Background: Senam Asma Indonesia (SAI) is a longstanding Indonesian structured asthma exercise program associated with Yayasan Asma Indonesia (YAI), asthma clubs, and Persahabatan Hospital. Its historical development has not previously been synthesized with explicit grading of source verification. Methods: This non-systematic narrative historical review used targeted searches of PubMed/MEDLINE, Google Scholar, Indonesian journal portals, official government and hospital websites, and institutional repositories, without a lower date limit and updated on 10 July 2026. Historical statements were appraised according to source type and proximity to the event; discrepancies and unverified milestones were reported explicitly. Results: An official Ministry of Health retrospective account states that YAI activities began in 1985 as an Asthma Club at RSUP Persahabatan, providing counseling and therapist-led breathing exercise. A 1993 standardization seminar is described in secondary sources, but original proceedings were not retrieved. A peer-reviewed retrospective review dates formalization of SAI to 1994. A 2002 clinical publication confirms that SAI was established in practice, while the 2003 revision manual is repeatedly cited but was not available in full through open sources. Subsequent Indonesian studies and hospital reports show continued clinical and community use, although the SAI-specific evidence remains small and heterogeneous. Conclusion: Persahabatan Hospital was an early institutional setting for organized asthma education and breathing exercise and has remained linked to SAI-related activity. The verified historical record supports a narrative of local development, formalization, revision, and continued use, but national reach and several early milestones require primary archival confirmation. Future priorities include archival and oral-history research, national program mapping, standardized outcomes, and multicenter implementation studies.

Abstract English: Background Chronic obstructive pulmonary disease (COPD) remains a significant global health burden. Due to limited donor organs, it is essential to implement rigorous selection criteria for lung transplantation candidates to maximise survival outcomes. Methods This study is a systematic review and meta-analysis of mortality-associated prognostic factors, survival rates (SR), lung function and complications among COPD patients who underwent lung transplantation. We follow preferred reporting items for systematic reviews and meta-analyses 2020 guidelines and register this review in PROSPERO (CRD42024617160). Eligibility criteria guided article selection through Medline, Scopus, ProQuest, Central and manual searches. Study quality was assessed using the Newcastle–Ottawa scale (NOS). Data were extracted and analysed, including performing meta-analysis for relevant outcomes. Results Our analysis identified prognostic factors associated with post-transplant mortality, including increased age per year (HR: 1.03, 95% CI: 1.02–1.03; I 2 = 0%), diabetes mellitus (HR: 1.38, 95% CI: 1.22–1.57; I 2 = 0%), ECMO support (HR: 3.58, 95% CI: 1.95–6.57; I 2 = 5%) and white donor race (HR: 0.81, 95% CI: 0.74–0.89; I 2 = 0%). Other significant factors included previous lung surgery, non-alpha-1 antitrypsin deficiency, induction agent type, continuous mechanical ventilation, 6-min walk distance and pulmonary hypertension. Lung transplantation significantly improves survival in COPD patients, with pooled SR of 79.8% (95% CI: 69.2%–87.4%) at 1 year and 55.3% (95% CI: 47.3%–63.1%) at 5 years. Lung function also showed marked improvement. Reported complications included infections, metabolic complications, rejection and bronchiolitis obliterans syndrome. Conclusions This systematic review identifies the key prognostic factors associated with mortality in post-transplant COPD patients, as well as post-transplant SR, lung function improvements and common complications.

