Jurnal Respirasi

Back Matter Vol 11 No 1, 2025

Back Matter — Thu, 30 Jan 2025 00:00:00 +0700

Determining Chronic Cough Using the Methacholine Bronchial Provocation Test

Esra Arslan Aksu, Oğuz Uzun — Thu, 30 Jan 2025 00:00:00 +0700

Introduction: Chronic cough is a common symptom in pulmonology outpatient clinics, often associated with lung conditions, though extrapulmonary causes can also be responsible. This study aimed to detect bronchial hyperreactivity (BHR) and cough-variant asthma using a methacholine bronchial provocation test (BPT) in patients with chronic cough for whom standard diagnostic procedures could not identify a cause.

Methods: This prospective study evaluated patients admitted to the clinic who presented with chronic coughs over one year. A BPT was performed on patients for whom standard diagnostic procedures failed to identify a cause, and this selected group was included in this study.

Results: This study included a total of 40 patients who were examined for chronic cough symptoms without an identifiable etiology. The BPT was negative (PD20 >16 mg/mL) in 30 patients (75%) and positive in 10 patients (25%). Among the patients with negative BPT results, 13 (43.3%) had no identifiable cause for their cough.

Conclusion: This study differs from others by focusing on a selected group of patients with chronic coughs for whom the etiology could not be determined through standard diagnostic procedures. The BPT was performed alongside typical diagnostic tests, and no diagnoses were made in the included patients. Tests identified BHR and cough-variant asthma in 25% of these patients, suggesting that BPT is a valuable tool in diagnosing chronic cough when conventional methods fail.

Nutritional Status and Lung Cavity in Pulmonary Tuberculosis Patient

Thu, 30 Jan 2025 00:00:00 +0700

Introduction: As one of the leading causes of death worldwide, pulmonary tuberculosis (PTB) is an infectious disease that continues to pose a serious threat to public health. The presence of cavities in radiological imaging of patients with PTB is associated with malnutrition, age, gender, and other comorbidities, including diabetes mellitus. This study aimed to find the association between nutritional status and lung cavity in PTB patients.

Methods: This was an analytical observational study with a cross-sectional design that involved 134 adult patients who were diagnosed with PTB at Persahabatan National Respiratory Referral Hospital, Jakarta. All patients were interviewed using a questionnaire for sociodemographic and anthropometric data, the nutritional status was assessed using the subjective global assessment (SGA), and the lung cavity was determined using a chest X-ray interpreted by radiologists. The Chi-square test was performed using the Statistical Package for the Social Sciences (SPSS) version 25 for Windows.

Results: Of 134 PTB patients, 61.9% were males, and 92.5% were from the 18-59 years old age group. Based on the SGA score, 77 (57.5%) were grouped as mild-moderate malnutrition/SGA B and 22 (16.4%) as severe malnutrition/SGA C. Lung cavity was found in 42 (31.3%) patients. The analysis showed that malnutrition was statistically significantly associated with lung cavity with OR=6.933 (95%CI 1.986-24.205; p=0.002) and the adjusted OR were 7.303 (95%CI 2.060-25.890; p=0.002) after controlling for age, sex, smoking, education, and comorbidities.

Conclusion: This study found that malnutrition was associated with lung cavities in PTB patients. These findings might indicate how malnutrition impaired the immune function in PTB patients.

Depression in Patients with Lung Cancer during the COVID-19 Pandemic

Hanna Lianti Afladhia, Sita Andarini — Thu, 30 Jan 2025 00:00:00 +0700

Introduction: The coronavirus disease (COVID-19) pandemic has caused significant disruptions in various aspects of life, leading to psychological distress and an increase in mental health disorders, particularly in vulnerable populations such as lung cancer patients. This study investigated the depression levels among lung cancer patients during the COVID-19 pandemic.

Methods: A cross-sectional study was conducted at the Thoracic Oncology Outpatient Clinic of Persahabatan National Respiratory Referral Hospital, Jakarta. Depression levels were evaluated using the Patient Health Questionnaire-9 (PHQ-9) in Indonesian. Sociodemographic and clinical characteristics and COVID-19-related stress factors (such as concerns about treatment delays, access to healthcare, psychological pressure, and interpersonal relationships) were also assessed.

