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Addition of macrolide in treating adult hospitalized community-acquired pneumonia

Loh LC, Quah SY, Khoo SK, Vijayasingham P, Thayaparan T

Respirology, 2005 Jun;10(3):371-7.
PMID: 15955152

Current clinical practice guidelines, including those in south Asia, recommend the addition of a macrolide to a broad-spectrum antibiotic for the treatment of severe hospitalized community-acquired pneumonia (CAP). The aim of this study was to observe the influence of macrolide addition on clinical outcomes of hospitalized adult patients with CAP.
Asthma control in adults in Asia-Pacific

Zainudin BM, Lai CK, Soriano JB, Jia-Horng W, De Guia TS, Asthma Insights and Reality in Asia-Pacific (AIRIAP) Steering Committee

Respirology, 2005 Nov;10(5):579-86.
PMID: 16268910 DOI: 10.1111/j.1440-1843.2005.00753.x

OBJECTIVE: The Asthma Insights and Reality in Asia-Pacific (AIRIAP) survey collected detailed information on asthma severity and management in the urban centres of eight areas of the Asia-Pacific region. This study compared asthma morbidity and management practices in these areas.
METHODOLOGY: Following recruitment, face-to-face interviews were completed with 2323 adults with diagnosed asthma, who had current symptoms or were using asthma medication. Comparisons between areas were made for asthma severity, asthma burden and management practices.
RESULTS Asthma severity varied significantly between areas (P < 0.01), with Vietnam and mainland China reporting the most cases with severe, persistent symptoms. Severity of asthma was significantly associated with advancing age and a lower level of education in a multivariate analysis (P < 0.001). The total use of acute healthcare for asthma was significantly associated with increased asthma severity. Work absence due to asthma was highest in the Philippines (46.6%) and lowest in South Korea (7.5%). The use of inhaled corticosteroids was associated with age in a non-linear manner. There was significant variation among countries in usage of inhaled corticosteroids, from 1.3% in South Korea to 29.0% in Taiwan (P < 0.00001). A peak flow meter was owned by a total of 7.7% of respondents, and overall, 17.9% of adults had a written action plan for asthma management.
CONCLUSIONS: Within the Asia-Pacific region, asthma in adults differs significantly in disease severity, management and treatment according to area of residence. International recommendations on the management of asthma are generally not being followed.
Study site: urban areas in several countries in Asia-Pacific region (via random street interception, random door-to-door recruitment, or telephone recruitment)
Gemcitabine and carboplatin in the treatment of locally advanced and metastatic non-small cell lung cancer

Leow CH, Liam CK

Respirology, 2005 Nov;10(5):629-35.
PMID: 16268917

The aim of the study was to evaluate the response, survival advantage and toxicity profile of gemcitabine-carboplatin combination cytotoxic chemotherapy in patients with locally advanced and metastatic non-small cell lung cancer (NSCLC).
Epidermal growth factor receptor targeted therapy with gefitinib in locally advanced and metastatic primary lung adenocarcinoma

Liam CK, Pang YK, Leow CH

Respirology, 2006 May;11(3):287-91.
PMID: 16635086

To describe the efficacy of monotherapy with the epidermal growth factor receptor-tyrosine kinase inhibitor, gefitinib in patients with locally advanced and metastatic primary lung adenocarcinoma.
Extrinsic allergic alveolitis

Ismail T, McSharry C, Boyd G

Respirology, 2006 May;11(3):262-8.
PMID: 16635083

Extrinsic allergic alveolitis (also known as hypersensitivity pneumonitis) is caused by repeated inhalation of mainly organic antigens by sensitized subjects. This induces a hypersensitivity response in the distal bronchioles and alveoli and subjects may present clinically with a variety of symptoms. The aims of this review are to describe the current concepts of the immunological response, the diverse clinical presentation of this disease, the relevant investigations and management, and areas for future studies.
Pulmonary tuberculosis presenting as community-acquired pneumonia

Liam CK, Pang YK, Poosparajah S

Respirology, 2006 Nov;11(6):786-92.
PMID: 17052309

The aims of this study were to investigate the frequency of Mycobacterium tuberculosis as a cause of community-acquired pneumonia (CAP) requiring hospitalization in Malaysia, and to define the clinical features of pulmonary tuberculosis (PTB) that distinguish it from non-TB CAP.
Sarcoidosis in Singapore: epidemiology, clinical presentation and ethnic differences

