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Fulltext Prevalence of asthma and risk factors among Chinese, Malay, and Indian adults in Singapore

Ng TP, Hui KP, Tan WC

Thorax, 1994 Apr;49(4):347-51.
PMID: 8202905

BACKGROUND: The prevalence and morbidity of asthma vary greatly among different ethnic communities and geographical locations, but the roles of environmental and genetic factors are not fully understood. The differences in prevalence of adult asthma among Chinese, Malay, and Indian ethnic groups in Singapore were examined, and the extent to which these could be explained by personal and environmental factors were investigated.
METHODS: A stratified disproportionate random sample (n = 2868) of Chinese (n = 1018), Malays (n = 967), and Indians (n = 883) of both sexes was drawn from households in five public housing estates, and an interviewer administered questionnaire was used to determine cumulative and current prevalence of "physician diagnosed asthma" (symptoms with a physician diagnosis of asthma).
RESULTS: Lifetime cumulative prevalence (standardised to the general population) of "physician diagnosed asthma" was 4.7% in men and 4.3% in women; 12 month period prevalences were 2.4% and 2.0%, respectively. Cumulative prevalence of asthma was significantly higher in Indians (6.6%) and Malays (6.0%) than in Chinese (3.0%); period prevalences of asthma were 4.5% in Indians, 3.3% in Malays, and 0.9% in Chinese. Ownership of cats or dogs was more frequent in Malays (15.4%) and Indians (11.2%) than in Chinese (8.8%). Rugs and carpets were also more frequently used by Malays (52.2%) and Indians (40.7%) than by Chinese (8.9%). Current smoking prevalences were higher in Malays (27.3%) than in Indians (19.4%) and Chinese (23.0%). Malays and Indians did not have higher rates of atopy (11.1% and 15.2%, respectively) than Chinese (15.4%). Adjustment for these factors in multivariate analyses reduced the greater odds of asthma in Malays and Indians, but not to a significant extent.
CONCLUSIONS: There are ethnic differences in the prevalence of asthma in Singapore which are not entirely explained by differences in smoking, atopy, or other risk factors. Other unmeasured environmental factors or genetic influences are likely to account for residual differences in the prevalence of asthma.

Matched MeSH terms: Asthma/etiology; Asthma/epidemiology*
The effects of exclusion of dietary egg and milk in the management of asthmatic children: a pilot study

Yusoff NA, Hampton SM, Dickerson JW, Morgan JB

J R Soc Promot Health, 2004 Mar;124(2):74-80.
PMID: 15067979 DOI: 10.1177/146642400412400211

Current understanding of the use of exclusion diets in the management of asthma in children is limited and controversial. The aim of this study was to examine the effects of excluding eggs and milk on the occurrence of symptoms in children with asthma and involved 22 children aged between three and 14 years clinically diagnosed as having mild to moderate disease. The investigation was single blind and prospective, and parents were given the option of volunteering to join the 'experiment' group, avoiding eggs, milk and their products for eight weeks, or the 'control' group, who consumed their customary food. Thirteen children were recruited to the experimental group and nine to the control group. A trained paediatrician at the beginning and end of the study period assessed the children. A seven-day assessment of food intake was made before, during and immediately after the period of dietary intervention in both groups. A blood sample was taken from each child for determination of food specific antibodies and in those children who could do so, the peak expiratory flow rate (PEFR) was measured. Based on the recommended nutrient intake (RNI), the mean percentage energy intake of the children in the experimental group was significantly lower (p < 0.05) in the experimental group. After the eight-week study period and compared with baseline values, the mean serum anti-ovalbumin IgG and anti-beta lactoglobulin IgG concentrations were statistically significantly reduced (p < 0.05) for both in the experimental group. In contrast, the values for anti-ovalbumin IgG in the control group were significantly increased and those for anti-beta lactoglobulin IgG were practically unchanged. The total IgE values were unchanged in both groups. Over the study period, the PEFR in those children in the experimental group able to perform the test was significantly increased, but no such change was noted in the children in the control group who could do the test. These results suggest that even over the short time period of eight weeks, an egg- and milk-free diet can reduce atopic symptoms and improve lung function in asthmatic children.
Study site: Outpatient Department, Royal County Hospital and the Frimley Children’s Centre, United Kingdom

