FAKTOR-FAKTOR YANG BERHUBUNGAN DENGAN EKSASERBASI PADA PASIEN PENYAKIT PARU OBSTRUKSI KRONIK (PPOK) DI RSUD DR. H. ABDUL MOELOEK
Keywords:
Eksaserbasi PPOK, Faktor risiko, RSUD Dr. H. Abdul Moeloek, Status Merokok
Abstract
Penyakit Paru Obstruktif Kronik (PPOK) adalah penyakit paru kronik dengan gejala seperti sesak napas, batuk, dan produksi sputum yang bisa mengalami perburukan atau eksaserbasi. Identifikasi faktor risiko eksaserbasi PPOK penting untuk strategi pencegahan. Penelitian ini bertujuan menentukan prevalensi, karakteristik, dan faktor-faktor yang berkaitan dengan eksaserbasi. Penelitian ini merupakan penelitian non-eksperimental dengan desain penelitian cross-sectional. Pengambilan sampel menggunakan teknik total sampling pada 90 pasien PPOK yang menjalani rawat inap di RSUD Dr. H. Abdul Moeloek yang memenuhi kriteria inklusi dan eksklusi. Data sekunder berupa rekam medik dianalisis secara statistik menggunakan uji Chi-square dan regresi logistik. Hasil penelitian menunjukkan prevalensi eksaserbasi PPOK sebesar 57,6%. Karakteristik pasien PPOK yaitu berjenis kelamin laki-laki (78,8%), usia >60 tahun (56,1%), perokok (62,1%), memiliki komorbid (95,5%), tidak mengalami eksaserbasi dalam satu tahun terakhir (62,1%), dan tidak ada riwayat penggunaan kortikosteroid sistemik (53%). Variabel status merokok (p=0,002) dan riwayat eksaserbasi sebelumnya (p=0,035) menjadi dua dari lima variabel yang menunjukkan hubungan signifikan dalam analisis bivariat. Analisis multivariat menunjukkan status merokok sebagai faktor paling berhubungan dengan eksaserbasi PPOK (p=0,003; OR=12,137; 95% CI=2,31263,714). Berdasarkan hasil penelitian, faktor risiko eksaserbasi PPOK mencakup status merokok dan riwayat eksaserbasi dalam satu tahun terakhir, dengan status merokok merupakan faktor yang paling berhubungan terhadap kejadian eksaserbasi PPOK.
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References
[1] GOLD, “Global Initiative for Chronic Obstructive Lung Disease Global Strategy for The Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (2018 Report),” 2018. [Online]. Available: Www.Goldcopd.Org
[2] W. H. O. WHO, “Chronic Obstructive Pulmonary Disease (COPD).” Accessed: May 16, 2024. [Online]. Available: https://www.who.int/newsroom/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)
[3] A. Agustí et al., “Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary,” European Respiratory Journal, vol. 61, no. 4, Apr. 2023, doi: 10.1183/13993003.00239-2023.
[4] Kemenkes RI, “Laporan Riskesdas 2018 Nasional,” Jakarta, 2018.
[5] Balitbangkes RI, “Laporan Riskesdas 2013,” Jakarta, 2013.
[6] Perhimpunan Dokter Paru Indonesia (PDPI), PPOK : Pedoman Diagnosis dan Tatalaksanaan di Indonesia. Jakarta: Perhimpunan Dokter Paru Indonesia, 2023.
[7] H. Whittaker et al., “Frequency and Severity of Exacerbations of COPD Associated with Future Risk of Exacerbations and Mortality: A UK Routine Health Care Data Study,” International Journal of COPD, vol. 17, pp. 427– 437, 2022, doi: 10.2147/COPD.S346591.
[8] F. Z. Yuan, W. Shui, Y. L. Xing, Y. Y. Niu, X. Zhang, and C. R. Zhang, “Association of Red Cell Index and Adverse Hospitalization Outcomes in Chronic Obstructive Pulmonary Disease Patients with Acute Exacerbation: A Retrospective Cohort Study,” International Journal of COPD, vol. 17, pp. 2263–2275, 2022, doi: 10.2147/COPD.S373114.
[9] G. C. Donaldson and J. A. Wedzicha, “COPD Exacerbations · 1: Epidemiology,” Feb. 2006. doi: 10.1136/thx.2005.041806.
