Direct healthcare costs associated with management of asthma: comparison of two treatment regimens in Indonesia, Thailand and Vietnam.

OBJECTIVE: Daily inhaled corticosteroid (ICS) and long-acting beta-2-agonist (LABA) combinations comprising either regular maintenance therapy with ICS/LABA plus as-needed short-acting beta-2-agonist (SABA) or ICS-formoterol combinations used as maintenance and reliever therapy (MART) are recommended for moderate asthma. This analysis compares the direct costs of twice-daily fluticasone propionate/salmeterol (FP/salm) and budesonide/formoterol MART in three Southeast Asian countries. METHODS: A literature review identified three randomized trials in patients with asthma (≥ 12 years) comparing regular twice-daily FP/salm with as-needed SABA versus MART in moderate asthma: AHEAD (NCT00242775/17 countries/2309 patients), COMPASS (AstraZeneca study SD-039-0735/16 countries/3335 patients), and COSMOS (AstraZeneca study SD-039-0691/16 countries/2143 patients). Economic analyses, conducted from a healthcare sector perspective (medication costs + healthcare utilization costs), applied unit costs from countries where healthcare costs are publicly available: Indonesia, Thailand and Vietnam. Results are expressed in British pound sterling (GBP/patient/year). RESULTS: Annual exacerbation rates were low and differences between treatment strategies were small (range, FP/salm: 0.31-0.38, MART: 0.24-0.25) although statistically significant in favor of MART. Total average (minimum-maximum) direct costs (in GBP/patient/year) across the three studies were £187 (£137-£284), £158 (£125-£190), and £151 (£141-£164) for those who used FP/salm, and £242 (£217-£267), £284 (£237-£340) and £266 (£224-£315) for MART in Indonesia, Thailand and Vietnam, respectively. On average, total direct costs/patient/year with FP/salm were 22.8%, 44.6% and 43.0% lower than with MART for Indonesia, Thailand and Vietnam, respectively. CONCLUSIONS: In the three countries evaluated, total treatment costs with regular twice-daily FP/salm were consistently lower than with budesonide/formoterol MART due to lower direct healthcare costs.

Management of COPD in Asia: A position statement of the Asian Pacific Society of Respirology.

Chronic obstructive pulmonary disease (COPD) is a major disease in Asia. However, how to manage specifically Asian COPD patients has not been proposed. Awareness of COPD is very low and underdiagnosis/undertreatment is common in Asian countries. Low utilization of pulmonary function test and inhalers is also a problem. Moreover, high smoking prevalence and air pollution are barriers to managing Asian patients with COPD. The relatively low body mass index of Asian patients with COPD can increase their risk for experiencing adverse effects from COPD drugs. Physicians should consider the unique features of Asian populations with COPD such as the high prevalence rates of bronchiectasis and tuberculosis-destroyed lungs, biomass smoke exposure and parasitic infection.

Asthma in Asia: Physician perspectives on control, inhaler use and patient communications.

OBJECTIVE: We examined the physician perspectives on asthma management in Asia. METHODS: An online/face-to-face, questionnaire-based survey of respiratory specialists and primary care physicians from eight Asian countries/region was carried out. The survey explored asthma control, inhaler selection, technique and use; physician-patient communications and asthma education. Inclusion criteria were >50% of practice time spent on direct patient care; and treated >30 patients with asthma per month, of which >60% were aged >12 years. RESULTS: REALISE Asia (Phase 2) involved 375 physicians with average 15.9(±6.8) years of clinical experience. 89.1% of physicians reporting use of guidelines estimated that 53.2% of their patients have well-controlled (GINA-defined) asthma. Top consideration for inhaler choice was asthma severity (82.4%) and lowest, socio-economic status (32.5%). Then 54.7% of physicians checked their patients' inhaler techniques during consultations but 28.2(±19.1)% of patients were using their inhalers incorrectly; 21.1-57.9% of physicians could spot improper inhaler techniques in video demonstrations. And 79.6% of physicians believed combination inhalers could increase adherence because of convenience (53.7%), efficacy (52.7%) and usability (18.9%). Initial and follow-up consultations took 16.8(±8.4) and 9.2(±5.3) minutes, respectively. Most (85.1%) physicians used verbal conversations and least (24.5%), video demonstrations of inhaler use; 56.8% agreed that patient attitudes influenced their treatment approach. CONCLUSION: Physicians and patients have different views of 'well-controlled' asthma. Although physicians informed patients about asthma and inhaler usage, they overestimated actual usage and patients' knowledge was sub-optimal. Physician-patient interactions can be augmented with understanding of patient attitudes, visual aids and ancillary support to perform physical demonstrations to improve treatment outcomes.