Results: Out of 42 patients, 42.9% were found to have depression during the pandemic. Factors significantly associated with depression included being female, having a lower economic status, poor performance status, undergoing chemotherapy, and experiencing higher levels of psychological pressure related to COVID-19.

Conclusion: This study highlighted a high prevalence of depression among lung cancer patients during the COVID-19 pandemic. Psychological assessment and interventions are crucial to prevent further deterioration in mental health and quality of life, which could negatively affect patients' prognoses.

The Time to Progression in Lung Adenocarcinoma Patients Receiving First- and Second-Generation EGFR-TKI in Indonesia

Thu, 30 Jan 2025 00:00:00 +0700

Introduction: Targeted therapy, particularly epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI), is the first-line treatment for non-small cell lung cancer (NSCLC). However, drug resistance has grown in the last few decades. This study compared the progression time of lung cancer patients treated with first- and second-generation EGFR-TKI.

Methods: Based on cytology and histological results, this cross-sectional study included 1,008 participants diagnosed with lung adenocarcinoma (LUAD) from 11 Indonesian Respiratory Centers. Every three months, the response to treatment was assessed using the Response Evaluation Criteria in Solid Tumours (RECIST) criteria in 1.1. Significant differences in the clinical features of the three TKI treatment groups were identified using logistic regression analysis, the median time to disease progression was estimated using the Kaplan-Meier technique, and independent prognostic factors related to the time to progression (TTP) were assessed using Cox proportional hazards regression.

Results: This study examined 505 patients, the majority of whom were females (50.9%), never smoked (59.8%), diagnosed at an advanced stage (99.2%), and had an Eastern Cooperative Oncology Group (ECOG) scale of 0-1 (83.2%). Approximately 98.1% of patients were treated with afatinib (14.8%), erlotinib (18.6%), and gefitinib (66.1%) due to common mutations. The groups did not differ significantly (p>0.05). The median overall survival (OS) rate was 9 months. The time to LUAD progression in lung cancer was significantly impacted by poor performance (p=0.001).

Conclusion: Epidermal growth factor receptor-tyrosine kinase inhibitor treatment can only prolong the TTP of LUAD by up to 9 months, and the performance scale when receiving the EGFR-TKI significantly affects the prognosis.

The Influence of Nigella sativa on the Increase of IFN-γ and Quality of Life in Lung Cancer Patients Undergoing Chemotherapy

Thu, 30 Jan 2025 00:00:00 +0700

Introduction: In vitro and animal model studies have shown that Nigella sativa reduces cancer cell proliferation and improves chemotherapy effectiveness. Cellular activation triggers the production of IFN-γ by natural killer (NK) cells. This study examined the effect of Nigella sativa supplementation on IFN-γ levels and quality of life in lung cancer patients before and after interferon therapy.

Methods: This study used a non-equivalent control experimental design involving 21 lung cancer patients undergoing initial chemotherapy at Dr. Saiful Anwar General Hospital, Malang, in 2023. The patients were divided into two groups: one group received standard chemotherapy, and another group received a combination of chemotherapy and Nigella sativa supplementation at a dose of 2x500 mg for nine weeks. The effects of this intervention were assessed by measuring IFN-γ levels using an enzyme-linked immunosorbent assay (ELISA) kit and evaluating quality of life using the European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life (QLQ-C30) questionnaire before and after the fourth cycle of chemotherapy.

Results: The results showed a significant increase in IFN-γ levels in the combination group undergoing chemotherapy and receiving Nigella sativa supplementation (6140.44±2233.89) compared to the standard chemotherapy group (3827.08±1722.79), with a p-value of 0.015. Quality of life improved in both groups, with scores of 53.70±6.05 before and 65.74±14.70 after chemotherapy (p=0.000).

Conclusion: This study found that Nigella sativa supplementation can enhance IFN-γ levels and quality of life in lung cancer patients after four chemotherapy treatment cycles. These findings indicated that Nigella sativa could be a beneficial supplement for lung cancer patients.

Double-Lumen vs Small-Bore Pigtail Catheter for Pleural Effusion: Which is Superior?