Background: Post-tuberculosis (post-TB) sequelae are long-term pulmonary complications that persist despite completion of anti-tuberculosis treatment (ATT). These long-term effects frequently contribute to diminished pulmonary function and a lower quality of life. Matrix metalloproteinase-9 (MMP-9) is thought to be involved in the process of lung tissue injury among individuals recovering from tuberculosis. This study aimed to explore the correlation between serum MMP-9 levels and pulmonary function impairment in post-TB patients. Methods: An observational case-control study was carried out at Dr. H. Abdul Moeloek Hospital in Lampung between April 2023 and March 2024. The study involved 35 post-TB patients (case group) and 35 healthy individuals (control group). Pulmonary function was evaluated using spirometry, while serum MMP-9 concentrations were measured by ELISA. The data were statistically analysed using the Mann-Whitney U test and Spearman's rank correlation. Results: The post-TB group exhibited higher serum MMP-9 levels compared to the control group (1137.7±527.4 vs. 939.5±360.1), though the difference did not reach statistical significance. Post-TB patients showed reduced lung function, particularly in FEV1/FVC, FEV1, and FVC values. There was a significant correlation between MMP-9 levels and pulmonary function parameters, including pre-bronchodilator FEV1/FVC (r = -0.321; P=0.007), post-bronchodilator FEV1/FVC (r = -0.265; P=0.027), and %FEV1 (r = -0.254; P=0.034). Conclusion: Increased serum MMP-9 levels are associated with reduced lung function in post-tuberculosis patients, particularly in cases of obstructive impairment. MMP-9 has the potential to be used as a biomarker for lung injury in individuals with a history of tuberculosis.

Background: In the era of personalized medicine, biomarkers have become an important tool for detecting and predicting asthma episodes over the last decade, one of them is urinary bromotyrosine. It has several advantages as a potential biomarker for asthma, including its stability and the practicality of noninvasive urine sampling. Therefore, this study aims to investigate further the role of urinary bromotyrosine levels and their correlation with eosinophil levels in asthma patients. Methods: This is an analytical observational study with a cross-sectional design. From May to December 2023, the study involved 82 patients from the Harum Melati Clinic in Pringsewu, Lampung, Indonesia. The participants underwent spirometry, differential leukocyte count, urinalysis, and chest X-rays. The severity of asthma obstruction was classified into asthmatic (n=72) as the case group, with non-asthmatic patients (n=10) serving as the control group. Urinary bromotyrosine levels were tested using the 3-BrY ELISA Kit EU3112. Results: Urinary bromotyrosine levels were significantly higher in asthma patients compared to the non-asthma group (154.11 ng/mL vs. 11.87 ng/mL; P=0.0001). Furthermore, elevated eosinophil levels in asthma patients showed a strong correlation coefficient (0.307) with higher urinary bromotyrosine levels, indicating statistical significance (P=0.005). Conclusion: This study found a significant difference in urinary bromotyrosine levels between asthmatic and non-asthmatic participants. There was a strong correlation between elevated eosinophil counts in patients with asthma and increased urinary bromotyrosine levels.

Introduction: Chronic obstructive pulmonary disease (COPD) may effect chronic hypoxemia due to ventilation–perfusion mismatch. The perfusion index (PI) based on pulse oximetry reflects peripheral perfusion and may vary by measurement site. This study evaluated differences in PI values among fingers to determine the most reliable site for PI measurement in patients with COPD. Materials and Methods: This descriptive observational research with a cross-sectional design among patients with stable COPD attending the Pulmonology Clinic at Kolonel Abundjani General Hospital in August 2025. Subjects were recruited using consecutive sampling. Patient characteristics, including sex, age, smoking history, and Brinkman index, were obtained from medical records. Perfusion index measurements were taken from all fingers of both hands using a pulse oximeter and analyzed using descriptive statistics. Results: A total of 22 patients with stable COPD were ivolvedncluded. Most participants were male (86.4%) and aged over 55 years (86.4%), with the majority having a history of smoking and a Brinkman index of 200–600 (45.5%). The highest mean PI value in the right hand was observed in the ring finger (4.89 ± 3.12), while in the left hand it was found in the index finger (5.59 ± 3.41). PI values tended to be higher in several fingers of the left hand. The coefficient of variation analysis showed considerable variability across all fingers, although the thumbs exhibited relatively lower variability. A significant difference was observed only in the middle finger between the right and left hands (p = 0.012). Age and smoking history were not significantly associated with PI values (p > 0.05). Conclusion: PI measurements in patients with stable COPD varied across different fingers. The thumbs showed relatively more stable values and may represent more reliable sites for PI assessment.

