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PART I
INTRODUCTION
I.1.
BACKGROUND
Bronchial asthma is a disease that is still an issue
the health of society in almost all countries in the world, suffered by children
children to adults with a degree of mild to severe illness,
can even be life-threatening. More than one hundred million
people around the world suffer from asthma with increased prevalence
in children. (GINA, 2006)
Various factors that can cause asthma attacks among
other sports (exercise), infections, allergens, changes in temperature, exposure to
irritants
cigarette smoke, and others. In addition there are various other factors that
affect the prevalence of asthma among others, age, sex,
race, socio-economic and environmental factors. These factors can be
affect the occurrence of asthma attacks, degree of asthma and also death
due to asthma (Rahajoe, Supriyatno and Setyanto, 2008).
Epidemiology of asthma problems at the moment is
the morbidity and mortality of asthma is relatively high and
has increased. World asthma day 2005 is themed
Unmet Needs of Asthma (Asthma Needs Unmet) WHO
The current estimated 100-150 million people in the world affected by asthma and
180,000 expected to continue to grow each year (Firshein, 2006).
Based on the report NCHS (National Center for Health Statistics)
In 2000, there were 4,487 deaths due to asthma or approximately 1.6
per 100,000 population, while also obtained as many as 223 deaths
children aged 0-17 years and 0.3 per 100,000 population. In addition, death
in women 40% higher than men (NCHS, 2003). Results
Another study showed mortality on the sex
40% more women than men, with the death of a child
0-14 years of age is 0.3 per 100,000 population (BRFSS, 2003).
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According to the results of a multicenter study in the state
Serkat Americans are 43.6% of patients showed a year
terahir use emergency facility, hospitalization, or visit
Her other emergency doctor. The impact of asthma on quality of life and
productivity of a person's life is also indicated from the following report,

such limitations found in recreation or sports 52.7%,

physical akrivitas 44.1%, 37.9% career selection, 38% of social activity, a way
live 37.1% and 32.6% household chores. Absent from school
and work experienced by 36.5% of children and 26.5% in the
adult. (Cochran, 1996).
Some surveys suggest that asthma causes
loss of 16% of school days in children in Asia, 43% of children in
Europe, and 40% of the children in the United States (Vita Health,
2006). In Indonesia there are still many diseases are becoming a problem
public health, one of which asthma is classified
non-communicable diseases. Asthma can affect the quality of
and productivity of Indonesian public life, especially in children,
this is indicated by the figures obtained asthma relapse
high and loss of school days in children (RI Health Department 2009).
Asthma can occur at any age and can strike at
all sexes, but from time to time there is a trend
occurrence of an increase in patients. Various studies say
that several major cities in Indonesia mentioning the prevalence of asthma
range 3.8% -6.9% (Samsuridjal D, 2000).
National prevalence for asthma by 4.0%
(Based on diagnosis and symptoms of health professionals). A total of 9 provinces
who have Asthma prevalence above the national prevalence,
include NAD in the first place, followed
by West Java, West Nusa Tenggara, East Nusa Tenggara, Kalimantan
South, Central Sulawesi, Southeast Sulawesi, Gorontalo, and West Papua
(RIKESDAS, 2007).
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1999 data in one of the public hospitals in Indonesia mentioning
Most people with the disease are outpatient tract infection
respiratory, influenza and pharyngitis. While respiratory disease,
pneumonia, asthma, bronchitis, emphysema and pulmonary obstruction disease
the other is a disease that most diseases are within 10
hospitalization (MOH, 2002).
The prevalence of asthma in Indonesia is still unknown,
but research on school-aged children aged 13-14 years with
using the ISAAC questionnaire (International Study of Asthma and
Allergy in Children) 1995 the prevalence of asthma was 2.1% and the
in 2003 increased to 5.2%. Results of a survey of asthma
in school children in Indonesia showed the prevalence of asthma in children
Elementary (6-12 years) ranged between 3.7% -6.4%, while in junior high school
children in
Central Jakarta by 8.6% in 1995 and 2001 in Jakarta

East at 8.6%. Based on the above, it can be analyzed that

asthma a public health problem. (MOH, 2009)
Based on the report Sundaru Heru (Department of Medicine
Faculty of medicine / RSCM) the prevalence of asthma in London (5.2%), Semarang
(5.5%), Denpasar (4.3%) and Jakarta (7.5%). In Palembang, in
1995 the prevalence of asthma in junior high school students and 8.7% of students
High School in 1997 amounted to 8.7% and in 2005 performed
evaluation of the junior high school students the prevalence of asthma was 9.2%.
Asthma can affect all ages and genders, 80-90%
the onset of symptoms before the age of 5-9 years.
Effect of passive smoking on the development of asthma found
that parents who smoke are associated with the incidence of asthma
settle in children. Cohort study of 650 children aged 5-9 years,
9.2% had persistent wheezing, households whose parents
no smoking incidence of wheezing in children is only 1.85%, household
one of the parents smoke with reduced lung function
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low. In asthmatic patients there is an association between increased sensitivity
airway of mothers who smoked (Sears, 1998).
Soil health centers Sareal Bogor into PHC with
group visits in which the highest 70% of the visits were
from outside the working area, because of its geographical position which is quite
strategic that can be reached by vehicle, especially transport
general.
The number of residents in the District Land Sareal recorded on
In 2009 as many as 9,494 people with 2,621 households. Density
population reached 9,106 / km
2
with an average density of 5 people per
household. Composition of the population by sex almost
Similarly, the 4,963 men and 4,531 women.
Based on the annual report noted Sareal Soil Health Center
There are over 2000 children who occupy its territory and
shows the prevalence of children with bronchial asthma as much as 85
patients with bronchial asthma at the age of 1-15 years during the period of 2010.
This is what makes one of the considerations in the selection of land
Soil research in the health center Sareal Bogor.
I.2.
Problem Formulation
Based on the background above, the problem in
This research is "whether the risk factors that influence
on the incidence of bronchial asthma in children? "With the formulation

these studies are as follows:

1.
Is there a relationship between a family history of disease
the incidence of bronchial asthma in children?
2
Is there a relationship between the incidence of cigarette smoke
Bronchial asthma in children?
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I.3.
Research Objectives
I.3.1. General Purpose
To determine the relationship between family history and
cigarette smoke exposure on the incidence of bronchial asthma
in children at the health center Sareal Land, Bogor in January 2010
until December 2010.
I.3.2. Special Purpose
a.
Knowing the incidence of bronchial asthma in children
Soil health center Sareal, Bogor in January 2010 to
December 2010.
b.
Knowing the relationship with the incidence of a family history of asthma
bronchial asthma in children in health centers Sareal Land,
Bogor in January 2010 to December 2010.
c.
Knowing the relationship with the incidence of cigarette smoke exposure
bronchial asthma in children in health centers Sareal Land,
Bogor in January 2010 to December 2010.
I.4.
Benefits of Research
1.
For Asthmatics Children & Parents
Knowing the risk factors and symptoms of asthma attack
occur in asthma attacks in order to know how to prevent
the onset of an asthma attack
2.
Land for PHC Sareal
Provide input in determining preventive measures
by reducing the risk factors that can be avoided is the
This study is the behavior of smoking in the family so that it can
rapid and precise decision in handling the
The.