Novi Andriani Siagian, Noni Novisari Soeroso, Syamsul Bihar, Taufik Ashar — Thu, 30 Jan 2025 00:00:00 +0700

Introduction: Pleural effusion is associated with a high mortality rate. Tube thoracostomy remains the standard treatment. Despite this, double-lumen catheters, typically used for central venous access, are infrequently employed for pleural drainage. This study compared the characteristics of patients undergoing double-lumen catheter versus pigtail catheter placements for pleural effusion.

Methods: A retrospective cross-sectional study was conducted on adult patients at Prof. Dr. Chairuddin Panusunan Lubis Universitas Sumatera Utara Hospital, Haji Adam Malik General Hospital, and St. Elisabeth Hospital, Medan, from September 2022 to April 2024. This study analyzed patient demographics and clinical presentations for those receiving either catheter type.

Results: The mean age of patients with double-lumen catheters was 58.21 years old, while those with pigtail catheters averaged 54.9 years old. Patients with double-lumen catheters frequently presented with a combination of shortness of breath, cough, and chest pain, while those with pigtail catheters primarily reported shortness of breath. Both groups predominantly exhibited exudative pleural effusions. Radiological evaluations indicated moderate pleural effusion was most common in both groups, with thoracic ultrasound revealing fluid volumes between 500 and 2,000 cc.

Conclusion: Double-lumen catheters are more frequently utilized for moderate to massive pleural effusion, whereas pigtail catheters are typically reserved for moderate cases. The choice of catheter depends on the patient's condition, the underlying cause of the effusion, and radiological findings.

Anaplastic Lymphoma Kinase (ALK) Rearrangement of Lung Adenocarcinoma among North Sumatera Population

Thu, 30 Jan 2025 00:00:00 +0700

Introduction: Lung cancer is a malignancy of the lung parenchyma or bronchi. Molecular targeted therapy directed at oncogene driver mutations, such as anaplastic lymphoma kinase (ALK), improves the prognosis of patients with non-small cell lung carcinoma (NSCLC). This study aimed to determine the characteristics of lung adenocarcinoma patients and the prevalence of ALK rearrangement among the North Sumatra population.

Methods: This descriptive study used data from patients' formalin-fixed paraffin-embedded (FFPE) ALK examination results and medical records. The laboratory analyzed the patient’s FFPE for ALK fusion protein expression using the VENTANA anti-ALK (D5F3) procedure to determine the prevalence of ALK rearrangement.

Results: Of the 34 subjects, it was revealed that the characteristics of lung adenocarcinoma patients were 18 patients aged >60 years old (52.9%), 26 male patients (76.4%), and 24 heavy smoker patients (70.6%). Based on the pathological tumor-node-metastasis (pTNM) stage, most samples were classified as stage IVA, with 24 cases (70.6%) showing the highest metastases to the pleura. There were 2 cases of ALK mutations obtained through immunohistochemical examination with a percentage of 5.8%.

Conclusion: There are relatively few ALK rearrangement mutations in lung adenocarcinoma patients without screening. Additional research is needed to ascertain the distribution of lung adenocarcinoma patient characteristics associated with a higher prevalence of ALK rearrangement mutations.

The Effects of Inspiratory Muscle Training in Lung Cancer Patients: A Scoping Review

Thu, 30 Jan 2025 00:00:00 +0700

Introduction: Lung cancer is the leading cause of cancer worldwide, with a high mortality rate. Chronic dyspnea promotes a pathologic cycle of decreased activity, which has been shown to limit exercise tolerance and deteriorate quality of life (QoL). Inspiratory muscle training (IMT) is a resistance-based exercise regimen that aims to improve the strength and endurance of the inspiratory muscles, thereby reducing respiratory symptoms. This study aimed to comprehensively review the possible beneficial effects of IMT on various aspects of lung cancer patients.

Methods: The PubMed, Embase, and Cochrane databases were searched from inception to 20 May 2024. All clinical trials examining the impact of IMT on lung cancer patients, utilizing either quantitative or qualitative approaches, were included. The extracted data were then descriptively presented, focusing on the main themes to provide a comprehensive literature review.