[10] P. Kuwalairat, S. Ratanaopas, and R. Sornkate, “Prevalence of Chronic Obstructive Pulmonary Diseases Related-Hospitalization with Acute Exacerbation and Its Associated Factors in Thailand,” in General Practice and Primary Care, European Respiratory Society, Sep. 2017, p. PA930. doi: 10.1183/1393003.congress-2017.PA930
[11] S. Benady, “The Human and Economic Burden Of COPD : A Leading Cause of Hospital Admission in Canada,” Canada, 2010.
[12] W. H. O. WHO, “WHO REPORT ON THE GLOBAL TOBACCO EPIDEMIC, 2011 Warning About The Dangers Of Tobacco Executive Summary,” 2011. [Online]. Available: http://www.who.int/about/licensing/
[13] KEMENKES RI, Global Youth Tobacco Survey (GYTS) Indonesia Report, 2014 Ministry of Health Republic of Indonesia. 2015.
[14] J. R. Hurst et al., “Prognostic risk factors for moderate-to-severe exacerbations in patients with chronic obstructive pulmonary disease: a systematic literature review,” Dec. 01, 2022, BioMed Central Ltd. doi: 10.1186/s12931-022-02123-5.
[15] S. P. Hogea, E. Tudorache, A. P. Fildan, O. Fira-Mladinescu, M. Marc, and C. Oancea, “Risk factors of chronic obstructive pulmonary disease exacerbations,” Mar. 01, 2020, Blackwell Publishing Ltd. doi: 10.1111/crj.13129
[16] P. Sivapalan et al., “Effect of different corticosteroid regimes for hospitalised patients with exacerbated COPD: pooled analysis of individual participant data from the REDUCE and CORTICO-COP trials,” Respir Res, vol. 22, no. 1, Dec. 2021, doi: 10.1186/s12931-021-01745-5.
[17] C.-A. Brandsma, M. de Vries, R. Costa, R. R. Woldhuis, M. Königshoff, and W. Timens, “Lung ageing and COPD: is there a role for ageing in abnormal tissue repair?,” European Respiratory Review, vol. 26, no. 146, p. 170073, Dec. 2017, doi: 10.1183/16000617.0073-2017.
[18] S. Kukrety, J. Parekh, and K. Bailey, “Chronic obstructive pulmonary disease and the hallmarks of aging,” Lung India, vol. 35, no. 4, p. 321, 2018, doi: 10.4103/lungindia.lungindia_266_17.
[19] H. Hasan and R. Arusita, “Perubahan Fungsi Paru Pada Usia Tua,” Jurnal Respirasi, vol. 3, no. 2, 2017.
[20] R. Adi Saputra, S. Ayubbana, and A. Keperawatan Dharma Wacana Metro, “Penerapan Pursed Lips Breathing Terhadap Respiratory Rate Dan Skala Sesak Pasien Penyakit Paru Obstruksi Kronik Di Ruang Paru Rsud Jendral Ahmad Yani Kota Metro,” Jurnal Cendikia Muda, vol. 4, no. 4, 2024.
[21] G. Gerungan, F. B. Runtu, and N. Bawiling, “Karakteristik Penderita Penyakit Paru Obstruktif Kronis Yang Di Rawat Inap Di Rumah Sakit Budi Setia Langowan,” Jurnal Kesehatan Masyarakat UNIMA, vol. 01, no. 01, 2020.
[22] Najihah, E. M. Theovena, M. I. Ose, and D. T. Wahyudi, “Prevalensi Penyakit Paru Obstruksi Kronik (PPOK) Berdasarkan Karakteristik Demografi Dan Derajat Keparahan,” Journal of Borneo Holistic Health, vol. 6, no. 1, pp. 109–115, 2023.
[23] L. Tina and N. Kholifah, “Analisis Faktor Resiko Kejadian Penyakit Paru Obstruktif Kronik (PPOK) pada Pasien RSUD Bahteramas Provinsi Sulawesi Tenggara Tahun 2017,” Jurnal Ilmiah Praktisi Kesehatan Masyarakat Sulawesi Tenggara, vol. 3, no. 1, pp. 1–8, 2018.
[24] W. H. O. WHO, “GATS|Global Adult Tobacco Survey Fact Sheet Indonesia 2021,” 2021.
[25] W. H. O. WHO, “WHO REPORT ON THE GLOBAL TOBACCO EPIDEMIC, 2011 Warning About The Dangers Of Tobacco Executive Summary,” 2011. [Online]. Available: http://www.who.int/about/licensing/
[26] Firdausi, “Hubungan Derajat Obstruksi Paru dengan Kualitas Hidup Penderita PPOK di RSUD. Dr. Soedarso Pontianak,” Universitas Tanjungpura, Pontianak, 2014.