Matched MeSH terms: Asthma/diet therapy*; Asthma/immunology; Asthma/physiopathology
Recurrent Trichosporon asahii glossitis: a case report

Shareef BT, Harun A, Roziawati Y, Bahari IS, Deris ZZ, Ravichandran M

J Contemp Dent Pract, 2008;9(3):114-20.
PMID: 18335127

This case report aims at describing an infection of the tongue as a manifestation of a Trichosporon asahii infection, its association with bronchial asthma and steroid administration, and to present a review of the literature pertaining to its antifungal susceptibility profile.

Matched MeSH terms: Asthma/drug therapy
Vernal Keratoconjunctivitis-When Medication Fails

Abd Hamid MR, Tai ELM, Wan Hazabbah WH, Ramli N

J Allergy Clin Immunol Pract, 2019 Apr;7(4):1308-1309.
PMID: 30581132 DOI: 10.1016/j.jaip.2018.11.016
Matched MeSH terms: Asthma/diagnosis*
The Effects of Telemedicine on Asthma Control and Patients' Quality of Life in Adults: A Systematic Review and Meta-analysis

Chongmelaxme B, Lee S, Dhippayom T, Saokaew S, Chaiyakunapruk N, Dilokthornsakul P

J Allergy Clin Immunol Pract, 2019 01;7(1):199-216.e11.
PMID: 30055283 DOI: 10.1016/j.jaip.2018.07.015

BACKGROUND: Telemedicine is increasingly used to improve health outcomes in asthma. However, it is still inconclusive which telemedicine works effectively.
OBJECTIVE: This study aimed to determine the effects of telemedicine on asthma control and the quality of life in adults.
METHODS: An electronic search was performed from the inception to March 2018 on the following databases: Cochrane CENTRAL, CINAHL, ClinicalTrials.gov, EMBASE, PubMed, and Scopus. Randomized controlled trials that assessed the effects of telemedicine in adults with asthma were included in this analysis, and the outcomes of interest were levels of asthma control and quality of life. Random-effects model meta-analyses were performed.
RESULTS: A total of 22 studies (10,281 participants) were included. Each of 11 studies investigated the effects of single-telemedicine and combined-telemedicine (combinations of telemedicine approaches), and the meta-analyses showed that combined tele-case management could significantly improve asthma control compared with usual care (standardized mean difference [SMD] = 0.78; 95% confidence interval [CI]: 0.56, 1.01). Combined tele-case management and tele-consultation (SMD = 0.52 [95% CI: 0.13, 0.91]) and combined tele-consultation (SMD = 0.28 [95% CI: 0.13, 0.44]) also significantly improved asthma outcomes, but to a lesser degree. In addition, combined tele-case management (SMD = 0.59 [95% CI: 0.31, 0.88]) was the most effective telemedicine for improving quality of life, followed by combined tele-case management and tele-consultation (SMD = 0.31 [95% CI: 0.03, 0.59]), tele-case management (SMD = 0.30 [95% CI: 0.05, 0.55]), and combined tele-consultation (SMD = 0.27 [95% CI: 0.11, 0.43]), respectively.
CONCLUSIONS: Combined-telemedicine involving tele-case management or tele-consultation appear to be effective telemedicine interventions to improve asthma control and quality of life in adults. Our findings are expected to provide health care professionals with current evidence of the effects of telemedicine on asthma control and patients' quality of life.

Matched MeSH terms: Asthma/diagnosis*; Asthma/therapy
Awareness of the ozone layer and acceptance of a new CFC-free metered dose inhaler among asthmatic patients

Liam CK, Lim KH

Int J Tuberc Lung Dis, 1998 Aug;2(8):683-9.
PMID: 9712285

University of Malaya Medical Centre, Kuala Lumpur, Malaysia.

