Tesis

Proporsi dan karakteristik klinis aspergillosis paru pada asma tidak terkontrol di RSUP Persahabatan = Proportion and clinical features of pulmonary Aspergillosis in uncontrolled asthma patients in Persahabatan Hospital.

Latar Belakang : Asma merupakan penyakit heterogen yang memiliki karakteristik inflamasi kronik saluran napas. Sistem pertahanan tubuh pada penyakit asma berkurang karena fungsi bersihan mukosilier yang sudah menurun akibat proses inflamasi kronik, maka itu bentuk matur dari spora Aspergillus fumigatus bisa tumbuh dan melepaskan protein inflamasi yang bersifat toksik. Sensitisasi aspergillus merupakan suatu kondisi awal aspergillosis paru pada asma yang dapat berkembang menjadi Allergic Bronchopulmonary Aspergillosis (ABPA). Penegakkan diagnosis aspergillosis paru didapatkan jika reaksi hipersensitisasi terhadap antigen A.fumigatus positif, sedangkan penilaian diagnosis ABPA didapatkan dari karakteristik klinis, imunologi dan radiologi. Jika terjadi misdiagnosed pada penyakit ABPA akibat tidak dilakukan skrining sensitisasi terhadap A.fumigatus, maka akan menyebabkan kerusakan permanen pada paru. Metode : Penelitian ini menggunakan metode potong lintang pada 86 pasien asma yang berobat ke RSUP Persahabatan dengan nilai Asthma Control Test (ACT) ≤ 24. Subjek penelitian dibagi 2 kelompok berdasarkan aspergillosis paru. Penilaian aspergillosis paru menggunakan pemeriksaan Imunoglobulin E (IgE) spesifik A.fumigatus. Kriteria diagnosis ABPA yang digunakan pada penelitian ini menggunakan kriteria International Society of Human and Animal Mycology (ISHAM) yaitu dua kriteria obligatory (IgE spesifik A.fumigatus dan IgE total) serta 3 kriteria tambahan (IgG spesifik A.fumigatus, eosinofil total, gambaran foto toraks). Hasil : Proporsi pasien asma belum terkontrol yang memiliki aspergillosis paru didapatkan 3,5% (3/86) sedangkan proporsi ABPA didapatkan 1,1% (1/86). Terdapat faktor-faktor yang memengaruhi aspergillosis paru pada asma belum terkontrol, diantaranya adalah nilai IMT (p=0,77), riwayat merokok (p=0,86) dan riwayat TB paru (p=0,03). Karakteristik gejala klinis batuk dengan dahak produktif dan berwarna kecoklatan didapatkan pada 2/3 subjek. Karakteristik imunologi didapatkan nilai median IgE total pada subjek dengan aspergillosis paru 465(22-1690) IU/ml dan nilai median eosinofil 380 (0-770) sel/µl. Gambaran radiolologi ektasis dan fibroinfiltrat didapatkan pada 2/3 subjek aspergillosis paru. Dari penilaian spirometri pada subjek aspergillosis paru didapatkan nilai median KVP 1630(950-2150) ml, nilai rerata KVP%prediksi 70±33,71%, nilai VEP1 1150(470-1240) ml, nilai median VEP1% prediksi 54(24-76)%, nilai rerata VEP1/KVP 59,33±14,57)% serta nilai rerata DLCO 84,67±24,66%. Nilai median FeNO pada asma belum terkontrol dengan aspergillosis paru pada penelitian ini didapatkan 32 (12-45) ppb. Kesimpulan : Penegakkan diagnosis aspergillosis paru pada pasien asma tidak terkontrol harus dilakukan sejak awal, terutama pada pasien dengan riwayat TB paru. Hal tersebut dapat mencegah aspergillosis paru pada asma belum terkontrol berkembang menjadi penyakit ABPA serta kerusakan paru yang permanen.
Kata kunci Asma, Aspergillus fumigatus, Allergic Bronchopulmonary Aspergillosis


Background : Asthma is a heterogeneous disease with characteristics of chronic airways inflammation. The body's defense system in patient who has asthma has reduced because the mucociliary clearance function has decreased due to the chronic inflammatory process. Therefore, the mature form of Aspergillus fumigatus spores could grow and release toxic inflammatory proteins. Aspergillus sensitization is an early condition of pulmonary aspergillosis in asthma, which could progress to Allergic Bronchopulmonary Aspergillosis (ABPA). The diagnosis of pulmonary aspergillosis was obtained if the hypersensitivity reaction to the positive A. fumigatus antigen, while the assessment of the ABPA diagnosis was obtained from clinical, immunological and radiological characteristics. If there is a misdiagnos in ABPA disease due to not being screened for sensitization to A. fumigatus, it will cause permanent damage to the lungs. Methods : This study used a cross-sectional method on 86 asthma patients who went to Persahabatan Hospital with an Asthma Control Test (ACT) scored 24. The study subjects were divided into two groups based on pulmonary aspergillosis. Assessment of pulmonary aspergillosis using specific Immunoglobulin E (IgE) examination of A. fumigatus. The ABPA diagnostic criteria used in this study has also used the International Society of Human and Animal Mycology (ISHAM) criterias, which are two obligatory criterias (A.fumigatus-specific IgE and total IgE) and 3 additional criterias (A.fumigatus-specific IgG, total eosinophils, photos thorax). Results : The proportion of uncontrolled asthma patients who had pulmonary aspergillosis was 3.5% (3/86) while the proportion of ABPA was 1.1% (1/86). There are factors that influencedm pulmonary aspergillosis in uncontrolled asthma, including BMI value (p=0.77), smoking history (p=0.86) and pulmonary TB history (p=0.03). Characteristics of clinical symptoms of cough with productive and brownish phlegm were found in 2/3 of the subjects. Immunological characteristics obtained a median value with a total of IgE in subjects with pulmonary aspergillosis 465 (22-1690) IU/ml and a median eosinophil value of 380 (0-770) cells/µl. Radiologic features of ectasis and fibroinfiltrate were found in 2/3 of subjects with pulmonary aspergillosis. From the spirometry assessment in pulmonary aspergillosis subjects, the median VEP value was 1630 (950-2150) ml, the mean VEP% predicted value was 70±33.71%, the VEP1 value was 1150(470-1240) ml, the predicted VEP1% median value was 54(24-24). 76)%, the mean value of VEP1/KVP 59.33±14.57)% and the mean value of DLCO 84.67±24.66%. The median value of FeNO in uncontrolled asthma with pulmonary aspergillosis in this study was 32 (12-45) ppb. Conclusion : Diagnosis of pulmonary aspergillosis in patients with uncontrolled asthma should be carried out early, especially in patients with a history of pulmonary TB. This can prevent pulmonary aspergillosis in uncontrolled asthma from developing into ABPA disease and permanent lung damage.
Keyword Asthma, Aspergillus fumigatus, Allergic Bronchopulmonary Aspergillosis