Background Indonesia continues to face a significant problem with Tuberculosis (TB), ranking as the country with the second highest global burden. Concordance behavior is crucial to treatment adherence. However, understanding of concordance behavior determinants remains incomplete. Objective This study aims to explore the understanding and experience of TB patients, their families, and health workers regarding communication in support of TB treatment concordance. Methods We employed a phenomenological design to explore the lived experiences of individuals involved in TB treatment. Semi-structured interviews were conducted with a purposive sample of TB patients, family members, and healthcare workers at primary healthcare centers in Padang City, Indonesia. We utilized the Braun and Clarke approach-guided thematic analysis to identify salient themes emerging from the interview data. Results Data analysis yielded four principal themes: understanding of concordance, the role of the family in treatment communication, communication barriers, and effective communication strategies to support the concordance. Many patients and relatives were unsure about TB treatment. Family pressure on medication adherence was significant, yet it sometimes caused patient stress. Healthcare workers' time and TB stigma hindered communication. Brochures, films, and digital media have improved knowledge and adherence. Conclusion Concordance behavior among patients, families, and healthcare workers is essential. Enhancing adherence necessitates ongoing education, family engagement, and reduction of stigma for TB treatment.

Background: The prevalence of COPD is high in lung cancer patients ranging from 40-70%, but is often undiagnosed due to similar risk factors and chronic respiratory symptoms. Chronic obstructive pulmonary disease not only contributes to the occurrence of lung cancer but can also be an overlapping condition that affects prognosis and treatment options. Methods: A descriptive-analytic study with a cross-sectional design was conducted on lung cancer patients who had known cell types at the polyclinic of Dr. M Djamil Padang Hospital and spirometry examination was performed. Results: Total 49 subjects with 77.6% male, 40-59 years old (46.9%), former smokers (73.5%) with severe Brinkman index (IB) (78.9%). The most common type of lung cancer was squamous cell carcinoma (61.2%) and most subjects were at an advanced stage (83.6%) with ECOG clinical appearance 1 (79.6%). The location of lung cancer lesions was predominantly central (83.7%) with restriction lung function values (98%) and 37.5% of them with obstruction. The prevalence of COPD in lung cancer patients was 34.7% with patient characteristics mainly male (88.2%), 60-79 years (58.8%), former smokers (82.4%) with severe IB (86.7%). The types of lung cancer of subjects with COPD were mainly squamous cell carcinoma (52.9%), advanced stage (76.5%), ECOG 1 (70.6%) and centralized (94.1%). The degree of obstruction in the COPD group was mainly GOLD 2 (41.2%) with population group E (64.7%). There was no association between the type, staging, and location of lung cancer lesions with the degree of obstruction or with the COPD population group Conclusion: Lung cancer patients with COPD are mainly male with an older age, the most common type is squamous cell carcinoma, advanced stage, with central lesion all lung cancer patients with COPD in the study were undiagnosed COPD cases.

Asthma poses a significant global health problem. Despite the availability of effective treatments, management practices often fall short of current recommendations. The SABA use IN Asthma (SABINA) programme demonstrated that short-acting β2-agonist (SABA) over-reliance significantly contributes to disease burden. A panel of 20 international healthcare practitioners (HCPs) invited to a summit meeting discussed five innovative interventions to reduce SABA over-reliance and assessed the feasibility of implementing them across countries. The interventions included the SABA rEductioN Through ImplemeNting Hull asthma guidELines (SENTINEL) quality improvement programme in the UK, the pay-for-performance (P4P) programme in Taiwan, the Asthma Right Care (ARC) programme in Spain, a SABA-free asthma clinic in Argentina, and a modified emergency department discharge protocol and SABA alert system in the United Arab Emirates. Following a review of the available clinical evidence from these five interventions, the HCPs proposed six themes to tackle SABA over-reliance: (1) consistent delivery of services across healthcare systems in individual countries to facilitate standardisation of optimal treatment approaches and resource allocation; (2) educational initiatives targeted at HCPs and patients to mitigate drivers of SABA over-reliance; (3) adopting a SABA-free treatment paradigm that provides concomitant anti-inflammatory therapy with a fast-acting bronchodilator for symptom relief; (4) regulating over-the-counter SABA purchase without a prescription; (5) engaging policymakers to integrate current evidence-based treatment recommendations into routine clinical practice; and (6) expanding use of digital technology as a key component of a patient-centric approach and monitoring prescribing practices. Since SABAs were the preferred reliever for > 30 years, reducing SABA over-reliance will necessitate a considerable shift in asthma management practices. This transition requires coordinated efforts among clinicians, pharmacists, and policymakers to develop and tailor strategies for raising awareness of the clinical and economic burden of SABA overuse and address local/national barriers to integration of evidence-based recommendations in routine clinical practice.