3.
For Educational Institutions
Provide additional information and a description of the problem
health, especially on bronchial asthma in children.
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4.
For the Public
Provide information to the public about the influencing factors
on the incidence of asthma in children so that people can know
and can take precautions.
5.
For Researchers
Increase knowledge and insight about asthma in
children and various risk factors that accompany the occurrence of asthma
bronchial in children.
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CHAPTER II
THEORY
II.1. Review of Literature
II.1.1 Definition of Asthma
Global Initiative for Asthma (GINA) defines asthma as
chronic inflammatory airway disorder with many cells that play a role,
in particular mast cells, eosinophils, and lymphocytes T. In susceptible people
inflammation may cause recurrent wheezing, shortness of breath, chest flavors
distressed and coughing, particularly at night or early morning.
Nelson defines asthma as a collection of signs and symptoms
wheezing and coughing with the following characteristics; arise
episodic or chronic, tends at night or early morning
(Nocturnal), seasonal. The presence of precipitating factors including physical
activity
and is reversible either spontaneously or with obstruction,
as well as a history of asthma or other atopy in the patient or family,
whereas other causes have been ruled out (Nelson, 1996).
National Asthma Guidelines for Children also use restrictions
practical operational constraints, namely in the form of recurrent wheezing
sometimes
persistent cough accompanied with the following characteristics: arise
episodic, tend to be at night or early morning (nocturnal), seasonal,

precipitating factors including physical activity, and good reversible

spontaneously or with treatment, as well as a history of asthma
or other atopic patients or their families (PPIDAI, 2004).
II.1.2 Asthma Pathogenesis
Understanding asthma previously defined as obstruction
breath suddenly arise, will improve spontaneously or with
treatment. The main mechanism of the onset of symptoms of asthma caused
bronchial hyperreactivity, so the main treatment of asthma is
tackle bronchospasm. Current concepts that asthma is a
typical chronic inflammatory process, involving the wall of the channel
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respiratory, causing limited airflow and increase
airway reactivity. Characteristic features of inflammation channel
Respiratory activation of eosinophils, mast cells, macrophages, and lymphocytes.
T in the respiratory tract mucosa and lumen. This inflammatory process occurs
although mild or asymptomatic asthma (PP IDAI, 2004).
Many cases, especially in children and young adults, asthma
associated with a history of atopic manifestations through mechanisms IgEdependent. At an estimated population factors provide a history of atopy
contribute to 40% of children and adults with asthma (PPIDAI, 2004).
Immunological reaction resulting from exposure to allergens
initially cause sensitization phase. Consequently formed IgE specific
by plasma cells. IgE attached to the Fc receptors on mast cell membranes and
basophils. If there is a subsequent stimulation of the same allergen, will arise
rapid asthmatic reaction (immediate reaction asthma) (Warner, 2001).
Occurs mast cell degranulation, release of mediators:
histamine, leukotriene C4 (LTC4), prostaglandin D2 (PGD2), thromboxane A2,
tryptase. These mediators cause bronchial muscle spasm,
gland hypersecretion, edema, increased capillary permeability, followed
with accumulation of eosinophils. Clinical picture that arises is
acute asthma attack. This situation will soon recover (attack
asthma is lost) with treatment (Warner, 2001).
After 6-8 hours then it happened the next process, called the reaction
slow asthma (asthma late reaction). result of the influence of cytokines IL3, IL4,
GM-CSF is produced by mast cells and activated T lymphocytes,
will activate inflammatory cells such as eosinophils, basophils, monocytes and
lymphocytes. There are at least two types of T-helper (Th), CD4 lymphocyte subtypes
+
has been known in the cytokine production profile. Although both types of
T lymphocytes secrete IL-3 and granulocyte-macrophage colony stimulating factor (GM-CSF), Th-l mainly produce IL-2, IF
gamma and TNF beta, while Th-2 cytokines are mainly produced

involved in asthma, namely IL-4, IL-5, IL-9, IL-13, and IL-16 (Warner,
2001).
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Cytokines produced by Th-2 responsible for the occurrence
delayed type hypersensitivity reaction. Each of these inflammatory cells
capable of removing inflammatory mediators. Eosinophils produce
LTC4, Eosinophils Peroxidase (EPX), Eosinophils Cathion Protein (ECP)
and Major Basic Protein (MBP). These mediators is
inflammatory mediators that cause tissue damage. Basophil cells
secrete histamine, LTC4, PGD2. Mediators that may cause
bronchospasm (Warner, 2001).
Macrophages secrete IL-8, platelet activating factor (PAF),
regulated upon activation of novel T cell expression and presumably secreted
(RANTES). All of the above is a mediator of inflammatory mediators that
enhance the inflammatory process maintains the inflammatory process
(Warner, 2001).
Inflammatory mediators that will make the sensitivity of bronchial
redundant, so easy bronchi constrict, epithelial damage,
thickening of the basal membrane and an increase in permeability when
there are specific and non-specific stimuli. Clinically, the symptoms of asthma
settled, people will be more sensitive to stimulation. Damage
network will be irreversible if exposure continues and
inadequate management (PPIDAI, 2004).
Figure 1 Pathogenesis of Asthma (Quoted from GINA 2002)
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Inflammation and airway remodeling
In line with the process of chronic inflammation, bronchial epithelial damage
stimulate the repair process that results in respiratory tract
structural and functional changes that deviate in the channel
Respiratory known as remodeling or repair.
Bronchial epithelial damage caused by the release of cytokines from cells
inflammation such as eosinophils. Now demonstrated that airway smooth muscle
also produce cytokines and chemokines such as eotaxin, RANTES, GMCSF and IL-5, as well as growth factors and lipid mediators, thus
resulting in a buildup of collagen in the lamina propria (Warner, 2001).
In the process of remodeling which is the role of cytokines IL4, TGF
beta and Eosinophils Growth Factor (EGF). TGF-beta stimulates cell
proliferating fibroblasts, epithelial hyperplasia experience, the formation of

collagen increases. As a result of the remodeling process of the release

damaged epithelial, mucosal tissue basement membrane thickening
(Pseudothickening), gland hyperplasia, submucosal edema, cell infiltration
muscle inflammation and hyperplasia. Such changes do not provide
clinical improvement, but resulted in a narrowing of the bronchial lumen
persistent and give the clinical picture of chronic asthma (Warner, 2001).
Figure 2 Process Asthma Inflammation & Remodelling pd (Quoted from GINA,
2002)
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According to the previous paradigm, the remodeling process is due
Bronchial epithelial damage caused by a chronic inflammatory process.
So if the anti-inflammatory drugs are not given as early as possible
as prophylaxis, the inflammation goes on and obstruction
becomes irreversible and airway remodeling process intensified
(Warner, 2001).
In a study of children with a family history of atopy
not manifest as asthma was found infiltration of eosinophils
and thickening of the reticular lamina. It is suspicious that the process
remodeling has occurred prior to or simultaneously with the inflammatory process.
If given early intervention as soon as symptoms of asthma occur, could
so we have delayed action to prevent the process
remodeling (Warner, 2001).
II.1.3. Pathophysiology of Asthma
Manifestations of airway obstruction in asthma is caused by
bronkokontriksi, hypersecretion of mucus, mucosal edema, cellular infiltration, and
desquamation of epithelial cells and inflammatory cells (Price, 1995). Various stimuli
allergy and nonspecific stimuli, the existence of airway
hyperactivity, and inflammatory bronkokontriksi trigger response. Stimulation
These include inhaled allergens (dust mites, pollen, soymilk,
castor oil and proteins), other vegetable proteins, viral infections, smoke
smoking, air pollutants, odor, drugs (metabisulfite), cold air,
and sports (Sundaru, 2006).
Pathology of severe asthma is bronkokontriksi, smooth muscle hypertrophy
bronchial mucous gland hypertrophy, mucus hypersecretion, mucosal edema,
infiltration of inflammatory cells (eosinophils, neutrophils, basophils, macrophages),
and
desquamation. (Sundaru, 2006).
Airway inflammation in patients with asthma is
the underlying disorder is a function of channel obstruction
breath causes air flow resistance so that it can return the
spontaneously or after treatment. Functional changes associated

