Eight caaes of this condition are described, the patients being four Ceylonese, three Indians, and one Chinese, all males except one. Symptoms consisted of breathlessness and cough, sputum being sometimes purulent and occasionally blood-stained. Six of the patients complained of loss of weight, and in one, a Ceylonese schoolboy, this was the only presenting symptom. The authors found the most troublesome complaint to be a paroxysmal cough which was always worst at night. On clinical examination rhonchi were heard scattered throughout both lung fields in five cases, the lungs being clear in the other three. X-ray examination showed characteristic mottling of both lungs in four cases and of one lung in one case; another showed increased vascular markings, while in two the lungs were clear. Sputum was examined for tubercle bacilli and mites but none were found. The technique used for searching for mites is not described. A marked eosinophilia was found in all cases, the highest count recorded being 33, 264 eosinophils per cmm.Treatment consisted of arsenic, given in the form of neoarsphenamine, six injections of 0.3 gm. in six cases, and stovarsol 4 grains t.d.s. for seven and ten days respectively in the other two. Four of the patients were cured, three were improved, while one was showing a favourable response although treatment had not been completed.The author emphasizes the importance of performing repeated blood counts in order to avoid missing this condition. Out of the eight cases which he describes, one had been wrongly diagnosed as pulmonary tuberculosis and three as bronchial asthma. One of the latter had an initial eosinophil count of 4, 092 which rose to 17, 700 three weeks later. H. T. H. Wilson
148 patients, 79 males and 60 females were seen in 1978 at Medical Unit Universiti Kebangsaan Kuala Lumpur. For majority of the patients the attacks of asthma begin at an early age. History of allergies were found in majority of the patients. Family history of asthma was noted in about 50%. Of the allergens that triggers of an attack of asthma, household dusts, rhinitis and pollen tops the list. Of the food the common allergens were shrimps, eggs and crabs. Most of the above allergens can be avoided or counteracted.
Study site: Medical Unit, Hospital Kuala Lumpur (UKM unit), Malaysia
This study was proposed to identify specific radiological appearances in Malaysian patients with bronchial asthma. All consecutive patients, seen in the Medical Unit, Universiti Kebangsaan Malaysia between 1976 and 1979, satisfying the American Thoracic Society [1962] criteria for bronchial asthma formed the subjects of this study. Analysis of 207 patients led to the following conclusion. There are specific radiological changes present in a proportion of bronchial asthmatics during the acute episode. These changes are more frequent in the younger age group and in those in which the age of onset are early, The duration of asthma seems to have some bearing to the radiological changes.
Asthmatic patients constitute up to 5% of admissions to medical wards in our area. Analysis of 1099 adult asthmatic admissions over a 3-year period showed that Malays composed 31% of patients (expected 23%), Indians composed 36% (expected 31%) and Chinese only 32% (expected 46%). There was a reduced prevalence of asthma in the Chinese (P less than 0.001). Male asthmatic admissions showed a non-seasonal cyclic variation (P less than 0.01) with an increasing trend in the number of admissions (P less than 0.02). The proportion of male to female asthmatic admissions did not differ. In a sample of 50 asthmatic patients, studied in detail, the mean age of onset was 33.3 years (range 6-74) while only 14% of subjects had onset of asthma before the age of 10 years. Although the clinical features of these patients differ from those of Caucasian asthmatics, skin prick tests and other features suggest that the majority of our patients suffer from extrinsic atopic asthma.
Study site: Hospital [unknown], Pulau Pinang, Malaysia
In a cross-sectional study of 7 to 12-year-old primary school children in Kuala Lumpur, the prevalence of chronic cough and/or phlegm, persistent wheeze, and doctor-diagnosed asthma were 8.0%, 8.0% and 8.7%, respectively. The prevalence of asthma (defined as persistent wheeze and/or doctor-diagnosed asthma) was 13.8%. 4.3% experienced at least one episode of chest illness that resulted in inactivity for at least 3 days in the previous year. The mean age of commencement of symptoms in the doctor-diagnosed asthma group was 2.75 years. The prevalence of chronic cough and/or phlegm and persistent wheeze were highest among Indian children (p less than 0.05). More Malays had been diagnosed as having asthma than the other ethnic groups but the differences were not statistically significant. The patients' fathers' low levels of education were associated with chronic cough and/or phlegm (p less than 0.05) but not with other complaints. Asthma was significantly more common among boys than girls. No age differences were noted. Further analysis showed that persistent wheeze and doctor-diagnosed asthma were associated with increased likelihood of other respiratory illnesses or doctor-diagnosed allergy before the age of 2 years.
The use of pressurised metered dose inhalers was assessed among 93 asthmatic patients attending the respiratory out patient clinic between January to October 1989. They were regular users of the inhalers prior to the assessment. 62.4% of the patients were found to use the inhalers incorrectly. Forty three percent made more than one error. The commonest error observed was the failure to actuate and inhale the aerosol together in 41.9%. There was no difference in the occurrence of incorrect performance between different sexes, age groups, duration of inhaler used and previous supervision or no supervision by the doctors.
Study site: Respiratory clinic, Hospital Kuala Lumpur (UKM), Malaysia
The effects of indoor environmental factors on respiratory illness were studied in 15017-12 year old school children in Kuala Lumpur. Exposure to mosquito coil smoke for at least three nights a week was independently associated with asthma and persistent wheeze. Passive smoking, defined as sharing a bedroom with an adult smoker, was independently associated with a chest illness in the past year. No relationships were found between exposure to kerosene stoves, wood stoves, fumigation mat mosquito repellents or aerosol insecticides and respiratory illness. Host factors predictive of at least one respiratory outcome included family history of chest illness, history of allergy, male sex, hospitalization in the neonatal period and low paternal education. With 95% confidence, avoidance of regular exposure to mosquito coil smoke and passive smoking could reduce the prevalences of persistent wheeze, asthma and chest illness by up to 29%. Measurements of lung function confirmed the validity of questions pertaining to wheezing and asthma in the study questionnaire.