Anantham D, Ong SJ, Chuah KL, Fook-Chong S, Hsu A, Eng P

Respirology, 2007 May;12(3):355-60.
PMID: 17539838

The aim of this study is to better understand the epidemiological and clinical features of patients with sarcoidosis in Singapore and to ascertain if ethnic differences exist.
Snoring and breathing pauses during sleep in the Malaysian population

Kamil MA, Teng CL, Hassan SA

Respirology, 2007 May;12(3):375-80.
PMID: 17539841 DOI: 10.1111/j.1440-1843.2007.01030.x

OBJECTIVE: The aim of this study was to determine the prevalence of snoring and breathing pauses during sleep, and to assess associated factors, including morbidity and the impact on daytime functioning, in an adult Malaysian population.
METHODS: A cross-sectional survey of community-dwelling adults aged 30-70 years was conducted. Daytime sleepiness was assessed using the Epworth Sleepiness Scale. Physical examinations were limited to measurements of body habitus and blood pressure.
RESULTS: The sample consisted of 1611 adults (52.9% male). The prevalence of habitual snoring, breathing pauses and excessive daytime sleepiness were 47.3%, 15.2% and 14.8%, respectively. Seven per cent of respondents (8.8% male, 5.1% female) were clinically suspected to have obstructive sleep apnoea syndrome (OSAS). The independent predictors of habitual snoring were older age, Chinese or Indian ethnicity (compared with Malays), smoking, obesity and use of sedatives. Clinically suspected OSAS and habitual snoring were significantly associated with difficulty in getting up in the morning, morning headache, driving and workplace accidents, hypertension, and ischaemic heart disease.
CONCLUSIONS: The prevalence of habitual snoring is high in the Malaysian population. Sleep-related breathing disorders in Malaysian adults are associated with significant morbidity.
Introduction: Avian influenza: from basic biology to pandemic planning

Loh LC, Hui DS, Beasley R

Respirology, 2008 Mar;13 Suppl 1:S1.
PMID: 18366520 DOI: 10.1111/j.1440-1843.2008.01245.x
A multicentre surveillance study on the characteristics, bacterial aetiologies and in vitro antibiotic susceptibilities in patients with acute exacerbations of chronic bronchitis

Hui DS, Ip M, Ling T, Chang SC, Liao CH, Yoo CG, et al.

Respirology, 2011 Apr;16(3):532-9.
PMID: 21299688 DOI: 10.1111/j.1440-1843.2011.01943.x

Antimicrobial resistance is a global problem and the prevalence is high in many Asian countries.
Insights, attitudes and perceptions about asthma and its treatment: findings from a multinational survey of patients from 8 Asia-Pacific countries and Hong Kong

Thompson PJ, Salvi S, Lin J, Cho YJ, Eng P, Abdul Manap R, et al.

Respirology, 2013 Aug;18(6):957-67.
PMID: 23730953 DOI: 10.1111/resp.12137

BACKGROUND AND OBJECTIVE: The Asthma Insight and Management (AIM) survey was conducted in North America, Europe, the Asia-Pacific region and Latin America to characterize patients' insights, attitudes and perceptions about their asthma and its treatment. We report findings from the Asia-Pacific survey.
METHODS: Asthma patients (≥12 years) from Australia, China, Hong Kong, India, Malaysia, Singapore, South Korea, Taiwan and Thailand were surveyed. Patients answered 53 questions exploring general health, diagnosis/history, symptoms, exacerbations, patient burden, disease management, medications/treatments and patient's attitudes. The Global Initiative for Asthma guidelines were used to assess asthma control. The survey was conducted by random digit telephone dialling (Australia, China and Hong Kong) or by random face-to-face interviews (India, Malaysia, Singapore, South Korea, Taiwan and Thailand).
RESULTS: There were 80 761 households screened. Data from 3630 patients were collected. Wide disparity existed between objective measures of control and patient perception. Reported exacerbations during the previous year ranged from 19% (Hong Kong) to 67% (India). Reported unscheduled urgent/emergency visits to a doctor's office/hospital/clinic in the previous year ranged from 15% (Hong Kong) to 46% (Taiwan). Patients who reported having controlled asthma in the previous month ranged from 27% (South Korea) to 84% (Taiwan). Substantial functional and emotional limitations due to asthma were identified by 13% (South Korea) to 78% (India) of patients.
CONCLUSIONS: Asthma has a profound impact on patients' well-being despite the availability of effective treatments and evidence-based management guidelines. Substantial differences across the surveyed countries exist, suggesting unmet, country-specific cultural and educational needs. A large proportion of asthma patients overestimate their level of control.
Study site: random digit telephone dialling or by random face-to-face interviews at pre-selected locations.
Fulltext Detection of airflow limitation using a handheld spirometer in a primary care setting

Ching SM, Pang YK, Price D, Cheong AT, Lee PY, Irmi I, et al.

