Roflumilast - A Review of Chronic Obstructive Pulmonary Disease (COPD) Treatment

QANUN MEDIKA
QANUN Vol 5 VOL.4

MEDIKA No41.l no
VOL JANUARY
no 11 Mei 2021
Mei 2019
2019
QANUN
QANUN MEDIKA
MEDIKA
JURNAL
JURNALKEDOKTERAN
KEDOKTERANFKUM
FKUMSURABAYA
SURABAYA
http://journal.um-surabaya.ac.id/index.php/qanunmedika
CaseReport
Case Report
Literature review
Diabetes insipidus in patiens with traumatic severe brain injury
Roflumilast: A review
Yudha Adi Prabowo1, PranandaofSurya
chronic obstructive pulmonary disease
Airlangga2
Yudha Adi Prabowo1, Prananda Surya Airlangga2
(COPD) treatment
1) Resident of Anesthesiology and Intensive Care of RSUD Dr. Soetomo, Medical Faculty of
1) Resident
AirlanggaofUniversity.
Anesthesiology and Intensive Care of RSUD Dr. Soetomo, Medical Faculty of
Airlangga
Octafia 1
University.
Ita2) Staff Departement of Anesthesiology and Reanimation of RSUD Dr. Soetomo, Medical Fac-
, Dwi Octamy Sari1, Novi Wulandari1, Sandra Annisa1, Linda Wahyuni Wongkar1, Ferdias kurnia
Bahari , Faiz Farikhah , Moh. Firmansah1, Erfin Midhiawati1, Fauna Herawati1,2*
2) Staff Departement of Anesthesiology and Reanimation of RSUD Dr. Soetomo, Medical Fac-
1 1
ulty of Airlangga University.
1) Magister Program of Clinical Pharmacy, Faculty of Pharmacy, Surabaya University, Surabaya, Indonesia
2) Department of Clinical and Community Pharmacy, Faculty of Pharmacy, University of Surabaya, Indonesia
AARRTTIICCLLEE IINNFFOO ABSTRACT

ABSTRACT
Traumatic severe brain injury is a fatal injury, with a
Submitted : Januari 2019 mortality rate of up to 50%. About 1.5 million people
Accepted : February 2019 ABSTRACT
experience severe brain injury in the United States. There
A R T I C L :EMei
Published I N2019
FO
are more than
Chronic Obstructive 50,000 Pulmonary
deaths and Disease
500,000 incidents
(COPD) is of
a
Submitted : June 2020 permanent neurological sequelae. About 85%
chronic airway inflammation with resulting progressive of mortality
Accepted
Keywords: : September 2020 occurs in the first 2 weeks after the injury. One complication
airflow limitation that has a high incidence, morbidity,
Published : January 2021 of a severe brain injury is diabetes insipidus. There are no
and mortality. Roflumilast is an oral phosphodiesterase-4
Diabetes insipidus, brain injury,
hypernatremia, desmopressin, ICU definitive
inhibitor asdata a on the incidence
therapy to decreaseof diabetes
the risk insipidus
of COPD in
patients with traumatic severe brain injury
exacerbations in patients with moderate-severe COPD of Indonesia
Keywords:
Correspondence: so far. In this case report, a male, 45 years old, was taken
with a history of chronic bronchitis. Roflumilast can be
to the orally
given Emergency Installation
once daily (IRD) orafter
as a single experiencing
combination drug.a
COPD, Roflumilast,
yud180987@yahoo.com
traffic accident 12 hours before being hospitalized.
It can be used as COPD moderate-severe but also more After
phosphodiesterase-4 inhibitor
surgery,
beneficialthe assigns
COPDof diabetes insipidus was
mild treatment. The presented
efficacy of by
polyuria
Roflumilast can prevent exacerbations of repetition and/
of 300cc / hour urine production and 149mmol
*Correspondence: L hypernatremia, although the immediate administration of
can fixed lung function both in terms of FEV1 and vital
fauna@staff.ubaya.ac.id desmopressin,
capacity to force. the The
patients clinical
incidence of and
side hemodynamic
effects, which was
are
not shown any improvements. The patient passed away in the
diarrhea and digestive disorders. The cost-effectiveness
days five of treatment in the Intensive Care Unit (ICU). The
showed that Quality of life patient with Roflumilast is
main
bettertreatments
than the groupfor diabetes
without insipidus
additional.in This
traumatic severe
paper aimed
brain injury
to review are adequate Roflumilast
systematically rehydration asand COPDadministration
treatment
of
for desmopressin. Adequate hypovolemic, polyuric and
the clinical application.
hypernatremia corrections are the keys to the successful
treatment of diabetes insipidus. Diabetes insipidus in cases
of brain injury requires complicated treatment. Therefore,
in the case of being handled improperly, it can bring death.
ABSTRAK
Cedera otak berat traumatis adalah cedera fatal, dengan tingkat kematian hingga 50%. Sekitar 1,5
juta orang mengalami cedera otak berat di Amerika Serikat. Terdapat lebih dari 50.000 kematian
dan 500.000 insiden gangguan neurologis permanen. Sekitar 85% kematian terjadi dalam 2 minggu
pertama setelah cedera. Salah satu komplikasi dari cedera otak yang parah adalah diabetes insipidus.
Tidak ada data pasti tentang kejadian diabetes insipidus pada pasien dengan cedera otak traumatis
1
35
QANUN MEDIKA Vol 5 QANUN
QANUN MEDIKA
No 1 JANUARY 2021 MEDIKA VOL.4
VOL 4 .lNo
no11 Mei
Mei2019
2019
QANUN
QANUN MEDIKA
MEDIKA
JURNAL
JURNALKEDOKTERAN
KEDOKTERANFKUM
FKUMSURABAYA
SURABAYA
Case Report
berat di Indonesia sejauh ini. Pada laporan kasus ini, seorang pria, 45 tahun, dibawa ke Instalasi
INTRODUCTION cytokines released can induce macrophages.
Rawat Darurat (IRD) setelah mengalami kecelakaan lalu lintas 12 jam sebelum dirawat di rumah
Diabetes
COPDSetelah
sakit.
insipidus
(Chronicoperasi,
in patiens
obstructive
tanda-tanda pulmonary
with traumatic
diabetes insipidus
Production ofsevere
ditandai
IL-8 from brainalveolar injury
macrophages
together with dengan
pulmonary adanya poliuria
epithelial produksi
cells results
Yudha
disease Adi
) is aPrabowo1,
disease followed Prananda SuryaairAirlangga2
by persistent
urin 300cc / jam dan hipernatremia 149 mmol / L, meskipun segera diberikan desmopresin, kondis
in neutrophilic infiltrates in COPD patients.
flow obstruction
1) Resident symptoms because
of Anesthesiology and of alveolarCare of RSUD Dr. Soetomo, Medical Faculty of
klinis dan hemodinamik pasien tidak menunjukkan perbaikan. Pasien meninggal pada hari kelima
Intensive Neutrophils, macrophages, CD4 +, CD8 + are
abnormalities
perawatan caused
di Unit by meaningful
Perawatan exposure
Intensif (ICU). Perawatan utama cells untuk
Airlangga University. inflammatory thatdiabetes
are presentinsipidus
in COPDpada
to hazardous particles or gases. COPD should
cedera otak berat traumatis adalah rehidrasi dan pemberian desmopresin yang adekuat. Koreksi
pathogenesis (Agustí & Hogg, 2019).
be ulty
considered
hipovolemik, in patients
poliurik,
of Airlangga with dyspnea,
dan hipernatremia
University. yang adekuat adalah kunci keberhasilan pengobatan
chronic insipidus.
diabetes coughing Diabetes or sputuminsipidus
establishment,
dalam kasus Besides,
cedera otak proteases are alsoperawatan
membutuhkan activatedyang by
a history of recurrent lower respiratory tract neutrophils
rumit. Karena itu, jika ditangani dengan tidak tepat, bisa menyebabkan kematian. and macrophages. Protease is the
infections, or previous exposure toABSTRACT disease main factor that drives the development of
ARTICLE INFO emphysema. The effect can be resisted with anti-
risk factors.
Kata kunci Chronic : airflow Diabeteslimitations
insipidus,
Traumaticare severe
cedera otak, hipernatremia,
brain injury is desmopressin,
a fatal injury, ICU with a
COPD characteristics
Correspondence
Submitted : Januari due
2019 to a combination
: yud180987@yahoo.com proteases such as α-1 antitrypsin. Antitrypsin
mortality rate of up to 50%. About 1.5 million people
of two types :ofFebruary
Accepted small airway 2019 diseases deficiency α-1 can cause dangerous and early
(e.g., severe
experience brain injury in the United States. There
obstructive bronchiolitis)
Published
INTRODUCTION : Mei 2019 and emphysema onset of
CASE REPORTemphysema. Arterial stiffness and
are more than 50,000 deaths and 500,000 incidents of
(Global Initiative for Chronic Obstructive neutrophils mediate inflammation activation
Traumatic brain injury is a fatal injury, with neurological
permanent sequelae. About 85% of mortality
A 45-year-old man was taken to the Emergency
(Berg & Wright, 2016).
a Lung Disease,
mortality
Keywords: rate 2019).
of up to The50%.
prevalence
About of
1.5
occurs in the first 2 weeks after the injury. One complication
Hospital (IRD) Dr. Soetomo after a motorcycle
COPD in
million Indonesia
people with based
severe on RISKESDAS
brain injury in There areaccident
three pathology mechanisms
of a severe brain injury is diabetes insipidus. There are no in COPD
Diabetes insipidus, brain2013).
injury, traffic 12 hours before being
2013 was 3,8% (Dasar,
the United States have more than definitive 50,000 data patients; chronic
on the incidence bronchiolitis
of diabetes obstruction,
insipidus in
hypernatremia, desmopressin, ICU hospitalized. The patient is unconscious since
deaths
The most and 500,000
common permanent
cause of COPD neurological
is patients
cigarette with emphysema,
traumatic and
severe mucus
brain blockage.
injury
the accident occurred. First aid was given in the of Activation
Indonesia
sequelae
smoke, (Agha
dust, air and Thompson,
pollutants, and 2006).
alpha-1 of inflammatory mediators continuously
so far. In this case report, a male, 45 years old, was taken
previous health facility; RSUD Tuban, thus the
Correspondence:
Approximately 85% of mortality occurs in the
antitrypsin reduction. Chronic bronchitis to the can will cause
Emergency a chronic
Installation (IRD) inflammatory
patient was referred to IRD Dr. Soetomo. process in
after experiencing a
yud180987@yahoo.com
first 2 weeks
be called after the injury,
a long-standing mucus which exhibits
buildup. The COPD, involving the immune system is most
traffic accident
The 12 hours has
patient before being a hospitalized.
attached collar brace at After
the
the initial impact of systemic hypotension and
mucous layer is epithelial tissue suchsurgery, evident
as loose the arrival in the
signs of indiabetes bronchial
insipidus
resuscitation wall
room of the airways.
was ofpresented
Dr. RSUD by
intracranial hypertension
connective tissue, and it (Benvenga
has a submucosa
polyuria Emphysema
et al., of 300cc / hour mainly
urine affects
production
Soetomo. Responding to pain, with the the small
and airways
149mmol /
2000).
whose glands produce mucus naturally if caused by an inflammatory
L hypernatremia, although the immediate administration of process
examination of anisocoria round pupils 4/3 involving
One of the complications
pathogens enter the respiratoryof a severe brain
tract. injury
Chronic
desmopressin, thethe both
mm, parenchyma
patients light and
eye clinical and chronic
reflexes hemodynamic bronchitis.
were decreased. was
is diabetes occurs
bronchitis insipidus. due to (Agha and Thompson,
an increase Accumulation of mucus
innot shown any improvements. The patient passed away in the
mucous exudate
Spontaneous breathing 30 times per minute in the lumen
2006; Hannon et al., 2012). Diabetes insipidus
production so much that it causes narrowing and an increase in bronchial
presented with an additional wall breath
gurgling tissue
is
ofa the
disease caused tract.
respiratory by the lower production,
Usually, it occurs to
main treatments capacity result in
for diabetes small in
insipidus airflow
with oxygen saturation of 92% using an oxygen traumatic obstruction
severe
secretion,
be preceded andby function
irritation of by Anti
smoking Diuretic
brain dust, (King,
injury mask 2015).
are adequate The
of 5 liters pulmonary
rehydration
per minute. structural
and Blood damage
administration
pressure
Hormone (ADH). Kidney
which is responded to by ourabnormalities
bodyof as an manifests
desmopressin. inflammation
Adequate hypovolemic,
110/75 mmHg (MAP 86), pulse 120 times per in COPDpolyuric induced
and
were marked
obstructive by the
disorder unresponsiveness
narrowing of
the hypernatremia
airways, by CD8+
corrections
minute. T
Tip of are cell-mediated,
the the neutrophil-based
keys to were
extremity the warm,
successful dry
physiological ADH stimulation,
by resulting in hypertrophy and hyperplasia which is
of chronic inflammation, including
and red with an examination of capillary refill interleukins,
characterized by excessive thirst (polydipsia)
the mucous glands. If this goes on for of abrain TNF-α,
long injury <2 etc.
requires
time (Zhang The
complicated
seconds. et al.,treatment.
2018).
right The mediator
Therefore,
parietooccipital
and large amounts of urine (polyuria). There is
time, there will be ciliary damage (Centers for inflammation is released by
hematoma was found. The patient was cAMP, which has
no definitive data on the incidence of diabetes
Disease Control and Prevention (US), 2010). been hydrolyzed
immediately by phosphodiesterase
suctioned and oxygenated(PDE). with
insipidus in patients with severe brain injury
Smoking
ABSTRAK can cause tissue damage directly, The expression of PDE4 in
Jackson Reese 10 liters per minute, a two-lane the lung tissue of
in Indonesia
through so far. stress, and indirectly, by
oxidative COPD patients
intravenous line shown PDE4 as aand
was attached potential drug
30° head-
Cedera otak berat traumatis adalah cedera fatal, dengan
in the tingkat
treatment kematian hingga 50%. Sekitar 1,5
Diabetes
causing an insipidus in cases response.
inflammatory of brain injury
Toxic up position. The ofpatient
COPDwas (Zuo et al., 2019).
prepared to be
juta orang mengalami cedera otak berat di Amerika Serikat.
Roflumilast Terdapat
is a ETT lebih
selective dari 50.000 kematian
requires
substancescomplicated
such as those treatment. Diabetes
in cigarettes will intubated using No.7 phosphodiesterase-4
and the lip border
dan 500.000
insipidus insiden gangguan
can lead to ofdeath neurologis
when handled permanen. Sekitar
inhibitor 85%
(PDE4) kematian
used terjadi
to treat dalam 2 minggu
the patient with
cause inflammation the airways, which was 21cm. The ventilator used PCV mode with
pertama setelah
improperly. cedera.
Therefore, Salah satu komplikasi
the authors dari
are cedera
COPD. otak yang parah adalah diabetes insipidus.
will then call in inflammatory mediators. RR 16, PC 15, trigger 2, I: E 1: 2, FiO2 50%.
Tidak ada data
interested in pasti tentang
discussing the kejadian
managementdiabetes of insipidus pada pasien dengan cedera otak traumatis
COPD patients show mark inflammation that The goal of therapy in stable COPD is to
correlates to the severity of the disease; the overcome and prevent acute exacerbations,
2
36
QANUN MEDIKA
QANUN Vol 5 VOL.4
MEDIKA No41.l no
VOL JANUARY
no 11 Mei 2021
Mei 2019
2019
QANUN
QANUN MEDIKA
MEDIKA
hydrolyzed by phosphodiesterase
JURNAL (PDE). The expression
JURNALKEDOKTERAN
KEDOKTERAN FKUM of PDE4 in the lung tissue of COPD
FKUMSURABAYA
SURABAYA
patients shown PDE4 http://journal.um-surabaya.ac.id/index.php/qanunmedika
as a potential drug in the treatment of COPD (Zuo et al., 2019). Roflumilast
is a selective phosphodiesterase-4 inhibitor (PDE4) used to treat the patient with COPD.
CaseReport
Case
reduce Report
The goal progression,
disease of therapy in stable
improveCOPDthe is to overcome and prevent
function and prolong acute exacerbations,
survival. reduce
The treatment
diseasephysical
Diabetes
patient’s progression,
insipidus inimprove
patiensthewith
and psychological patient's
state physical
traumatic
so that andcan
severe
given psychological
brain ininjury
besevere state of
the form so pharmacological
that the patient can
Diabetes
carry outcan
insipidus
daily activities,
in patiens
reduce the
with
number
traumatic
of days spent and
in the
brain injury
hospital, and reducetreatment.
the number
the patient
Yudha Adi carry
Prabowo1, out Prananda
daily activities,
Surya reduce
Airlangga2treatment non-pharmacological
Yudha
theofnumberAdi Prabowo1,
deaths.ofThe Prananda Surya Airlangga2
1) Resident ofdays spent
goal in theand
of therapy
Anesthesiology hospital,
acuteand
inIntensive CarePharmacological
exacerbations
of RSUDis Dr. therapies
to maintain
Soetomo, that canFaculty
respiratory
Medical be given
of toand
function
reduce the
1)prolong number
Resident of deaths.
ofUniversity.
Anesthesiology
survival.
Airlangga The
The treatment goal of
andgiven therapy
Intensive
can beCare stable COPD
of RSUD
in the form ofDr.include:
Soetomo, Medical
pharmacological Facultyand
treatment of non-
in2) Staff Departement of Anesthesiology and Reanimation of RSUD Dr. Soetomo, Medical Fac-
acute exacerbations
Airlangga is
University. to maintain respiratory
pharmacological treatment. Pharmacological therapies that can be given to stable COPD include:
Table
Table1. The commonly drungs
drugsused
usedininthe
thetreatment
treatmentofofCOPD
ulty 1.
of The commonly
Airlangga University. COPD
GENERAL TYPE NEBUL ORAL INJECTI DOA
ON
MEDICINE INHALER IZER
A R BETA
T I C 2L- ANTAGONIS
E INFO ABSTRACT
ABSTRACT
Traumatic severe brain injury is a fatal injury, with a
Submitted
SHORT-ACTING: Januari 2019
(SABA) mortality rate of up to 50%. About 1.5 million people
Accepted : February 2019 experience severe brain injury in the United States. There
Published
Fenoterol : Mei 2019 MDI √ Tablet, syrup 4-6 hours
Levalbuterol MDI permanent
√ neurological sequelae. About 85% of mortality
6-8 hours
Keywords: occurs in the first 2 weeks after the injury. One complication
Salbutamol MDI & DPI of a severe brain injury is diabetes insipidus. There are no
√ Tablet, syrup, √ 4-6 hours
(albuterol) desmopressin, ICU definitive data
hypernatremia, on the
sustain incidence of diabetes
release insipidus in
12 hours
patients with traumatic severe brain injury of
sustain
Indonesia
to the Emergency Installation (IRD) after release
experiencing a
yud180987@yahoo.com
DPI
traffic accident 12 hours
Tablet
before
√
being hospitalized. After
Terbutalin 4-6 hours
surgery, the signs of diabetes insipidus was presented by
LONG-ACTING (LABA) polyuria of 300cc / hour urine production and 149mmol /
L hypernatremia, although the immediate administration of
Arformoterol desmopressin,
√ the patients clinical and hemodynamic
12 hours was
Formoterol DPI 12 hours
main treatments for diabetes insipidus in traumatic severe
Indaceterol DPI 24 hours
brain injury are adequate rehydration and administration
Olodaterol SMI of desmopressin. Adequate hypovolemic, polyuric and
24 hours
Salmeterol MDI & DPI treatment of diabetes insipidus. Diabetes insipidus in cases
12 hours
ANTICOLINERGIK in the case of being handled improperly, it can bring death.
SHORT-ACTING (SAMA)
ABSTRAK
Ipratropium
Cedera bromide MDI cedera fatal,
√ dengan tingkat kematian hingga6-850%.
hoursSekitar 1,5
otak berat traumatis adalah
juta orang mengalami
Oxitropium bromidecedera otak
MDI berat di Amerika Serikat. Terdapat lebih dari7-9
50.000
hours kematian
LONG-ACTING
pertama (LAMA)
setelah cedera. Salah satu komplikasi dari cedera otak yang parah adalah diabetes insipidus.
Acidinium bromide DPI, MDI 12 hours
Glycopironium DPI solution √ 12 -24