Matched MeSH terms: Asthma/drug therapy; Anti-Asthmatic Agents/administration & dosage
Common concerns in managing bronchial asthma during the COVID-19 pandemic

Chai CS, Liam CK

Int J Tuberc Lung Dis, 2020 Jul 01;24(7):750-752.
PMID: 32718416 DOI: 10.5588/ijtld.20.0378
Matched MeSH terms: Asthma/drug therapy*; Asthma/virology
Respiratory health among office workers in Malaysia and endotoxin and (1,3)-β-glucan in office dust

Lim FL, Hashim Z, Than LTL, Md Said S, Hashim JH, Norbäck D

Int J Tuberc Lung Dis, 2019 11 01;23(11):1171-1177.
PMID: 31718753 DOI: 10.5588/ijtld.18.0668

OBJECTIVE: To examine the associations between endotoxin and (1,3)-β-glucan concentrations in office dust and respiratory symptoms and airway inflammation among 695 office workers in Malaysia.METHODS: Health data were collected using a questionnaire, sensitisation testing and measurement of fractional exhaled nitric oxide (FeNO). Indoor temperature, relative air humidity (RH) and carbon dioxide (CO₂) were measured in the offices and settled dust was vacuumed and analysed for endotoxin and (1,3)-β-glucan concentrations. Associations were analysed by two level multiple logistic regression.RESULTS: Overall, 9.6% of the workers had doctor-diagnosed asthma, 15.5% had wheeze, 18.4% had daytime attacks of breathlessness and 25.8% had elevated FeNO (≥25 ppb). The median levels in office dust were 11.3 EU/mg endotoxin and 62.9 ng/g (1,3)-β-glucan. After adjusting for personal and home environment factors, endotoxin concentration in dust was associated with wheeze (P = 0.02) and rhinoconjunctivitis (P = 0.007). The amount of surface dust (P = 0.04) and (1,3)-β-glucan concentration dust (P = 0.03) were associated with elevated FeNO.CONCLUSION: Endotoxin in office dust could be a risk factor for wheeze and rhinoconjunctivitis among office workers in mechanically ventilated offices in a tropical country. The amount of dust and (1,3)-β-glucan (a marker of indoor mould exposure) were associated with Th2 driven airway inflammation.

Matched MeSH terms: Asthma/epidemiology*
Asthma among adult patients presenting with dyspnea to the emergency department: An observational study

Kuan WS, Craig S, Kelly AM, Keijzers G, Klim S, Graham CA, et al.

Clin Respir J, 2018 Jun;12(6):2117-2125.
PMID: 29469993 DOI: 10.1111/crj.12782

INTRODUCTION: Shortness of breath is a common presenting symptom to the emergency department (ED) that can arise from a myriad of possible diagnoses. Asthma is one of the major causes.
OBJECTIVE: The aim of this study was to describe the demographic features, clinical characteristics, management and outcomes of adults with an ED diagnosis of asthma who presented to an ED in the Asia Pacific region with a principal symptom of dyspnea.
METHODS: Planned sub-study of patients with an ED diagnosis of asthma identified in the Asia, Australia and New Zealand Dyspnoea in Emergency Departments (AANZDEM) study. AANZDEM was a prospective cohort study conducted in 46 EDs in Australia, New Zealand, Singapore, Hong Kong and Malaysia over three 72 hour 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: Of the 3044 patients with dyspnea, 387 (12.7%) patients had an ED diagnosis of asthma. The median age was 45 years, 60.1% were female, 16.1% were active or recent smokers and 30.4% arrived by ambulance. Inhaled bronchodilator therapy was initiated in 88.1% of patients, and 66.9% received both inhaled bronchodilators and systemic corticosteroids. After treatment in the ED, 65.4% were discharged. No death was reported.
CONCLUSION: Asthma is common among patients presenting with a principal symptom of dyspnea in the ED of the Asia Pacific region. There was a suboptimal adherence to international guidelines on investigations and treatments of acute asthma exacerbations presenting an opportunity to improve the efficiency of care.