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with typical symptoms of asthma is coughing, wheezing and shortness
and accompanied
Respiratory tract hyperreactivity to various stimuli. Cough
very likely caused by stimulation of sensory nerves in the channel
Respiratory by inflammatory mediators and especially in children, cough
repeated may be the only symptom of asthma were found.
(Sundaru, 2006).
II.1.4. Epidemiology of Asthma
Asthma can occur at any age, whereas 30% of patients
have symptoms at the age of 1 year, whereas 80-90% of children who
asthmatic symptoms first appear before age of 4-5 years.
Most of the affected children sometimes just gets
mild to moderate attacks, which are relatively easy to handle. Most
little experience severe asthma protracted, usually more
continuous rather than seasonal ones. It is the
not able to make it and disrupt school attendance,
play activities, and functions from day to day (Sundaru, 2006).
In Australia the prevalence of asthma aged 8-11 years in 1982
of 12.9% increased to 29.7% in 1992 Research in
Indonesia gives results that vary between 3% -8%, research in
Manado, Palembang, Makassar and Yogyakarta gave figures
7.99% respectively; 8.08%; 17% and 4.8%. Epidemiological studies of asthma
also performed at the junior high school students in several places in Indonesia,
among
Other: Palembang, where the prevalence of asthma was 7.4%; Jakarta prevalence
asthma of 5.7% and London at 6.7% prevalence of asthma. Not
can be inferred trend of change in prevalence by
age due to the lack of research with the target student
Junior high, but looks a decrease (outgrow) prevalence of asthma
comparable with age especially after the age of ten years.
This led to the prevalence of asthma in adults more
low when compared with the incidence of asthma in children
(Manfaati, 2004).
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Table 1 Prevalence of Asthma in Indonesia
Source: Children's Textbook Respirology 2010
II.1.5. Etiology of Asthma
Asthma is a complex disorder that involves factors
autonomic, immunologic, infectious, endocrine and psychological level at

various individuals. Bronkokontriktor neural activity mediated by

the cholinergic autonomic nervous system. End of the vagus sensory epithelium
airway, called cough receptors or irritant, depending on its location,
trigger the afferent branch of the reflex arc, which at the end of the efferent branch
stimulates contraction of bronchial smooth muscle (Sundaru, 2006).
Neurotransmission vasoactive intestinal peptide (PIV) start
relaxation of bronchial smooth muscle. Neurotramnisi a vasoactive peptide
a dominant neuropeptides involved in airway opening
(Sundaru, 2006).
Immunological factors extrinsic asthma or allergy sufferers, occurs
after exposure to environmental factors such as house dust, flour
cider and dandruff. Often, total and specific IgE levels of patients
Such increase of the antigen involved. In patients with
others with similar asthma clinically no evidence of involvement
IgE where negative skin test and IgE levels were low. This form of asthma
most often found in the first 2 years of age are also people
adults (asthma that arise later), called intrinsic asthma
(Sundaru, 2006).
Researchers
(City)
Year
Number
Samples
Age
(Year)
Prevalence
(%)
Djajanto (Jakarta)
Rosmayudi
(London)
Dahlan (Jakarta)
Arifin (Palembang)
Rosalina (London)
Yunus F (Jakarta)
Kartasasmita CB
(London)
Rahajoe NN (Jakarta)
1991
1993
1996
1996
1997
2001
2002
2002

1200
4865
1296
3118
2234
2678
2836
1296
6-12
6-12
6-12
13-15
13-15
13-14
6-7
13-14
13-14
16.4
6.6
17.4
5.7
2.6
11.5
3.0
5.2
6.7
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Endocrine factors causing asthma worse in
relation to pregnancy and menstruation or when women
menopause, and improved asthma in some children during puberty, it is
associated with hormonal. In addition, emotional psychological factors can
trigger asthma symptoms in some children and adults who
asthma, but emotional or behavioral nature and found
asthma in children more often than in children with chronic illness
Other psychological instability associated with the child (Sundaru, 2006).
II.1.6. Risk Factors for Asthma
Several risk factors for the onset of bronchial asthma has been known
for sure, among other things: family history, low socioeconomic level,
ethnic, urban areas, geographical residence, raising dogs
or cat in the home, exposure to cigarette smoke.
In general, risk factors for asthma were divided into two groups

large, the risk factors associated with the occurrence or

development of asthma and risk factors associated with
occurrence of asthma exacerbations or attacks are called trigger factor or
factors (GINA 2006). The triggers of asthma risk factors
Bronchial among others:
A. Smoke
B. House Dust Mites
C. Gender
D. Animals Pet
E. Type of Food
F. Appliances
G. Changes in Weather
H. Disease Family History
A.
Cigarette Smoke
Cigarette smoke can cause asthma, both in smokers was
itself and the people exposed to cigarette smoke. A study in
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Finland showed that adults were exposed to cigarette smoke
likely to suffer from asthma twice as compared to people who do not
exposed to cigarette smoke (Jaakkola et al, 2001). Another study showed that
someone with asthma is exposed to cigarette smoke for one hour, then
approximately 20% will experience damage lung function. (Dahms et al, 1998).
In children, the smoke will give the effect of more severe
compared to adults, is due to the width of the airways child
narrower, so the number of breaths the child will be faster than the
adult. As a result, the amount of smoke that enters the channel
breathing becomes more than his weight. In addition,
because the immune system is not developed, the emergence
symptoms of asthma in children is much faster than adults
(Ramaiah, 2006).
The results of the analysis of 4,000 children aged 0-5 years showed
that children whose parents smoked 10 cigarettes per day,
causes an increase in the number of cases of asthma and accelerate
the appearance of symptoms of asthma in children. Likewise, children who
returned from the hospital after acute asthma care, healing will
disturbed because parents who smoked (Abulhosn et al, 1997).
Effects of cigarette smoke is not only a negative effect on
children who have been born, but also the fetus was still inside
uterus. Therefore, in developed countries such as Japan, throughout the hospital
delivery is not available where you can smoke. This is because they
really understand the dangers of cigarettes. Babies who will

born of a mother who smoked during pregnancy

will more often experience respiratory diseases, including asthma
Bronchial on childhood (Ramaiah, 2006).
The burning of tobacco as a source of irritants in the home
produce a complex mixture of gases and particles
dangerous. More than 4500 types of contaminants have been detected in
tobacco, including polycyclic hydrocarbons, carbon monoxide, carbon
dioxide, nitric oxide, nicotine, and acrolein (GINA 2006).
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Figure 3 The chemicals contained in cigarettes (Quoted from
http://bebasrokok.files.wordpress.com/2008/01/bahayamerokok.gif?w=500)
In general, smokers are divided into two types, namely (Hall, 2010):
a. Active smokers (active smoker)
Someone who actually have a smoking habit.
Smoking has become part of his life, so it is not good when the day
Just do not smoke. Smoking may increase the risk of developing
asthma despite little evidence that active smoking is a factor
risk of developing asthma in general or because of work on
workers exposed to multiple sensitization in the workplace
(Danusaputro, 2000).
b. Secondhand smoke (passive smoker)
Someone who does not have the habit of smoking, but
forced to suck smoke exhaled by others
which happens to be nearby. Children were significantly exposed to smoke
cigarettes. Side stream smoke that burns hotter and more toxic than the
smokers inhaled smoke, especially in the mucosal irritation
breath. Passive exposure to tobacco smoke resulted in a more dangerous symptom
lower respiratory tract illness (cough, phlegm and wheezing) and increased risk of
asthma and asthma attacks (Danusaputro, 2000).
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B.
House Dust Mites
Dust mites are the most common cause worldwide.
Mite allergy is more common in cities and developing countries. It is
occurs due to the use of modern and insulation techniques
memuningkankan mites live better (Ramaniah, 2005).
Bronchial asthma is associated by the entry of an allergen such as
dust mites. Dust mite feces will release the protein-coated

