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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 389 Documents
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Comparative Analysis of Copeptin, IL-6, and TNF-α as Predictive Biomarkers for Clinical Outcome in Moderate to Severe COVID-19 Patients Harsini Harsini; Jatu Aphridasari; Sihsusetyaningtyas Tiominar Siregar
Jurnal Respirologi Indonesia Vol 46 No 1 (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.v46i1.1114

Abstract

Background: Cytokine release syndrome (CRS) plays a central role in disease progression, driven by pro-inflammatory cytokines such as interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), as well as neuroendocrine stress markers such as copeptin. Perbandingan langsung biomarker copeptin, IL-6, dan TNF-α sangat penting untuk mengidentifikasi prediktor hasil COVID-19 yang paling andal, terutama pada kasus sedang hingga berat. This retrospective clinical study aimed to evaluate the correlation of copeptin, IL-6, and TNF-α levels with the clinical outcomes of patients with moderate to severe COVID-19. Methods: The study included patients who met the selection criteria and provided written informed consent. A sample size of 41 was determined via power analysis to achieve 80% power at a 0.05 significance level. Consecutive sampling was employed to select participants. The study utilized medical records of patients with moderate to severe COVID-19 who underwent copeptin, IL-6, and TNF-α testing. Correlation analyses and Bonferroni corrections were performed using SPSS® ver. 21. Results: Results revealed a moderate positive correlation between copeptin levels and patient outcomes (Bonferroni correlation=0.597; P<0.001). A weak positive correlation was observed between IL-6 levels and outcomes (Bonferroni correlation=0.239; P=0.055), while a negligible positive correlation was found for TNF-α levels (Bonferroni correlation=0.140; P=0.177), which was not statistically significant. Conclusion: Copeptin emerged as a more sensitive biomarker for predicting the outcomes of COVID-19 patients. Elevated copeptin levels were associated with a poorer prognosis. Furthermore, its stability in serum renders copeptin a more sensitive biomarker than IL-6 and TNF-α.
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

Abstract

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.
The Agreement Level of Colorimetric Indicator Paper and pH Meter Examination Compared to Urine Analyzer in Measuring Exudative Pleural Effusion Fluid pH Muttaqin Huda; Yusup Subagio Sutanto; Jatu Aphridasari
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.v46i2.1086

Abstract

Background: Pleural effusion is an abnormal accumulation of fluid in the pleural space, commonly associated with pulmonary infections and malignancies. Measurement of pleural fluid pH is necessary for diagnosis, therapeutic decision-making, and prognostic evaluation. Multiple methods are used, including pH meters, indicator papers, and urine analyzers, but their concordance has not been widely studied in Indonesia. This study aimed to assess the agreement of pleural fluid pH results measured using pH meters, indicator papers, and urine analyzers to support the appropriate selection of diagnostic methods. Methods: This observational analytic study with a cross-sectional design was conducted at dr. Moewardi General Hospital, Surakarta, from February to June 2025. The sample consisted of 55 patients with exudative pleural effusion who met the inclusion criteria. Pleural fluid pH was measured using three methods: colorimetric indicator paper, a pH meter, and a urine analyzer. Data were analyzed using the Kappa coefficient and the Intraclass Correlation Coefficient (ICC) to assess the agreement between methods. Results: The mean pH values of pleural fluid measured by the urine analyzer, pH meter, and colorimetric indicator paper were 8.18±0.47, 8.13±0.46, and 8.15±0.59, respectively. Agreement analysis showed a very strong and statistically significant correlation between the pH meter and urine analyzer (ICC=0.948; P<0.001), between the pH strip and urine analyzer (ICC=0.855; P<0.001), and between the pH meter and pH strip (ICC=0.916; P<0.001). A significant positive correlation was also observed between glucose levels and pH measured by both the urine analyzer and the pH meter. Conclusion: There is good agreement among pH measurements obtained using colorimetric indicator paper, urine analyzer, and pH meter in exudative pleural effusion fluid.
A Compounding Challenge: An Evidence-Based Case Report on the Association Between Obesity and Asthma Exacerbations in Pregnancy Muhammad Bimo Ramadhan; Halidza Nursasqia Pasyah; Aurora Serena Ueda; Rafi Akbar Putranto; Fanny Fachrucha
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.v46i2.1083