Chronic obstructive pulmonary disease (COPD) has a high burden in Asia. These patients are also susceptible to various cardiovascular diseases (CVD). A panel of expert Asian pulmonologists explored the published literature to understand the impact of COPD and CVD on each other and to identify the cardiopulmonary risk factors in the region. The experts concluded that an elevated risk of all-cause mortality and acute cardiovascular events persists for up to 2 years following moderate and severe COPD exacerbations, with the risk of death being highest in the first 30 days after the exacerbation. High smoking rate (especially in males), high indoor and outdoor air pollution in Asia, relatively low vaccination rate in Asia (especially in low- and middle-income countries), and relatively low rate of utilisation of inhaler medications impact the cardiopulmonary risk in Asia.

Introduction: Chronic obstructive pulmonary disease (COPD) represents an increasing global health burden. Among its significant comorbidities, cardiovascular complications, particularly arrhythmias, are of significant concern. Chronic obstructive pulmonary disease and arrhythmias share common risk factors, including advanced age and smoking. This study investigated the prevalence and contributing factors of arrhythmias in stable COPD patients. Methods: This cross-sectional study was conducted among stable COPD patients attending the Asthma-COPD Clinic at Persahabatan National Respiratory Referral Hospital, Jakarta, Indonesia, from January to April 2018. The inclusion criteria encompassed a clinical diagnosis of COPD and voluntary participation with written informed consent. Each participant underwent laboratory evaluation, electrocardiography (ECG), blood pressure measurement, and a structured interview. Patients were excluded if they had experienced acute COPD exacerbations during the assessment, had a history of other chronic lung diseases, suffered a recent myocardial infarction, had structural heart disease, were diagnosed with fibrillation, or declined to participate. Results: The prevalence of arrhythmias in stable COPD patients was 24.1%. The types included sinus bradycardia (2.41%), premature atrial contractions/PACs (3.61%), premature ventricular contractions/PVCs (8.43%), and sinus tachycardia (9.64%). The majority of arrhythmic patients were males, with an average age of 68 years old. These patients also had a history of heart disease, exhibited severe COPD symptoms, and demonstrated significant airflow obstruction (average pCO₂ of 36 mmHg). Conclusion: Decreased chloride levels were associated with an increased incidence of arrhythmias. However, no significant associations were observed with airflow limitation, sex, age, bronchodilator use, or arterial blood gas parameters.

Background: Type-2 Diabetes Mellitus (type-2 DM) is one of the comorbidities in Chronic Obstructive Pulmonary Disease (COPD), associated with the incidence of respiratory tract infections which is a risk factor for COPD exacerbations. Methods: Systematic review include publications from January 1st 2015 to October 31th 2021, using data base Pubmed and Google Scholar and meta-analysis conducted to summarize prevalence of COPD exacerbation with type-2 DM with subgroup analysis base on geographical location, study design, study period also characteristic population COPD exacerbation with type-2 DM comorbidities. Results: Seven studies conducted in the meta-analysis. Pooled prevalence of COPD exacerbations with type-2 DM comorbidity was 34.22% (95%CI: 27.49%-41.28%) and heterogeneity (I2=87.69%, Q=48.75, p=<0.001). Five studies were based in Europe, one study in Asia and the Americas. Prevalence of COPD exacerbations with type-2 DM comorbidity based on WHO region subgroup analysis found European region 34.70% (95%CI:25.88%-43.96%), America’s region 40.28% (95%CI: 39 .89%-40.79%) and the Western Pacific region 26.01%(95%CI:0.20;0.32) with statistical heterogeneity (I2 = 77%, Q=17.63, p=<0.001). Population age of the study was above 60 years and more males than females (n=30,58.8% vs n=21,41.1%). Most common other comorbidities of COPD exacerbation were hypertension, obesity, and coronary heart disease. Conclusion: Pooled prevalence of COPD exacerbations with comorbid type-2 DM in this systematic review and meta-analysis was 34.22% (95%CI: 27.49%-41.28%)