at each point of the particles. which cause allergic reactions for

asthmatics when entering into the respiratory tract. When these mites
dead, decaying bodies mixes with household dust
(Ramaiah, 2006). House dust mites in size from 0.1 to 0.3 mm and
width of 0.2 mm is usually found in places or objects
contains a lot of dust (Vitahealth, 2006). For example, dust coming
of carpets and seat upholstery, especially long haired thick and not
cleaned, also from a pile of newspapers, books, old clothes (Danusaputro,
2000).
C.
Sex
Total incidence of asthma in boys more
compared with girls (Sundaru, 2006). The different types of
sex on the incidence of asthma varies, depending on age and
differences in biological characteristics. The incidence of asthma in boys
age 2-5 years, it was 2 times more often than girls
whereas at the age of 14 years old boy with asthma risk 4 times more
often. A visit to the hospital 3 times more often than children
women at that age, but at the age of 20 years the incidence of asthma
the male is the opposite of this incident (Yunus, 2006).
Increased risk in boys due to the
narrowness of the respiratory tract, the change in the vocal cords, and perhaps
an increase in IgE in men who tend to limit the response
breathing (Sundaru, 2006)
Hypothesis is supported again by the presence of the observation that
showed no difference in channel diameter ratio pernafasam The entrepreneurs
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men and women after the age of 10 years, probably due
changes in the size of the chest cavity that occurs in puberty males and
not in women. Predisposing women who have asthma
higher in males during puberty began, so the prevalence
asthma in children who previously men is higher than in women
changes where the prevalence rate in women over
higher than in males (GINA 2006).
D.
Pets:
Furry pets such as dogs, cats, hamsters,
birds can be a source of inhalant allergens. Source causes asthma
allergens are proteins found in the fur on the face
and excretion. Allergens that have a very small size (approximately
3-4 microns) and can fly in the air, causing the attack
asthma, especially of birds and mammals because the hair will fall

and fly to follow the air (Sundaru, 2006).

E.
Type of Food
Food allergies are often not diagnosed as one of
triggers of asthma although research shows as food allergies
originator bronkokontriksi at 2% - 5% of children with asthma (Ramaiah,
2006).
Although the relationship between sensitivity to certain foods
and the development of asthma is still debated, but babies and children
are sensitive to certain foods or suffer enteropathy or
colitis due to certain food allergies tend to suffer from asthma.
(GINA 2006).
Some foods cause food allergies such as dairy cows,
marine fish, nuts, various fruits such as tomatoes, strawberries,
mango, durian role seranga trigger asthma (Hand,
2004).
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Food industry products with artificial colors (eg:
tartazine), preservatives (metabisulfite), MSG (monosodium glutamate -MSG)
can also trigger an asthma attack. Food is especially frequent
result in fatal reactions are peanuts, fish and eggs
(Hand, 2004).
Research in Saudi Arabia compare the food with asthma
with no asthma. Son of Saudi Arabia who lived in urban areas
many showed symptoms of wheezing or a wheezing. These children
frequent dining at fast food outlets and food significantly
less intake of traditional foods, including vegetables, milk,
foods rich in fiber, vitamins and minerals (Sundaru, 2006).
F.
Household furnishings.
Indoor pollutants include indoor pollutants
biological (viruses, bacteria, fungi), formadehyde, volatile organic
coumpounds (VOCs), combustion products (CO1, NO2, SO2) which
usually derived from cigarette smoke and smoke kitchen. Sources of VOC pollutants
derived from insect sprays, paints, cleaners, cosmetics, Hairspray,
deodorant, air freshener, sprayed everything with
as an aerosol propellant and a diluent (solvent) such as thinner. Source
indoor formaldehyde are building materials, insulation, furniture,
carpet (Ramaiah, 2006).
Formaldehyde exposure to pollutants can result in
irritation of the eyes and upper respiratory tract. Dust particles,
especially respilable dust besides causing discomfort

reactions can also cause lung inflammation (Hand, 2004).

G.
Changes in Weather
Weather conditions such as cold temperatures, high humidity
can lead to more severe asthma, which can make the epidemic
become more severe asthma associated with storms and rising
concentration of allergenic particles (Ramaiah, 2006).
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Where can sweep pollen particles are brought
by water and air. Changes in atmospheric pressure and temperature aggravate
asthma shortness of breath and excessive mucus discharge. It is common
occurs when high humidity, rain, storms during the winter. Air
dry and cold cause tightness in the respiratory tract
(Ramaiah, 2006).
According to Linacre (1999) climate-related asthma, City
big as Auckland, Brisbane, Hong Kong and New Orleans are
have hot temperatures> 24
o
C and the average annual rainfall> 100cm,
have a high prevalence of asthma.
Cipto showed patients with a change in the air
likely to experience asthma 31.83 x greater than patients
without a change in the weather. This is reinforced by research in America
bundle which proves that there is a relationship between asthma visits
the cold and dry weather in the spring (Kalsteinet et al, 1995).
H. Disease Family History
It has been proven by many researchers that if both parents
suffer from allergic diseases, then it is likely his son will be 60%
allergic disease, either asthma, rhinitis, atopic dermatitis or shape
other allergies. If one parent has allergic disease, the
likely 40% of their children will suffer from allergies. If the second
None of them are affected by allergic diseases, then it is likely 15% suffer
allergic diseases (Ramaiah, 2006).
Approximately 25% of patients with asthma, immediate family
also suffer from asthma, although asthma is not active anymore, among family
two thirds of asthma patients showed a positive allergy test (Sundaru, 2006).
Risk parents with asthma have a child with asthma
is three times higher if a family history of asthma
accompanied with a history of atopy. Family predisposition to
get asthma when the child is with one parent
exposed to the risk of suffering from asthma had 25%, the risk increases to

Page 15

21
approximately 50% if both parents asmatisk. Asthma does not always exist in
monozygotic twins, the level of stability there bronkokontriksi in sports
in identical twins, but not in dizygotic twins (Sundaru, 2006)
Parents are 8-16 times lower likelihood of asthma asthma compared
with parents who are not asthma, especially if the child is allergic to
house dust mites (Ramaiah, 2006).
II.1.7. Diagnosis of Asthma
For the diagnosis of asthma is based on the
anamnesis, physical examination and investigation (Ramailah,
2006).
A.
History
Obtained in the form of episodic complaints of chronic recurrent cough, wheezing,
tightness or heaviness in the chest. The presence of other allergic diseases in patients
or family such as allergic rhinitis, atopic dermatis, etc.. In addition to
it needs to be known trigger factors can trigger the onset of an attack
attack.
Trigger factors in asthma, namely:
respiratory viral infection: influenza
Exposure to mite allergen, house dust, feathers
animals
Exposure to irritant smoke, perfume
Physical activity: running
emotional expressions of fear, anger, frustration
Drug-drug aspirin, beta blockers, NSAIDs
Work environment: chemical vapor
Air pollution
Food Preservatives: sulfite
Other: menstruation, pregnancy, sinusitis
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22
What distinguishes asthma with other lung diseases, namely on
Asthma attacks can be lost with or without medication, meaning asthma attack
untreated nothing is lost by itself.
B.
Physical Examination
The discovery marks the physical examination of patients with asthma depends
degree of airway obstruction among others are prolonged expiration,
wheezing, hyperinflation of the chest, rapid breathing until cyanosis, etc..
C.

Investigations
Examination of pulmonary function tests before and after administration
methacholine or bronchodilator before and after exercise can
help establish the diagnosis of asthma.
Simple test of lung function with peak flow meter or a
more complete with a spirometer, another test may be through provocation
bronchus with histamine, methacholine, exercise (exercise), air dried and
cold, or with hypertonic NaCl. The use of peak flow meters
are important and should be pursued, as well as supporting
diagnosis, also determine the success for the treatment of asthma, in addition to the
can also use as alternative daily record sheet.
Her other investigations that may be done include:
sputum examination, total eosinophils, skin testing, total IgE or specific kada
IgE, photographs chest and blood gas analysis.
II.1.8. Complications of Asthma
Complications that may be due to bronchial asthma, among
as follows (Vitahealth, 2006):
A.
Pneumothorax
B.
Pneumomediastinum and subcutaneous emphysema
C.
Atelectasis
D.
Respiratory failure
E.
Bronchitis
F.
Rib fracture
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23
II.1.9 Classification and Degree of Asthma
Based on the causes of asthma are divided into: (Hartantyo, 1997)
A.
Extrinsic asthma
Extrinsic asthma is the most common form of asthma that
caused by an allergic reaction to allergens and patient
not bring any effect on a healthy person.
B.
Intrinsic Asthma
Intrinsic asthma is asthma that are not responsive to the trigger
derived from allergens. Asthma is caused by stress, infections
Events and bad environment such as humidity, temperature, pollution

air and excessive sports activities.