1
bromide 37 hours
QANUN MEDIKA
VOL 4 .lNo
no11 Mei
Mei2019
2019
Oxitropium bromide
QANUN
QANUN
MDI
MEDIKA
MEDIKA 7-9 hours
JURNAL
JURNALKEDOKTERAN
KEDOKTERANFKUM
FKUMSURABAYA
SURABAYA
LONG-ACTING (LAMA)
Acidinium bromide DPI, MDI 12 hours

Case Report
Glycopironium DPI solution
Rawat Darurat (IRD) setelah mengalami kecelakaan lalu lintas 12 jam sebelum dirawat di rumah √ 12 -24
Diabetes
sakit. Setelah
insipidus in patiens with traumatic severe
bromideoperasi, tanda-tanda diabetes insipidus ditandai dengan adanya poliuria
brain injury
hoursproduksi
of AnesthesiologyDPI,
Tiotropium
andSMI
Intensive Care of RSUD Dr. Soetomo, Medical24Faculty
1) Resident hours
of
perawatan
Airlangga di Unit Perawatan Intensif (ICU). Perawatan utama untuk diabetes insipidus pada
University.
Umeclidnium DPI 24 hours
hipovolemik,
ultyCOMBINATIONpoliurik,
of Airlangga dan hipernatremia
University.
SHORT-ACTING BETAyang adekuat adalah kunci keberhasilan pengobatan
2- AGONIS DAN ATIKOLINERGIK
diabetes insipidus. Diabetes insipidus dalam kasus cedera otak membutuhkan perawatan yang
(SABA/SAMA)
rumit. Karena itu, jika ditangani dengan tidak tepat, bisa menyebabkan kematian.
A R T IFenoterol/Iprotropiu
CLE INFO SMI ABSTRACT √ 6-8 hours
Kata kuncim
: Diabetes insipidus, cedera otak, hipernatremia, desmopressin,
Traumatic severe brain injury is a fatal injury, ICUwith a
Correspondence
Submitted : Januari 2019
: yud180987@yahoo.com
mortality √ rate of up to 50%. About 1.5 million
Salbutamol SMI, MDI 6-8 hourspeople
Accepted : February 2019 experience severe brain injury in the United States. There
Published /Iprotropium
INTRODUCTION : Mei 2019 CASE REPORT
a mortality
Keywords: rate of up
COMBINATION to 50%. About
SHORT-ACTING 1.5 2- AGONIS
BETA AND ANTICOLINERGIK
million (LABA/LAMA)
people with severe brain injury in
of a severe brain injury is diabetes insipidus. There are no
traffic accident 12 hours before being
the United States have more than definitive 50,000 data on the incidence
hospitalized. of diabetes
The patient insipidus
is unconscious in
since
hypernatremia, desmopressin, ICU
deaths Formoterol/aclidiniu
and 500,000 permanent DPI neurological
patients with traumatic severe brain injury 12 hours
of
the accident occurred. First aid was given in the Indonesia
sequelae m (Agha and Thompson, so far. In this case report, a male, 45 years old, was taken
2006). previous health facility; RSUD Tuban, thus the
Correspondence:
Formoterol/ MDI to the Emergency Installation (IRD) after experiencing
patient was referred to IRD Dr. Soetomo. 12 hours a
yud180987@yahoo.com
first 2 weeks after the injury, which traffic
exhibits
Glycopironium accident
The 12 hours has
attached After
collar brace at the
the initial impact of systemic hypotension and surgery, the arrival
signs of indiabetes insipidus
resuscitation room was ofpresented
Dr. RSUD by
Indecaterol/Glycopir
intracranial hypertension (Benvenga DPI et al., of 300cc 12 -24
onium
polyuria / hour urine production
Soetomo. Responding to pain, and 149mmol
hourswith the /
2000). L hypernatremia, although the immediate administration of
examination of anisocoria round pupils 4/3
One of tVilanterol/Umeclidin
he complications of a severe brain
DPI injury
desmopressin, the both
mm, patients
eye clinical and hemodynamic
light reflexes were was
decreased.
24 hours
ium
is diabetes insipidus. (Agha and Thompson, not shown any improvements. The patient passed away in the
Spontaneous breathing 30 times per minute
2006; Hannon et al., 2012). Diabetes insipidus days five of treatment in the Intensive Care Unit (ICU). The
presented with an additional gurgling
Olodaterol/Tiotropiu SMI 24 hours breath
is a disease
m caused by the lower production,
main treatments for diabetes insipidus in traumatic
with oxygen saturation of 92% using an oxygen severe
secretion, and function of Anti brain Diuretic injury mask
are adequate rehydration
of 5 liters per minute. and Blood
administration
pressure
Hormone (ADH). Kidney abnormalities
METHYLXANTIN of desmopressin. Adequate hypovolemic,
110/75 mmHg (MAP 86), pulse 120 times per polyuric and
were marked by the unresponsiveness of
hypernatremia corrections
minute. Tip of are
the the keys to were
extremity the warm,
successful
dry
Aminophilin solution √ Up to 24
physiological ADH stimulation, which is
and red with an examination of capillary refill
characterized by excessive thirst (polydipsia) of brain injury requires complicated hours
time <2 seconds. The treatment. Therefore,
right parietooccipital
and large amounts of urine (polyuria). There is in the case of being handled improperly, it can bring death.
hematoma was found. The Uppatient was
Teofilin SR Tablet √ to 24
no definitive data on the incidence of diabetes immediately suctioned and oxygenated with
insipidus in patients with severe brain injury hours
ABSTRAK Jackson Reese 10 liters per minute, a two-lane
in Indonesia so far. intravenous line was attached and 30° head-
Cedera
Diabetes otak berat traumatis
insipidus in cases adalah cedera
of brain fatal, dengan tingkat kematian hingga 50%. Sekitar 1,5
injury up position. The patient was prepared to be
juta orang complicated
requires mengalami cedera otak berat
treatment. di Amerika Serikat. Terdapat lebih dari 50.000 kematian
Diabetes intubated using ETT No.7 and the lip border
dan 500.000can
insipidus insiden
lead gangguan
to death neurologis permanen. Sekitar 85% kematian terjadi dalam 2 minggu
when handled was 21cm. The ventilator used PCV mode with
pertama setelah cedera. Salah satu
improperly. Therefore, the authors are komplikasi dari cedera otak yang parah adalah diabetes insipidus.
RR 16, PC 15, trigger 2, I: E 1: 2, FiO2 50%.
Tidak ada data
interested pasti tentang
in discussing thekejadian diabetes
management ofinsipidus pada pasien dengan cedera otak traumatis
2
38
QANUN MEDIKA
QANUN Vol 5 VOL.4
MEDIKA No41.l no
VOL JANUARY
no 11 Mei 2021
Mei 2019
2019
QANUN
QANUN MEDIKA
MEDIKA
JURNAL
JURNALKEDOKTERAN
KEDOKTERANFKUM
FKUMSURABAYA
SURABAYA
CaseCOMBINATION
Case Report
Report SHORT-ACTING BETA 2- AGONIS AND KORTIKOSTEROID
(LABA/ICS)
Yudha Adi Prabowo1, Prananda
Formoterol/Beclomet MDI Surya Airlangga2
1) Resident of Anesthesiology and Intensive Care of RSUD Dr. Soetomo, Medical Faculty of
1) Resident
Airlangga
asone ofUniversity.
Anesthesiology and Intensive Care of RSUD Dr. Soetomo, Medical Faculty of
Airlangga University.
Formoterol/Budesoni MDI, DPI
ulty
de of Airlangga University.
Formoterol/Mometas MDI
one
A R Salmeterol/
TICLE INFO MDI, DPIABSTRACT
ABSTRACT
Fluticasone Traumatic severe brain injury is a fatal injury, with a
Vilanterol/ : February 2019
Accepted DPI
Fluticasone :furoate
Published Mei 2019 are more than 50,000 deaths and 500,000 incidents of
TRIPEL COMBINATION LAMA/LABA/ICSpermanent neurological sequelae. About 85% of mortality
Fluticasone/ DPI
Diabetes insipidus, brain injury, of a severe brain injury is diabetes insipidus. There are no
Umeclidinium
hypernatremia, desmopressin, ICU definitive data on the incidence of diabetes insipidus in
/Vilanterol patients with traumatic severe brain injury of Indonesia
Beclometasone/Form
Correspondence: MDI so far. In this case report, a male, 45 years old, was taken
oter/ Glycopironium to the Emergency Installation (IRD) after experiencing a
yud180987@yahoo.com
traffic accident 12 hours before being hospitalized. After
PHOSPODIESTERASE-4 INHIBITOR polyuria of 300cc / hour urine production and 149mmol /
Roflumilast
Tablet
desmopressin, the patients clinical and hemodynamic was
MUCOLITIC not shown any improvements. The patient passed away in the
Erdostine main treatments for diabetes insipidus in traumatic severe
Tablet
*) MDI= Metered Dose Inhaler, DPI= of Dry
desmopressin. Adequate
Powder Inhaler, hypovolemic,
SMI= Soft Mist Inhalerpolyuric and
(GOLD, 2017)
ABSTRAK
1
39
QANUN MEDIKA
VOL 4 .lNo
no11 Mei
Mei2019
2019
QANUN
QANUN MEDIKA
MEDIKA
JURNAL
JURNALKEDOKTERAN
KEDOKTERANFKUM
FKUMSURABAYA
SURABAYA
Case Report
Roflumilast accumulation, and decreased release chemokine
Diabetes
The IUPAC
sakit. Setelah
insipidus inforpatiens
nametanda-tanda
operasi,
with traumatic
Roflumilast level significantly severe brain
(Sisson et al.,injury
diabetes insipidus ditandai dengan adanya poliuria produksi
2018).
is
Yudha 3-(cyclopropylmethoxy)
Adi Prabowo1, Prananda Surya N-(3,5-Airlangga2 Roflumilast is available in a 500 mg single dose
dichloropyridin-4-yl)-4-(difluoromethoxy)
1) Resident of Anesthesiology and Intensive Caredaily tablet.
of RSUD Dr. Bioavailability
Soetomo, Medical is around
Faculty of 80%.
benzamide
perawatan
Airlangga (figure
di Unit 1); CAS 162401-32-3
Perawatan
University. with Perawatan
Intensif (ICU). Maximum plasma
utama untuk Roflumilast concentration
diabetes insipidus pada
empirical formula C17H14Cl2F2N2O3 and is achieved
2) Staff Departement of Anesthesiology and Reanimation of RSUD Dr. Soetomo, Medical Fac- approximately 1 hour (range 0.5-2
molecular
ulty ofweight
hipovolemik, is 403,22.
poliurik,
Airlangga dan These compounds
hipernatremia
University. hours) after
yang adekuat adalah a single
kunci dose administration.
keberhasilan At the
pengobatan
are achiral,
diabetes a whiteDiabetes
insipidus. crystalline solid, and
insipidus dalam its kasus same time,otak
cedera the membutuhkan
high concentration in the yang
perawatan form
melting point is 158°C (Giembycz & Field, of active
rumit. Karena itu, jika ditangani dengan tidak tepat, bisa menyebabkan kematian. N-oxide metabolites is accomplished
2010). Roflumilast is a highly-selective ABSTRACTwithin 8 hours (range 4-13 hours). Roflumilast
A R T I C L E I N F inhibitor
phosphodiesterase-4 O (PDE4) part has anhipernatremia,
active metabolite form both ICU have strong
Kata kunci : Diabetes insipidus, Traumaticcederasevere
otak, brain injury is desmopressin,
a fatal injury, with a
of Roflumilast
the PDA enzyme as a therapy for severe plasma protein bonds of around 97%. In phase
Correspondence
: yud180987@yahoo.com mortality rate of up to 50%. About 1.5 million people
COPD
Accepted with a : name
The IUPAC history
FebruaryforofRoflumilast
chronic bronchitis
2019 I, cytochrome N-(3,5-dichloropyridin-4-yl)-4-
is 3-(cyclopropylmethoxy) P450 (CYP) isoenzymes 1A2
and exacerbations.
Published
INTRODUCTION
(difluoromethoxy) The
: Mei 2019 mechanism
benzamide (figure of PDE4 1); than and
CASE
CAS 3A4 and
REPORT
162401-32-3 in phase II, conjugation reactions
are more 50,000 deaths with empiricalincidents
and 500,000 formula of
inhibitors is by hydrolyzing
C17H14Cl2F2N2O3 and cyclic adenosine
molecular weight is metabolic
403,22. These processes
compounds takes
are place.
achiral, Roflumilast
a white
monophosphate
crystalline solid, (cAMP)
andup in inflammatory
its melting point is 158°C has a half-life of 17 Roflumilast
hours. In patients with
a mortality
Keywords: rate of to 50%. About 1.5 (Giembycz & Field, 2010).
Hospital (IRD) Dr. Soetomo after a motorcycle is a highly-
cells. Somephosphodiesterase-4
selective anti-inflammatoryinhibitor effects(PDE4)are part hepatic
of the PDA disorders,
enzymeRoflumilast
as a therapy for elimination
severe
million people with severe brain injury in
Diabetes
produced insipidus,
by brain
increasing injury,
intracellular cAMP, disorder is likely to occur, however dosage
the COPD
United withStates
a history of chronic
have bronchitis
more than and
50,000 exacerbations. The mechanism of PDE4 inhibitors
hypernatremia,
including
is by and
hydrolyzingdesmopressin,
decreased ICU definitive
neutrophil release
data on the incidence
hospitalized.
adjustments The
are not
of diabetes
patient
required. Dose
insipidus
is unconscious adjustment
in
since
deaths 500,000 cyclic adenosine
permanent monophosphate
neurological
patients with
the (cAMP) in
traumatic
accident inflammatory
severe brain
occurred. First cells.
injury
aid waswith Some
of anti-
Indonesia
givenkidney
in the
as inflammatory
an inflammatory are mediator, cytokinin is also not necessary cAMP,in including
patients
sequelae (Agha effects and Thompson, produced by increasing
2006). intracellular
previous health facility; RSUD Tuban, thus the decreased
Correspondence:
release, and apoptosis.
neutrophil release as an Roflumilast
inflammatory decreases
mediator, disorders.
cytokinin Roflumilast
release, and is not supposed
apoptosis. Roflumilast to be
Approximately 85% of mortality occurs in the to the Emergency Installation (IRD)
patient was referred to IRD Dr. Soetomo. after experiencing a
allergens
decreases that
yud180987@yahoo.com cause
allergens that inflammation
cause inflammation and and given
stabilize along
the with CYP3A4
inflammatory systemstrong inhibitors
induced by
first 2 weeks after the injury, which traffic exhibits accident
The 12 hours has
attached collar After
brace at the
stabilize the inflammatory
lipopolysaccharides. system induced
Phosphodiesterase inhibition or dual
present CYP3A4
as and CYP1A2
anti-inflammation, anti inhibitors
remodeling, such
Dr. RSUD by
by andlipopolysaccharides.
bronchodilator Phosphodiesterase
effect (Benvenga
(Zuo et al., 2019). as studies
erythromycin, ketoconazole, cimetidine
reduces or
intracranial hypertension et al., Other
polyuria of 300cc
Soetomo. / showed
hour urine that
Responding
PDE4 inhibitor
production to and 149mmol /
inhibition
pulmonary present
fibrosis byastargeted
anti-inflammation,
type II AEC injury, rifampicin.
collagen Azithromycin
accumulation, and a pain,
is decreased
macrolide with group
release
the
examination of anisocoria round with pupils 4/3
antichemokine
remodeling, and bronchodilator
level significantly (Sisson etieffect
al., 2018).that is generally given to patients COPD
One of the complications of a severe brain njury
desmopressin, mm, the patients
both clinical and hemodynamic was
(Zuo et al., 2019). Other studies showed that who is onlyeye light inhibitor
a weak reflexes were of CYP3A4 decreased. and
PDE4 inhibitor reduces pulmonary fibrosis interactions with Roflumilast lighter than
presented with an additional
by targeted type II AEC injury, collagen erythromycin (Wedzicha et al., gurgling
2016). breath
is a disease caused by the lower production, main treatments for diabetes insipidus in
with oxygen saturation of 92% using an oxygen traumatic severe
are adequate
of 5 liters rehydration
per minute. and Blood
administration
pressure
Hormone (ADH). Kidney abnormalities of desmopressin. Adequate hypovolemic,
were marked by the unresponsiveness of
minute. Tip of are the the keys to were
extremity the warm,
successful dry
characterized by excessive thirst (polydipsia) of brain injury time requires complicated
<2 seconds. The treatment. Therefore,
hematoma was found. The patient was
in Indonesia so far. intravenous line was attached and 30° head-
Cedera
dan 500.000can
insipidus insiden
lead gangguan
to death neurologis
when permanen. Sekitar 85% kematian terjadi dalam 2 minggu
handled
Figure 1. The Structure was 21cm. The&ventilator
of Roflumilast used PCV mode with
pertama setelah
Figurecedera.
1. Salah
The satu
Structure
improperly. Therefore, the authors are komplikasi
of Roflumilast cedera(Giembycz
dari(Giembycz otak&yang Field, Field,
parah 2010)
2010)adalah diabetes insipidus.
Tidak ada data
interested
Roflumilast pasti
in discussing
is tentang
available theinkejadian diabetes
amanagement
500 mg ofinsipidus
single dose daily pada pasien
tablet. dengan cedera
Bioavailability otak traumatis
is around 80%.
Maximum plasma Roflumilast concentration is achieved approximately 1 hour (range 0.5-2 hours)
after a single dose administration. At the same time, the high concentration in the form of active
2 (range 4-13 hours). Roflumilast has an active
N-oxide metabolites is accomplished within 8 hours
metabolite form both have strong plasma protein40 bonds of around 97%. In phase I, cytochrome
P450 (CYP) isoenzymes 1A2 and 3A4 and in phase II, conjugation reactions metabolic processes
QANUN MEDIKA
QANUN Vol 5 VOL.4
MEDIKA No41.l no
VOL JANUARY
no 11 Mei 2021
Mei 2019
2019
QANUN
QANUN MEDIKA
MEDIKA
JURNAL
JURNALKEDOKTERAN
KEDOKTERANFKUM
FKUMSURABAYA
SURABAYA
Case
Case
An Reportdrug reaction of Roflumilast is
Report
adverse Seven randomized controlled trials on
Diabetes
digestive insipidus
disorders in patiens
such asindiarrhea,with traumatic
nausea, severe
the brain injury
participants’ safety tend injury
to have more
Diabetes insipidus patiens with traumatic severe brain
and
Yudha weight loss.
Adi along Other
Prabowo1, side effects
Prananda that
Surya arise
Airlangga2side effects of Roflumilast than placebo,
Yudhabe given
Adi with CYP3A4
Prabowo1, Prananda strong inhibitors
Surya or dual CYP3A4 and CYP1A2 inhibitors such as
Airlangga2
are sleep disturbance,
1)erythromycin,
Resident decreased and
of Anesthesiology appetite, and Caregastrointestinal
Intensive of RSUD side effects
Dr. Soetomo, (diarrhea,
Medical nausea,
Faculty ofthat is
back pain when ketoconazole,
compared with cimetidine
placebo. or rifampicin.
The vomiting),Azithromycin
headaches, is a
and macrolide
weight group
loss. There
1) Resident
Airlangga of Anesthesiology
University. and Intensive Care of RSUD Dr. Soetomo, Medical Faculty of
generally
general given
side effect
Airlangga to patients
of with COPD
severe COPD
University. is weightwho is only
was anoweak inhibitor difference
meaningful of CYP3A4inand theinteractions
risk of
loss.with Roflumilast
ThisofcanAirlangga lighter
be attributed than erythromycin
to increased cAMP (Wedzicha et al., 2016).
heart complications or flu-like symptoms
ulty University.
on lipolysis regulation.
ulty of Airlangga Research conducted
University. or upper respiratory infections. Roflumilast
An adverse drug reaction of Roflumilast
in China states that the most common adverse is digestive disorders
reduces moderate such to
as severe
diarrhea, nausea,
attacks andleads
and weight
loss.related
effects Other side
to the effects thatRoflumilast
use of arise are sleep are disturbance, decreased
to significant appetite, andinback
improvements pain when
pulmonary
uppercompared with tract
respiratory placebo. The general
infections, side effect
anorexia,
ABSTRACT
ABSTRACT of severe
function COPD is
regardless of weight loss. This
the severity of can
the be
ARTICLE INFO
attributed
weight loss, toandincreased cAMP
diarrhea. on lipolysis
Physical checkregulation.
Traumatic diseaseResearch
severe conducted
and concomitant
brain injury is ause inofChina
fatal standardstates
injury, thatathe
COPD
with
Submitted
and laboratory
most common :tests,
Januari
such2019
adverse aseffects
complete blood
related to the
mortality therapies
rate use
of of (Andarian
up Roflumilast etare
to 50%. About al., 2016).
upper respiratory
1.5 million tract
people
Accepted
tests,
infections, : Februaryweight
blood chemistry,
anorexia, 2019 analysis,
urine andand
loss, experience
diarrhea. Physical
severe check in
brain injury andthe laboratory tests, such as
United States. There
Published
electrocardiogram, : Mei 2019
did not explain
complete blood tests, blood chemistry, clinically urinethan
are more analysis,
50,000 anddeaths
electrocardiogram,
and 500,000 did not explain
incidents of
relevant side effects (Lee et al., 2016).
clinically relevant side effects (Leepermanent et al., 2016).neurological sequelae. About 85% of mortality
Table 2. Side
Table 2. insipidus, Effects
Side Effects of Roflumilast
of Roflumilast of a severe brain injury is diabetes insipidus. There are no
Diabetes brain injury,
Roflumilast
patients (n=102) Placebo (n=105)
with traumatic severe brain injury value
of pIndonesia
n (%) case n (%) case
to the Emergency Installation (IRD) after experiencing a
yud180987@yahoo.com
All bad events traffic accident
71 (69,6) 176 12 hours
48 (45,7) before being
78 hospitalized.
<0,01 After
Upper respiratory tract polyuria
21 (20,6) of 24
300cc / hour
10 (9,5)urine production
10 and 149mmol /
0,03
infection L hypernatremia, although the immediate administration of
Diarrhea not shown any improvements. The patient passed away in the
14 (13,7) 14 0 0 <0,01
Weight loss 9 (8,8) 9
main treatments 1 (1,0) insipidus
for diabetes 1 in traumatic
0,01 severe
Anorexia 9 (8,8) 9
of desmopressin. 0
Adequate 0
hypovolemic, <0,01
polyuric and
COPD exerbation 9 (8,8) 9 12 (11,4) 14
treatment of diabetes insipidus. Diabetes insipidus in cases 0,64
Decreased appetite 6 (5,9) 6 1 (1,0) 1 0,06
Gastritis 5 (4,9) 5 0 0 0,03
ABSTRAK
Constipation 4 (3,9) 4 1 (1,0) 1 0,20
juta orang mengalami cedera otak4berat
Dizzy (3,9)di Amerika 4 Serikat. Terdapat
0 lebih0 dari 50.0000,06 kematian
pertama setelah cedera. Salah satu komplikasi
Rhinorrhea 4 (3,9) dari cedera
4 otak1 yang
(1,0) parah adalah
1 diabetes
0,21insipidus.
Source: Lee et al., 2016
1
41
QANUN MEDIKA
VOL 4 .lNo
no11 Mei
Mei2019
2019
QANUN
QANUN MEDIKA
MEDIKA
JURNAL
JURNALKEDOKTERAN
KEDOKTERANFKUM
FKUMSURABAYA
SURABAYA
Case Report
Efficacy and safety The safety dan clinical effect of Roflumilast in
Diabetes
The effectiveness
sakit.
insipidus
Setelah operasi,
in patiens
and tanda-tanda
safety of Roflumilast with traumatic
diabetes insipidus
the COPD patient
ditandai
severe
dengan
wasbrain
evaluated
adanya
injury
by a Chinese
poliuria produksi
for the administration of COPD were assessed study group using RCT. They identified nine
in articles and 13 RCT studies showing that
1) 9Resident
phase IIof/ Anesthesiology
IV randomizedand double-blind
Intensive Carepatientsof RSUD Dr. Soetomo,
given Medicalbenefited
with Roflumilast Faculty of from
clinical
perawatan trials.
Airlangga Past
di Unit phase III studies, treatment
Perawatan Intensif (ICU). Perawatan
University. utama untuk diabetes insipidus pada
with 500 mg Roflumilast tablets, have an improved lung function and quality of life only
with some side effects. Roflumilast can prevent
increased
hipovolemik, pulmonary
poliurik, function
dan association
hipernatremia yang adekuat adalah increase
kunci keberhasilan
ulty of Airlangga
comparedinsipidus.
with placebo.
University.
Other studiesdalam also kasus exacerbation, lung functionpengobatan
in terms of
diabetes Diabetes insipidus cedera otak membutuhkan perawatan
FEV 1, and forced vital capacity. As for safety, yang
explained Roflumilast could fixed lung
function in severe COPD. It couldABSTRACT reduce the overall cumulative incidence of ADR for
A R T I C L E inI N
exacerbations FO
moderate to severe COPD the Roflumilast group was more significant
Kata kunci : Diabetes insipidus, cederasevere
Traumatic otak,
than thehipernatremia,
brain injury
placebo groupdesmopressin,
is a fatal
(Liu ICUwith a
injury,
et al., 2018).
compared
Correspondence
Submitted to placebo.
: Januari The2019 study showed
: yud180987@yahoo.com that
Roflumilast therapy
Accepted significantly
: February 2019 reduced the
average
Published
INTRODUCTION incidence of
: Mei 2019 repeated exacerbations CASE REPORT
and the length of stay in the hospital (Cilli et
al., 2019).
a mortality rate of up to 50%. About
Keywords: 1.5
million people with severe brain injury in
Diabetes
Table 3. insipidus, brain injury,
Cost-Effectiveness of Roflumilast Addition
is unconscious in
since
deaths and 500,000 permanent neurological patients with traumatic severe brain injury
the accident occurred. First aid was given in theof Indonesia
sequelae (Agha and LAMA+ Thompson, LA 2006). Incr LAB LAB Incr LAMA+ LA
previous health facility; RSUD Tuban, thus the
Incr
Correspondence: Roflumil MA eme A/IC A/IC eme LABA/I MA eme
Approximately 85% of mortality occurs in the to the Emergency Installation (IRD) after experiencing a
yud180987@yahoo.com ast ntal S+ patient was referred to IRD Dr. Soetomo.
S ntal CS+ +LA ntal
first 2 weeks after the injury, which traffic exhibits accident
The 12 hours has
patient before being hospitalized.
attached After
Rofl Roflumil a collar
BA/I brace at the
the initial impact of systemic hypotension and surgery, the umilsigns of indiabetes
arrival insipidus
resuscitation
ast room was ofpresented
CS Dr. RSUD by
intracranial hypertension (Benvenga polyuria et al., of 300cc / hour urine production
ast Soetomo. Responding to pain, with the and 149mmol /
One Total
of the c omplications
cost of CHF o f
86.754a
s evere b rain
83.364 i njury
desmopressin,
3390 91.470 the patients
mm, 88.161
both 3308 clinical
99.364 and hemodynamic
eye light reflexes 95.564 3799
were decreased. was
35.857 25.481 10.376 40.917 30.279 10.638 43.533 37.682 10.851
2006; Hannon et al., 2012). Diabetes insipidus
Maintenance costs, CHF days five of treatment in the Intensive Care Unit (ICU). The
presented with an additional gurgling breath
is a disease caused by the lower production, main treatments for diabetes insipidus in 2331
traumatic
with oxygen saturation of 92% using an oxygen severe
2039 2.331 -292 20248. 2331 -306 2036 -295
secretion, and function of Anti brain
Exerbation treatment Diuretic injury are adequate
5285mask rehydration
administration
pressure
Hormone
costs, CHF (ADH). Kidney abnormalities of desmopressin. Adequate hypovolemic,
were marked by the 48.858 unresponsiveness
55.552 -6694
of 9.642minute.
55.552Tip of are
-7024 the the keys 55.552
extremity
48.795 to were
the -6757
successful
warm, dry
Ex-hospital maintenance
fees
of brain injury time requires complicated
<2 seconds. The treatment. Therefore,
and large amounts of urine (polyuria). There is
Life year (LY) 9.625 9.278in the case of being handled improperly, it can bring death.
0,347 hematoma
6.479 9.278 was 9.628
0,364 found. The 9.278 patient
0.351 was
QALY 6.466 6.191 0,275 11.456 6191 0,289 6.468 6.191 0,278
in Indonesia
ICER,CHF perso far. 12.313
QALY 9078intravenous line was 13.671 attached and 30° head-
Cedera otak
Diabetes insipidus berat traumatis
in cases adalah cedera
injury up position. The 10.833 patient was prepared to be
ICER,CHF
requires mengalami
per LY cedera
9.757 otak berat
treatment. di Amerika Serikat. Terdapat
Diabetes lebih dari 50.000 kematian
intubated using ETT No.7 and the lip border
dan 500.000can
insipidus insiden
lead gangguan
to costs
death neurologis
when medical permanen. Sekitar 85% kematian terjadi dalam 2 minggu
handled
*) note: maintenance including serviceswasand21cm.
COPD The fees,ventilator
reimbursementusedofPCV costsmode with of
(deduction
pertama
improperly. setelah cedera.
Therefore, Salah satu komplikasi
the et authors dari cedera otak yang parah adalah diabetes insipidus.
Roflumilast fees) (Samyshkin al., 2014) are RR 16, PC 15, trigger 2, I: E 1: 2, FiO2 50%.
Tidak
interestedada data pasti tentang
in discussing thekejadian
managementdiabetes ofinsipidus pada pasien dengan cedera otak traumatis
Cost-effectiveness
The cost-effectiveness of adding therapy
2 with Roflumilast can be seen from the magnitude
of treatment costs and the effectiveness of the therapy as in (Table 3). From observations, show
42
that the addition of Roflumilast can increase the total cost. The addition of Roflumilast for
maintenance can lead to increased medical costs. Costs needed in patients with increased
LAMA+ LA Incr LAB LABMEDIKA
Incr Vol
LAMA+ LA1 JANUARY
QANUN
QANUN MEDIKA 5 VOL.4
No
VOL noIncr
4 .l no 11 Mei 2021
Mei 2019
2019
Roflumil MA eme A/IC A/IC eme LABA/I MA eme
ast ntal S+ S ntal CS+ +LA ntal
Rofl Roflumil BA/I
QANUN
QANUN MEDIKA
MEDIKA umil ast CS
ast
JURNAL
JURNALKEDOKTERAN
KEDOKTERANFKUM
FKUMSURABAYA
SURABAYA
86.754 http://journal.um-surabaya.ac.id/index.php/qanunmedika
83.364 3390 91.470 88.161 3308 99.364 95.564 3799
Total cost of CHF
35.857 25.481 10.376 40.917 30.279 10.638 43.533 37.682 10.851