Results: This scoping review identified 9 unique studies comprising eight randomized-controlled trials and one retrospective cohort study with 460 lung cancer patients. An IMT regimen was proven to reduce sedentary behavior and significantly improve physical activity and health-related quality of life (HRQL). Furthermore, the IMT program reduced dyspnea, improving maximum inspiratory pressure (PImax) and 6-minute walking test (6MWT). It also provided the benefits of shorter postoperative stay and reduced patient distress concerning dyspnea.

Conclusion: Inspiratory muscle training provides several benefits, including improvements in dyspnea indexes, exercise tolerance, and overall HRQL. Further studies are required to determine the optimal IMT regimen for this special population.

How to Manage Lung Injury Related to Cancer Therapy?

Haryati Haryati, Muhammad Hendi Saputra, Farah Fatma Wati — Thu, 30 Jan 2025 00:00:00 +0700

Modern technology has improved our understanding of cancer biology, especially anti-cancer medicines from cytotoxic chemotherapy, radiotherapy, targeted therapy, and immunotherapy. Nevertheless, these treatments can result in significant pulmonary toxicities, including interstitial lung disease (ILD) and radiation-induced lung injury (RILI), which can result in a high rate of morbidity and mortality despite being less severe than injuries to other organ systems. Lung injury mechanisms occur through various pathways, such as immune-mediated damage and oxidative stress. Through clinical history and examination, imaging techniques such as high-resolution computed tomography (HRCT), and the necessity of eliminating other possibilities of respiratory symptoms, lung injuries due to cancer therapies can be identified. The management strategies are based on the severity of the condition and may include discontinuing the responsible agent, corticosteroid treatment, and supportive care. The challenge is early identification and management of these lung injuries due to the variability in patient responses and the lack of comprehensive guidelines. Therefore, awareness is needed to monitor lung health in cancer patients undergoing therapy.

Lung Aging and Lung Function Assessment in Elderly

Made Agustya Darma Putra Wesnawa, I Made Subagiarta, Evelyn Nathania — Thu, 30 Jan 2025 00:00:00 +0700

The lung is one of the organs that experiences the most frequent decline in function among the elderly. Reduced lung function associated with aging is a physiological condition. The lungs transform both their cellular composition and their functional capabilities. The lungs of an aging population may show structural changes to the respiratory muscles, chest wall, lung parenchyma, and upper and lower respiratory tracts. The elderly are more susceptible to reduced lung perfusion, respiratory mechanics, infection, and weaker respiratory muscles because of aging. The body plethysmograph, oscillometer, spirometry, and carbon monoxide (CO) diffusing lung capacity are techniques used to assess lung function in the elderly. For elderly people, lung function testing might be challenging due to frailty and cognitive decline. Consequently, choosing the best lung function test method for the elderly and offering an accurate and suitable interpretation of the test findings are crucial. Early detection of changes in lung function and accurate assessment of lung function can help identify lung function abnormalities in the elderly and give the appropriate treatment and intervention. This review focused on lung aging, the potential benefits and drawbacks of different lung function tests in the elderly, and the proper way to interpret specific lung function tests.

Deterioration of Respiratory Symptoms in Uncontrolled CPFE: A Case Report

Frans Raffael, Amira Permatasari Tarigan — Thu, 30 Jan 2025 00:00:00 +0700

Introduction: Chronic obstructive pulmonary disease (COPD) has a global impact on health and increases healthcare costs. Combined pulmonary fibrosis and emphysema (CPFE) combines interstitial lung disease (ILD) and emphysema. Excessive short-acting β2-agonist (SABA) usage escalates exacerbation risk, affecting prognosis.

Case: A 44-year-old former smoker presented with worsening shortness of breath, cough, and weight loss. Examination showed respiratory distress, including wheezing. Initially, he was diagnosed with tuberculosis (TB) and COPD exacerbation. He regularly used jet nebulizers without medical supervision, and during the initial treatment, he developed acute respiratory failure, leading to acidosis. Treatment involved SABA and short-acting muscarinic-antagonist (SAMA), steroids, and oxygen therapy. In November 2023, his condition worsened, requiring emergency treatment. Radiological findings indicated CPFE. Management included nebulized medications, intravenous steroids, and antibiotics. Despite challenges, he rarely attended follow-up appointments after showing improvement, missing scheduled rehabilitation therapy, inhaler monitoring, comorbid therapy, and home oxygen monitoring.