Efficacy and tolerability of budesonide/formoterol added to tiotropium compared with tiotropium alone in patients with severe or very severe COPD: A randomized, multicentre study in East Asia.

BACKGROUND AND OBJECTIVE: Triple combination therapy with tiotropium plus budesonide/formoterol has improved lung function and reduced exacerbation risk in patients with chronic obstructive pulmonary disease (COPD) in Western countries, but no such data exist for East Asian patients. This study aimed to evaluate the efficacy and tolerability of adding budesonide/formoterol to tiotropium compared with tiotropium alone in East Asian patients with severe/very severe COPD. METHODS: This 12-week, randomized, parallel-group, multicentre, open-label study was conducted in East Asia. After a 14-day run-in period during which patients received tiotropium 18 µg once daily, patients were randomized to tiotropium (18 µg once daily) + budesonide/formoterol (160/4.5 µg 2 inhalations twice daily) or tiotropium alone (18 µg once daily). The primary endpoint was change from baseline in pre-dose forced expiratory volume in 1 s (FEV1 ) to the mean of values measured at Weeks 1, 6 and 12. RESULTS: Pre-dose FEV1 significantly increased from baseline with tiotropium plus budesonide/formoterol (n = 287) versus tiotropium alone (n = 291) (5.0% vs 0.6%; treatment difference: 4.4% (95% CI: 1.9-6.9), P = 0.0004). Triple therapy also reduced the COPD exacerbation rate by 40.7% (P = 0.0032) and prolonged time to first exacerbation (38.6% risk reduction, P = 0.0167) versus tiotropium alone and markedly improved health-related quality of life (HRQoL), measured using the St George's Respiratory Questionnaire. Incidence of adverse events was 26% for both groups. CONCLUSIONS: In East Asian patients with severe/very severe COPD, adding budesonide/formoterol to tiotropium was associated with significant improvements in FEV1 and HRQoL and lower COPD exacerbation rates. Treatment was generally well tolerated. CLINICAL TRIAL REGISTRATION: NCT01397890 at Clinicaltrials.gov.

The Effect of Screen Size on Mobile Phone User Comprehension of Health Information and Application Structure: An Experimental Approach.

This research analyzes the impact of mobile phone screen size on user comprehension of health information and application structure. Applying experimental approach, we asked randomly selected users to read content and conduct tasks on a commonly used diabetes mobile application using three different mobile phone screen sizes. We timed and tracked a number of parameters, including correctness, effectiveness of completing tasks, content ease of reading, clarity of information organization, and comprehension. The impact of screen size on user comprehension/retention, clarity of information organization, and reading time were mixed. It is assumed on first glance that mobile screen size would affect all qualities of information reading and comprehension, including clarity of displayed information organization, reading time and user comprehension/retention of displayed information, but actually the screen size, in this experimental research, did not have significant impact on user comprehension/retention of the content or on understanding the application structure. However, it did have significant impact on clarity of information organization and reading time. Participants with larger screen size took shorter time reading the content with a significant difference in the ease of reading. While there was no significant difference in the comprehension of information or the application structures, there were a higher task completion rate and a lower number of errors with the bigger screen size. Screen size does not directly affect user comprehension of health information. However, it does affect clarity of information organization, reading time and user's ability to recall information.

The prevalence and patient characteristics of chronic obstructive pulmonary disease in non-smokers in Vietnam and Indonesia: An observational survey.