CaseReport
Case
Maintenance
Combination Report
costs, CHF
Roflumilast with salmeterol and
Diabetes
tiotropium insipidus
also 2039in
gives patiens
significant with-292traumatic
results when peptide
severe-306agonists
brain are one treatment
injury for diabetes.
Diabetes
Exerbation insipidus
treatment in 2.331
patiens with traumatic
20248. 2331
5285
severe
2036
brain
2331
In a 12-week study, compared with placebo injury
-295
compared
Yudha with single drug administration.
CHF Adi Prabowo1, Prananda Surya Airlangga2
costs,
Yudha Adi
Patients withPrabowo1,
COPD Prananda exacerbations Surya Airlangga2 patients newly diagnosed with type II diabetes,
1) Resident of Anesthesiology and IntensiveofCareRoflumilastof RSUD Dr. canSoetomo,
increase Medical
insulin Faculty of
sensitivity
more than
1) Resident 2 ofyears
Airlangga University.
Ex-hospital maintenance receiving
Anesthesiology
48.858 treatment
and
55.552 -6694 with
Intensive Care
9.642 of
55.552RSUD-7024 Dr. Soetomo,
48.795 Medical
55.552 Faculty
-6757 of
Roflumilast
fees Airlanggashowed University. a very large reduction and reduce the HbA1c value (Wedzicha et al.,
the duration of exacerbations 2016).
in2) Staff Departement of Anesthesiology and Reanimation of RSUD Dr. Soetomo, Medical Fac-
ulty of Airlangga University. compared to
placebo.
Life year (LY)The same9.625
ulty of Airlanggaresults were
University.9.278 also 0,347shown 6.479 Cost-effectiveness
9.278 0,364 9.628 9.278 0.351
with
QALY the use of Roflumilast 6.466 combined
6.191 0,275LABA 11.456 The6191 cost-effectiveness
0,289 6.468 of6.191
adding therapy with
0,278
(long-acting beta-2 agonist) or ICS (inhalation Roflumilast can be seen from the magnitude
ICER,CHF per QALY 12.313 9078 13.671
corticosteroid). In DAKOTA (Daxas for COPD
ABSTRACT
ABSTRACT of treatment costs and the effectiveness of the
ARTICLE INFO
therapy)
ICER,CHF per research
LY on the impact of Roflumilast
9.757 Traumatic severe therapybrain injury
10.833 is a fatal injury, with a
as in (Table 3). From observations, show
Submitted
on the quality :ofJanuari life of 2019patients withmortality COPD, rate
*)itAccepted
note: maintenance costs including medical services
that the addition ofAbout
of up to 50%. 1.5 million
Roflumilast
and COPD fees, reimbursement of costs (deduction of
people
can increase
shows that: February
Roflumilast 2019can provide a
Roflumilast fees) (Samyshkin et al., 2014) experience severe the totalbrain
cost.injury
The in the United
addition States. There
of Roflumilast for
Published
substantial : Mei 2019in the quality
improvement are ofmore
life than 50,000 deaths and 500,000 incidents of
maintenance can lead to increased medical
than placebo. However,
Cost-effectiveness the statistics did not
permanent neurological
costs. Costs sequelae. About
needed in patients 85% with of increased
mortality
show
Keywords: a difference significant in terms of cost;
exacerbations, in outpatients and inpatients can
the useThe of cost-effectiveness
Roflumilast can save of adding therapy
if used with Roflumilast can be seen from the magnitude
costsof a severe brain injury is diabetes insipidus. There are no
reduce
Diabetes
of insipidus,
treatment costs brain
and injury,
the
in treatment standards. Roflumilast definitive effectiveness of the
can also data therapy astreatment
in (Table costs.
3). From In terms of age, ashow
observations, little
hypernatremia, desmopressin, ICU can on
longer the
in incidence
patients using of diabetes
additional insipidus
Roflumilast. in
save that costs
the addition
when of Roflumilast
combined with increase the total cost. The addition of Roflumilast for
tiotropium
maintenance can lead to or increased patients
medical with traumatic
While in terms severe brain
neededofinquality injury
of with of
age in Indonesia
patients
and salmeterol/fluticasone or ICS. costs. with
Costs
Roflumilast
patients
LABAso far. In this case report, a male, 45 years old, was taken
slightly higher than
increased
those not
exacerbations, in outpatients
Correspondence:
Glucagon-like-peptide-1 levels areandincreased
inpatientsbycan reduce treatment costs. In terms of age, a little
longer in patients using additional to the Emergency
Roflumilast. While Installation
usinginadditional
terms of quality (IRD) of after
Roflumilast. inexperiencing
age (van witha
der Schans
patients
yud180987@yahoo.com
PDE4 inhibitor. Where glucagon receptors like
traffic
Roflumilast slightly higher than those not using additional accident 12 hours
et al., 2017). Roflumilast. (van der Schans etAfter
before being hospitalized. al.,
2017). surgery, the signs of diabetes insipidus was presented by
polyuria of 300cc / hour urine production and 149mmol /
Table 4. Cost Effectiveness of Roflumilast L hypernatremia, although the immediate administration of
Table 3. Cost Effectiveness of Roflumilast
First Type Horizo Pundin desmopressin,
Drug Differentthe patients
Differenticlinical ICERand hemodynamic
Author's was
QHES
author of n g
therapy ial total al conclusion score
(year) researc cost s S
countr h brain injury (year)
are adequate rehydration and administration
y of desmopressin. Adequate hypovolemic, polyuric and
(Samysh Marcov lifetime takeda treatment of diabetes insipidus. Diabetes insipidus in cases
1. LABA 1 vs 2 + +0.164QAL £19,505 Roflumilast 91
kin et al., model +Roflumil £3197 Ys (€22.305)per combination
2014) (CUA) ast (+£3656) QALY with PROFIT
+0,175 LY
(UK) 2. LABA several becomes cost
years effective in
ABSTRAK research COPD
dan 500.000
(Samysh insiden
Marcov gangguan
lifetime takedaneurologis
1. The permanen.1 vs 2acSekitar
+ 1a 85% kematian
vs 2ac 1a vs terjadi dalam 2inminggu
2ac Roflumilast 94
pertama
kin et al., setelah
model cedera. Salah satu komplikasi
addition of dari cedera
£3390 CHF otak yang parah
+0.347 adalah
12.313 CHF diabetes
combinationinsipidus.
Tidak
2013) ada(CUA) data pasti tentang kejadian diabetes
Roflumila insipidus
(+£2815) pada pasien dengan
LY/+0,275 (€10.225) cedera
with otak traumatis
PROFIT
(Switzerl st on: per QALY becomes a cost
and) a. LAMA 1b vs 2bc + 1b vs 2b effective with
3308 CHF +0,364 1b vs 2b
b. LABA/I 1 exacerbation
CS 43
(£2747) LY/0,289 11.456 CHF frequency
c. LAMA QALY (€ 9511) per
1c vs 2c
QANUN MEDIKA
VOL 4 .lNo
no11 Mei
Mei2019
2019
(Samysh Marcov lifetime takeda 1. LABA 1 vs 2 + +0.164QAL £19,505 Roflumilast 91
kin et al., model +Roflumil £3197 Ys (€22.305)per combination
2014)
(UK)
(CUA)
QANUN
QANUN MEDIKA
MEDIKAast
2. LABA
(+£3656)
several +0,175 LY
QALY with PROFIT
becomes cost
JURNAL
JURNALKEDOKTERAN
KEDOKTERAN
years
FKUM
FKUMSURABAYA
SURABAYA effective in
research COPD
Case Report
(Samysh Marcov lifetime takeda 1. The 1 vs 2ac + 1a vs 2ac 1a vs 2ac Roflumilast in 94
Diabetes
kin et al., modelinsipidus in patiens with
addition of traumatic
£3390 CHF +0.347severe brain
12.313
sakit. Setelah operasi, tanda-tanda diabetes insipidus ditandai dengan adanya poliuria produksi
injury
CHF combination
2013) (CUA) Roflumila (+£2815) LY/+0,275 (€10.225) with PROFIT
(Switzerl st on: per QALY becomes a cost
1)
and)Resident of Anesthesiology and Intensive a. LAMA Care 1b vsof RSUD
2bc + 1b Dr. vs Soetomo,
2b Medical Faculty
effective with of
perawatan
Airlangga di Unit Perawatan Intensif b. (ICU).
University. Perawatan utama untuk
LABA/I 3308 CHF +0,364 1b diabetes insipidus pada
vs 2b exacerbation
CS (£2747) LY/0,289 11.456 CHF frequency
hipovolemik, poliurik,
ulty of Airlangga dan hipernatremia
University. c. LAMA yang adekuat adalah
QALY kunci
(€ keberhasilan
9511) per pengobatan
1c vs 2c
diabetes insipidus. Diabetes insipidus dalam +LABA kasus cedera otak membutuhkan
QALY perawatan yang
+3799 CHF 1c vs 2c
/ICS
(£3155) +0,351 1c vs 2c
2.ABSTRACT
LABA
ARTICLE INFO LY/+0,278 13.671 CHF
Kata kunci : Diabetes insipidus,
Traumatic cedera otak, hipernatremia,
severe brain desmopressin, ICUwith a
QALYinjury (€11.353)
is a fatal injury,
a. LAMA (2011)
Correspondence
: yud180987@yahoo.comb. LABA/I
mortality rate of up to 50%. About per QALY 1.5 million people
Accepted : February 2019 CS
Published
INTRODUCTION : Mei 2019 c. LAMA
are more than CASE REPORT
50,000 deaths and 500,000 incidents of
+LABA
/ICS
a mortality rate of up to 50%. About
Keywords: 1.5
(Hertel et Marcov lifetime MSD 1. The
million people with severe brain injury in ICStraffic
tolerant ICS ICS tolerant Roflumilast for 85
accident 12 hours before being
Diabetes
al., insipidus,
model brain injury, addition of +£414 tolerance: £16,566 standard
is unconscious in
since
hypernatremia,
2012a) (CUA) desmopressin, ICU Roflumila (£447) +0,03 (€19.087) treatment is
deaths and 500,000 permanent neurological patients with traumatic
the accident severe
occurred. brain injury
First aid cost of Indonesia
was effective
given in the
(UK) st on: LY/+0,003 per QALY
sequelae (Agha and Thompson, so far. In this case report, a male, 45 years old, was taken
2006). ICSprevious health facility; RSUD Tuban, thus the
Correspondence: LAMA QALY for patients
Approximately 85% of mortality occurs in the to the Emergency Installation (IRD)
patient was referred to IRD Dr. Soetomo.
intolerant + ICS after experiencing a
yud180987@yahoo.com
first 2 weeks after the injury, which traffic
+LABA
exhibits
who continue
/ICS
accident The
£ 408 12
(£470) hours
patient
ICS has before being a hospitalized.
attached
intolerant collar brace at
bronchodilator
After
the
the initial impact of systemic hypotension and surgery, the
2. LAMA+L
signs of inintolerant:
arrival
(2011) diabetes insipidus
resuscitation
£36,764 room was ofpresented
Dr. RSUD
exacerbation
by
intracranial hypertension (Benvenga polyuria et
ABA/ICS
al., of 300cc / hour urine production
Soetomo. Responding to pain, with the
+0,04 (€15.859) and 149mmol /
For ICS examination of anisocoria
LY/+0,003 per QALY round pupils 4/3
One of the complications of a severe brain i njury
desmopressin,
tolerant the patients clinical
mm, both eye light reflexes
QALY and hemodynamic
were decreased. was
and Spontaneous breathing 30 times per minute
intolerant presented with an additional gurgling breath
is a disease caused by the lower production, main treatments
separately for diabetes insipidus in traumatic severe
with oxygen saturation of 92% using an oxygen
are adequate rehydration
administration
pressure
Hormone (ADH). Kidney abnormalities of desmopressin. Adequate hypovolemic,
were
(Nowak
marked
Marcov
by lifetime
the unresponsiveness
Nycomed 1.Roflum
of +64500
minute. Tip are the
+0,234of the €19,457
keys
extremity to Cost
per were
the effective
successful
warm, dry
83,5
physiological
et al., model
ADH stimulation, which
ilast +
is
(2011) QALY QALY get Roflumilast
2013) (CUA) of
LABA brain injury
time requires
<2 +0,257 complicated
seconds.
LY The treatment.
€1852 right Therefore,
parietooccipital
per added LABA
hematoma was found. The in patients with was
patient
no definitive data on the incidence of diabetes immediately suctioned and oxygenated COPD with
ABSTRAK
(German 2. Jackson Reese 10 liters per minute, a two-lane
-2,43 reduction in symptoms with
iny)Indonesia so far. LABA intravenous line was attached theand
exacerbation 30°
addition of head-
Cedera
several
additional
dan 500.000can
insipidus insiden
lead gangguan
to death neurologis
when handled permanen. Sekitar 85% kematian terjadi dalam 2 minggu
was 21cm. The ventilator used PCV mode with treatments
pertama setelah cedera. Salah satu
improperly. Therefore, the authors are komplikasi dari cedera otak yang parah adalah diabetes insipidus.
Tidak ada data
interested pasti tentang
in discussing thekejadian diabetes
management ofinsipidus pada pasien dengan cedera otak traumatis
According to (Samyshkin et al., 2014) (UK), it was explained that in the administration of therapy
with LABA combined with Roflumilast compared 2 with therapy only with LABA giving a
44
difference in treatment costs of + £ 3197 with different results of +0.164 QALYs and a value of +
0.175 Lys with an ICER value of £ 19.505 per QALY. In concluding that Roflumilast's addition
QANUN MEDIKA
QANUN Vol 5 VOL.4
MEDIKA No41.l no
VOL JANUARY
no 11 Mei 2021
Mei 2019
2019
QANUN
QANUN MEDIKA
MEDIKA
JURNAL
JURNALKEDOKTERAN
KEDOKTERANFKUM
FKUMSURABAYA
SURABAYA
CaseReport
Case
AccordingReport to (Samyshkin et al., 2014) (UK), in the administration of therapy with LABA
Diabetes
itDiabetes insipidus
was explained that in
in patiens
the with traumatic +severe braincompared
injury with LABA giving
insipidus inadministration
patiens with of traumatic
Roflumilast severe brain injury
therapy withPrabowo1,
Yudha Adi LABA combined Pranandawith Roflumilast
Surya Airlangga2 a difference in + € 4500. The conclusion is
Yudha Adi
compared with Prabowo1, Prananda Surya
givingAirlangga2
1) Resident oftherapy only
Anesthesiology withandLABAIntensive Carethe cost-effectiveness
of RSUD Dr. Soetomo, of Medical
adding Roflumilast
Faculty of
a 1)
difference
Resident inoftreatment costs
Anesthesiology
Airlangga University. of +
and£ 3197 with
Intensive Careto
of LABA
RSUD therapy
Dr. in patients
Soetomo, with
Medical severe of
Faculty and
different resultsUniversity.
Airlangga of +0.164 QALYs and a value very severe COPD is comparable to other
of2) Staff Departement of Anesthesiology and Reanimation of RSUD Dr. Soetomo, Medical Fac-
+ ulty
0.175ofLys with an University.
Airlangga ICER value of £ 19.505 therapy. Roflumilast preparations already exist
per ulty
QALY. In concluding
of Airlangga that Roflumilast’s in Indonesia with the trade name DAXAS 500
University.
addition to the PROFIT can increase the micrograms film-coated (Takeda) but there is
effectiveness and cost of diagnosing severe no data on the use of roflumilast in Indonesia.
COPD. According to (Samyshkin et al., 2013)
ABSTRACT
ABSTRACT
ARTICLE INFO
in Switzerland, it was explained that in the severe brain injury is a fatal injury, with a
Traumatic
Submitted : of
administration Januari
therapy 2019 with LAMA CONCLUSION
(1) rate
mortality of up to 50%. About 1.5 million people
Accepted
or LABA / ICS: February
(2) or LAMA 2019+ LABA / ICS Roflumilast
experience severe is PDE4
brain injury inhibitor
in the as an anti-
United States. There
Published
(3) combined :with Mei Roflumilast
2019 compared
are more to than
inflammation and anti-remodeling.
50,000 deaths and 500,000 Roflumilast
incidents of
therapy with only LAMA (1) or LABA / ICS can be usedsequelae. About
permanent neurological single or in combination. In a
85% of mortality
(2) or LAMA
Keywords: + LABA / ICS (3) alone gives review of efficacy, it can prevent exacerbations
a difference in treatment costs of +3390 CHF and improve FEV1 and vital capacity to force.