Various pregnancy-related disorders are known to affect fetal lung development negatively. During pregnancy, chronic nutrition and/or oxygen limitation is known to impede lung maturation and induce airway and lung abnormalities. Structural abnormalities and reduced lung function may be evident immediately after birth, persist, or develop with age. The expansion of the fetal lung, fetal breath movements, fetal lung growth, alveolarization, blood-air barrier, extracellular matrix (ECM), airways, surfactant system, and lung immune function are all affected by nutritional limitations during pregnancy. Gestational hypoxia disrupts fetal lung development, which manifests as morphological and functional pulmonary abnormalities. Additionally, intrauterine growth restriction (IUGR), preeclampsia (PE), exposure to air pollution, and smoking are known to interfere with embryonic lung development. Birth defects, such as bronchopulmonary dysplasia, as well as chronic obstructive pulmonary disease (COPD), can be caused by abnormalities in pregnancy. Adequate nutrition, avoidance of smoking, and watchful monitoring and intervention during pregnancy should be promoted to prevent chronic lung disease of the newborn, child, and adult.

Background: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide. Most of these deaths are related to cardiovascular disease. This is due to systemic inflammation that causes increased vascular stiffness and hypertension. These comorbidities lead to poor quality of life, low exercise tolerance, and an increased risk of hospitalization. This study aims to report the proportion of hypertension among stable COPD patients in the Indonesian population.Methods: This cross-sectional study was conducted at the National Respiratory Center Persahabatan Hospital between February and March 2023. Stable COPD patients admitted to the Asthma and COPD Polyclinic who met the criteria were enrolled. Clinical information, vital signs, spirometry results, and DLCO measurements were collected.Results: There were 84 subjects participating in this study. The result of this study shows a 60.7% proportion of hypertension in stable COPD patients. Hypertension has a significant correlation with pulmonary functional values (P=0.021), severity degree of clinical COPD (P=0.004), Brinkman index (P=0.008), and age (P=0.0001). However, hypertension association with COPD duration (P=0.505) and DLCO (P=0.122) were not significant.Conclusion: The hypertension proportion in stable COPD Indonesian patients is 60.7%. Hypertension shows a significant association with pulmonary function values, severity degree of clinical COPD, Brinkman index, and age.

Asthma is a chronic respiratory condition with a growing global prevalence, affecting millions of individuals annually. While asthma can develop at any age, late-onset asthma is a specific phenotype that begins in adulthood, as recognized by the Global Initiative for Asthma (GINA) in its 2024 guidelines. This form of asthma is often associated with several predisposing factors, including gender, obesity, occupational exposure, rhinitis, respiratory infections, smoking, stress, and diminished lung function. Unlike early-onset asthma, which frequently involves a history of allergies, late-onset asthma tends to lack allergic triggers, making it a distinct and challenging form of the disease. Managing late-onset asthma is often more complex, as it typically requires higher doses of corticosteroids and demonstrates a reduced responsiveness to standard steroid treatments. The exact mechanisms and pathophysiological processes contributing to the increased severity and poorer clinical outcomes in late-onset asthma remain largely unclear. This uncertainty often leads to underdiagnosis and inadequate management, further complicating patient care. Phenotypic analysis is recommended to improve treatment outcomes. This includes assessing clinical features and utilizing biomarkers, such as inflammatory markers and immunoglobulin E (IgE) levels, to guide targeted therapy when conventional steroid treatments are insufficient. However, there is a significant need for further research to elucidate the underlying mechanisms of late-onset asthma. This literature review is essential to develop more effective, personalized treatment strategies that can address the unique challenges posed by this asthma phenotype, ultimately leading to better management and improved patient outcomes.