[27] Q. Siti Hurul Aini, “Gambaran Jumlah Neutrofil Darah Tepi Pasien Penyakit Paru Obstruktif Kronik (PPOK) di Ruang Rawat Inap RSUD Arifin Achmad Provinsi Riau Tahun 2017,” Jurnal Ilmu Kedokteran, vol. 13, no. 2, pp. 134– 140, 2019.
[28] S. N. Kasanah and R. I. Sudra, “Analisis Keakuratan Kode Diagnosis PPOK Eksaserbasi Akut Berdasarkan ICD 10 pada Dokumen Rekam Medis Pasien Rawat Inap di RSUD Sragen Triwulan II Tahun 2011,” Jurnal Kesehatan, vol. V, no. 1, pp. 72–78, 2011.
[29] M. Tuti, R. Sri, and M. Munir, “Gambaran Kualitas Hidup Pasien Ppok Stabil Di Poli Paru RSUD Arifin Achmad Provinsi Riau Dengan Menggunakan Kuesioner SGRQ,” 2015.
[30] N. R. MacIntyre, “Toward Reducing COPD Hospitalization,” Respir Care, vol. 65, no. 1, pp. 127–128, Jan. 2020, doi: 10.4187/respcare.07491.
[31] C. F. Vogelmeier, J. Diesing, N. Kossack, M. Pignot, and F. W. Friedrich, “COPD Exacerbation History and Impact on Future Exacerbations – 8-Year Retrospective Observational Database Cohort Study from Germany,” Int J Chron Obstruct Pulmon Dis, vol. Volume 16, pp. 2407–2417, Aug. 2021, doi: 10.2147/COPD.S322036.
[32] D. P. Blagev et al., “Stability of Frequency of Severe Chronic Obstructive Pulmonary Disease Exacerbations and Health Care Utilization in Clinical Populations,” Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation, vol. 5, no. 3, pp. 208–220, 2018, doi: 10.15326/jcopdf.5.3.2017.0183.
[33] A. Asyrofy, T. Arisdiani, and M. Aspihan, “Karakteristik dan kualitas hidup pasien Penyakit Paru Obstruksi Konik (PPOK),” NURSCOPE: Jurnal Penelitian dan Pemikiran Ilmiah Keperawatan, vol. 7, no. 1, p. 13, Aug. 2021, doi: 10.30659/nurscope.7.1.13-21
[35] N. Putcha, M. B. Drummond, R. A. Wise, and N. N. Hansel, “Comorbidities and Chronic Obstructive Pulmonary Disease: Prevalence, Influence on Outcomes, and Management,” Semin Respir Crit Care Med, vol. 36, no. 4, pp. 575–591, Aug. 2015, doi: 10.1055/s-0035-1556063.
[36] H. Chen et al., “Association between chronic obstructive pulmonary disease and cardiovascular disease in adults aged 40 years and above: data from NHANES 2013–2018,” BMC Pulm Med, vol. 23, no. 1, Dec. 2023, doi: 10.1186/s12890-023-02606-1.
[37] M. N. Amin et al., “Inflammatory cytokines in the pathogenesis of cardiovascular disease and cancer,” SAGE Open Med, vol. 8, p. 205031212096575, Jan. 2020, doi: 10.1177/2050312120965752.
[111] A. M. B. Menezes et al., “Tuberculosis and airflow obstruction: evidence from the PLATINO study in Latin America,” European Respiratory Journal, vol. 30, no. 6, pp. 1180–1185, Aug. 2007, doi: 10.1183/09031936.00083507.
[38] R. Amran, W. Abdulkadir, J. Farmasi, F. Olahraga dan Kesehatan, and R. Amwan Jurusan Farmasi Fakultas Olahraga dan Kesehatan, “Tingkat Kepatuhan Penggunaan Obat Anti Tuberkulosis Pada Pasien Di Puskesmas Tombulilato Kabupaten Bone Bolango,” Indonesian Journal of Pharmaceutical Education (e-Journal), vol. 1, no. 1, pp. 2775–3670, 2021, doi: 10.22487/.ijpe.vlil.101223.
[39] A. A. Pritami, R. Ariza, S. Soemarwoto, and R. Wintoko, “Faktor Risiko Kanker Paru: Tinjauan Pustaka,” Agromedicine, vol. 9, no. 2, 2022.
[40] F. Laghi, N. Adiguzel, and M. J. Tobin, “Endocrinological derangements in COPD,” European Respiratory Journal, vol. 34, no. 4, pp. 975–996, Oct. 2009, doi: 10.1183/09031936.00103708.
