located in Hutumuri Village, South Leitimur District, Ambon City which included 53 Batu Gong Elementary School, Toisapu Elementary School, 52 Lawena Elementary School and Hutumuri Christian Elementary School.Results: The value of PEF rate increased in the group of children with aged ≥12-13 years, the group of children with body weight ≥36 kg, the group of children with height ≥139 cm, the group of children who did not have a history of respiratory disease, and the group of children with swimming as hobby.Conclusion: The average value of PEF in children who live in coastal areas had increased and of the 215 respondents studied, most were found in the normal PEF group or the percentage of 80-100% with 114 respondents (53.0%).
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.
Comparison of NEWS, SIRS, and qSOFA Score as Predictors of Mortality and Length of Stay in Patients Pneumonia with Sepsis Harsini, Harsini; Alfarizi, Aditya; Aphridasari, Jatu; Raharjo, A Farih; 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

Abstract

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.
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.
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.
Association Between Ferritin Levels and Sepsis in Patients with COVID-19 at Dr. M. Djamil Hospital Asrini, Diana Nur; Khairsyaf, Oea; Afriani, Afriani
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.v44i1.545

Abstract

Background: Ferritin is an important mediator of immunomodulatory dysregulation and pro-inflammatory effects, which contribute to cytokine storms that could lead to sepsis in a critically ill patients with COVID-19. The role of ferritin as a biomarker of sepsis in those patients is yet fully understood. The aim of this study is to investigate an association between ferritin levels and sepsis in patients with COVID-19.Method: This study was a retrospective, cross-sectional study of 474 COVID-19 hospitalized patients at Dr. M. Djamil Hospital, Padang.Result: Most of the COVID-19 patients in this study were between the ages of 18 and 49 (38,61%), female (55.91%), with moderate clinical illness (40.50%), and had one comorbidity (41,14%) with obesity as the most common comorbidity (37.97%). More than half of patients (54,22%) had ferritin levels of ≥500 ng/mL (median 1,201 ng/mL with a range of 503–12,010 ng/mL). The incidence of sepsis was significantly higher in the group whose ferritin level was ≥ 500 ng/ml compared to those with less ferritin level (P<0.001; OR=3.33; 5.99% vs 17.91%; CI 95%=1.74-6.36).Conclusion: There is a statistically significant association between the ferritin level and sepsis in patiens with COVID-19 at DR M Djamil Hospital.
Duration of Hospitalization and Risk Factors of Readmission of Community-Acquired Pneumonia Incidence in Hospitalized Toddlers Lisa, Corina; Arini, Merita
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.v44i1.560

Abstract

Background: The Indonesia Health Profile Report 2020 stated that pneumonia is one of the causes of high infant and toddler mortality in Indonesia. Length of stay and readmission are crucial indicators of service quality for hospitalized pneumonia patients. This study aims to determine the duration of hospitalization and identify risk factors for readmission among toddlers hospitalized with CAP.Methods: This cross-sectional study was conducted with subjects of pneumonia toddlers hospitalized in Sarila Husada Hospital Sragen from November 2021 to Januari 2023Results: A total of 357 toddlers were hospitalized with CAP (median age = 17 months; IQR 7–24); the majority were under 36 months old (309 subjects; 86%); male (54%) predominated than female (46%). Median duration of hospitalization for CAP=2 days with IQR=3.0-5.0. Readmission events were only 5, higher among toddlers aged 2-36 months but not statistically significant. Factors associated with readmission in CAP toddlers were the history of previous hospitalizations during the past year due to infection (P=0.012; adjusted odds ratio [aOR]=13.6; confidence interval [CI]=1.49–12.34).Conclusion: The readmission rate was very low in our study. Toddlers 2–36 months of age and those with previous hospitalizations with infections are at higher risk of readmission in CAP.

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