Abstract

Background: Asthma exacerbations during pregnancy have been associated with an increased risk of adverse perinatal outcomes. Asthma control through inflammatory mechanisms is hypothesized to worsen in the case of obesity during pregnancy. However, the scientific evidence regarding the association between the two variables remains contradictory. Therefore, this evidence-based case report aims to determine the association between early-pregnancy obesity and asthma exacerbation during pregnancy by synthesizing findings from various related studies. Methods: A literature search was conducted using relevant keywords in the databases PubMed, ScienceDirect, Cochrane, and ClinicalTrials.gov. The Oxford Centre for Evidence-Based Medicine (CEBM) framework was used to appraise the studies that met the inclusion and exclusion criteria. Results: This review identified five studies, comprising one systematic review and meta-analysis and four cohort studies. These studies were appraised as having acceptable validity, importance, and applicability. Four of the five studies reported a significantly increased risk of asthma exacerbation in pregnant women with early-pregnancy obesity. Stevens et al reported a decreased risk of exacerbation among pregnant women with obesity compared with the control group, attributing this to differences in perception thresholds between the groups and the possibility of study bias. Conclusion: Pregnant women with obesity in early pregnancy have a higher risk of experiencing asthma exacerbations during pregnancy compared to non-obese groups. Consequently, these patients require intensified monitoring and optimized asthma management to prevent maternal and perinatal complications.
The Relationship Between Urinary Bromotyrosine Levels and Eosinophils in Asthma and Non-Asthma Patients at Harum Melati Clinic, Pringsewu, Lampung, Indonesia Dimas Trend Pinaka Baladika; Retno Ariza Soeprihatini Soemarwoto; Syazili Mustofa; Faisal Yunus; Diyan Ekawati; Adityo Wibowo
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.v46i2.940

Abstract

Background: In the era of personalized medicine, biomarkers have become an important tool for detecting and predicting asthma episodes over the last decade, one of them is urinary bromotyrosine. It has several advantages as a potential biomarker for asthma, including its stability and the practicality of noninvasive urine sampling. Therefore, this study aims to investigate further the role of urinary bromotyrosine levels and their correlation with eosinophil levels in asthma patients. Methods: This is an analytical observational study with a cross-sectional design. From May to December 2023, the study involved 82 patients from the Harum Melati Clinic in Pringsewu, Lampung, Indonesia. The participants underwent spirometry, differential leukocyte count, urinalysis, and chest X-rays. The severity of asthma obstruction was classified into asthmatic (n=72) as the case group, with non-asthmatic patients (n=10) serving as the control group. Urinary bromotyrosine levels were tested using the 3-BrY ELISA Kit EU3112. Results: Urinary bromotyrosine levels were significantly higher in asthma patients compared to the non-asthma group (154.11 ng/mL vs. 11.87 ng/mL; P=0.0001). Furthermore, elevated eosinophil levels in asthma patients showed a strong correlation coefficient (0.307) with higher urinary bromotyrosine levels, indicating statistical significance (P=0.005). Conclusion: This study found a significant difference in urinary bromotyrosine levels between asthmatic and non-asthmatic participants. There was a strong correlation between elevated eosinophil counts in patients with asthma and increased urinary bromotyrosine levels.
KL-6 Serum Elevation among Supit Urang Landfill Workers: Based on the Length of Work Duration and the Type of Work Rizki Diah Anggraeni; Tri Wahju Astuti; Fitri Indah Sari; Sastia Rakhma
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.v46i2.1095