Respirology, 2014 Jul;19(5):689-93.
PMID: 24708063 DOI: 10.1111/resp.12291

BACKGROUND AND OBJECTIVE: Early diagnosis of chronic obstructive pulmonary disease (COPD) in primary care settings is difficult to achieve chiefly due to lack of availability of spirometry. This study estimated the prevalence of airflow limitation among chronic smokers using a handheld spirometer in this setting.
METHODS: This is a cross-sectional study performed on consecutive patients who were ≥40 years old with ≥10 pack-years smoking history. Face-to-face interviews were carried out to obtain demographic data and relevant information. Handheld spirometry was performed according to a standard protocol using the COPd-6 device (Model 4000, Vitalograph, Ennis, Ireland) in addition to standard spirometry. Airflow limitation was defined as ratio of forced expiratory volume in 1 s (FEV1 )/forced expiratory volume in 6 s <0.75 (COPd-6) or FEV1 /forced vital capacity <0.7. Multiple logistic regression analyses were used to determine predictors of airflow limitation.
RESULTS: A total of 416 patients were recruited with mean age of 53 years old. The prevalence of airflow limitation was 10.6% (n = 44) with COPd-6 versus 6% as gauged using standard spirometry. Risk factors for airflow limitation were age >65 years (odds ratio (OR) 3.732 95% confidence interval (CI): 1.100-1.280), a history of 'bad health' (OR 2.524, 95% CI: 1.037-6.142) and low to normal body mass index (OR 2.914, 95% CI: 1.191-7.190).
CONCLUSIONS: In a primary care setting, handheld spirometry (COPd-6) found a prevalence of airflow limitation of ∼10% in smokers. Patients were older, not overweight and had an ill-defined history of health problems.
KEYWORDS: Malaysia; chronic obstructive pulmonary disease; prevalence; primary care; smoke
Study site: Public primary health‐care clinic (Klinik Kesihatan), Sepang District, Selangor, Malaysia
Fulltext Efficacy of azithromycin in the treatment of bronchiectasis

Lourdesamy Anthony AI, Muthukumaru U

Respirology, 2014 Nov;19(8):1178-82.
PMID: 25183304 DOI: 10.1111/resp.12375

We evaluated the efficacy of a 12-week oral treatment with azithromycin in adult patients with bronchiectasis. The objectives were to demonstrate that this treatment reduces sputum volume, improves quality of life and to assess the lengths of effects after cessation of therapy.
Fulltext Lung cancer staging now and in the future

Liam CK, Andarini S, Lee P, Ho JC, Chau NQ, Tscheikuna J

Respirology, 2015 May;20(4):526-34.
PMID: 25682805 DOI: 10.1111/resp.12489

For a long time lung cancer was associated with a fatalistic approach by healthcare professionals. In recent years, advances in imaging, improved diagnostic techniques and more effective treatment modalities are reasons for optimism. Accurate lung cancer staging is vitally important because treatment options and prognosis differ significantly by stage. The staging algorithm should include a contrast computed tomography (CT) of the chest and the upper abdomen including adrenals, positron emission tomography/CT for staging the mediastinum and to rule out extrathoracic metastasis in patients considered for surgical resection, endosonography-guided needle sampling procedure replacing mediastinoscopy for near complete mediastinal staging, and brain imaging as clinically indicated. Applicability of evidence-based guidelines for staging of lung cancer depends on the available expertise and level of resources and is directly impacted by financial issues. Considering the diversity of healthcare infrastructure and economic performance of Asian countries, optimal and cost-effective use of staging methods appropriate to the available resources is prudent. The pulmonologist plays a central role in the multidisciplinary approach to lung cancer diagnosis, staging and management. Regional respiratory societies such as the Asian Pacific Society of Respirology should work with national respiratory societies to strive for uniform standards of care. For developing countries, a minimum set of care standards should be formulated. Cost-effective delivery of optimal care for lung cancer patients, including staging within the various healthcare systems, should be encouraged and most importantly, tobacco control implementation should receive an absolute priority status in all countries in Asia.
Fulltext Abstracts of The Asian Pacific Society of Respirology 20th Congress, December 3-6, 2015, Kuala Lumpur, Malaysia

