Kesesuaian Terapi pada Pasien Penyakit Paru Obstruktif Kronis Rawat Jalan di RS Khusus Paru Respira Yogyakarta

REGINA GITA P, Prof. Dr. apt. Tri Murti Andayani, Sp.FRS.

2023 | Skripsi | S1 FARMASI

Penyakit paru obstruktif kronis (PPOK) merupakan penyakit yang bersifat kronis sehingga pasien terus membutuhkan obat untuk mengontrol gejala dan mencegah keparahan penyakit. Tercapainya tujuan terapi pasien PPOK sangat bergantung dari strategi pengobatan yang tepat dan kepatuhan pasien dalam menjalankan terapi tersebut. Penelitian ini bertujuan untuk mengetahui gambaran terapi, luaran klinik, dan kesesuaian terapi pasien PPOK rawat jalan di RS Khusus Paru Respira Yogyakarta berdasarkan pedoman GOLD (2022). Penelitian observasional deskriptif ini dilakukan secara cross-sectional dengan pengambilan data primer dan sekunder menggunakan metode consecutive sampling dari kuesioner dan rekam medik pasien. Terapi pasien PPOK digambarkan melalui golongan obat, jenis sediaan, dan pola terapi. Sedangkan luaran klinik digambarkan melalui skor COPD Assessment Test (CAT) dan frekuensi eksaserbasi. Skor CAT dan frekuensi eksaserbasi digunakan untuk mengelompokkan pasien sesuai tingkat keparahan PPOK berdasarkan GOLD (2022). Kesesuaian terapi akan ditinjau berdasarkan pedoman terapi farmakologi menurut GOLD (2022) dan dihitung persentasenya. Hasil penelitian pada 136 pasien PPOK menunjukkan bahwa mayoritas pasien termasuk kategori lanjut usia (�60 tahun), berjenis kelamin laki-laki, tidak memiliki riwayat merokok, dan menderita PPOK selama 1-5 tahun. Terapi yang paling banyak diberikan kepada pasien yaitu budesonide inhalasi (83,09%), tiotropium bromide inhalasi (80,15%), teofilin oral (67,65%), dan ipratropium bromide inhalasi (66,18%). Pola terapi yang paling banyak diberikan kepada pasien yaitu terapi kombinasi lima obat (51,47%) berupa golongan ICS/LABA + LAMA + SAMA/SABA dan tiga obat (28,68%) berupa golongan ICS/LABA + LAMA (23,53%). Pasien dengan skor CAT <10 sebesar 52,21% dan dengan skor CAT �10 sebesar 47,79%. Pasien dengan frekuensi eksaserbasi 0-1 sebesar 94,85% dan dengan frekuensi eksaserbasi �2 sebesar 5,15%. Terdapat 19 pasien (13,97%) dengan terapi yang tidak sesuai dengan pedoman GOLD (2022) dan 117 pasien (86,03%) yang sesuai. Ketidaksesuaian terapi diakibatkan oleh penggunaan dua sediaan dengan kombinasi golongan obat yang sama dan penggunaan fluticasone yang berisiko bagi pasien pneumonia.

Chronic obstructive pulmonary disease (COPD) is a chronic disease that patients need medication continuously to control symptoms and prevent its severity. The achievement of COPD patient therapy goals highly depends on the appropriate treatment strategy and patient�s compliance in carrying out the therapy. The objective of this study was to describe the therapy, its clinical outcome, and the suitability of outpatient COPD therapy at Respira Lung Hospital Yogyakarta based on GOLD (2022). This descriptive observational study was conducted in a cross-sectional manner by collecting primary and secondary data using consecutive sampling method from questionnaires and electronic medical records. Treatment of COPD outpatients was described through drug classes, route of administrations, and patterns of therapy. While clinical outcomes were examined through COPD Assessment Test (CAT) scores and frequency of exacerbation. Both clinical outcomes were used to group the outpatients according to their disease severity based on GOLD (2022). The suitability of therapy was reviewed based on pharmacological therapy guideline of GOLD (2022) and the percentage was calculated. The study result on 136 COPD patients showed that the majority of patients were elderly (�60 years old), male, had no history of smoking, and had COPD for 1-5 years. The most common therapies given to the patients were inhaled budesonide (83,09%), inhaled tiotropium bromide (80,15%), oral theophylline (67,65%), and inhaled ipratropium bromide (66,18%). The most given patterns of therapy were five drugs combination (51,47%) of ICS/LABA + LAMA + SAMA/SABA and three drugs combination (28,68%) of ICS/LABA + LAMA (23,53%). Patients who had <10 CAT score were 52,21% and those with �10 CAT score were 47,79%. Patients with an exacerbation frequency of 0-1 were 94,85% and those with an exacerbation frequency of �2 were 5,15%. There were 19 patients (13,97%) with therapy that did not comply with GOLD (2022) and 117 patients (86,03%) who were suitable. Therapeutic inappropriateness resulted from the use of two drugs with the same groups combination and the use of fluticasone at risk for patients with pneumonia.

Kata Kunci : PPOK, gambaran terapi, luaran klinik, kesesuaian terapi