Distribution of the degree of asthma was made by Phelan et al (quoted from
Third International Pediatric Consensus 1998) terbagii 3, namely:
A.
Episodic asthma rarely
Is 75% of the population in children. Characterized by episodes
<1x every 4-6 weeks, wheezing after strenuous activity, there
symptoms between episodes, and normal lung function between
attack. Prophylactic therapy is not needed.
B.
Frequent episodic asthma
Represents 20% of the population of asthma in children. Characterized by
attack frequency and arise more frequently wheezing on exertion
being, but it can be prevented by administration of agonists 2
. Symptoms
less than 1x / week and lung function between attacks almost
normal. Prophylactic therapy is usually required.
C.
Persistent asthma
Occurs in about 5% of the population. Marked by frequent
attacks, wheezing occur during light activity, very
agonist needed 2
at intervals of symptoms. Symptoms occur more than
3x / week. Prophylactic therapy is needed.
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24
Table 2 Distribution of Degree of Asthma.
No.
Clinical parameters
medication needs and
Lung function
Episodic asthma
rarely
(Mild asthma)
Episodic asthma
often
(Asthma)
Persistent asthma
(Severe asthma)
1.
Frequency of attacks

<From 1x / month> than 1x / month Often

2.
The duration of attacks
A few days
A week or
More
There is no
Remission
3.
The intensity of the attack
Lightweight
More heavy
Weight
4.
Among attack
Without symptoms
No symptoms
Symptoms during the
Night
5.
Sleep and activity
Not
disturbed
Often
disturbed
Very disturbed
6.
Physical Examination
outside attacks
Normal
Maybe
Disturbed
Never
Normal
7.
Drug controller
(Anti-inflammatory)
No need to
Need
nonsteroids
Need steroids
8.
Lung function beyond
Attacks

PEF / PEVI> 80
%
PEF / PEVI 60 to
80%
PEV / Fevi <60%
& Variability
20-30%
9.
Lung function in
during attacks
Variability
Variability
20-30%
Variability 50%
Source: National Consensus Treatment of Asthma in Children. In 1994.
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25
According to the Global Initiative for Asthma (GINA) classification of asthma
based on the severity of the disease divided by 4 (four), namely:
1.
Intermittent asthma (asthma rarely)
Symptoms less than a week
brief attack
Symptoms at night <2 times a month
PEV or FEV 1> 80%
PEF or FEV1 variability of 20% - 30%
2.
Mild persistent asthma (mild persistent asthma)
Symptoms more than once a week
Attacks disrupt activity and sleep
Symptoms at night> 2 times a month
PEV or FEV 1> 80%
variability in PEF or FEV 1 <20% - 30%
3.
Moderate persistent asthma (persistent moderate asthma)
Symptoms of every day
Attacks disrupt activity and sleep
Symptoms at night> 1 week
PEV know FEV 1 60% - 80%
PEF or FEV1 variability> 30%
4.
Severe persistent asthma (severe persistent asthma)
Symptoms of every day

 continuous attack
Symptoms at night every day
There was restriction of physical activity
FEV1 or PEF = 60%
PEF or FEV variability> 30%
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26
II.1.10.Penatalaksanaan Asthma
Asthma medications can be divided into 2 major groups, namely reliever
(Reliever) and the drug controller (the controller). The first group is the drug
reliever or lozenges or the drug raid. Reliever medication (reliever) asthma is
used to relieve the symptoms of asthma attack or if it was incurred.
When the attack has been resolved and is no longer the symptoms of this drug
not used anymore. The second group is a controller medication, frequent
referred to as preventive medicine, or prophylactic drugs. This drug is used
to address the basic problem of asthma is a chronic inflammatory respitorik
(Taufik, 2009).
Asthma medication can be given in several ways such as oral,
inhalation or injection. The main advantage of inhaled drugs is generating
Direct effects to the respiratory tract, which results in a local concentration
high with less systemic risk (Taufik, 2009).
Table 3: Classification of asthma drugs
Controller
Reliever
Corticosteroids (inhaled,
Systemic)
Leucotriene modifeier
Long acting 2
agonist
(PROFIT)
Chromolin
:
Sodium
cromoglycate
and
Nedocromil Sodiem
Theophylline sustained release
Anti-IgE
Anticholinergics: Tiotropium
Short-acting 2
agonist

(SABA)
Systemic Corticosteroids
Anticholinergic
:
Ipratropium
bromide,
oxitropium
Theophylline
Source:
http://yayanakhyar.files.wordpress.com/2009/09/penatalaksanaan-asmakini_filesofthedrsmed.pdf.
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27
The goal of asthma treatment is controlled, marked:

Symptoms of chronic minimal, ideally none at all, including

night asthma symptoms.

Minimal (rarely) attack.

No kujungan to the emergency room.

2 agonist minimum usage requirements.

Normal activities are not disrupted.

APE small daily variation of 20%.

APE values close to normal.

Side effects minimal or no medication at all.

Dispensing Asthma by Severity:
Stage 1: Intermittent
Controller : not required.
Reliever : SABA: agonists
2
inhalation if necessary, but less than once
week. Intensity of treatment depends on the weight - severity
attack. Inhaled -agonist
2
or cromolyn or nedocromil before
exercise or exposure to allergens.
Stage 2: Persistent Light:
Controller : Daily Medication:, 200-500 mcg, or cromolyn, or

nedocromil, or sustained release theophylline. Inhaled corticosteroids if necessary,

increase the dose of inhaled corticosteroids. If the dose is being used
500 mcg to 800 mcg increase, or add a bronchodilator action
long (especially for asthma attack the night): the action of inhaled 2 agonists long
or sustained release theophylline, or oral 2 agonists.
Reliever : SABA: inhaled 2 agonists as necessary, no more than 3-4 times
a day.
Stage 3: Persistent Medium:
Controller : Daily Drug: Inhaled corticosteroids , 800 - 2000 mcg and
PROFIT, especially for night asthma: inhaled 2-agonists or long action
sustained release theophylline or a 2 agonist long oral action.
Reliever : SABA: inhaled 2 agonists as necessary, no more than 3-4 times
a day.
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28
Stage 4: Persistent Weight:
Controller : Daily Drug: Inhaled corticosteroids , 800 - 2000 mcg or
more and PROFIT: 2 agonists long action or sustained release theophylline, and / or
oral 2-agonist long action and long-term oral corticosteroids.
Reliever : SABA: inhaled 2 agonists if necessary.
MANAGEMENT OF ASTHMA ATTACK IN HOSPITAL
Severe asthma attacks or potentially life-threatening status
asthmaticus. Care must be immediately and safest treatment
performed in the hospital or in the hospital emergency department
(Taufik, 2009).
Initial assessment:
A brief history and physical examination in connection with
asthma attack is very important before giving treatment.
Concise history include:

Weighing complaints include activity limitations and interference

sleep.

All the drugs used.

Time began to attack and cause an attack.

Hospitalization and visits to emergency departments

because previous asthma attack.
The physical examination includes:

Assessing the severity of the attack (see division-degree assault).

