ANALYSIS OF FACTORS AFFECTING THE THERAPEUTICAL OUTCOMES IN STABLE CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) PATIENTS AT GATOT SOEBROTO ARMY CENTRAL HOSPITAL

• Main Author: Utari Nurwulandari, Nunik
• Format: Theses
• Language: Indonesia
• Online Access: https://digilib.itb.ac.id/gdl/view/72134
• Institution: Institut Teknologi Bandung

Chronic Obstructive Pulmonary Disease (COPD) is a non-communicable disease and a global health problem characterized by persistent respiratory symptoms and airflow limitation with abnormal lung function progression. Of the four countries in Asia, COPD patients in Indonesia have poor clinical characteristics with the worst lung function values, the second worst COPD symptom scores, the highest number of exacerbations per year and the highest number of users of drug regimens for COPD with the severest outcomes. This indicates that therapeutic outcomes for COPD patients in Indonesia are not successful. Several factors and patient characteristics are associated with clinical outcomes as the determinants of therapeutic outcome. This study aims to identify the significant factors and the probability of their affect on the therapeutic outcome of COPD patients through the correlation between patient factors and characteristics with the clinical outcomes. This study used a descriptive-observational design with a cross sectional design involving 74 research subjects. The minimum number of research subjects was calculated using Raosoft Sample Size Calculator. The test subjects used in this study were obtained through purposive sampling by involving COPD patients in the outpatient pulmonary department polyclinic at Gatot Soebroto Army Hospital Jakarta who met the inclusion criteria, including stable COPD, at least a 1-year diagnosis of COPD, with accessible medical records and agree to the informed consent and complete the questionnaire. The questionnaire that was used in the study had been validated and reliable with p value <0.05 and Cronbach alpha ?0.6. Data were collected qualitatively through observation and interviews by filling out forms and questionnaires with secondary data in the form of medical record data. Data analysis was analyzed quantitatively on independent variables and dependent variables with univariate statistical analysis by descriptive tests, while bivariate and multivariate analysis with correlation and logistic regression tests using the Minitab application. The independent variables in this study were patient demographic data, exposure history, history of alcohol consumption, drugs and Drug Induced Interstitial Lung Disease (DIILD), smoking history, comorbidities and disease history, patient treatment profile also treatment compliance (MARS-5) iv and accuracy of inhaler use. While the dependent variables are clinical outcomes, including COPD Assessment Test (CAT) scores, modified Medical Research Council Dyspnea Scale (mMRC) scores, frequency of exacerbations per year, severity of exacerbations, history of hospitalization per year and current COPD severity with Grade ABCD. This study showed that tumor/cancer comorbidity was the most significant factor affecting the worsening of CAT scores (p=0.049, OR=10.89, 95%CI=1.01-117.23). The use of ICS/LABA medication most significantly affected the improvement of mMRC score (p=0.024 OR=0.26, 95%CI=0.08-0.84). History of TB disease was most significant in increasing the severity of exacerbations (p=0.045, OR=7.25, 95%CI=1.05-50.23), while age of starting smoking over 20 years was most significant in decreasing the severity of exacerbations (OR=0.03, 95%CI=0.002-0.61, p=0.022). History of alcohol use (OR=7.26 and 167.56, p=0.014 and 0.004) and comorbid pneumonia (OR=28.14 and 44.25, p=0.035 and 0.014) were the most associated with increased frequency of exacerbations and hospitalizations per year. On the other hand, middle economic status decreased hospitalization per year (OR=0.06, 95%CI=0.00-0.91, p=0.043). Severity of COPD diagnosis and history of alcohol consumption influenced the reduction of current COPD severity (Grade ABCD) (OR=0.12 and 0.24, p=0.039- 0.009). The factors that most affected clinical outcomes need to be considered related to the achievement of therapeutic outcomes for COPD patients, which can determine the selection of drugs and the addition of other therapies. This study has limitations related to the limited number of subjects and Covid-19 conditions that do not allow spirometry measurement as one of the outcomes, so multicenter research and VEP1 examination are recommended in future studies.