Matched MeSH terms: Asthma/complications; Asthma/epidemiology*; Asthma/therapy
The direct cost of treating bronchial asthma in a teaching hospital in Malaysia

Chan PW, Hussain S, Ghani NH, Debruyne JA, Liam CK

Southeast Asian J. Trop. Med. Public Health, 2002 Sep;33(3):600-3.
PMID: 12693597

A pilot study to evaluate the direct cost of treating 51 adults and 50 children with bronchial asthma was conducted. All aspects of the medical care provided over a 6-month period were considered. The mean treatment costs per month were US dollars 22.97 (adults) and US dollars 15.56 (children). The cost of maintenance therapy accounted for 55.5% and 73.4% of the total direct cost treatment for adults and children respectively. Only 27 (52.9%) adults and 17 (34.0%) children paid for their inhaled prophylactic drugs, amounting to 12.3% of the total maintenance therapy costs. Thirteen (25.4%) adults and 9 (18.0%) children were using alternative therapy at a monthly cost of US dollars 41.50 and US dollars 16.77 respectively. A substantial proportion of the direct cost of asthma treatment is heavily subsidized in Malaysia. Adequate attention to the allocation of the health budget, to ensure the optimal provision of health care, is warranted.

Matched MeSH terms: Asthma/economics*; Asthma/therapy
Fulltext House dust mite fauna in the Klang Valley, Malaysia

Mariana A, Ho TM, Sofian-Azirun M, Wong AL

Southeast Asian J. Trop. Med. Public Health, 2000 Dec;31(4):712-21.
PMID: 11414418

Allergy to house dust mites (HDM) is an important cause of asthma and rhinitis in Malaysia. This study was carried out to evaluate the dust mite fauna in the Klang Valley. Dust samples were collected from 20 houses from March 1994 to February 1995. Thirty-three dust samples from mattresses were examined monthly for the occurrence of HDM. A total of 22 species in 9 families of HDM was identified. The most common and densely populated species was Blomia tropicalis with an average density of 8,934 mites/g of dust. Dermatophagoides pteronyssinus was the next in abundance, followed by Malayoglyphus intermedius. All houses surveyed were found to be infested with HDM and every house had at least 6 species of HDM. B. tropicalis and D. pteronyssinus were found in all mattresses. HDM in the Klang Valley were found to be highly prevalent and present in high densities. In this study, counts of D. pteronyssinus was found to exceed the proposed exposure threshold of 500 mites/g dust, for triggering acute asthma. Although counts of B. tropicalis exceeded D. pteronyssinus, no conclusion could be made because there is currently no exposure threshold for triggering acute asthma, for this species. Monthly distribution of B. tropicalis and D. pteronyssinus showed 2 peaks and 4 peaks, respectively. The major peak for D. pteronysinus was in January 1995 whereas for B. tropicalis, the major peak was more variable and occurred between November 1994 to January 1995. Both the species showed minor peak in April 1994.

Matched MeSH terms: Asthma/etiology
Endotoxin, ergosterol, muramic acid and fungal DNA in dust from schools in Johor Bahru, Malaysia--Associations with rhinitis and sick building syndrome (SBS) in junior high school students

Norbäck D, Hashim JH, Markowicz P, Cai GH, Hashim Z, Ali F, et al.