[41] E. Rastoder et al., “Systemic Corticosteroids and the Risk of Venous Thromboembolism in Patients with Severe COPD: A Nationwide Study of 30,473 Outpatients,” Biomedicines, vol. 9, 2021, doi: 10.3390/biomedicines.
[42] Y. S. Indreswari, C. M. Rumende, C. W. Pitoyo, D. Respirologi, D. Perawatan, and P. Kritis, “Faktor-Faktor yang Berhubungan dengan Eksaserbasi pada Pasien Penyakit Paru Obstruktif Kronik di Rumah Sakit Cipto Mangunkusumo, Jakarta,” Indonesian Journal of Chest Critical and Emergency Medicine, vol. 1, no. 4, 2014.
[43] I. U. A. Sihombing, “FAKTOR-FAKTOR YANG BERHUBUNGAN DENGAN KEJADIAN EKSASERBASI PADA PENDERITA PENYAKIT PARU OBSTRUKTIF KRONIK (PPOK) DI BALAI BESAR KESEHATAN PARU MASYARAKAT BANDUNG TAHUN 2015–2020,” UPN Veteran Jakarta, Jakarta, 2021.
[44] A. Maunaturrohmah et al., “Hubungan Lama Menderita Dengan Kenyamanan Fisik Pada Pasien PPOK Di Ruang Paviliun Cempaka RSUD Jombang,” 2018.
[45] A. R. van Buul, M. J. Kasteleyn, N. H. Chavannes, and C. Taube, “Association between morning symptoms and physical activity in COPD: a systematic review,” European Respiratory Review, vol. 26, no. 143, p. 160033, Mar. 2017, doi: 10.1183/16000617.0033-2016.
[46] W. Nugraha, “Pengaruh Riwayat Durasi Merokok Terhadap Frekuensi Eksaserbasi Penyakit Paru Obstruktif Kronis (PPOK) Pada Pasien Rumah Sakit Gotong Royong,” Universitas Katolik Widya Mandala Surabaya, Surabaya, 2022.
[47] B. S. Handiansyah, “Korelasi merokok dengan kekerapan eksaserbasi PPOK,” Universitas Trisakti, Jakarta, 2019.
[48] T. A. L. S. Sari, “Hubungan Derajat Merokok Terhadap Sesak Nafas Pada Pasien Penyakit Paru Obstruktif Kronik (PPOK): Narrative Review,” Universitas ’Aisyiyah, Yogyakarta, 2021.
[49] R. J. Sitorus, I. G. Purba, M. Natalia, and K. Tantrakarnapa, “The Effect of Smoking and Respiration of Carbon Monoxide among Active Smokers in Palembang, Indonesia,” Kesmas, vol. 16, no. 2, pp. 108–112, May 2021, doi: 10.21109/KESMAS.V16I2.3297.
[50] W. Lu and J. Zheng, “The function of mucins in the COPD airway,” Curr Respir Care Rep, vol. 2, no. 3, pp. 155–166, Sep. 2013, doi: 10.1007/s13665013-0051-3.
[51] T. Hardiyanti, N. M. Yasin, and T. M. Andayani, “Pengaruh Readmisi Terhadap Biaya pada Pasien PPOK Eksaserbasi Akut dan Faktor-Faktor yang Mempengaruhinya,” Majalah Farmaseutik, vol. 17, no. 3, Sep. 2021, doi: 10.22146/farmaseutik.v17i3.65382.
[52] D. F. Mariniello et al., “Comorbidities in COPD: Current and Future Treatment Challenges,” J Clin Med, vol. 13, no. 3, p. 743, Jan. 2024, doi: 10.3390/jcm13030743.
[53] Ç. Koç and F. Şahin, “What Are the Most Effective Factors in Determining Future Exacerbations, Morbidity Weight, and Mortality in Patients with COPD Attack?,” Medicina (B Aires), vol. 58, no. 2, p. 163, Jan. 2022, doi: 10.3390/medicina58020163
[54] N. Cuesta-Gomez, G. J. Graham, and J. D. M. Campbell, “Chemokines and their receptors: predictors of the therapeutic potential of mesenchymal stromal cells,” Dec. 01, 2021, BioMed Central Ltd. doi: 10.1186/s12967021-02822-5.
[55] J. A. Walters, D. J. Tan, C. J. White, P. G. Gibson, R. Wood-Baker, and E. H. Walters, “Systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease,” Cochrane Database of Systematic Reviews, vol. 9, no. 1, 2014, doi: 10.1002/14651858.CD001288.pub4.