Abstract

Background: Waste workers at the Supit Urang Landfill, Malang, Indonesia, are exposed to occupational inhalation hazards, including bacterial bioaerosols, VOCs, CH4, CO, and H2S. Chronic exposure to these agents may induce alveolar epithelial injury and inflammatory responses, potentially leading to increased serum Krebs von den Lungen-6 (KL-6) levels. KL-6 itself is a glycoprotein biomarker associated with lung epithelial injury and inflammation.  Therefore, this study was conducted to analyze serum KL-6 levels in relation to occupational exposure duration and type of work. Methods: This analytical observational study used a cross-sectional design. A total of 79 workers were categorized based on exposure duration (<5 years, 5–10 years, >10 years) and type of work (scavengers, waste sorters, waste processors, laboratory technicians). Measurement of serum KL-6 levels used ELISA. Then, group differences were analyzed using the Kruskal–Wallis test. Results: KL-6 serum levels were higher among workers with >10 years of exposure (1170.3±621.4 U/mL) compared to the other groups (P=0.0001). KL-6 levels differed significantly across job types (P=0.402), with higher levels observed among scavengers (1049.6±586.6 U/mL). Conclusion: Serum KL-6 levels were associated with job type and showed a rising trend with longer exposure duration, particularly among workers with more than 10 years of occupational exposure.
Comparison Between Imprint Cytology and Histopathology Results in Pleural Effusion Cases Undergoing Pleuroscopy Wahju Aniwidyaningsih; Dian Prastiti Utami; Dicky Soehardiman; Mohammad Fahmi; Prasenohadi; Mia Elhidsi; Ginanjar Arum; Tina Reisa; Menaldi Rasmin; Ruth Emalian Sembiring; Romi Beginta; Eylin Rahardjo; Flora Dameria; Ni Putu Laksmi Ananda Martini
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.v46i2.1111

Abstract

Background: Pleuroscopy is a valuable minimally invasive procedure for evaluating undiagnosed pleural effusion. Rapid diagnosis of malignancy is often needed to reduce procedure time and patient discomfort, particularly when pleurodesis is planned. Imprint cytology is a quick and simple method, though underutilized in pleuroscopy practice in Indonesia. This study aimed to compare the diagnostic yield of imprint cytology and histopathology in pleural effusion cases undergoing pleuroscopy. Methods: This retrospective observational study was conducted from August to November 2024 and included patients with pleural effusion who underwent diagnostic pleuroscopy. Pleural biopsies were taken using forceps. Imprint cytology was performed by directly smearing the biopsy tissue onto slides, followed by staining. Histopathology was done using standard tissue processing. Results: Of the 25 patients who underwent pleuroscopy, 14 met the inclusion criteria. Pleuroscopic findings varied, with the most common being mass lesions (35.7%), followed by multiple nodules (21.4%) and sago-nodules (14.3%). Histopathology revealed malignancy in 10 patients (71.4%) and non-malignant in 4 (28.6%). Imprint cytology detected malignancy in 12 patients (85.7%) and non-malignant findings in 2 patients (14.3%). Conclusion: Imprint cytology offers a rapid and reliable diagnostic method during pleuroscopy, particularly in resource-limited settings. It may facilitate early detection of malignancy and support timely clinical decision-making.
Rapid Onset of Cutaneous Adverse Drug Reaction to 2HPMZ/2HPM: A Case Report Pandu Widiarto; Farchan Azzumar; Khansa Putriana; Erlina Burhan
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.v46i2.1081

Abstract

Background: The World Health Organization (WHO) has endorsed the 4-month tuberculosis (TB) regimen, 2HPMZ/2HPM (Isoniazid, Rifapentine, Moxifloxacin, Pyrazinamide), as a non-inferior alternative to the standard six-month course, representing a major advancement in global TB control. While large clinical trials established its general safety, real-world data and management of its cutaneous adverse drug reactions (CADRs) remain limited. Case: A case of a 19-year-old male initiated on the 2HPMZ/2HPM regimen for pulmonary TB. Within 30 minutes of treatment initiation, the patient developed a maculopapular erythematous rash on both arms and legs. Given the mild degree, the treatment was continued, along with administration of Cetirizine and Prednisone, for 7 days. Discussion: This case demonstrates safe continuation of treatment following the emergence of mild CADR. CADR can manifest as early as 30 minutes following ingestion, as exhibited in this case. Showing the importance of close initial observation for the 2HPMZ/2HPM regimen. 7-days of antihistamine and corticosteroid administration also appeared to be sufficient when done promptly. Conclusion: This case demonstrates the safety and feasibility of maintaining the full 2HPMZ/2HPM regimen despite mild cutaneous manifestations, thus avoiding treatment interruption, the need for complex re-challenge protocols, and potential treatment failure.
COVID-19 Vaccination and Admission Severity: Clinician-Rated WHO Severity and AI-Classified Lung Involvement on Chest X-Ray in a 2022 Indonesian Hospital Cohort Amalia Nanda Mutia; Budi Yanti; Teuku Muhammad Yus; Teuku Geumpana
Jurnal Respirologi Indonesia Vol 46 No 1 (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.v46i1.1030