Sci Total Environ, 2016 Mar 1;545-546:95-103.
PMID: 26745297 DOI: 10.1016/j.scitotenv.2015.12.072

This paper studied associations between ocular symptoms, rhinitis, throat and dermal symptoms, headache and fatigue in students by ethnicity and in relation to exposure to chemical microbial markers and fungal DNA in vacuumed dust in schools in Malaysia. A total of 462 students from 8 randomly selected secondary schools in Johor Bahru, Malaysia, participated (96% response rate). Dust was vacuumed from 32 classrooms and analysed for levels of five types of endotoxin as 3-hydroxy fatty acids (C10, C12, C14, C16 and C18 3-OH), muramic acid, ergosterol and five sequences of fungal DNA. Multiple logistic regression was applied. Totally 11.9% reported weekly ocular symptoms, 18.8% rhinitis, 15.6% throat and 11.1% dermal symptoms, 20.6% headache and 22.1% tiredness. Totally 21.1% reported pollen or furry pet allergy (atopy) and 22.0% parental asthma or allergy. Chinese students had less headache than Malay and Indian had less rhinitis and less tiredness than Malay. Parental asthma/allergy was a risk factor for ocular (odds ratio=3.79) and rhinitis symptoms (OR=3.48). Atopy was a risk factor for throat symptoms (OR=2.66), headache (OR=2.13) and tiredness (OR=2.02). There were positive associations between amount of fine dust in the dust samples and ocular symptoms (p<0.001) and rhinitis (p=0.006). There were positive associations between C14 3-OH and rhinitis (p<0.001) and between C18 3-OH and dermal symptoms (p=0.007). There were negative (protective) associations between levels of total endotoxin (LPS) (p=0.004) and levels of ergosterol (p=0.03) and rhinitis and between C12 3-OH and throat symptoms (p=0.004). In conclusion, the amount of fine dust in the classroom was associated with rhinitis and other SBS symptoms and improved cleaning of the schools is important. Endotoxin in the school dust seems to be mainly protective for rhinitis and throat symptoms but different types of endotoxin could have different effects. The ethnic differences in symptoms among the students deserve further attention.

Matched MeSH terms: Asthma
Respiratory symptoms and fractional exhaled nitric oxide (FeNO) among students in Penang, Malaysia in relation to signs of dampness at school and fungal DNA in school dust

Norbäck D, Hashim JH, Hashim Z, Cai GH, Sooria V, Ismail SA, et al.

Sci Total Environ, 2017 Jan 15;577:148-154.
PMID: 27802882 DOI: 10.1016/j.scitotenv.2016.10.148

Few health studies exist on dampness and mould in schools in the tropics. We studied associations between fraction of exhaled nitric oxide (FeNO), respiratory symptoms and airway infections among students and dampness and fungal DNA in schools in Malaysia. A total of 368 randomly selected students from 32 classrooms in 8 secondary schools in Penang, Malaysia, participated (58% participation rate). Information on current respiratory symptoms and the home environment was collected by a standardised questionnaire. FeNO was measured by NIOX MINO (50ml/min). The classrooms were inspected and dust was collected by vacuuming on special filters and was analysed for five fungal DNA sequences by quantitative PCR. Linear mixed models and 3-level multiple logistic regression (school, classroom, student) were applied adjusting for demographic data and the home environment. Totally 10.3% reported doctor's diagnosed asthma, 15.1% current wheeze, 12.4% current asthma, 37.3% daytime breathlessness, 10.2% nocturnal breathlessness, 38.9% airway infections and 15.5% had pollen or furry pet allergy. The geometric mean of FeNO was 19.9ppb and 45% had elevated FeNO (>20ppb). Boys had higher levels of FeNO. Chinese had less daytime breathlessness than Malay (OR=0.30: p<0.001). Indoor carbon dioxide levels were low (380-720ppm). Dampness was observed in 18% of the classrooms and was associated with respiratory infections (OR=3.70; 95% CI 1.14-12.1) and FeNO (p=0.04). Aspergillus versicolor DNA was detected in 67% of the classrooms. Higher numbers of Aspergillus versicolor DNA in classroom dust were associated with wheeze (p=0.006), current asthma (p=0.002), respiratory infections (p=0.005) and elevated FeNO levels (p=0.02). In conclusion, respiratory symptoms were common among the students and the high FeNO levels indicate ongoing airway inflammation. Building dampness and the mould Aspergillus versicolor in schools in Malaysia can be risk factors for impaired respiratory health among the students.