[56] G. Wang et al., “Acute exacerbations of chronic obstructive pulmonary disease in a cohort of Chinese never smokers goes along with decreased risks of recurrent acute exacerbation, emphysema and comorbidity of lung cancer as well as decreased levels of circulating eosinophils and basophils,” Front Med (Lausanne), vol. 9, Aug. 2022, doi: 10.3389/fmed.2022.907893
[57] D. E. O’Donnell, “COPD exacerbations : Pathophysiology,” Thorax, vol. 61, no. 4, pp. 354–361, Apr. 2006, doi: 10.1136/thx.2005.041830.
[58] A. A. Diaz et al., “Airway-Occluding Mucus Plugs and Mortality in Patients With Chronic Obstructive Pulmonary Disease,” JAMA, vol. 329, no. 21, p. 1832, Jun. 2023, doi: 10.1001/jama.2023.2065.
[59] N. Vij, P. Chandramani-Shivalingappa, C. Van Westphal, R. Hole, and M. Bodas, “Cigarette smoke-induced autophagy impairment accelerates lung aging, COPD-emphysema exacerbations and pathogenesis,” American Journal of Physiology-Cell Physiology, vol. 314, no. 1, pp. C73–C87, Jan. 2018, doi: 10.1152/ajpcell.00110.2016.
[2] W. H. O. WHO, “Chronic Obstructive Pulmonary Disease (COPD).” Accessed: May 16, 2024. [Online]. Available: https://www.who.int/newsroom/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)
[3] A. Agustí et al., “Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary,” European Respiratory Journal, vol. 61, no. 4, Apr. 2023, doi: 10.1183/13993003.00239-2023.
[4] Kemenkes RI, “Laporan Riskesdas 2018 Nasional,” Jakarta, 2018.
[5] Balitbangkes RI, “Laporan Riskesdas 2013,” Jakarta, 2013.
[6] Perhimpunan Dokter Paru Indonesia (PDPI), PPOK : Pedoman Diagnosis dan Tatalaksanaan di Indonesia. Jakarta: Perhimpunan Dokter Paru Indonesia, 2023.
[7] H. Whittaker et al., “Frequency and Severity of Exacerbations of COPD Associated with Future Risk of Exacerbations and Mortality: A UK Routine Health Care Data Study,” International Journal of COPD, vol. 17, pp. 427– 437, 2022, doi: 10.2147/COPD.S346591.
[8] F. Z. Yuan, W. Shui, Y. L. Xing, Y. Y. Niu, X. Zhang, and C. R. Zhang, “Association of Red Cell Index and Adverse Hospitalization Outcomes in Chronic Obstructive Pulmonary Disease Patients with Acute Exacerbation: A Retrospective Cohort Study,” International Journal of COPD, vol. 17, pp. 2263–2275, 2022, doi: 10.2147/COPD.S373114.
[9] G. C. Donaldson and J. A. Wedzicha, “COPD Exacerbations · 1: Epidemiology,” Feb. 2006. doi: 10.1136/thx.2005.041806.
[10] P. Kuwalairat, S. Ratanaopas, and R. Sornkate, “Prevalence of Chronic Obstructive Pulmonary Diseases Related-Hospitalization with Acute Exacerbation and Its Associated Factors in Thailand,” in General Practice and Primary Care, European Respiratory Society, Sep. 2017, p. PA930. doi: 10.1183/1393003.congress-2017.PA930
[11] S. Benady, “The Human and Economic Burden Of COPD : A Leading Cause of Hospital Admission in Canada,” Canada, 2010.
[12] W. H. O. WHO, “WHO REPORT ON THE GLOBAL TOBACCO EPIDEMIC, 2011 Warning About The Dangers Of Tobacco Executive Summary,” 2011. [Online]. Available: http://www.who.int/about/licensing/
[13] KEMENKES RI, Global Youth Tobacco Survey (GYTS) Indonesia Report, 2014 Ministry of Health Republic of Indonesia. 2015.
[14] J. R. Hurst et al., “Prognostic risk factors for moderate-to-severe exacerbations in patients with chronic obstructive pulmonary disease: a systematic literature review,” Dec. 01, 2022, BioMed Central Ltd. doi: 10.1186/s12931-022-02123-5.
[15] S. P. Hogea, E. Tudorache, A. P. Fildan, O. Fira-Mladinescu, M. Marc, and C. Oancea, “Risk factors of chronic obstructive pulmonary disease exacerbations,” Mar. 01, 2020, Blackwell Publishing Ltd. doi: 10.1111/crj.13129
[16] P. Sivapalan et al., “Effect of different corticosteroid regimes for hospitalised patients with exacerbated COPD: pooled analysis of individual participant data from the REDUCE and CORTICO-COP trials,” Respir Res, vol. 22, no. 1, Dec. 2021, doi: 10.1186/s12931-021-01745-5.
