Diferensiasi Asma Atopik dengan Nonatopik pada Pasien Rawat Jalan di Klinik Paru-Asma

Prayudi Santoso, Zul Dahlan

Abstract


Terdapat kesulitan penatalaksanaan asma karena mekanisme asma yang kurang jelas dan terdapat berbagai fenotipe asma yang bersifat individual memerlukan terapi pendekatan individual. Salah satu fenotipe asma adalah asma atopik dan nonatopik yang secara klinis susah dibedakan. Penelitian bersifat deskriptif analitik, rancangan potong lintang dilakukan untuk melihat perbedaan karakteristik asma atopik dengan nonatopik. Subjek penelitian penderita asma baru yang berobat jalan di klinik Paru Asma An-Nur Bandung tahun 2007–2008. Pada pasien tersebut dilakukan pemeriksaan nilai total IgE, spirometri, dan tes tusuk kulit. Terdapat 198 pasien asma terdiri atas 149 (75,3%) pasien atopik dan 49 (24,7%) nonatopik. Median usia pasien nonatopik adalah 39 tahun dan atopik 34 tahun (p=0,039). Terdapat perbedaan bermakna keluhan sesak napas kelompok atopik (68,5%) dan nonatopik (44,9%) (p=0,003), tidak bermakna pada pemeriksaan spirometri. Riwayat atopik pasien sendiri terdapat pada kelompok asma atopik (p=0,011), bermakna pada rinitis (81,2 vs 61,2 OR 2,7) dan urtikaria (14,8 vs 4,1 OR 4,0). Asma nonatopik tidak lebih berat dibandingkan dengan atopik yang diketahui dari pemeriksaan persentase forced expiratory volume first second (FEV1). Pada pasien rinitis dengan urtikaria, risiko mendapatkan asma atopik lebih besar. Simpulan, tidak ada perbedaan hasil tes tusuk kulit pada kedua kelompok. Gejala klinis kelompok atopik sesuai dengan positivitas hasil pemeriksaan IgE. Keadaan klinis rinitis dan urtikaria lebih menjuruskan diagnosis ke arah asma atopik dibandingkan dengan gambaran klinis lainnya atau hasil spirometri. [MKB. 2013;45(2):105–11]

Kata kunci: Asma atopik, asma nonatopik, IgE, karakteristik klinis


Differentiation of Atopic and Non-Atopic Asthma in Out-Patient Pulmo-Asthma Clinic

There is a difficulty in asthma management regarding to unclear mechanism of asthma, and a variety of asthma phenotypes that individually require individual therapy and approach. The asthmatic phenotype atopic and nonatopic was clinically difficult to distinguish. The study was analytical descriptive with cross-sectional design. The study aim was to explore the differences of atopic and non-atopic asthmatic characteristics. The study subjects were newly asthmatic patients who were out-patients of An-Nur Lung-Asthmatic Clinic, Bandung, in 2007–2008. In patients examined total IgE, spirometry and skin prick test. There were 198 asthmatic patients comprising 149 (75.3%) atopic and 40 (24.7%) non-atopic asthma. The median of the non-atopic age was 39 years, while the atopic was 34 years (p=0.039). There was a significant difference between atopic (68.5%) and non-atopic (44.9%) in complaint of short breath (p=0.003), but non significant in spirometric examination. The history of atopy were present in atopic asthma group (p=0.011), with significance in rhinitis (81.2 vs 61.2 OR=2.7) and urticaria (14.8 vs 4.1 OR=4.0). Non-atopic asthma was not more severe that atopic asthma was known from examination of forced expiratory volume first second (FEV1). Rhinitis patient, having urticaria, have greater risk for atopic asthma. There were no difference in skin prick test results between both groups. The clinical symptoms of atopic group were in line with the positivenes results of IgE examination. Clinical condition of rhinitis and urticaria direct to the diagnosed towards atopic asthma compared than other clinical features or spirometric result. [MKB. 2013;45(2):105–11]

Key words: Atopic asthma, clinical characteristics, IgE, non-atopic asthma

 

DOI: http://dx.doi.org/10.15395/mkb.v45n2.112


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