BACKGROUND AND OBJECTIVE: An estimated 25-40% of patients with chronic obstructive pulmonary disease (COPD) have never smoked. We investigated the prevalence and patient characteristics of COPD in non-smokers from Vietnam and Indonesia. METHODS: This population-based cross-sectional survey of participants from urban and rural Vietnam and Indonesia used a stratified multistage cluster sampling design, with sample and population weights applied to ensure representativeness. Participants were female or male (recruited in the ratio 2:1) non-smokers, 40 years or older and able to perform a spirometry test. Spirometry was performed at a single study visit. Other clinical information was collected via standardized questionnaires. RESULTS: The 1506 evaluable participants were approximately equally distributed between Vietnam and Indonesia, and rural and urban areas. Overall prevalence of COPD was found to be 6.9% (95% confidence interval (CI): 5.7-8.3), with almost three times higher prevalence in men than women (12.9% (95% CI: 9.1-18.0) vs 4.4% (95% CI: 3.0-6.5)). We found higher rates of COPD in Vietnam than Indonesia (8.1% (95% CI: 5.8-11.3) vs 6.3% (95% CI: 4.8-8.3)), with a particularly high prevalence in urban Vietnam (11.1% (95% CI: 8.1-15.1)). Very few participants (6%) diagnosed to have COPD during the study had been previously diagnosed with COPD. Respiratory symptoms and lower health-related quality of life were more common in participants with COPD. CONCLUSIONS: The prevalence of COPD in non-smoking individuals from rural and urban Vietnam and Indonesia was 6.9%, of which a significant proportion (94%) were previously undiagnosed.

Association of Tumor Necrosis Factor Alpha and Lymphotoxin Alpha Gene Polymorphisms with the Presence of Chronic Obstructive Pulmonary Disease.

AIM: to analyze the occurrence of chronic obstructive pulmonary disease (COPD) and its association with the polymorphisms of -308G/A, -238G/A of TNF gene and +252A/G LT gene polymorphism in smokers. METHODS: cross-sectional study, comparing the genetic group of people who have COPD and who do not have COPD with the same smoking history. The study was conducted from January 2011 to March 2012 at several health centers; such as Adam Malik Hospital, Pirngadi Hospital, Tembakau Deli Hospital, Siti Hajar Hospital in Medan and several health centers in the city of Medan. Examination of lung function was done using spirometry and the existence of genetic polymorhisms in the TNF and LT gene was performed using polymerase chain reaction-restriction fragment length polymorphisms (PCR-RFLP). RESULTS: of the total of 227 samples that met inclusion criteria and after equalizing the age and history of smoking, 186 subjects were enrolled, of which, 93 people as COPD group and 93 people as non-COPD group. Analysis of the association between the -308G/A polymorphism with the COPD revealed the odds ratio (OR) 0.436 (95% CI 0.224-0.850, p=0.014). Polymorphism at -238G/A of the TNF gene showed the OR 2.094 (95% CI 0.608 - 7.211, p=0.241). Polymorphism at +252A/G LT gene showed OR 1.256 (95% CI 0.694 - 2.272; p=0.450). The findings indicated that polymorphism at -308G showed a protective factor whereas the -238G/A of the TNF and +252A/G of the LT genes did not show any significant association with the COPD. CONCLUSION: polymorphism -308 TNF gene shown to be a protective factor for the occurrence of COPD. Polymorphism -238 TNF gene and +252 LT gene did not show any significant association with COPD.

Reference equation for prediction of a total distance during six-minute walk test using Indonesian anthropometrics.

AIM: to develop a reference equation for prediction of the total distance walk using Indonesian anthropometrics of sedentary healthy subjects. Subsequently, the prediction obtained was compared to those calculated by the Caucasian-based Enright prediction equation. METHODS: the cross-sectional study was conducted among 123 healthy Indonesian adults with sedentary life style (58 male and 65 female subjects in an age range between 18 and 50 years). Heart rate was recorded using Polar with expectation in the sub-maximal zone (120-170 beats per minute). The subjects performed two six-minute walk tests, the first one on a 15-meter track according to the protocol developed by the investigator. The second walk was carried out on Biodex®gait trainer as gold standard. RESULTS: an average total distance of 547±54.24 m was found, not significantly different from the gold standard of 544.72±54.11 m (p>0.05). Multiple regression analysis was performed to develop the new equation. CONCLUSION: the reference equation for prediction of the total distance using Indonesian anthropometrics is more applicable in Indonesia.