(1), +3308 CHF (2), +3799 CHF (3).definitive Give a The frequent side effects of Roflumilast are
hypernatremia,
difference desmopressin,
in results +0.275 QALY ICU (1), +0.289 data on the incidence of diabetes insipidus in
patients with diarrhea
traumatic andsevere
digestive
brain disorders.
injury of The cost-
Indonesia
QALY (2), +0.278 QALY (3). Gives ICER effectiveness, using Roflumilast can enhance
Correspondence:
12,313 CHF per QALY (1), ICER 11,456 CHF the quality
to the Emergency of life (IRD)
Installation patients compared
after to the a
experiencing
yud180987@yahoo.com
per QALY (2), ICER 13,671 CHF per QALY group
traffic accident 12 without additional
hours before Roflumilast.
being hospitalized. After
(3). It concludes that the addition of Roflumilastsurgery, the signs of diabetes insipidus was presented by
is more cost-effective in patients withpolyuria frequent of 300cc / hour urine production and 149mmol /
exacerbations. L hypernatremia, although the immediate administration of
REFERENCES
According to (Hertel et al., 2012b) desmopressin,
(UK) Agustí, the patients clinical and hemodynamic was
A., & Hogg, J. C. (2019). Update
explained that the provision of LAMA + LABA not shown any improvements. The patient passed away in the
on the pathogenesis of chronic
/ ICS therapy combined with Roflumilast days five of treatment in the Intensive Care Unit (ICU). The
obstructive pulmonary disease. New
compared to LAMA + LABA / ICSmain treatments for diabetes insipidus in traumatic severe
therapy England Journal of Medicine, 381(13),
alone gives a difference in treatment costs brain ofinjury
+ are adequate rehydration and administration
1248–1256. https://doi.org/10.1056/
£ 414 in patients tolerant of ICS and +of desmopressin.
£ 408 in Adequate hypovolemic, polyuric and
NEJMra1900475
patients intolerant of ICS. Furthermorehypernatremia
provides corrections are the keys to the successful
a difference with results of +0.03 QALY Andarian, S. J., Olyaeemanesh, A., Hosseini,
in
patients who are tolerant of ICS and +0.03 of QALY S. A., complicated
brain injury requires Sari, A. A.,treatment.
Firoozbakhsh, S.,
Therefore,
Jadesi, M. N., & Mobinizadeh, M.
in patients who are intolerant of ICS.in the case of being handled improperly, it can bring death.
Patients
who were tolerant of ICH gave ICER results of (2016). The safety and effectiveness of
£ABSTRAK
16,566 per QALY, whereas patients who were the current treatment regimen with or
intolerant of ICH gave ICER results of £ 13,764 without roflumilast in advanced COPD
Cedera otak berat traumatis adalah cedera fatal, denganpatients: tingkat kematian hingga
A systematic 50%.and
review Sekitar 1,5
meta-
per QALY. The addition of Roflumilast therapy
juta orang mengalami cedera otak berat di Amerika Serikat. Terdapat lebih dari 50.000
analysis of randomized controlled trials. kematian
to the standard of care is a cost-effective way
dan 500.000 insiden gangguan neurologis permanen. Sekitar 85% Journal
Medical kematianofterjadi dalamRepublic
the Islamic 2 minggu
for patients with severe COPD and worsens
pertama setelah cedera. Salah satu komplikasi dari cederaof otak yang
Iran, parah adalah diabetes insipidus.
30(1).
despite the use of bronchodilators. According to
(Nowak et al., 2013) (Germany) was explained
1
45
QANUN MEDIKA
VOL 4 .lNo
no11 Mei
Mei2019
2019
QANUN
QANUN MEDIKA
MEDIKA
JURNAL
JURNALKEDOKTERAN
KEDOKTERANFKUM
FKUMSURABAYA
SURABAYA
Case Report
Berg, K., & Wright, J. L. (2016). The pathology Journal of COPD, 7, 183–199. https://doi.
Diabetesof chronic
sakit. Progress
insipidus
obstructivein
Setelah operasi,
patiens
pulmonary
tanda-tanda
with traumatic
disease: severe brain injury
org/10.2147/COPD.S29820
in the 20th and 21st diabetes
centuries.insipidus ditandai dengan adanya poliuria produksi
Hertel, N., Kotchie, Samyshkin, Radford,
Archives of Pathology and Laboratory Humphreys, & Jameson.
1) Resident
Medicine, of Anesthesiology
140(12), 1423–1428. and Intensive
https://Care of RSUD Dr. Soetomo, Medical(2012b).
Faculty of Cost-
perawatan
Airlangga di Unit Perawatan Intensif (ICU). Perawatan
University. effectiveness
utama untuk ofdiabetes
available treatment
insipidus pada
doi.org/10.5858/arpa.2015-0455-RS options for patients suffering from severe
Centers
hipovolemik,
ulty of forAirlangga
Disease
poliurik, Control and Prevention
dan hipernatremia
University. yang adekuat COPD adalah inkunci
the UK: a fully incremental
keberhasilan pengobatan
(US).
diabetes (2010).Diabetes
insipidus. How Tobacco
insipidus Smoke
dalam kasus cedera analysis.
otak International
membutuhkan Journal of Chronic
perawatan yang
Causes Disease: The Biology and Obstructive
rumit. Karena itu, jika ditangani dengan tidak tepat, bisa menyebabkan kematian. Pulmonary Disease, 183.
Behavioral Basis for Smoking-
ABSTRACT https://doi.org/10.2147/COPD.S29820
A R TAttributable
I C L E I NDisease: FO A Report of the
Kata kunci : Diabetes insipidus, cederasevere
Traumatic otak,
King,hipernatremia,
P. T. injury
brain (2015).is desmopressin,
Inflammation
a fatal injury, ICU
in with
chronic a
Surgeon
Correspondence
Submitted General.
: Januari National
2019 Center
: yud180987@yahoo.com for obstructive pulmonary disease and its role
AcceptedChronic Disease
: February Prevention
2019 andexperience
Health
severe inbrain
cardiovascular disease
injury in the United andStates. There
lung cancer.
Promotion
Published
INTRODUCTION (US);
: Mei 2019 Office on Smoking and CASE REPORT
Clinical and and Translational Medicine,
are more than 50,000 deaths 500,000 incidents of
Health (US). 4(1), 26. https://doi.org/10.1186/s40169-
Cilli, A., Bal,rate
a mortality
Keywords: H., &of Gunen,
up to H.50%.
(2019). Efficacy
About 1.5 015-0068-z
million andpeople
safety profile of roflumilast
with severe in a real-
brain injury in
traffic
Lee, J. S., accident
Hong, Y.12 hours T. before
K., Park, S., Lee, S. being
W.,
world experience.
the United States have Journal of Thoracic
more than 50,000
definitive data on the
hospitalized.
Oh, Y.incidence
The
M., & of
patient
Lee, diabetes
S. is
Do. insipidus
unconscious
(2016). in
since
Efficacy
deaths Disease,
and 500,000 1100–1105.neurological
11(4), permanent https://doi.
patients with traumatic
the accident
and safety severe
occurred. brain injury
First aidinwas
of roflumilast of Indonesia
given
Korean in the
patients
org/10.21037/jtd.2019.04.49
sequelae (Agha and Thompson, so far. In this case report, a male, 45 years old, was taken
2006). previous health facility; RSUD Tuban, thus the
with COPD. Yonsei Medical Journal,
Correspondence:
Dasar, R. K. (2013). Penyajian to the Emergency
Pokok-Pokok Installation
57(4), (IRD) after experiencing a
patient was referred to IRD Dr. Soetomo.
928–935. https://doi.org/10.3349/
yud180987@yahoo.com
first 2 weeks after the injury, which exhibits
Hasil Riset Kesehatan Dasar traffic
2013. accident
The 12 hours has
patient before
ymj.2016.57.4.928 being a hospitalized.
attached collar brace at After
the
Dr. RSUD by
Giembycz,
intracranial M. A., & Field,
hypertension S. K. polyuria
(Benvenga (2010). Liu, D.
et al., of 300cc / Y., Wang,
hour urine Z. G., Gao,and
production Y.,149mmol
Zhang, H. /
Soetomo. Responding to pain, with the
2000). Roflumilast: First phosphodiesterase M., Zhang, Y. X., Wang,
L hypernatremia, although the immediate administration of X. J., & Peng,
One o4f the inhibitor approved
complications of a sfor
evere treatment
brain of
injury
desmopressin, mm, the D. (2018).clinical
patients
both
Effect and
and safety
eye light reflexes
of roflumilast
hemodynamic
were decreased. was
COPD. Drug Design,
is diabetes insipidus. (Agha and Thompson, Development for chronic obstructive
not shown any improvements. The patient passed away in the pulmonary
and Therapy, 4, 147–158. https://doi.
2006; Hannon et al., 2012). Diabetes insipidus disease in Chinese patients. Medicine
presented with an additional gurgling breath
org/10.2147/dddt.s7667
is a disease caused by the lower production,
main treatments (United
for diabetes States), 97(7),
insipidus 2–5. https://doi.
in traumatic severe
with oxygen saturation of 92% using an oxygen
secretion,
Global and for
Initiative function
ChronicofObstructive
Anti brain
Diuretic
Lung injury mask org/10.1097/MD.0000000000009864
are adequate rehydration and Blood
administration
of 5 liters per minute. pressure
Hormone Disease. (ADH).
(2019).Kidney
GOLD Pocketabnormalities
of Guide
desmopressin.
Nowak, Adequate
D., hypovolemic,
Ehlken, B., Kotchie,
110/75 mmHg (MAP 86), pulse 120 times per polyuric
R., and
Wecht,
were 2019.
marked Gold, by 1–49.
the unresponsiveness of
minute. S., Tip of are
the the
& Magnussen, keys to were
H. (2013).
extremity the Roflumilast
successful
warm, dry
in Kombination mit langwirksamen
GOLD. (2017). Global Initiative for Chronic
characterized by excessive thirst (polydipsia) of brain injury requires complicated
time Bronchodilatatoren
<2 seconds. The intreatment. Therefore,
der Versorgung
right parietooccipital von
Obstructive. GOLD, Global Obstructive
Patienten
hematoma was mit found.
schwererThe und sehr schwerer
patient was
Lung Disease, 1–44. http://www.
no definitive data on the incidence of diabetes COPD: Eine Kosten-Effektivitäts-Analyse
immediately suctioned and oxygenated with
goldcopd.org/uploads/users/files/
ABSTRAK für Deutschland. Deutsche Medizinische
Jackson Reese 10 liters per minute, a two-lane
GOLD_Report_2015_Apr2.pdf
in Indonesia so far. Wochenschrift,
intravenous line was 138(4),
attached 119–125.
and 30° https://
head-
Cedera
Hertel,
N.,insipidus
Kotchie, W.,adalah
in R.cases cedera
Samyshkin,
of brain fatal,
Y., dengan
injury tingkat kematian hingga 50%. Sekitar 1,5
doi.org/10.1055/s-0032-1327416
up position. The patient was prepared to be
juta orang
Radford,
requires mengalami cedera
M., Humphreys,
complicated otak
S., &
treatment. berat di Amerika Serikat. Terdapat lebih dari 50.000 kematian
Jameson,
Diabetes intubated
Pedoman using ETT No.7
Diagnosis dan and the lip border
Penatalaksanaan
dan 500.000
K. can
insipidus insiden
lead gangguan
(2012a). death neurologis
to Cost-effectiveness
when handled permanen.
of Sekitar 85% kematian terjadi dalam 2 minggu
was 21cm. The ventilator(2003).
used PCV mode with
pertama setelahTherefore,
available
improperly. cedera. Salah
treatment satuauthors
options
the komplikasi
for patients
are dari cedera Asma
otak yang di Indonesia.
parah adalah diabetes insipidus.
Tidak ada data
suffering
interested pasti severe
from
in discussingtentang kejadian
COPD
the diabetes
in the
management UK:of Ainsipidus pada pasien dengan cedera otak traumatis
fully incremental analysis. International
2
46
QANUN MEDIKA
QANUN Vol 5 VOL.4
MEDIKA No41.l no
VOL JANUARY
no 11 Mei 2021
Mei 2019
2019
QANUN
QANUN MEDIKA
MEDIKA
JURNAL
JURNALKEDOKTERAN
KEDOKTERANFKUM
FKUMSURABAYA
SURABAYA
CaseReport
Case ReportY., Kotchie, R. W., Mörk, A. Wedzicha, J. A., Calverley, P. M., & Rabe, K.
Samyshkin,
Diabetes insipidus
C., Briggs, A. inH.,patiens
& with traumatic severe brainRoflumilast:
F. (2016). injury A review of its use
Diabetes insipidus in Bateman,
patiens E. D. traumatic
with severe brain injury
(2014). Cost-effectiveness of roflumilast
Yudha Adi Prabowo1, Prananda Surya Airlangga2 in the treatment of COPD. International
Yudha as Adi Prabowo1,
an add-on Prananda
treatment to Surya Airlangga2 81–90.Faculty
https://doi.
1) Resident of Anesthesiology andlong-acting
Intensive Care of RSUD Journal Dr.ofSoetomo,
COPD, 11,Medical of
bronchodilators
1) Resident of in
Airlangga University. the treatment
Anesthesiology and of COPD
Intensive Care of org/10.2147/COPD.S89849
RSUD Dr. Soetomo, Medical Faculty of
associatedUniversity.
Airlangga with chronic bronchitis in the Zhang, X., Chen, Y., Fan, L., Ye, J., Fan,
United Kingdom.University.
European Journal of
ulty of Airlangga J., Xu, X., You, D., Liu, S., Chen, X.,
Health
ulty Economics,
of Airlangga 15(1), 69–82. https://
University. & Luo, P. (2018). Pharmacological
doi.org/10.1007/s10198-013-0456-5 mechanism of roflumilast in the treatment
Samyshkin, Y., Schlunegger, Haefliger, of asthma–COPD overlap. Drug Design,
Ledderhose,
ARTICLE INFO & Radford. ABSTRACT
ABSTRACT
(2013). Cost- Development and Therapy, 12, 2371–
Traumatic severe2379.
effectiveness of roflumilast in combination brain injury is a fatal injury, with a
https://doi.org/10.2147/DDDT.
with bronchodilator therapies in patients S165161
Accepted : February 2019 experience
with severe and very severe COPD in severe brain injury in the United States. There
Zuo, H., Cattani-Cavalieri, I., Musheshe, N.,
Published : Mei 2019 are more than 50,000 deaths and 500,000 incidents of
Switzerland. International Journal of Nikolaev, V. O., & Schmidt, M. (2019).
Chronic Obstructive Pulmonary permanent
Disease, neurological sequelae. About 85% of mortality
Phosphodiesterases as therapeutic
Keywords:
79. occurs in the first 2 weeks after the injury. One complication
https://doi.org/10.2147/COPD. targets for respiratory diseases.
S37486
Diabetes insipidus, brain injury, of a severe brain injury is diabetes insipidus. There are no
Pharmacology and Therapeutics, 197,
Sisson, T. H., Christensen, P. J., Muraki, Y., 225–242. https://doi.org/10.1016/j.
patients with traumatic severe brain injury of Indonesia
Dils, A. J., Chibucos, L., Subbotina, N., pharmthera.2019.02.002
Tohyama, K., Horowitz, J. C., Matsuo,
to the Emergency Installation (IRD) after experiencing a
T., Bailie, M., Nikam, S., & Hazama, M.
yud180987@yahoo.com
traffic accident 12 hours before being hospitalized. After
(2018). Phosphodiesterase 4 inhibition
reduces lung fibrosis following targeted
polyuria of 300cc / hour urine production and 149mmol /
type II alveolar epithelial cell injury.
Physiological Reports, 6(12), 1–15.
https://doi.org/10.14814/phy2.13753
van der Schans, S., Goossens, L. M. A.,days five of treatment in the Intensive Care Unit (ICU). The
Boland,
M. R. S., Kocks, J. W. H., Postma, M.
J., van Boven, J. F. M., & Rutten-van brain injury are adequate rehydration and administration
Mölken, M. P. M. H. (2017). Systematicof desmopressin. Adequate hypovolemic, polyuric and
Review and Quality Appraisal hypernatremia
of Cost- corrections are the keys to the successful
Effectiveness Analyses of Pharmacologic
Maintenance Treatment for of Chronic
brain injury requires complicated treatment. Therefore,
Obstructive Pulmonary Disease:
Methodological Considerations and
Recommendations. PharmacoEconomics,
ABSTRAK
35(1), 43–63. https://doi.org/10.1007/
s40273-016-0448-2
1
47