Determining the presence of

complications
(Pneumonia, atelektase,
pneumotorak or pneumomediastinum)
Assessment of lung function include:

APE and VEP1 kuranya at every hour, with measurements

done before the start of treatment if possible.

O2 saturation with the " pulse OXYMETRY "if any.

Other investigations:

X-ray chest x-ray if suspected cardiopulmonary complications

pulmonary.
Page 23

29

Blood gas analysis in patients with APE estimated 30-50%

or worsening after initial treatment. PaO2 less than 60
mmHg and / or more than 45 mmHg PaCO2 showed
respiratory failure and an indication for incoming Space
Intensive Care (ICU)
TREATMENT
The following treatment is usually given together to be able to
as soon as possible to overcome asthma attacks (Taufik, 2009).
a.
Administration of oxygen: Oxygen is given 4-6 L / min for
get O2 saturation 90% or more.
b.
Agonist 2: 2 agonists are usually given short action
nebulized every 20 minutes during the first hour (salbutamol 5 mg
or fenoterol 2.5 mg, 10 mg tarbutalin). Administration
Parenteral 2 agonists can be done when the administration
nebulized not give results.
c.
Adrenaline (epinephrine): This drug can be administered
intramuscularly or subcutaneously when: 2 agonists are not available or
no response to inhaled 2 agonists.
d.
Additional bronchodilators: 2 agonist combination with
anticholinergics (ipratropium bromide) gives effect
bronchodilator better than given alone - alone.
This medicine is given before considering aminophylline.

Regarding aminophylline in addressing these attacks is still there

controversy. Although there are benefits, but aminophylline
Intravenous not recommended in the first 4 hours on handling
asthma attack. Aminophylline intravenously at a dose of 6 mg per kg body weight
given slowly (within 10 minutes) given to patients
Acute severe asthma who need treatment in hospital, if the patient
not received theophylline in the previous 48 hours.
e.
Corticosteroids: Systemic corticosteroids can accelerate
healing attacks refractory to bronchodilator drugs.
Page 24

30
Oral administration is as effective as intravenous and more
preferred because it's easier and cheaper. Corticosteroids
The new minimal effect after 4 hours. Corticosteroids
granted if:

Moderate to severe asthma attack.

Inhaled 2 agonists showed no improvement or:

Attacks occur even if the patient has received

Long-term oral corticosteroids.

Previous attacks also require corticosteroids

Oral.
Criteria for hospitalization:

Response to treatment within 1-2 hours is inadequate.

Severe narrowing of the airway settled (APE <40% estimate /

personal best value).

A history of severe asthma, especially when in need of home care

ill.

Patients with high-risk asthma.

Complaints had long before come to the hospital.

A place to stay away and unsanitary conditions.

Criteria for admission Intensive Outpatient Space:

There is no response to initial treatment in the emergency

emergency or situation deteriorated rapidly.

The presence of disorientation, drowsiness or loss of consciousness.

The threat of stopping breathing: hipoxemia despite providing

oxygen (PO2 <60 MHG and / or PCO2> 45 mmHg)
Diruang intensive care may be required intubation
when:

The situation continued to deteriorate despite optimal therapy already.

Patient fatigue.

PCO2 increased.
Page 25

31
II.2. Theory Framework
II.3. Framework Concept
Independent Variables
Dependent Variable
Environment:
Changes in weather
Smoke Cigarettes
Animals Peliharaann
Status
Allergies:
Food
Dust Mites
Disease History
Family
(Genetic)
Asthma
Bronchial
Disease History
Family
Type of Food
Changes in Weather
Dust Mites
Cigarette Smoke
Beast
Pets
Sex
Home Furnishings

Stairs
Bronchial Asthma
Variables examined
:
Variables studied:
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32
II.4. Hypothesis
H1: There is a relationship between a family history of the disease with numbers
incidence of asthma in PHC Land Sareal Bogor
H2: There is a relationship between cigarette smoke exposure with the incidence
asthma in Bogor Sareal Land Health Center.
II.5
Limitations of Research
At least the availability of data both from literature and internet
become an obstacle to the collection of information and research data
before that can be used as a reference by researchers. In addition,
the ability of researchers are still limited in terms of funding, time and
power so that the variables that are used only a family history of disease
and cigarette smoke alone.

Page 1

33
CHAPTER III
RESEARCH METHODOLOGY
III.1. Types of Research
This research is a descriptive analytic ie with
manggambarkan each independent variable and then
menghubungankan dependent and independent variables, with the approach
cross sectional namely by taking the independent variables
(Free) with a dependent variable (bound) at the same time.
The independent variables studied were family history of disease and
cigarette smoke exposure in children, while the dependent variable, namely its
asthma in children in the Land Sareal Bogor City Health Center.
The advantage of the use of the method is the cross-sectional design
Her research is easier, cheaper and faster results can be obtained, in addition to the
possibility that respondents "drop out" is very small. Data were examined
taken the form of primary data through interviews guided by

questionnaires to the parents of the respondents were diagnosed with asthma.

III.2. Place and Time Research
III.2.1. Places Research
This research was conducted at the health center Sareal Land, Bogor.
The following considerations are choosing this place:
A.
Location of Land Sareal strategic health center, so that
lets get a sufficient number of patients with
for examination.
B.
've Never done the same research in PHC Land
Sareal Bogor.
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34
III.2.2. Research time
This study was conducted starting in January 2011 in the period
for 3 months.
III.3. Subjects Research
III.3.1. Population
The study population was a group of people who will
studied, whereas the respondents were members of the population who used
as a source of data that meet the criteria of sample. Population in
This study is a Pediatric patients who visited the health center Land
Sareal Bogor peroide January 2010 to December 2010 with
diagnosis of asthma, as many as 85 people.
III.3.2. Samples
The samples were part of the population to be studied
and may represent a population. To calculate the sample size
This study uses Table
Krejcie-Morgan so that the sample
research as much as 70 respondents.
III.4. Identification of Research Variables
Independent variables: family medical history and exposure to cigarette smoke.
Dependent Variable: Incidence of asthma in children.
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35
III.5. Operational Definition of Variables
III.6. Inclusion Criteria
A.
Age 1-15 years

B.
Men and Women
C.
Diagnosed by a health center physician Land Sareal
No variable
Operational Definitions
Measure Scale Measurement Results
Measure
1
History
Diseases
Family
Is
children
which
have
History
Disease in either family
father and mother
asthma
which addressed health center
Land Sareal, Bogor City
Interview 1 Yes
2.
Nominal
2
Exposure
Smoke
Cigarette
Is the exposure of smoke
both active and cigarettes
passive obtained from
environmental and friends
of the child who was treated in
Soil health center Sareal
Bogor City
Interview 1. Yes
2.Tidak
Nominal
3
Incidence
Asthma
Patient is a child who
diagnosed
suffer

asthma by a physician
Health Center in the District
Land Sareal, Bogor City
Interview 1.Bergejala
2.Tidak
Nominal
Page 4

36
D.
Respondents are willing to be a study with approval
verbal informed consent.
III.7. Exclusion Criteria
A.
Not willing to be respondent
B.
People with asthma in children who are not hospitalized
III.8. Sampling Techniques
For sample selection is done by simple random sampling
the list of respondents who visit the health center for treatment
Land Sareal in Bogor City Health Center met the inclusion criteria.
Sampling with simple random sampling technique that every
members of the population have the same chance to be
as respondents / sample. Sampling with a simple way
random sampling technique used is by way of lottery
(Cointoss). The use of this technique has a simple estimation procedure
and simple.
III.9. Research Design
Cross-sectional study in a sample that is in
population to be studied. This research is when
where the data were taken on a visit list from January 2010
until December 2010, which aims to determine the relationship of
several independent variables on the dependent variable.
III.10. Type & Data Collection
This type of data is secondary data and primary data obtained from
interviews guided by a questionnaire to patients treated
by health centers are located in the District Land Sareal, Bogor.
Data collection was carried out with the help of health workers and cadres
working in their respective areas.
Page 5