Abstract Background: Asthma is a chronic inflammatory disease of the respiratory tract that significantly impacts daily activities and quality of life. Asthma exercise is a nonpharmacological approach to asthma management. The effects of asthma exercise on interleukin-17 (IL-17) and indoleamine 2,3-dioxygenase (IDO) levels remains understudied. The effects of asthma exercise on IL-17 and IDO levels were investigated. Methods: This study included 39 participants with mild-to-moderate persistent asthma. Participants engaged in 60 minute of asthma exercise four times a week for 2 months. IL-17 and IDO levels were measured in peripheral blood mononuclear cells (PBMCs) stimulated with the house dust mite allergen Dermatophagoides pteronyssinus using ELISAs. Skin prick tests were conducted using Dermatophagoides pteronyssinus, Dermatophagoides farinae, and Blomia tropicalis. Results: IDO levels (p-value= 0.03) increased significantly and IL-17 levels decreased significantly (p-value= 0.004) after asthma exercise. However, no significant correlation was found between the decrease in IL-17 and the increase in IDO (p-value = 0.09). Conclusion: Exercise suppresses immune responses in atopic asthma induced by house dust mite allergens. Thus, exercise is a promising therapeutic approach for atopic asthma. The effects of exercise on IDO and IL-17 levels highlight the potential of exercise to alleviate asthma-related inflammation and airway hypersensitivity.Further research is needed to understand the underlying mechanisms and optimize asthma management strategies.

Senam Asma Indonesia (SAI) merupakan rangkaian latihan fisis terstruktur yang disusun berbasis pengetahuan medis oleh tim multidisiplin dalam Yayasan Asma Indonesia (YAI). Latihan yang diciptakan pada tahun 1994 tersebut disusun dengan memperhatikan karakteristik pasien asma dan disesuaikan dengan derajat keparahan asmanya dengan pengaturan beban yang berbeda pada tiap tahapan latihannya. Prinsip penanganan asma adalah penghindaran pencetus, penggunaan medikamentosa, dan menjaga kebugaran jasmani. Kualitas hidup (QoL) pasien asma mengalami penurunan karena terbatasnya aktivitas kehidupan sehari-hari akibat gejala pernapasan yang diderita. Gejala multifaktorial pada asma seperti keterbatasan ventilasi, kelainan transfer gas, disfungsi pembuluh darah paru dan jantung, disfungsi otot ekstremitas, akan menyebabkan gangguan sesak saat aktivitas atau latihan fisis, yang disebut sebagai Exercise-induced Bronchoconstriction (EIB). Tatalaksana terapi steroid oral yang diberikan untuk mengobati eksaserbasi akut dapat menyebabkan miopati yang diinduksi steroid dan remodeling otot rangka, yang mengakibatkan penurunan endurance dari kinerja otot. SAI terdiri dari serangkaian gerakan yang dirancang untuk meningkatkan fungsi paru, memperkuat otot pernapasan, dan meningkatkan kualitas hidup pasien asma. Dalam perspektif rehabilitasi medis, SAI dapat berkontribusi terhadap optimalisasi mobilitas dinding dada, kontrol pernapasan dengan pursed-lip breathing, relaksasi, dan meningkatkan kebugaran kardiorespirasi.

Batuk adalah salah satu refleks primitif bawaan yang merupakan bagian dari sistem kekebalan tubuh untuk melindungi tubuh dari benda asing. Batuk merupakan manifestasi keluhan yang terdapat pada berbagai penyakit paru baik penyakit paru infeksi maupun noninfeksi. Asma varian batuk merupakan salah satu fenotip asma dengan keluhan utama batuk tanpa disertai keluhan respirasi lainnya. Pada asma varian batuk, didapatkan hiperresponsivitas saluran napas (bronkus) tanpa disertai kelainan pada uji faal paru. Hiperresponsivitas saluran napas dinilai dari uji provokasi bronkus dengan melihat provocation dose (PD20) atau provocation concentration (PC20). Pengobatan asma varian batuk tidak berbeda dengan pengobatan asma klasik yaitu inhalasi bronkodilator dan kortikosteroid. Penggunaan inhalasi bronkodilator dan kortikosteroid dapat mencegah perkembangan asma varian batuk menjadi asma klasik. Respons parsial terhadap terapi inhalasi dapat diatasi dengan mengubah bentuk pengobatan, meningkatkan dosis inhalasi, atau menambahkan obat lain seperti agonis β2 kerja lama, teofilin lepas lambat atau leukotriene receptor antagonist (LTRA).