Matched MeSH terms: Asthma/epidemiology*
Volatile organic compounds (VOC), formaldehyde and nitrogen dioxide (NO2) in schools in Johor Bahru, Malaysia: Associations with rhinitis, ocular, throat and dermal symptoms, headache and fatigue

Norbäck D, Hashim JH, Hashim Z, Ali F

Sci Total Environ, 2017 Aug 15;592:153-160.
PMID: 28319702 DOI: 10.1016/j.scitotenv.2017.02.215

This paper studied associations between volatile organic compounds (VOC), formaldehyde, nitrogen dioxide (NO2) and carbon dioxide (CO2) in schools in Malaysia and rhinitis, ocular, nasal and dermal symptoms, headache and fatigue among students. Pupils from eight randomly selected junior high schools in Johor Bahru, Malaysia (N=462), participated (96%). VOC, formaldehyde and NO2 were measured by diffusion sampling (one week) and VOC also by pumped air sampling during class. Associations were calculated by multi-level logistic regression adjusting for personal factors, the home environment and microbial compounds in the school dust. The prevalence of weekly rhinitis, ocular, throat and dermal symptoms were 18.8%, 11.6%, 15.6%, and 11.1%, respectively. Totally 20.6% had weekly headache and 22.1% fatigue. Indoor CO2 were low (range 380-690 ppm). Indoor median NO2 and formaldehyde concentrations over one week were 23μg/m3 and 2.0μg/m3, respectively. Median indoor concentration of toluene, ethylbenzene, xylene, and limonene over one week were 12.3, 1.6, 78.4 and 3.4μg/m3, respectively. For benzaldehyde, the mean indoor concentration was 2.0μg/m3 (median<1μg/m3). Median indoor levels during class of benzene and cyclohexane were 4.6 and 3.7μg/m3, respectively. NO2 was associated with ocular symptoms (p<0.001) and fatigue (p=0.01). Formaldehyde was associated with ocular (p=0.004), throat symptoms (p=0.006) and fatigue (p=0.001). Xylene was associated with fatigue (p<0.001) and benzaldehyde was associated with headache (p=0.03). In conclusion, xylene, benzaldehyde, formaldehyde and NO2 in schools can be risk factors for ocular and throat symptoms and fatigue among students in Malaysia. The indoor and outdoor levels of benzene were often higher than the EU standard of 5μg/m3.

Matched MeSH terms: Asthma/chemically induced
Fulltext A one month review of the types of medical emergencies and their treatment outcomes at two urban public health clinics

Chew BH, Than TL, Chew KS, Jamaludin NK, Hassan H

Med J Malaysia, 2012 Dec;67(6):571-6.
PMID: 23770947 MyJurnal

INTRODUCTION: Our study was to examine prevalence and treatment outcomes of medical emergencies at two urban public health clinics in the Petaling district, Selangor, Malaysia.
METHODS: A prospective universal sampling was employed to recruit all emergencies over one month period (12 April to 11 May 2011). A structured case record form was used to capture demographic data, whether the index case was selfpresenting or decided by health care workers as a medical emergency, presenting complaints, diagnoses, concurrent chronic diseases and their treatment outcomes at the clinic level. Emergency presentations and diagnoses were classified according to the International Classification of Primary Care, revised second edition (ICPC-2-R).
RESULTS: A total of 125 medical emergencies with 276 presenting complaints were recorded. The mean age was 30.7 years old (SD 19.9). The prevalence of medical emergency was 0.56% (125/22,320). Chief complaints were mainly from ICPC-2-R chapter R (respiratory system) and chapter A (general and unspecified), 40.0% and 28.0% respectively. The most common diagnosis was acute exacerbation of bronchial asthma (34.6%). Forty percent were referred to hospitals. After adjusting for age and gender, patients who presented with painful emergency (OR 4.9 95% CI 2.0 to 11.7), cardiovascular emergency (OR 63.4 95% CI 12.9 to 310.4) and non-respiratory emergency were predictors of hospital referral (OR 4.6 95% CI 1.1 to 19.1).
CONCLUSION: There was about one medical emergency for every 200 patients presenting to these urban public polyclinics which were mainly acute asthma. More than half were discharged well and given a follow-up.
Study site: Klinik Kesihatan Seri Kembangan and Klinik Kesihatan Puchong, Selangor, Malaysia