37

III.11. How it Works Research

III.11.1. Pre Research
Applying for a research area to the Department of Health
Bogor city to search for data in the asthma patient visits the health center
Land Sareal.
III.11.2. When Research
Retrieval of data through a visit to the respondent then
conducted interviews guided by a questionnaire to parents
patients.
III.11.3
Data Processing
Data already collected processed by computerized with
using statistical computer software.
III.11.4. Reporting Results
Reporting the results of research and comparing the research
previous or basic theory at trial, so the results of research
can be utilized by all parties.
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38
III.12. Chronology of Research
III.13. The reliability and validity of test data
There are two important terms in the questionnaire that the questionnaire should be
valid
and reliable. Here is his translation, namely:
III.13.1.
Validity
Valid questionnaire is a questionnaire that is capable of
reveal what is to be disclosed. To test the validity of
a questionnaire carried out by means of the correlation between
scores of each variable with the total score.
Problem Formulation
Selection of Research Themes
Determining the Source
Data
Literature Search
Determining Variable
Informed Consent and
Collecting Primary Data
through interviews
Determining Hypothesis
Reporting
Getting Results
Data Analysis Using

Computer programs Statistics

Page 7

39
III.13.2.
Reliability
Reliable questionnaire is a questionnaire that can be used
to take measurements twice or more for symptoms
the same and with the same measuring devices as well. To test
reliability is done after knowing how much the amount of data
valid, as it was seen by using alpha
Cronbach. Levels of reliability with Alpha-Cornbach method
measured by Cronbach's Alpha scale of zero to one. Here
size scale reliability with Alpha-Cornbach methods, namely:
a.
Cronbach's Alpha value of 0.00 up to 0.20 means less reliable
b.
Cronbach's Alpha value of 0.21 up to 0.40 means rather reliable
c.
Cronbach's Alpha value of 0.41 up to 0.60 means quite reliable
d.
Cronbach's Alpha value of 0.61 up to 0.80 means reliable
e.
Alpha-value of 1.00 means sd 0.81 Cornbach very reliable
Before the study was conducted, then the questionnaire conducted
validity and reliability of the questionnaire. The test is given at 30
respondents who are part of the population that has been drawn in
random. After it is done processing the data by using
computerized statistical computer programs.
From the results of validity and reliability of questionnaires showed that
25 valid questions with a significant value of 0.05 at the level of
by 95% and the value of Cronbach's Alpha 0.899 which means that the questionnaire
was
reliable. After that question is invalid and not reliable then
not used in the study. The results of validity and reliability
more attached.
III.14. Analysis of data
Data analysis Data processing is done in the following way:
Page 8

40
1.

Editing Data
This stage is to check each questionnaire
related to the completeness and kejelasana from interviews
on the questionnaire.
2.
Data Coding
This stage is done by changing the information contained
in the questionnaire in the form of numbers.
3.
Data Processing
Stage of processing this data using a computerized method
with statistical computer software program.
4.
Data Analysis
a.
Univariate analysis is used to describe
each variable, both the dependent variable and
independent variables of the case group and the control group
the frequency distribution table.
b.
Bivariate analysis was used to analyze the relationship
between two variables and the independent variables
incidence of bronchial asthma by using the chi-test
Square, for the interpretation of the results of using the degrees
significance () of 5% to a record if <0.05
then failed to reject the hypothesis and if > 0.05, the
reject the hypothesis
Chi-Square formula:
X = (f0 - fn)
Fn
Where: X = Chi-Square; observed frequency f0 = fn
= Expected frequency.
Page 9

41
III.15. Previous Research
1 Novi pendonor, 2006.Faktor-Factors associated with assault
asthma in Indonesia (Advanced Data Analysis of Household Health Survey 2004)
The results of the analysis of the relationship between smoking behavior with
asthma attacks that there are as many as 204 of 4692 (4.24%) of people
respondents who do not smoke who had an asthma attack.
Of those who smoked no 90 of 2281
(3.90%) of people who had an asthma attack. Results of statistical tests
p-value of 0.545 is obtained it can be concluded there is no difference

proportion of asthma attacks among the respondents who did not smoke and
smoking. From the results obtained by the analysis of the value of
OR (odds ratio) 0.92
means that respondents who did not smoke 0.92 times likely to
get asthma attacks compared to respondents who smoke.
2 Kuwat Naidoo, 2008 Description Genesis Asthma against tors
Risk Factors on Employees in a Cement Plant in West Java
2008
Distribution of respondents according to the symptoms of asthma and habits
smoking showed 88.3% of respondents found that smoking is not
no asthma symptoms. Smoking does not have a relationship
with asthma on respondents. It is seen from the large value of p = 0.38
(P> 0.05). While the distribution of respondents according to a history of asthma and
asthma in the family showed respondents whose families
have asthma, asthma symptoms was 29.4%. Relationship
history of asthma in the family has an influence on asthma if
seen from the value of p = 0.008 (p <0.05).
Frederique Jeanne Uktolseja 3, 1998 Factors that
Bronchial Asthma affects Genesis in the ER
General Hospital National Center Dr. Cipto Mangunkusumo
in 1995-1996
Page 10

42
In the bivariate analysis and the values obtained p value 0.000 OR = 970
with 95% CI = 4.83-19.87. This suggests that there
significant association between family history of the disease with
asthma status and also shows that people who have
family history of disease is likely to have asthma
Bronchial 9.70 times greater than those who had no history
family illness.

Page 1

43
CHAPTER IV
RESULTS AND DISCUSSION
IV.1. Overview of Research Sites
Land Sareal Bogor City Health Center is located on the road of health no.
3 Bogor. Jurisdiction covers the villages namely fruit
Tanah Sareal Bogor with an area of 105 hectares comprising

on 7 RW and RT 36.
Soil health centers Sareal Bogor has a human resources
amounted to 34 people and 3 specialists, but it also becomes
Health center visits with the highest group in which 70% of visits
The work comes from outside the region, because of their geography that
are strategic enough that can be reached by vehicles especially
public transport. In addition, based on the annual report noted there
more than 2000 children who occupies it works and shows
prevalence of children with bronchial asthma as many as 85 people with asthma
Bronchial at the age of 1-15 years during the period of 2010 It is the
make one of the considerations in the selection of the research area in
Soil health center Sareal Bogor.
IV.2. Analysis of Research Findings
1.
Results of Univariate Analysis
Univariate analysis is used to describe the characteristics
of each - each variable studied. Based on the results of research
that has been done at the health center with the Bogor City Land Sareal
number of respondents is 70 people obtained several variables
depicts an overview of the respondents surveyed. Here
are some of the variables studied, among other things:
Page 2

44
a.
Sex
Obtained were 41 respondents (58.6%) had type
male sex - men and 29 respondents (41.4%) had type
female sex.
Table 4 Frequency Distribution of Respondents by Type
Gender in Land Sareal Bogor City Health Center.
Sex
Frequency
Percentage
Male - Male
41
58.6%
Women
29
41.4%
Total
70
100%
b.