Real-life effectiveness of budesonide/formoterol maintenance and reliever therapy in asthma patients across Asia: SMARTASIA study.

BACKGROUND: The use of budesonide/formoterol in a single inhaler for both maintenance and reliever therapy is a recommended option for treatment of persistent asthma not responding well to inhaled corticosteroid (ICS) alone. METHODS: This was a multi-centre open-label study on patients whose asthma condition remained inadequately controlled by various asthma treatments other than budesonide/formoterol. After a 2-week run-in period, eligible patients underwent a 12-week treatment period with budesonide/formoterol (Symbicort SMART(®), 160/4.5 µg) twice daily plus as needed. Patient's asthma control and quality of life were assessed using the 5-item Asthma Control Questionnaire (ACQ-5) and the standardized Asthma Quality of Life Questionnaire (AQLQ-S), respectively. RESULTS: A total of 862 eligible asthma patients who have had asthma for a mean duration of 10.73 ± 12.03 years entered a 12-week treatment with budesonide/formoterol maintenance and reliever therapy. During treatment, ACQ-5 score improved significantly by 0.58 ± 0.93 (95% CI, 0.51 to 0.64, P < 0.0001) from the baseline level of 1.62 ± 1.00. AQLQ(S) score improved by 0.70 ± 0.89 (95% CI, 0.64 to 0.76, P < 0.0001) from baseline. Asthma symptom score was also reduced significantly (P < 0.0001); between run-in and treatment periods, night- and day-time symptom scores were reduced by 0.32 ± 0.54 (95% CI, 0.28 to 0.35) and 0.30 ± 0.52 (95% CI, 0.27 to 0.34), respectively. The percentage of nights with awakenings due to asthma symptoms was reduced by 11.09 ± 26.13% (95% CI, 9.34 to 12.85%), while the percentage of asthma-control and symptom-free days increased by 20.90 ± 34.40% (95% CI, 18.59 to 23.21%) and 23.89 ± 34.62% (95% CI, 21.56 to 26.21%), respectively (P < 0.0001). Together with the improvement in asthma control, the number of night- and day-time inhalations of as-needed reliever medication decreased by 0.30 ± 0.82 (95% CI, 0.24 to 0.35) inhalations and 0.30 ± 0.97 (95% CI, 0.23 to 0.36) inhalations, respectively (P < 0.0001). No unexpected adverse events were reported. CONCLUSION: During treatment of inadequately controlled asthmatic patients with budesonide/formoterol maintenance and reliever therapy, significant improvement in patients' asthma control and reductions in asthma symptoms and as-needed medication use was observed. Patients' quality of life was improved and the treatment was well tolerated. TRIAL REGISTRATION: ClinicalTrial.gov: (NCT00939341).

Developing a tool to measure tuberculosis-related stigma in workplaces in Indonesia: An internal validation study.

Workers with tuberculosis (TB) are often stigmatized, negatively impacting their socioeconomic position, mental health, and TB treatment outcomes. There is a dearth of validated tools to assess stigma in the worker population. This study aimed to develop and validate a novel, culturally adapted tool to measure TB-related stigma among workers in Indonesia. We translated, adapted, applied, and internally validated Van Rie's TB-Stigma Scale to the worker population in varying sizes businesses (formal and informal business sectors) in Indonesia. Psychometric evaluation using exploratory and confirmatory factor analyses (EFA and CFA) was performed to check the tool's internal consistency and reliability. The translation and cultural adaptation phases resulted in a final 11-item tool. From 172 participant responses, the EFA found two loading factors relating to responses on isolation and exclusion from the workplace. The CFA confirmed that the developed model had moderate fit with R2 values for each item ranging from 0.37 to 0.84. The tool was reliable (Cronbach's alpha 0.869). This validated, consistent and reliable adapted tool is ready to use in larger scale evaluations of TB-related stigma amongst workers in formal and informal business sectors of Indonesia to develop strategies to eliminate TB-related stigma from the workplace.