Home I Vol 5, No 1 (2021)
Qanun Medika is an official scientific journal of the Faculty of Medicine Muhammadiyah Surabaya University in
collaboration with Asosiasi Pendidikan Kedokteran dan Kesehatan Muhammadiyah (APKKM). This journal contains
writing and scientific articles that are made as a realization of tri dharma college. The pur pose of the publication is to
contribute actively to enhancing the quality and accessibility of scientific information related to medical science
information in the global era.
This journal is published every 6 months, at the end of January and July of each year and consists of three articles in the
form of research results, case reports, literature review. Each content of the article contains the latest information with
the priority on the values of novelty, originality, and usability. The scope of this journal is in the field of medicine and
health, including health management system as well.
The name 'Qanun Medika' is taken from the 1st book of lbnu Sina, 1st medica l doctor in the world.
Journa l of Qanun Medika is registered in LIP! and has ISSN as follows:
p-ISSN: 2541-2272
e·ISSN: 2548-9526
The Qanun Medika journal has also been indexed in 5 national scientific indexations and 9 international scientific
indexations in its first year. every article in this journal already has a DOl number.
The scope of this journal is all the field of medicine such as:
-Internal medicine (including Pulmonary medicine and cardiovascular medicine)
-Surgery (including urology, orthopaedic and traumatologic, plastic surgery, neurosurgery)
-Anesthesia and Emergency Medicine
-Neurology
-Dermatology
-Obstetric and Gynecologic
-Forensic and Medicolegal
-Clinical Pathology
-Anatomical Pathology
-Psychiatric
-Ophthalmology
-Otolaryngology
-Pediatric
-Rad iology
-Microbiology and parasitology
-Basic Science of Medicine (including biochemistry, physiology, anatomy and Histology)
-Public health and Health Management