[17] C.-A. Brandsma, M. de Vries, R. Costa, R. R. Woldhuis, M. Königshoff, and W. Timens, “Lung ageing and COPD: is there a role for ageing in abnormal tissue repair?,” European Respiratory Review, vol. 26, no. 146, p. 170073, Dec. 2017, doi: 10.1183/16000617.0073-2017.
[18] S. Kukrety, J. Parekh, and K. Bailey, “Chronic obstructive pulmonary disease and the hallmarks of aging,” Lung India, vol. 35, no. 4, p. 321, 2018, doi: 10.4103/lungindia.lungindia_266_17.
[19] H. Hasan and R. Arusita, “Perubahan Fungsi Paru Pada Usia Tua,” Jurnal Respirasi, vol. 3, no. 2, 2017.
[20] R. Adi Saputra, S. Ayubbana, and A. Keperawatan Dharma Wacana Metro, “Penerapan Pursed Lips Breathing Terhadap Respiratory Rate Dan Skala Sesak Pasien Penyakit Paru Obstruksi Kronik Di Ruang Paru Rsud Jendral Ahmad Yani Kota Metro,” Jurnal Cendikia Muda, vol. 4, no. 4, 2024.
[21] G. Gerungan, F. B. Runtu, and N. Bawiling, “Karakteristik Penderita Penyakit Paru Obstruktif Kronis Yang Di Rawat Inap Di Rumah Sakit Budi Setia Langowan,” Jurnal Kesehatan Masyarakat UNIMA, vol. 01, no. 01, 2020.
[22] Najihah, E. M. Theovena, M. I. Ose, and D. T. Wahyudi, “Prevalensi Penyakit Paru Obstruksi Kronik (PPOK) Berdasarkan Karakteristik Demografi Dan Derajat Keparahan,” Journal of Borneo Holistic Health, vol. 6, no. 1, pp. 109–115, 2023.
[23] L. Tina and N. Kholifah, “Analisis Faktor Resiko Kejadian Penyakit Paru Obstruktif Kronik (PPOK) pada Pasien RSUD Bahteramas Provinsi Sulawesi Tenggara Tahun 2017,” Jurnal Ilmiah Praktisi Kesehatan Masyarakat Sulawesi Tenggara, vol. 3, no. 1, pp. 1–8, 2018.
[24] W. H. O. WHO, “GATS|Global Adult Tobacco Survey Fact Sheet Indonesia 2021,” 2021.
[25] W. H. O. WHO, “WHO REPORT ON THE GLOBAL TOBACCO EPIDEMIC, 2011 Warning About The Dangers Of Tobacco Executive Summary,” 2011. [Online]. Available: http://www.who.int/about/licensing/
[26] Firdausi, “Hubungan Derajat Obstruksi Paru dengan Kualitas Hidup Penderita PPOK di RSUD. Dr. Soedarso Pontianak,” Universitas Tanjungpura, Pontianak, 2014.
[27] Q. Siti Hurul Aini, “Gambaran Jumlah Neutrofil Darah Tepi Pasien Penyakit Paru Obstruktif Kronik (PPOK) di Ruang Rawat Inap RSUD Arifin Achmad Provinsi Riau Tahun 2017,” Jurnal Ilmu Kedokteran, vol. 13, no. 2, pp. 134– 140, 2019.
[28] S. N. Kasanah and R. I. Sudra, “Analisis Keakuratan Kode Diagnosis PPOK Eksaserbasi Akut Berdasarkan ICD 10 pada Dokumen Rekam Medis Pasien Rawat Inap di RSUD Sragen Triwulan II Tahun 2011,” Jurnal Kesehatan, vol. V, no. 1, pp. 72–78, 2011.
[29] M. Tuti, R. Sri, and M. Munir, “Gambaran Kualitas Hidup Pasien Ppok Stabil Di Poli Paru RSUD Arifin Achmad Provinsi Riau Dengan Menggunakan Kuesioner SGRQ,” 2015.
[30] N. R. MacIntyre, “Toward Reducing COPD Hospitalization,” Respir Care, vol. 65, no. 1, pp. 127–128, Jan. 2020, doi: 10.4187/respcare.07491.