Matched MeSH terms: Asthma
Fulltext First detected human bocavirus in a Malaysian child with pneumonia and pre-existing asthma: a case report

Etemadi MR, Jalilian FA, Abd Wahab N, Jahanshiri F, Amini R, Othman N, et al.

Med J Malaysia, 2012 Aug;67(4):433-4.
PMID: 23082460 MyJurnal

Human bocavirus (HBoV) is a newly discovered parvovirus associated with respiratory disease in children. There are many reports worldwide on the endemicity of this virus. Since it is relatively new, detection in clinical laboratories is not routinely performed. We describe the first detection of HBoV in Malaysia in a 13-month-old boy with pneumonia and underlying asthma. The infective agent was confirmed by molecular methods.

Matched MeSH terms: Asthma/complications
Fulltext Methacholine challenge test as an adjunctive investigative tool in patients with asthma-like symptoms: the Sabah experience

Siew BTT, Wong JL, Beniyamin A, Ho A, Kannan SKK, Jamalul Azizi AR

Med J Malaysia, 2012 Apr;67(2):204-6.
PMID: 22822644 MyJurnal

INTRODUCTION: Patients with asthma-like symptoms pose a diagnostic dilemma when physical examination is normal. The usual practice in Malaysia would be to give empirical asthma treatment. Bronchial challenge test (BCT) is widely used in many countries to diagnose asthma objectively but it is not widely available in Malaysia.
OBJECTIVE: To describe our experience with BCT using methacholine at Queen Elizabeth Hospital as a supporting tool in the investigation of patients with asthma-like symptoms.
METHODOLOGY: Review of case notes of patients who underwent BCT from July 2008 till April 2009. BCT was performed via dosimeter technique. Results were classified as high hyper responsiveness if the provocative dose of methacholine required to achieve 20% fall in FEV1 (PD20) was less than or equal to 0.125 micromol, moderate hyper responsiveness if PD20 was between 0.125 to 1.99 micromol or mild hyper responsiveness if PD20 was between 2.00 to 6.6 micromol. PD20 of more than 6.6 micromol constitutes a negative MCT.
RESULTS: 29 patients had BCT during the study period. 19 cases were included in this review. The age ranged from 13 to 70 years old. There were 12 males and 7 females. Duration of symptoms ranged from 2 weeks to 23 years. BCT was positive (mild or moderate hyper responsiveness) in 10 out of 19 patients. No patient had high bronchial hyper responsiveness.
CONCLUSIONS: BCT is a useful adjunctive tool in the investigation of patients presenting with asthma-like symptoms. This test obviates empirical asthma treatment. BCT should be made available in all major hospitals in Malaysia.

Matched MeSH terms: Asthma/diagnosis*; Asthma/physiopathology
Fulltext Prevalence of bronchial asthma among orang asli in peninsular Malaysia