Editor in Chief
• Yelvi levani, (Scopus 10: 55200360700) (Sinta 10: 6689408) Faculty of Medicine Muhammadiyah University of
Surabaya,lndonesia
Editor
• Jan l Nouwen, (Scopus 10: 7004057332) Erasmus MC University Medical Center Rotterdam, Netherlands
• Abdullah AI Tarique, (Scopus ID: 25960456000} Child Health Research Centre Faculty of Medicine, University of
Queensland, Australia
• ProfTakashi Yashiro, (Scopus 10: 7007120815) JICHI Medical University School of Medicine, Japan
• Prof Murat Coskun, (Scopus 10: 24079683800) Istanbul University, Istanbul, Turkey, Turkey
• Muhammad Anas, (Scopus 10: 57192299850) Medical Faculty University Muhammadiyah of Surabaya,lndonesia
• Su hartono Taat Putra, (Scopus ID: 57194008862) Departemen Patobiologi UniversitasAirlangga Surabaya, Indonesia,
Indonesia
• Azis A limul Hidayat. (Scopus 10:57203654137} Universitas Muhammadiyah Surabaya,lndonesia
Section Editor
• Syafarinah Akil, Faculty of Medicine, Universitas Muhammadiyah Surabaya, Indonesia
• Ay u lidya Paramita, Faculty of Medicine Muhammadiyah University of Surabaya, Indonesia
Layout Editor
• Oede Nasrullah, (Scopus 10: 57212390877) Oepartement Nursing Faculty of Health. University Muhammadiyah of
Surabaya, Indonesia