Conclusion: Combined pulmonary fibrosis and emphysema combines ILD and emphysema, causing severe respiratory impairment. Management mirrors that of COPD, involving inhalers, corticosteroids, and oxygen therapy.

Unveiling Risk Factors in a Patient with Silicotuberculosis: A Case Report

Thu, 30 Jan 2025 00:00:00 +0700

Introduction: Silicosis, an occupational lung disease caused by crystalline silica dust, is often complicated by tuberculosis (TB). The epidemiological triad suggests disease results from imbalanced interactions between the host, agent, and environment.

Case: A 63-year-old underweight man presented with decreased consciousness after consuming drugs, chronic cough, low-grade fever, weight loss, and lower urinary tract symptoms. He was a smoker, drug abuser, and alcoholic. He had worked as a construction worker for 33 years without personal protective equipment (PPE). The patient lived in substandard housing, and three neighbors had a history of TB. Urine toxicology was positive for amphetamine. Abdominal ultrasound showed prostate enlargement. A chest X-ray showed fibroinfiltrates, cavities, and reticulogranular patterns. A high-kV chest X-ray revealed profusion levels of 1/2 S/S and 1/1 P/P. Contrast chest computed tomography (CT) showed tree-in-bud patterns, reticulogranular patterns, small nodules, and fibrosis. Brain CT was normal. GeneXpert sputum confirmed Mycobacterium tuberculosis (MTB), and bronchoalveolar lavage (BAL) spectrophotometric detected 38.90 ppm silica. He was diagnosed with amphetamine intoxication, benign prostatic hyperplasia, and silicotuberculosis. Haloperidol, tamsulosin, and anti-TB therapy were administered, while silicosis had no specific treatment. He was advised to change job to reduce silica exposure and planned to receive housing renovation assistance from the Health Office of Surabaya. The patient was declared cured after completing six months of TB treatment.

Conclusion: The host factors included nutritional status, comorbidity, and personal habits; the agent factor was MTB; and the environmental factors included inadequate ventilation, high housing density, close contact with TB patients, and occupational conditions. A holistic identification of host, agent, and environmental risk factors is essential for understanding the development, prevention, and diagnosis of silicotuberculosis.

Primary Pulmonary Myxoid Sarcoma: A Rare and Challenging Diagnosis in Thoracic Oncology

Yudi Apriyanto, Anna Febriani, Laksmi Wulandari, Farah Fatma Wati — Thu, 30 Jan 2025 00:00:00 +0700

Introduction: Primary pulmonary myxoid sarcoma (PPMS) is a rare malignant mesenchymal lung tumor, with fewer than 40 cases reported worldwide. This care report presented a case of PPMS with surgical difficulties.

Case: A 53-year-old man presented with a six-month history of exertional dyspnea, coughing up blood, right chest pain, anorexia, and weight loss. Thoracic computed tomography (CT) imaging revealed an enhancing solid mass in the middle-posterior mediastinum. Histopathological examination of a core biopsy identified anaplastic lipoblast cells indicative of liposarcoma. Based on the multidisciplinary team (MDT) discussion, the patient was diagnosed with mediastinal liposarcoma, and tumor excision was planned. However, during the surgery, a lung tumor with adhesions to the middle and lower lobes of the right lung was discovered, precluding the complete tumor. An open biopsy was performed instead, revealing a proliferation of anaplastic cells with round to oval spindle nuclei arranged reticularly within a myxoid stroma, along with positive Alcian blue staining. Immunohistochemical analysis demonstrated focal desmin positivity in the cytoplasm of the tumor cells. The diagnosis of PPMS was confirmed based on the criteria by the World Health Organization (WHO) in 2021, including primary lung tumor, spindle-shaped and round tumor cells in a reticular pattern within a myxoid stroma, and immunohistochemical findings that exclude other histologically similar tumors.

Conclusion: Although rare, PPMS should be considered in the differential diagnosis of thoracic tumors. Most PPMS patients were treated surgically and had a good prognosis. However, tumor excision could not be performed in this patient due to the adhesion of the tumor mass to the middle and lower lobes of the right lung.

Front Matter Vol 11 No 1, 2025

Front Matter — Thu, 30 Jan 2025 00:00:00 +0700