Tesis

Prevalens dan Karakteristik Sindrom Tumpang-Tindih Asma-Penyakit Paru Obstruktif Kronik pada Pasien Asma dan Penyakit Paru Obstruktif Kronik Rumah Sakit Umum Pusat Persahabatan = Prevalence and Characteristics ofAsthma – Chronic ObstructivePulmonary Disease Overlap Syndrome in Asthma and Chronic ObstructivePulmonary Disease Patients Treated at Persahabatan Hospital Jakarta, Indonesia.

Latar belakang: Asma dan PPOK merupakan dua penyakit berbeda. Beberapa kelompok pasien, terutama perokok dan usia tua seringkali memiliki gambaran klinis yang mirip dengan asma dan PPOK sehingga diagnosis sulit ditegakkan. Hal ini telah memunculkan suatu entitas klinis baru yang disebut STAP. Penelitian ini bertujuan untuk mengetahui prevalens dan karakteristik STAP pada pasien asma dan PPOK di RSUP Persahabatan. Metode: Penelitian menggunakan studi potong lintang, dilakukan di Poli Asma-PPOK RSUP Persahabatan Jakarta pada Maret-Agustus 2018. Kriteria GINA/GOLD 2017 yang dimodifikasi digunakan untuk mendiagnosis STAP. Pasien didiagnosis STAP apabila memiliki minimal tiga karakteristik klinis yang mendukung asma dan PPOK. Hasil: Penelitian melibatkan 60 subjek. Prevalens STAP didapatkan 58,3%. Sebagian besar pasien STAP memiliki jenis kelamin perempuan, tidak bekerja, berpendidikan tinggi, memiliki riwayat merokok dengan median indeks Brinkman 0,5 (0-1536) dan memiliki rerata IMT 24,9±3,8 kg/m2. Gejala paling banyak dikeluhkan adalah sesak (88,7%) dan mengi (77,1%). Satu tahun terakhir, median eksaserbasi kelompok STAP adalah 1 (0-10) kali dan median rawat inap di RS adalah 0 (0-1) kali. Setelah pemberian bronkodilator, kelompok STAP memiliki rerata atau median KVP% prediksi, VEP1% prediksi, VEP1/KVP, kenaikan VEP1 dan persentase kenaikan VEP1 berturut-turut 85,3%, 76,4%, 67,8%, 158,3 mL, dan 10,1%. Uji provokasi bronkus positif ditemukan pada 97,1% pasien STAP dan 48,6% pasien STAP memiliki hiperinflasi berat. Kesimpulan: Prevalens STAP pada penelitian ini sebesar 58,3%. Kebanyakan pasien STAP adalah perempuan, tidak bekerja, berpendidikan tinggi, memiliki riwayat merokok, indeks Brinkmann yang rendah, IMT normal, memiliki keluhan sesak napas, rerata VEP1/KVP pascabronkodilator 67,8%, median persentase kenaikan VEP1 pascabronkodilator 10,1% dan uji bronkodilator yang positif.
Kata kunci: Asma, PPOK, sindrom tumpang tindih asma-PPOK


Background: Asthma and chronic obstructive pulmonary disease (COPD) are two different diseases. Smokers and elderly patients often show overlapping asthma and COPD clinical features thus establishing definite diagnosis would be difficult. This has led to a new clinical entity called asthma-COPD overlap syndrome (ACOS). This study aims to determine the prevalence and characteristics of ACOS in patients with asthma and COPD. Methods: This cross sectional study was conducted between March – August 2018 at Asthma-COPD Polyclinics of Persahabatan Hospital Jakarta, Indonesia. The diagnosis of ACOS complied to the modified 2017 GINA/GOLD criteria; patient was diagnosed as ACOS if one presented with at least three clinical characteristics that suggestive for either asthma and COPD. Results: The study involved 60 subjects. The prevalence of ACOSwas 58.3%. Most of ACOS subjectswere females (51.4%), unemployed or not actively working (65.7%), highly educated (65.7%), had history of smoking (54,3%) and had mean body mass index (BMI) of 24.9±3.8 kg/m 2 . The common symptoms of ACOS were shortness of breath (88.7%) and wheezing (77.1%). The median exacerbation of ACOS subjects during the past year was 1 (0 – 10) times and median hospitalization was 0 (0 – 1) times. The average post-bronchodilator test values of FVC% predicted, FEV1% predicted, FEV1/FVC, FEV1 increase and percentage of FEV1 increase of ACOS subjects were 85.3%, 76.4%, 67.8%, 158.3 mL and 10.1%, respectively. Positive bronchial challenge test and severe hyperinflation found inACOS subjects was97.1% and 48.6%, respectively. Conclusion: The prevalence of ACOS in this study was 58.3%. Most of ACOS subjects were female, unemployed, highly educated, had history of smoking, had normal BMI, experiencing shortness of breath, had mean post-BD FEV1/FVC of 67.7%, had median FEV1 increase of 10.1% and had positive bronchial challenge test.
Keywords:Asthma, COPD, asthma-COPD overlap syndrome, lung function