Home / Archives / VoiS, No 1 (2021)
DOl: http:J/dx.doi.org/10.30651/jqm.vSil
Table of Contents
literature Review
The difference in severity and management between children and adult's cases of COVID-19 PDF
Mohammad Husin, Gina Noor Djalilah. R A Kaniraras, Afrita Amalia laitupa 1-18
The role of gut microbiota in health and diseases PDF
Deasy Fetarayani, Handoko Hariyono, Gatot Soegiarto 19-33
Roflumilast A Review of Chronic Obstructive Pulmonary Disease (COPD) Treatment PDF
Ita Octafia, Dwi Octamy Sari. Novi Wulandari. Sandra Annisa, linda Wahyuni Wongkar, Ferdias Kurnia Bahari, Faiz35-47
Farikhah, Moh Firmansah, Erfin Midhiawati, Fauna Herawati
Role of antioxidant to protect Leydig cells induced by reactive oxygen species: a literature review PDF
Anak Agung lstri Dalem Cinthya Riris, Reny l'tishom, Siti Khaerunnisa 49-60
Articles
Effects of acupressure therapy period towards blood sugar level in type 2 diabetes mellitus patients at lumajang PDF
acupressure clinic 61-67
Anung Putri Jllahika, Hean Safira
Clinical and Functional Outcome of Cervical Degenerative Disc Disease after Operative Treatment at Dr. Soetomo PDF
General Hospital Surabaya In 2013-2018 69-75
Reyner Valiant Tumbelaka, Dwikora Novembri Utomo, I Ketut Martians
Association between gestational age and persistent pulmonary hypertension of the newborn (PPHN) severity in PDF
preterm babies at Sidoarjo Regional Hospital 77-85
Aisyah Faadhilah, M . Perdana Airlangga, Nurma Yuliyanasari, Gina Noor Djalilah
Solanum betaceum Extract as a Protective on Spermatozoa Morphology of Mice Exposed to lead Acetate PDF
Rima Wirenviona, Reny l'tishom, Siti Khaerunnisa,AnakAgung lstri Dalem Cinthya Riris, Nurul Fatimah Susanti, 87-94
Nurul Jannatul Wahidah, Abadiyah Zakiah Kustantina
Identification of Thalassemia Carrier In Anemic Pregnant Women at Puskesmas Kertapati Palembang: PDF
Comparison of Five Erythrocyte Indices 95-101
Mitayani Purwoko, Eriko Erenkwot
Depression. anxiety, and stress levels in Denpasar community during the pandemic of Corona Virus Disease PDF
2019 (COVID-19) 103-111
I Gusti Ngurah Bagus Rai Mulya Hartawan, I Gede Gita Sastrawan, Rovie Hikari Parastan, luh Seri Ani
The association between demographic. and attitude factors with the practice of malaria prevention among the PDF
rural community in Purworejo district, Indonesia 113-124
Farindira Vesti Rahmasa ri, Winny Setyonugroho, I Ketut Swarjana, Des to Arisandi, Tri Wulandari
Kesetyaningsih