Abstract

Background: COVID-19 remains a global public health concern. Differences in disease severity and hospitalization have been observed between vaccinated and unvaccinated individuals. This study aimed to evaluate COVID-19 vaccination status and clinician-assessed clinical severity, as well as artificial intelligence (AI)-classified lung parenchymal involvement. Methods: This retrospective cohort study included COVID-19 patients from January to December 2022. Clinical severity at admission was determined by World Health Organization criteria (mild, moderate, severe, critical). Lung parenchymal involvement was classified using a previously validated VGG16-based deep learning model applied to admission chest X-ray images. Vaccination status, verified through the national Satu Sehat registry, was categorized as unvaccinated, single-dose, or two-dose, without regard to time since last vaccination and vaccine type cause not consistently available. Results: A total of 153 patients were included, 31 patients (20%) unvaccinated, 22 patients (15%) single-dose, and 100 patients (65%) two-dose recipients. Critical disease occurred in 12.9% of unvaccinated patients based on clinician assessment. No patients were classified as having severe lung parenchymal involvement by the AI model. Moderate lung involvement was more frequent in unvaccinated patients (29.0%) compared with single-dose (27.3%) and two-dose groups (7.0%). In multivariable ordinal logistic regression, two-dose vaccination was independently associated with lower odds of higher based on WHO clinical severity (adjusted odds ratio [aOR]=0.41; 95% confidence interval [CI]=0.19–0.86; P=0.018) and lower odds of more severe AI-classified lung involvement (aOR=0.32; 95% CI=0.14–0.71; P=0.005). Conclusion: Two-dose vaccination was associated with lower clinician-assessed severity and reduced AI-classified lung parenchymal involvement at admission in this retrospective hospital-based cohort.
Clinical Performance of a Molecular-based Lateral Flow Assay for Rapid and Simultaneous Detection of Tuberculosis and Non-Tuberculous Mycobacteria in Indonesia Lidya Chaidir; Nabilla Ghina Zavitri; Adi Imam Cahyadi; Claudia Selviyanti; Dyshelly Nurkartika Pascapurnama; Jessi Annisa; Bachti Alisjahbana; Prayudi Santoso
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.v46i2.1071

Abstract

Background: Diagnostic modalities that can differ Tuberculosis (TB) and Non-Tuberculosis Mycobacteria (NTM) are urgently needed, especially in TB high burden areas, to avoid misdiagnosis. A rapid molecular approach can be utilized to accommodate easy implementation for routine diagnosis in low-resource countries to decrease the turnaround time and increase sensitivity significantly. This study evaluated the diagnostic performance of PaxView® TB/NTM, a rapid multiplex PCR assay that utilizes universal lateral flow technology for the simultaneous detection and visualization of TB and NTM. Methods: The study was conducted in Bandung, Indonesia, using sputum samples from the outpatient TB clinic in Hasan Sadikin General Hospital. Sputum samples were collected consecutively from each patient. All the eligible samples underwent microbiological work-up and Xpert MTB/RIF testing with different sputum taken previously. The collected sputum was extracted, amplified, and then visualized using the PaxView® TB/NTM MPCR-ULFA kit. Results: The sensitivity and specificity of the PaxView® MPCR-ULFA were 83.0% and 92.1%, respectively. The positivity rate for MPCR ULFA showed significantly higher results (43.0%) compared to culture (32.8%), smear microscopy (26.3%), and was comparable with the Xpert MTB/RIF assay (43.5%). A total of 23 confirmed NTM-positive cases were found in this study (2.6%). Conclusion: The PaxView® MPCR-ULFA demonstrated promising performance for MTB and NTM detection. The sensitivity and specificity of this kit are comparable to those of other molecular diagnostic modalities. The simple platform using a test strip and straightforward visualization might be appropriately applied in poorly-equipped laboratories.

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