Respirology, 2015 Dec;20 Suppl 3:1-160.
PMID: 26633239 DOI: 10.1111/resp.12706
Low prevalence of obstructive lung disease in a suburban population of Malaysia: A BOLD collaborative study

Loh LC, Rashid A, Sholehah S, Gnatiuc L, Patel JH, Burney P

Respirology, 2016 Aug;21(6):1055-61.
PMID: 27061596 DOI: 10.1111/resp.12793

BACKGROUND AND OBJECTIVE: As a Burden of Obstructive Lung Disease (BOLD) collaboration, we studied the prevalence of chronic obstructive pulmonary disease (COPD) and its associated risk factors in a suburban population in Malaysia.

METHODS: Nonhospitalized men or women of age ≥ 40 years from a Penang district were recruited by stratified simple random sampling. Participants completed detailed questionnaires on respiratory symptoms and exposure to COPD risk factors. Prebronchodilator and post-bronchodilator spirometry conducted was standardized across all international BOLD sites in device and data quality control.

RESULTS: Of the 1218 individuals recruited for the study, 663 (340 men and 323 women) had complete questionnaire data and acceptable post-bronchodilator spirometry. The estimated population prevalence of Global Initiative for Chronic Obstructive Lung Disease (GOLD) ≥ stage I was 6.5% or 3.4% based on either fixed forced expiratory volume in 1 s/forced vital capacity ratio of <0.7 or National Health and Nutritional Examination Survey-derived lower limit of normal ratio while the prevalence of GOLD ≥ stage II was either 4.6% or 3.1%, respectively. Multivariate logistic regression analysis showed independent association between all stages of COPD with cigarette smoking pack years (adjusted odds ratio per 10-year increase: 1.73; 95% confidence interval: 1.09-2.75), use of biomass fuel for cooking (1.61; 1.10-2.36) and exposure to dusty job (1.50; 1.09-2.06).

CONCLUSION: This study represented the first robust population-based epidemiology data on COPD for Malaysia. Compared with other sites globally, our estimated population prevalence was relatively low. In addition to cigarette smoking, use of biomass fuel and exposure to dusty job represented significant risk to the development of COPD.
Fulltext TIOtropium Safety and Performance In Respimat® (TIOSPIRTM ): Analysis of Asian cohort of COPD patients

Zhong N, Moon HS, Lee KH, Mahayiddin AA, Boonsawat W, Isidro MG, et al.

Respirology, 2016 Nov;21(8):1397-1403.
PMID: 27490162 DOI: 10.1111/resp.12856

BACKGROUND AND OBJECTIVE: The TIOtropium Safety and Performance In Respimat (TIOSPIR) trial showed similar safety and exacerbation efficacy profiles for tiotropium Respimat and HandiHaler in patients with COPD. The TIOSPIR results for patients in Asia are presented here.
METHODS: TIOSPIR evaluated once-daily tiotropium Respimat 5 and 2.5 µg with HandiHaler 18 µg in patients with COPD. Primary endpoints included time to death and time to first COPD exacerbation. Safety and exacerbation efficacy profiles were determined for the Asian region, and for Asia (all treatment arms pooled) versus the rest of the world (RoW).
RESULTS: In Asia (n = 2356), time to death was similar for Respimat 5 and 2.5 µg versus HandiHaler 18 µg (hazard ratio (HR) (95% CI): 0.96 (0.67, 1.38) and 1.23 (0.87, 1.73)). Risk of COPD exacerbation was similar for Respimat 5 µg, but increased for 2.5 µg versus HandiHaler 18 µg (HR (95% CI): 0.99 (0.85, 1.15) and 1.17 (1.00, 1.35)). Time to death in Asia and RoW was similar (HR (95% CI): 1.15 (0.99, 1.35)). Time to first COPD exacerbation was longer (HR (95% CI): 0.84 (0.78, 0.89)) and exacerbation rates were lower in Asia, but severe exacerbations were more frequent than in the RoW. Risk of major adverse cardiovascular events was similar for both regions.
CONCLUSION: Similar safety and exacerbation efficacy profiles were observed for tiotropium Respimat 5 µg and HandiHaler 18 µg in patients with COPD from Asia, analogous to the global analysis. Asian patients had lower risk of, and fewer exacerbations overall, but a higher proportion of severe exacerbations than in the RoW.
Fulltext Role of routine post-operative laryngeal endoscopic assessment after lung cancer surgery