Severe acute respiratory syndrome coronavirus-2 antibody response after Moderna vaccine booster on healthcare providers.

INTRODUCTION: As an endeavor to control SARS-CoV-2 infection, the Moderna vaccine booster was given to healthcare workers to prevent reinfection and reduce the risk of complications from COVID-19. A heterologous booster vaccine is also thought to provide better protection against the current SARS-CoV-2 variants of concern. However, research that evaluates the effectiveness of the Moderna vaccine booster and the resulting SARS-CoV-2 antibody concentration is needed. OBJECTIVE: To evaluate the concentration of SARS-CoV-2 antibodies after the Moderna vaccine booster and the severity of SARS-CoV-2 infection before and after the Moderna vaccine booster. RESULTS: A total of 93 healthcare providers who received Moderna vaccine booster were included in the study. Examination of antibody concentration 3 months after the booster showed an average concentration of 10081.65 U/mL. There was an increase in antibody concentration before the booster and 3 months after, from a median of 1.7 U/mL to 9540 U/mL. Every subject showed a statistically significant increment of antibody concentration 3 months after the booster (p < 0.01). Thirty-seven (39.8%) subjects received two doses of the Sinovac vaccine and were confirmed to have COVID-19 with the Delta variant. After the booster, 26 (28%) subjects were infected with the Omicron Variant. Among the subjects who received two doses of the Sinovac vaccine and were confirmed with COVID-19, 36 (30.1%) had mild symptoms, and 1 (1.1%) was asymptomatic. CONCLUSIONS: Heterologous Moderna vaccine booster effectively increases antibody response against SARS-CoV-2 variants and shows mild symptoms of COVID-19 infection.

Relationship between asthma control status, the Asthma Control Test™ and urgent health-care utilization in Asia.

BACKGROUND AND OBJECTIVE: Accurate assessment of control is an integral part of asthma management. We investigated the relationship between control status derived from the Global Initiative for Asthma (GINA), the Asthma Control Test (ACT) and urgent health-care utilization. METHODS: Asthma Insights and Reality in Asia-Pacific Phase 2 (AIRIAP 2) was a cross-sectional, community-based survey of 4805 subjects with asthma from urban centres across Asia. A symptom control index was derived from the AIRIAP 2 questionnaire using the GINA control criteria for day- and night-time symptoms, need for rescue medication, activity limitation and exacerbations; lung function was excluded. The main outcomes were asthma control, based on these GINA criteria and the ACT, and the relationship between control and self-reported urgent health-care utilization (hospitalization, emergency room visits or other unscheduled urgent visits) related to asthma over the previous 12months. RESULTS: Each of the symptom criteria was significantly associated with urgent health-care utilization, with odds ratios (ORs) ranging from 2.25 (95% confidence interval (CI): 1.94-2.61) for daytime symptoms to 2.57 (95% CI: 2.29-2.90) for nocturnal awakening. Similarly, control status was significantly associated with urgent health-care utilization, with ORs of 0.19 (95% CI: 0.13-0.28), 0.70 (95% CI: 0.65-0.76) and 1.00 for controlled, partly controlled and uncontrolled, respectively. The optimal ACT cut-off score for identifying uncontrolled asthma was ≤19 for subjects aged ≥12years. Urgent health-care utilization was reported by 57.2% versus 28.7% of patients scoring ≤19 versus >19 (P<0.001). CONCLUSIONS: The GINA control classification and the ACT are valid symptom-based measures that are significantly associated with urgent health-care utilization.

Brief psychotic disorder in COVID-19 patient with no history of mental illness.