In vitro Alpha Lipoic Acid supplementation in freeze-dried human sperm: the impact on DNA fragmentation PDF
index 125-132
Rezia Octarina, M. P. B. Dyah Pramesti, Agustinus Agustinus
The effectiveness of classic lecture and workshop as interventions to improve primary healt h care providers PDF
knowledge and skill on t he management of pediatric emergencies: a case study 133-143
Ricky lndra Alfaray, Rahmat Sayyid Zharfan, Yudhistira Pradnyan Kloping, Yudith Annisa Ayu Rezkitha, Rafiqy
Sa'adiy Faizun, Saruuljavkhlan Batsaikhan, Ahmad Siddiq Muhajir, Bestya Presidiana, Umaimah Rosyidah,
Khodijah Nidaul Chasanah, Delia Nur Aini, Naufal Fauzy, Kamal Musthofa, Nur Firdaos, Samsriyaningsih
Handayani
Case Report
Cardia-vocal Syndrome as a Complication Patient with Severe Mitral Regurgitation and Moderate Aortic PDF
Regurgitation with Pulmonary Hypertension 145-151
Adityo Basworo, Agus Subagjo
Characteristics of complaints and functional outcomes of conservatively treated clavicle fractures in Dr. PDF
Soetomo general hospital: A case series 153-161
Brilliant Citra Wirashada, Maghrizal Roychan, Teddy Heri Wardhana

Roflumilast - A Review of Chronic Obstructive Pulmonary Disease (COPD) Treatment

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Roflumilast - A Review of Chronic Obstructive Pulmonary Disease (COPD) Treatment

Uploaded by

Copyright:

Available Formats

QANUN MEDIKA

QANUN Vol 5 VOL.4

AARRTTIICCLLEE IINNFFOO ABSTRACT

Glycopironium DPI solution √ 12 -24

Acidinium bromide DPI, MDI 12 hours

35.857 25.481 10.376 40.917 30.279 10.638 43.533 37.682 10.851

Journa l of Qanun Medika is registered in LIP! and has ISSN as follows:

You might also like