[31] C. F. Vogelmeier, J. Diesing, N. Kossack, M. Pignot, and F. W. Friedrich, “COPD Exacerbation History and Impact on Future Exacerbations – 8-Year Retrospective Observational Database Cohort Study from Germany,” Int J Chron Obstruct Pulmon Dis, vol. Volume 16, pp. 2407–2417, Aug. 2021, doi: 10.2147/COPD.S322036.
[32] D. P. Blagev et al., “Stability of Frequency of Severe Chronic Obstructive Pulmonary Disease Exacerbations and Health Care Utilization in Clinical Populations,” Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation, vol. 5, no. 3, pp. 208–220, 2018, doi: 10.15326/jcopdf.5.3.2017.0183.
[33] A. Asyrofy, T. Arisdiani, and M. Aspihan, “Karakteristik dan kualitas hidup pasien Penyakit Paru Obstruksi Konik (PPOK),” NURSCOPE: Jurnal Penelitian dan Pemikiran Ilmiah Keperawatan, vol. 7, no. 1, p. 13, Aug. 2021, doi: 10.30659/nurscope.7.1.13-21
[35] N. Putcha, M. B. Drummond, R. A. Wise, and N. N. Hansel, “Comorbidities and Chronic Obstructive Pulmonary Disease: Prevalence, Influence on Outcomes, and Management,” Semin Respir Crit Care Med, vol. 36, no. 4, pp. 575–591, Aug. 2015, doi: 10.1055/s-0035-1556063.
[36] H. Chen et al., “Association between chronic obstructive pulmonary disease and cardiovascular disease in adults aged 40 years and above: data from NHANES 2013–2018,” BMC Pulm Med, vol. 23, no. 1, Dec. 2023, doi: 10.1186/s12890-023-02606-1.
[37] M. N. Amin et al., “Inflammatory cytokines in the pathogenesis of cardiovascular disease and cancer,” SAGE Open Med, vol. 8, p. 205031212096575, Jan. 2020, doi: 10.1177/2050312120965752.
[111] A. M. B. Menezes et al., “Tuberculosis and airflow obstruction: evidence from the PLATINO study in Latin America,” European Respiratory Journal, vol. 30, no. 6, pp. 1180–1185, Aug. 2007, doi: 10.1183/09031936.00083507.
[38] R. Amran, W. Abdulkadir, J. Farmasi, F. Olahraga dan Kesehatan, and R. Amwan Jurusan Farmasi Fakultas Olahraga dan Kesehatan, “Tingkat Kepatuhan Penggunaan Obat Anti Tuberkulosis Pada Pasien Di Puskesmas Tombulilato Kabupaten Bone Bolango,” Indonesian Journal of Pharmaceutical Education (e-Journal), vol. 1, no. 1, pp. 2775–3670, 2021, doi: 10.22487/.ijpe.vlil.101223.
[39] A. A. Pritami, R. Ariza, S. Soemarwoto, and R. Wintoko, “Faktor Risiko Kanker Paru: Tinjauan Pustaka,” Agromedicine, vol. 9, no. 2, 2022.
[40] F. Laghi, N. Adiguzel, and M. J. Tobin, “Endocrinological derangements in COPD,” European Respiratory Journal, vol. 34, no. 4, pp. 975–996, Oct. 2009, doi: 10.1183/09031936.00103708.
[41] E. Rastoder et al., “Systemic Corticosteroids and the Risk of Venous Thromboembolism in Patients with Severe COPD: A Nationwide Study of 30,473 Outpatients,” Biomedicines, vol. 9, 2021, doi: 10.3390/biomedicines.
[42] Y. S. Indreswari, C. M. Rumende, C. W. Pitoyo, D. Respirologi, D. Perawatan, and P. Kritis, “Faktor-Faktor yang Berhubungan dengan Eksaserbasi pada Pasien Penyakit Paru Obstruktif Kronik di Rumah Sakit Cipto Mangunkusumo, Jakarta,” Indonesian Journal of Chest Critical and Emergency Medicine, vol. 1, no. 4, 2014.
[43] I. U. A. Sihombing, “FAKTOR-FAKTOR YANG BERHUBUNGAN DENGAN KEJADIAN EKSASERBASI PADA PENDERITA PENYAKIT PARU OBSTRUKTIF KRONIK (PPOK) DI BALAI BESAR KESEHATAN PARU MASYARAKAT BANDUNG TAHUN 2015–2020,” UPN Veteran Jakarta, Jakarta, 2021.
[44] A. Maunaturrohmah et al., “Hubungan Lama Menderita Dengan Kenyamanan Fisik Pada Pasien PPOK Di Ruang Paviliun Cempaka RSUD Jombang,” 2018.