Age
After the age groupings based on interval 5
a tender, obtained by 43 respondents (61.4%) aged 1-5
year, a total of 14 respondents (20%) aged 5-10 years and
as many as 13 respondents (18.6%) aged 11-15 years.
Table 5 Frequency Distribution of Respondents by
Age grouping by interval 5 Years in PHC
Land Sareal Bogor.
Age
Frequency
Percentage
1-5 Years
43
61.4%
6-10 Years
14
20%
11-15 Years
13
18.6%
Total
70
100%
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45
c.
Asthma Status
The number of asymptomatic children with asthma by 8 respondents
(11.4%), while children with symptomatic asthma were 62
respondents (88.6%).
Table 6 Frequency Distribution of Respondents by
Grouping Child Asthma Status in Soil Health Center Sareal
Bogor City
Asthma Status
Frequency
Percentage
Not
8
11.4%
Symptomatic
62
88.6%
Total

70
100%
d.
Family history of disease
There are 38 respondents (54.3%) of parents with asthma and
total of 32 respondents (45.7%) of parents are not asthma.
Table 7 Frequency Distribution of Respondents by Status People
Old Land Sareal Bogor City Health Center.
Disease History
Family
Frequency
Percentage
Not Asthma
38
54.3%
Asthma
32
45.7%
Total
70
100%
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46
e.
Cigarette Smoke Exposure
Having researched obtained as much as 54 respondents (77.1%)
including respondents were exposed to cigarette smoke and as much
16 respondents (22.9%) are not exposed to cigarette smoke.
Table 8 Frequency Distribution of Respondents by Exposure
Cigarette Smoke on Children's Health Center Land Sareal in Bogor
Smoke Exposure
Cigarette
Frequency
Percentage
Exposed
54
77.1%
Not
16
22.9%
Total
70
100%

2.
Results of Bivariate Analysis
Bivariate analysis is used to determine the relationship between the two
variables to be studied. The following variables to be studied, among other things:
A.
Relationship History Family Against Disease Asthma Status
Children in the Land Sareal Bogor City Health Center
Table 9 Relationship Family Disease History Against Disease
Asthma in Children in the Land Sareal Bogor City Health Center
History
Asthma Status
Total
P
Diseases
Not
Symptomatic
Value
Family
N
%
N
%
N
%
Asthma
1
2.6
37
97.4
38
100
0,020
Not Asthma
7
21.9 25
78.1
32
100
Total
8
11.4 62
88.6
70
100

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47
After statistical tests P value 0.020 obtained values more
smaller than the alpha value of 0.05 indicating the presence of
significant association between family history of the disease
asthma in children in the Land Sareal Bogor City Health Center.
B.
Relationship Against Cigarette Smoke Exposure on Asthma
Children in the Land Sareal Bogor City Health Center
Table 10 Relationship Status Against Cigarette Smoke Exposure Asthma
Children at the health center in the city of Bogor Land Sareal
Exposure
Smoke
Asthma Status
Total
P
Cigarette
Not
Symptomatic
Value
N%
N
%
N
%
Exposed
3
5.6
51
94.4
54
100
0,013
Not
5
31.3
11
68.7
16
100
Total
8
11.4
62

88.6
70
100
After statistical tests P value 0.013 obtained values more
smaller than the alpha value of 0.05 indicating the presence of
significant association between family history of the disease
asthma in children in the Land Sareal Bogor City Health Center.
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48
C.
Recapitulation of the Chi-Square Test Results of Relation Variables
with Asthma
Table 8 Summary of Chi-Square Test Results of Relation
Variables with Asthma
No.
Variables
Free
Test Data

Value
P
Remarks
1
History
Diseases
Family
Test
Alternative
Fisher
0.05
There is a relationship
meaningful, if there are
history of asthma in
family, the more
high possibility of child
asthma disease
2
Exposure
Smoke
Cigarette
Test
Alternative
Fisher

0.05
There is a relationship
meaningful, if there are
criteria smoking in children
then
more
high
possibility of children exposed
asthma
IV.3. Discussion
Results of research on family history and relationships
smoking status on the disease of asthma in children in PHC Land
Sareal Bogor and limitations of the study.
1.
Discussion The results of Chi-Square Analysis of Relationship History
Family Illness and Exposure to Tobacco Smoke Against Disease
Asthma.
A.
Relationship History Family Against Disease Asthma
Based on the results of a study of 70 respondents
showed that 38 respondents (54.3%) with a history
family disease of asthma, where as many as one respondent (2.6%) did not
0,020
0,013
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49
showed symptoms of asthma and 37 respondents (97.4%)
showed symptoms of asthma. The number of respondents who did not
have a family history of asthma by 32 respondents (45.7%),
where as many as seven respondents (21.9%) did not show symptoms of the disease
asthma and 25 respondents (78.1%) showed asthma.
Based on the analysis with an alternative test Fisher, obtained
significant association between family history of the disease with
asthma in children. It is shown from the results of the analysis between
variables and family history of asthma status in children obtained
P value equal to the value of 0.020 is less than the value of = 0.05.
This is consistent with research by Kuwat Naidoo (2008) who
stated that the results of the analysis of the relationship family history of disease
the incidence of asthma obtained ynag meaningful relationships. In
This study obtained information that people with asthma and there
family history of disease suffered only 29.4%, whereas those who
asthma but do not have a family history of asthma
71.6%. However, seen the value of p = 0.008 shows that there is a relationship

significant between family history of the disease and asthma status.

A second study by Jeanne Frdrique U (1998) On the analysis of
obtained bivariate p value 0.000 and OR = 970 values with 95% CI = 4.8319.87. This shows that there is a significant relationship
Among families with a history of asthma status and also
shows that people who have a family history of disease
Bronchial asthma is likely to experience 9.70 times greater than
people that there is no family history of disease.
B.
Cigarette Smoke Exposure Relationship Status Against Asthma.
Based on the results of a study of 70 respondents
indicate that as many as 54 respondents (77.2%) exposed to smoke
cigarettes, as many as 3 respondents (5.6%) did not suffer from asthma and
51 respondents (94.4%) suffered from asthma. The number of respondents who
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50
not exposed to cigarette smoke as many as 16 respondents (22.8%), as many as 5
respondents (31.3%) did not cause the symptoms of asthma and 11 respondents
(68.7%) cause of asthma symptoms.
Based on the analysis to test alternative Fisher, obtained
significant association between family history of the disease with
asthma in children. It is shown from the results of the analysis between
variables and family history of asthma status in children obtained
P value equal to the value of 0.013 is less than the value of = 0.05.
The results of the study according to the study in Finland (Jaakkola et
al, 2001) which shows that people are exposed to cigarette smoke
likely to suffer from asthma twice as compared to people who do not
exposed to cigarette smoke
But the above results contradict the results of the analysis
Novi Wati (2006) about the relationship between smoking behavior with asthma
obtained as many as 204 of 4692 (4.24%) respondents were not
smoke that got asthma. Respondents smoked 90 of 2281 (3.9%)
people get asthma. Statistical test results obtained p value 0.545
we can conclude there is no significant relationship between the difference
smoking with asthma.
The difference of the results of research that has been done due to the
differences in the characteristics of respondents who researched and precipitating
factors
that can cause an attack.

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CHAPTER V
CLOSING
V.1. Conclusion
Proven risk factors related to the incidence of asthma
bronchial in children are:
a.
Family history (p = 0.020)
b.
Cigarette smoke exposure (p = 0.013)
The results above were analyzed by chi-square with p value less
than the value of is 0.05, which indicates a significant relationship
between the dependent and independent variables, namely the relationship between
history
family illness and exposure to cigarette smoke on bronchial asthma status
child.
V.2. Suggestion
Based on the research that has been done, there are some suggestions
that need to be taken into consideration, among others, namely:
1.
For Asthmatics Children and Parents
The results of this study are expected to provide an overview
about the factors that influence risk and symptoms
arising on an asthma attack, so it can be done
prevention of asthma attacks and is expected to
active role in the prevention and treatment of disease
bronchial asthma in children suffering.
2.
Land for health centers Sareal
The increase in terms of health promotion and preventive measures
especially for bronchial asthma through education
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52
the health cadres, so that a picture of the disease
Bronchial asthma can be known by the general public.
3.
For Educational Institutions
Expected to provide additional information and overview
to health problems, especially on asthma
bronchial in children.
4.
For the Public

Expected to provide information to the public about

factors influence the incidence of asthma in children
so that people can know and can do
prevention.
5.
For Researchers
Expected to increase knowledge and insight
about asthma in children and various risk factors
accompanies the occurrence of bronchial asthma in children and may
Other variables examined.