INTRODUCTION: COVID-19 pandemic affects mental health globally. Reports showed the increase of mental illness as a response to the COVID-19 pandemic. However, the correlation between the COVID-19 and mental illness is not fully understood yet. METHODOLOGY: We reported a brief psychotic disorder in a COVID-19 patient with no history of mental illness who was hospitalized in Persahabatan Hospital, Jakarta, Indonesia. RESULTS: Psychotic symptoms appeared five days after COVID-19 onset and laboratory tests showed elevated levels of d-dimer and fibrinogen. CONCLUSIONS: Elevated levels of d-dimer and fibrinogen suggest an ongoing COVID-19-associated coagulopathy that might cause a microdamage in the central nervous system. It might contribute to the manifestation of psychotic symptoms. The correlation between brief psychotic disorder and COVID-19 requires further investigation.

Rate of Forced Expiratory Volume in One Second and Forced Expiratory Volume in One Second/Forced Vital Capacity Decline among Indonesian Patients with Chronic Obstructive Pulmonary Disease after a Year of Treatment.

BACKGROUND: The rate of decline in lung function in chronic obstructive pulmonary disease (COPD) patients showed more profound decline than normal individuals. However, a 1-year lung function among Indonesian patients with COPD has not been elucidated. AIM: This study attempted to determine the rate of lung function decline in terms of obstruction variable among COPD patients after a 1-year of treatment. MATERIALS AND METHODS: This retrospective cohort study measures the rate of decline in forced expiratory volume in 1 s (FEV1) and ratio of FEV1 to forced vital capacity (FEV1/FVC) in COPD patients at COPD Outpatient Clinic Persahabatan Hospital after 1-year of treatment. RESULTS: There were 31 COPD patients with the prevalence of 1-year declined FEV1 and FEV1/FVC which were 83.9% and 51.6%, respectively. Among 1-year declined lung function group, there were significant (P < 0.05) decline in FEV1 (121.53 ± 120 ml/year) and in FEV1/FVC (2.75 ± 0.47%). The rate of decline in FEV1 was more prevalent in Group D, while the rate of decline in FEV1/FVC was more prevalent in Group B. No significant associations were found between sex, age, respiratory complaints, smoking history, Brinkman index, type of cigarette, comorbid, educational level, diagnosed age, body mass index, symptoms-based COPD classification, and risk-based COPD classification, with the rate of decline in FEV1 and FEV1/FVC. CONCLUSIONS: Most patients had statistically significant rate of decline in FEV1 and FEV1/FVC within 1-year of COPD treatment. This study recognized an unfavorable prognosis in terms of irreversible deteriorating lung function of COPD patients despite therapeutic management.

The correlation of age and body mass index with the level of both protease MMP3 and anti-protease TIMP-1 among Indonesian patients with chronic obstructive pulmonary disease: a preliminary findings.

OBJECTIVES: Individuals with chronic obstructive pulmonary disease (COPD) are usually > 50 years of age and have a low body mass index (BMI). An imbalance between matrix metalloproteinases (MMPs), including MMP-3, and tissue inhibitor of metalloproteinase 1 (TIMP-1), play a role in tissue degradation of lung extracellular matrix among COPD individuals. The purpose of the present study was to correlate age and/or BMI with salivary levels of MMP-3 and TIMP-1 among Indonesian subjects with COPD. RESULTS: Thirty COPD patients were recruited to undergo thorough physical assessment and saliva collection for evaluating TIMP-1 and MMP-3 levels using commercially available kits enzyme-linked immunosorbent assay method. The mean (standard deviation) participant age and BMI were 60.5 (8.13) years, and 23.1 (4.75) kg/m2, respectively. Furthermore, the mean (standard deviation) of TIMP-1 and MMP3 levels were 23.99 (6.85) ng/mL and 1.81 (1.167) µM, respectively. Age was negatively correlated with MMP-3 (P < 0.05), but not with TIMP-1 levels. Age and BMI were not correlated with TIMP-1 level (P > 0.05). Collectively, this study demonstrated that age has a negative correlation with the protease marker (i.e. MMP-3), but not the anti-protease marker (TIMP-1). BMI was not correlated with either protease/anti-protease marker among Indonesian subjects with COPD.

Molecular Diagnosis of Tuberculosis.