[45] A. R. van Buul, M. J. Kasteleyn, N. H. Chavannes, and C. Taube, “Association between morning symptoms and physical activity in COPD: a systematic review,” European Respiratory Review, vol. 26, no. 143, p. 160033, Mar. 2017, doi: 10.1183/16000617.0033-2016.
[46] W. Nugraha, “Pengaruh Riwayat Durasi Merokok Terhadap Frekuensi Eksaserbasi Penyakit Paru Obstruktif Kronis (PPOK) Pada Pasien Rumah Sakit Gotong Royong,” Universitas Katolik Widya Mandala Surabaya, Surabaya, 2022.
[47] B. S. Handiansyah, “Korelasi merokok dengan kekerapan eksaserbasi PPOK,” Universitas Trisakti, Jakarta, 2019.
[48] T. A. L. S. Sari, “Hubungan Derajat Merokok Terhadap Sesak Nafas Pada Pasien Penyakit Paru Obstruktif Kronik (PPOK): Narrative Review,” Universitas ’Aisyiyah, Yogyakarta, 2021.
[49] R. J. Sitorus, I. G. Purba, M. Natalia, and K. Tantrakarnapa, “The Effect of Smoking and Respiration of Carbon Monoxide among Active Smokers in Palembang, Indonesia,” Kesmas, vol. 16, no. 2, pp. 108–112, May 2021, doi: 10.21109/KESMAS.V16I2.3297.
[50] W. Lu and J. Zheng, “The function of mucins in the COPD airway,” Curr Respir Care Rep, vol. 2, no. 3, pp. 155–166, Sep. 2013, doi: 10.1007/s13665013-0051-3.
[51] T. Hardiyanti, N. M. Yasin, and T. M. Andayani, “Pengaruh Readmisi Terhadap Biaya pada Pasien PPOK Eksaserbasi Akut dan Faktor-Faktor yang Mempengaruhinya,” Majalah Farmaseutik, vol. 17, no. 3, Sep. 2021, doi: 10.22146/farmaseutik.v17i3.65382.
[52] D. F. Mariniello et al., “Comorbidities in COPD: Current and Future Treatment Challenges,” J Clin Med, vol. 13, no. 3, p. 743, Jan. 2024, doi: 10.3390/jcm13030743.
[53] Ç. Koç and F. Şahin, “What Are the Most Effective Factors in Determining Future Exacerbations, Morbidity Weight, and Mortality in Patients with COPD Attack?,” Medicina (B Aires), vol. 58, no. 2, p. 163, Jan. 2022, doi: 10.3390/medicina58020163
[54] N. Cuesta-Gomez, G. J. Graham, and J. D. M. Campbell, “Chemokines and their receptors: predictors of the therapeutic potential of mesenchymal stromal cells,” Dec. 01, 2021, BioMed Central Ltd. doi: 10.1186/s12967021-02822-5.
[55] J. A. Walters, D. J. Tan, C. J. White, P. G. Gibson, R. Wood-Baker, and E. H. Walters, “Systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease,” Cochrane Database of Systematic Reviews, vol. 9, no. 1, 2014, doi: 10.1002/14651858.CD001288.pub4.
[56] G. Wang et al., “Acute exacerbations of chronic obstructive pulmonary disease in a cohort of Chinese never smokers goes along with decreased risks of recurrent acute exacerbation, emphysema and comorbidity of lung cancer as well as decreased levels of circulating eosinophils and basophils,” Front Med (Lausanne), vol. 9, Aug. 2022, doi: 10.3389/fmed.2022.907893
[57] D. E. O’Donnell, “COPD exacerbations : Pathophysiology,” Thorax, vol. 61, no. 4, pp. 354–361, Apr. 2006, doi: 10.1136/thx.2005.041830.
[58] A. A. Diaz et al., “Airway-Occluding Mucus Plugs and Mortality in Patients With Chronic Obstructive Pulmonary Disease,” JAMA, vol. 329, no. 21, p. 1832, Jun. 2023, doi: 10.1001/jama.2023.2065.
[59] N. Vij, P. Chandramani-Shivalingappa, C. Van Westphal, R. Hole, and M. Bodas, “Cigarette smoke-induced autophagy impairment accelerates lung aging, COPD-emphysema exacerbations and pathogenesis,” American Journal of Physiology-Cell Physiology, vol. 314, no. 1, pp. C73–C87, Jan. 2018, doi: 10.1152/ajpcell.00110.2016.