Liam CK

Respirology, 2018 01;23(1):10-11.
PMID: 28901032 DOI: 10.1111/resp.13172
Regression equations to estimate the 2-min walk distance in an adult Asian population aged 40-75 years

Mirza FT, Jenkins S, Justine M, Cecins N, Hill K

Respirology, 2018 Jul;23(7):674-680.
PMID: 29446206 DOI: 10.1111/resp.13262

BACKGROUND AND OBJECTIVE: There is increased use of the 2-min walk test (2MWT) to assess functional exercise capacity. However, the distance achieved during this test may be difficult to interpret in the absence of reference values from a local population. Regression equations to estimate the 2-min walk distance (2MWD) only exist for American and Brazilian populations. The objective of this study was to develop regression equations to estimate the 2MWD in Malaysian adults who were free from major health problems.
METHODS: Eighty-seven adults (43 males; mean ± SD age: 57.1 ± 9.6 years) performed two 2MWT using a standardized protocol. Heart rate (HR) was recorded every 30 s during the test. Stepwise multiple regression analysis was performed using age, gender, height, weight and change in HR (ΔHR) as independent variables, and better of the two 2MWD as the dependent variable. A second regression equation, without ΔHR, was planned if ΔHR was retained as one of the predictors of the 2MWD in the first equation.
RESULTS: The better of the two 2MWD was 200 ± 34 m. Males walked 33 ± 6 m further than females (P < 0.001). The two regression equations were 196 - 1.1 × age, years + 1.0 × ΔHR, bpm + 31.2 × gender (R2 = 0.73) and 279 - 1.7 × age, years + 35.9 × gender (R2 = 0.47) with females = 0 and males = 1.
CONCLUSION: The equations derived in this study may facilitate the interpretation of the 2MWD in clinical populations in Malaysia, as well as in countries with similar cultural backgrounds to Malaysia.
Study site: volunteers from four villages in the Batu sub-district, Gombak, Malaysia
Epidemiology, treatment, disposition and outcome of patients with acute exacerbation of COPD presenting to emergency departments in Australia and South East Asia: An AANZDEM study

Kelly AM, Holdgate A, Keijzers G, Klim S, Graham CA, Craig S, et al.

Respirology, 2018 07;23(7):681-686.
PMID: 29394524 DOI: 10.1111/resp.13259

BACKGROUND AND OBJECTIVE: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a common presentation to emergency departments (ED) but data regarding its epidemiology and outcomes are scarce. We describe the epidemiology, clinical features, treatment and outcome of patients treated for AECOPD in ED.
METHODS: This was a planned sub-study of patients with an ED diagnosis of AECOPD identified in the Asia, Australia and New Zealand Dyspnoea in Emergency Departments (AANZDEM) study. The AANZDEM was a prospective, interrupted time series cohort study conducted in 46 ED in Australia, New Zealand, Singapore, Hong Kong and Malaysia over three 72-h periods in May, August and October 2014. Primary outcomes were patient epidemiology, clinical features, treatment and outcomes (hospital length of stay (LOS) and mortality).
RESULTS: Forty-six ED participated. There were 415 patients with an ED primary diagnosis of AECOPD (13.6% of the overall cohort; 95% CI: 12.5-14.9%). Median age was 73 years, 60% males and 65% arrived by ambulance. Ninety-one percent had an existing COPD diagnosis. Eighty percent of patients received inhaled bronchodilators, 66% received systemic corticosteroids and 57% of those with pH < 7.30 were treated with non-invasive ventilation (NIV). Seventy-eight percent of patients were admitted to hospital, 7% to an intensive care unit. In-hospital mortality was 4% and median LOS was 4 days (95% CI: 2-7).
CONCLUSION: Patients treated in ED for AECOPD commonly arrive by ambulance, have a high admission rate and significant in-hospital mortality. Compliance with evidence-based treatments in ED is suboptimal affording an opportunity to improve care and potentially outcomes.

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