Ngui R, Lim YA, Chow SC, de Bruyne JA, Liam CK

Med J Malaysia, 2011 Mar;66(1):27-31.
PMID: 23765139 MyJurnal

A survey was carried out to determine the prevalence of bronchial asthma and their contributing risk factors among Orang Asli subgroups living in Malaysia using IUATLD questionnaire and spirometry without being discriminatory towards age or gender. Of the 1171 distributed questionnaires, 716 (61.1%) comprising of 62.7% Semai Pahang, 51.3% Temiar, 74.2% Mah Meri, 65.6% Semai Perak, 53.6% Temuan, 53.8% Semelai, 61.1% Jakun and 67.4% Orang Kuala subgroups completed their questionnaire and were included in the data analysis. Participants comprised 549 (76.7%) children and 167 (23.3%) adults, age between 1 to 83 years old, 304 (42.5%) males and 412 (57.5%) females. The overall prevalence of bronchial asthma was 1.4% of which 1.5% was children, 1.3% adults, 1.0% male and 1.7% female, respectively. Of the 8 subgroups surveyed, 5 out of 10 confirmed asthma cases were Semai Pahang, followed by 3 cases among Mah Meri, and one case each among Temuan and Semai Perak subgroups, respectively. This study also demonstrated that the prevalence of self-reported and confirmed bronchial asthma tend to be higher among those who had close contact with pets, smoking individuals and among those who had a family history of asthma.

Matched MeSH terms: Asthma*
Fulltext Budesonide/formoterol combination therapy as both maintenance and reliever medication in moderate-to-severe asthma: a real-life effectiveness study of Malaysian patients

Loh LC, Lim BK, Raman S, Vijayasingham P, Mohd Yusuf S

Med J Malaysia, 2008 Aug;63(3):188-92.
PMID: 19248687

Budesonide/Formoterol (Symbicort) combination therapy as both maintenance and reliever treatment (SMART) is a novel approach in asthma management. We examined its 'real-life effectiveness' in treating Malaysian patients with moderate-to-severe asthma in whom despite on combined inhaled corticosteroids and long-acting beta2-agonist, were still inadequately controlled. In a retrospective study, 22 eligible adult patients on SMART [mean (range) age: 49 (36-65) years; FEV1: 41 (21-74)% predicted] were identified from medical records of an urban-based university hospital chest clinic, and their clinical outcomes studied at three months. Another 16 patients [50 (14-66) years; 48 (20-91)% predicted] of similar severity and treatment (i.e. Symbicort maintenance treatment plus short-acting beta2-agonist as reliever), but not on SMART, were used as comparator over the same assessment period. In addition, the patients were separately interviewed with standard questionnaire on their satisfaction and compliance to the SMART approach. In SMART group, rescue treatment requirement (p<0.001) and FEV1 [median difference = 2.5%, p=0.015; mean difference: 90 ml, p=0.013] showed significant improvement while in comparator, there was significant improvement only in the requirement for rescue treatment (p=0.023). Hospital admission rates were significantly reduced in SMART group compared to the other (p=0.039), but not in emergency treatment. Five patients asked to discontinue SMART while all others were satisfied, compliant and perceived improvement of their asthma with SMART. The maximum daily doses of inhaled budesonide and formoterol were 1400 microg and 31.5 microg respectively. Our preliminary findings suggest that SMART approach can be attempted as an effective and safe treatment option for patients with inadequately controlled moderate-to-severe asthma in Malaysian setting.
Study site: Chest clinic, Hospital Tuanku Jaafar, Seremban, Negeri Sembilan, Malaysia

Matched MeSH terms: Asthma/drug therapy*; Anti-Asthmatic Agents/therapeutic use*
Fulltext Perception towards asthma clinical practice guidelines and appropriateness of prescribing practices--a comparison between government and private doctors

Loh LC, Wong PS

Med J Malaysia, 2007 Aug;62(3):210-3.
PMID: 18246909

A self-answered, anonymously completed, nationwide questionnaire survey was conducted between June 2002 and May 2003 among Malaysian doctors through post and at medical meetings. Findings based on 116 government and 110 private doctors who satisfactorily completed the forms (effective respondent rate: 30.1%) showed that more than 70% of government and private doctors claimed familiarity with asthma CPGs but proportionately more private doctors considered them "unworkable" and were reluctant to adopt them in their practice setting, quoting cost as the primary reason. Between those who frequently adopted the CPGs and those who did not, there was an equally high proportion of inappropriate prescribing. Despite the shortcomings of such a survey, our findings suggest that medicinal cost and practitioner's prescribing practices are important in the acceptance and execution of asthma CPGs recommendations.

Matched MeSH terms: Asthma/drug therapy*

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