Tuberculosis (TB) is one of the leading causes of adult death in the Asia-Pacific Region, including Indonesia. As an infectious disease caused by Mycobacterium tuberculosis (MTB), TB remains a major public health issue especially in developing nations due to the lack of adequate diagnostic testing facilities. Diagnosis of TB has entered an era of molecular detection that provides faster and more cost-effective methods to diagnose and confirm drug resistance in TB cases, meanwhile, diagnosis by conventional culture systems requires several weeks. New advances in the molecular detection of TB, including the faster and simpler nucleic acid amplification test (NAAT) and whole-genome sequencing (WGS), have resulted in a shorter time for diagnosis and, therefore, faster TB treatments. In this review, we explored the current findings on molecular diagnosis of TB and drug-resistant TB to see how this advancement could be integrated into public health systems in order to control TB.

Pulmonary Diffusion Capacity for Carbon Monoxide (DLCO) in Indonesian Patients with End-stage Renal Disease.

OBJECTIVES: End-stage renal disease affects all systems in human including the respiratory system. This study aimed to discover the lung diffusion capacity of carbon monoxide (DLCO) in chronic hemodialysis patients and to establish its relation to several demographic and clinical factors as well as spirometry parameters. MATERIAL AND METHODS: This was a cross-sectional study among chronic hemodialysis patients aged .18 years, clinically stable in the last four weeks, without prior history of lung and cardiac disorder. Spirometry and DLCO examination were performed in the span of 24 hours after hemodialysis. OUTCOMES: There were 40 subjects analyzed. Majority of them were males (67.5%), non-smokers (55%), with a median age of 51 years, a mean body mass index of 22.6±3.9 kg/m2, a hemoglobin level of 9.5±1.3 g/dL, a median dialysis adequacy of 1.62 and a hemodialysis duration of 31.5 months. Hypertension was the most common underlying disease. About 20% of subjects had varying degrees of dyspnea. Prevalence of DLCO reduction was 52.5% with mild to moderate degree. Restrictive spirometry pattern was evident in 47.5% of subjects and obstructive pattern in 5%. There was a significant relation between DLCO reduction with smoking history (OR 4.52 [95% CI 1.04-19.6]) and also with restrictive disorder [OR 5.5 (95% CI 1.29-23.8)]. We suspected a lung parenchymal disorder as the cause of lung restriction and diffusion inhibition. CONCLUSIONS: Reduction of lung diffusion capacity in chronic dialysis patients is common, although not accompanied by dyspnea. Risk factors for DLCO reduction are smoking history and restrictive disorder in spirometry.

Spirometry findings among drug users in the Indonesian National Narcotics and illicit drug Bureau Rehabilitation Center.

BACKGROUND: The increasing prevalence of drug user in Indonesia is affecting the health sectors. The lungs health were affected by the use of the illicit drug. However, lung function among drug users is still unclear. METHODS: This descriptive-analytic study involves 144 drug users who met the inclusion criteria. Chest X-ray was performed to identify the subject with pulmonary tuberculosis to exclude from the study. Subjects were then undergone spirometry test and interviewed using questionnaires. RESULTS: One hundred and forty-four subjects were included in this study. One hundred and twenty-one (84.03%) were male and 128 subjects showed normal lung function. Proportion of abnormal spirometry was 10.4% (n = 15). The restriction was found in ten subjects, and obstruction was found in four subjects. There was significant correlation between the ratio of forced expiratory volume in 1 s to forced vital capacity (FEV1/FVC) and age (P = 0.000; r = -0.454, moderate correlation), time of using cannabis (P = 0.01; r = -0.345, weak correlation), time of using methamphetamine inhalation (P = 0.004; r = -0.25, weak correlation), duration of using heroin injection (P = 0.025; r = -0.337, weak correlation), time of using cigarette (P = 0.000; r = -0.365, weak correlation), and the amount of cigarette consumption/day (P = 0.04; r = -0.238, weak correlation). CONCLUSION: This study found that there was a weak correlation between declined FEV1/FVC with a time of smoking, the amount of cigarette consume per day, time of cannabis inhalation, time of methamphetamine inhalation, and time of heroin injection.