Displaying publications 1 - 20 of 48 in total

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  1. Bousquet J, Jutel M, Akdis CA, Klimek L, Pfaar O, Nadeau KC, et al.
    Allergy, 2021 03;76(3):689-697.
    PMID: 32588922 DOI: 10.1111/all.14471
    Matched MeSH terms: Asthma/drug therapy
  2. Ng DC, Shangkeree RP, Khoo EJ
    J Paediatr Child Health, 2017 10;53(10):1024-1025.
    PMID: 28975762 DOI: 10.1111/jpc.1_13531
    Matched MeSH terms: Asthma/drug therapy*
  3. Dilokthornsakul P, Chaiyakunapruk N, Campbell JD
    J Asthma, 2017 01 02;54(1):17-23.
    PMID: 27284904 DOI: 10.1080/02770903.2016.1193601
    OBJECTIVE: To test the association of clinical evidence type, efficacy-based or effectiveness-based ("E"), versus whether or not asthma interventions' cost-effectiveness findings are favorable.

    DATA SOURCES: We conducted a systematic review of PubMed, EMBASE, Tufts CEA registry, Cochrane CENTRAL, and the UK National Health Services Economic Evaluation Database from 2009 to 2014.

    STUDY SELECTION: All cost-effectiveness studies evaluating asthma medication(s) were included. Clinical evidence type, "E," was classified as efficacy-based if the evidence was from an explanatory randomized controlled trial(s) or meta-analysis, while evidence from pragmatic trial(s) or observational study(s) was classified as effectiveness-based. We defined three times the World Health Organization cost-effectiveness willingness-to-pay (WTP) threshold or less as a favorable cost-effectiveness finding. Logistic regression tested the likelihood of favorable versus unfavorable cost-effectiveness findings against the type of "E."

    RESULTS AND CONCLUSIONS: 25 cost-effectiveness studies were included. Ten (40.0%) studies were effectiveness-based, yet 15 (60.0%) studies were efficacy-based. Of 17 studies using endpoints that could be compared to WTP threshold, 7 out of 8 (87.5%) effectiveness-based studies yielded favorable cost-effectiveness results, whereas 4 out of 9 (44.4%) efficacy-based studies yielded favorable cost-effectiveness results. The adjusted odds ratio was 15.12 (95% confidence interval; 0.59 to 388.75) for effectiveness-based versus efficacy-based achieving favorable cost-effectiveness findings. More asthma cost-effectiveness studies used efficacy-based evidence. Studies using effectiveness-based evidence trended toward being more likely to disseminate favorable cost-effective findings than those using efficacy. Health policy decision makers should pay attention to the type of clinical evidence used in cost-effectiveness studies for accurate interpretation and application.

    Matched MeSH terms: Asthma/drug therapy*
  4. 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*
  5. Loh LC, Wong PS
    Asian Pac J Allergy Immunol, 2005 Mar;23(1):7-17.
    PMID: 15997869
    A self-answered, anonymously completed questionnaire survey was performed between June 2002 and May 2003 where doctors from government and private sectors in Malaysia were invited to participate by post or during medical meetings. One hundred and sixteen government doctors and 110 private doctors provided satisfactorily completed questionnaires (effective respondent rate: 30.1%). The most preferred medications for 'first-line', 'second-line' and 'third-line' treatment were for government doctors: inhaled short-acting beta2-agonist (SABA) (98%), inhaled corticosteroids (CS) (75%), and leukotriene antagonist (52%); and for private doctors: oral SABA (81%), inhaled CS (68%), and oral CS (58%). The first choice inhaler device for most government and private doctors were metered dose inhalers, with cost and personal preferences (for private doctors), and technical ability (for government doctors) as the key considerations when deciding on the choice of device. This benchmark data on the asthma prescribing practices of a healthcare delivery system fully dichotomized into government and private sector, provides evidence for practice differences affected by the nature of the healthcare system, and might have implications on healthcare systems of other countries that share similarities with that of Malaysia.
    Matched MeSH terms: Asthma/drug therapy*
  6. Chan PW, DeBruyne JA
    Pediatr Int, 2000 Oct;42(5):547-51.
    PMID: 11059547
    BACKGROUND: Parental attitudes towards the use of inhaled therapy in children with chronic asthma influence treatment adherence and outcome. In the present study, we evaluated the perceptions and concerns of parents of children with chronic asthma towards inhaled therapy.

    METHODS: A self-administered standard questionnaire was distributed to parents of children attending the Paediatric Asthma Clinic. All these children required inhaled steroids for treatment.

    RESULTS: One-hundred and twelve of 170 parents (66%) surveyed were concerned with inhaled therapy. The most common concern with its use was medication side effects (91%), followed by 'inhaler dependency' (86%), cost of the inhaler (34%) and difficulty in using the inhaler (15%). Parental perception that the oral route was superior to the inhaled route, preference for the oral route for asthma prophylaxis and a higher steroid dose required for prophylaxis were more likely to be associated with concerns towards inhaled therapy. More importantly, these children were also more likely to miss > 25% of their prescribed doses of inhaled steroids (46 vs 22% in the group concerned about inhaled therapy compared with the group that was not concerned, respectively; P = 0.007) and had a higher mean number of nebulization treatments in the last year (3.2 +/- 2.9 vs 1.8 +/- 1.3 in the group concerned about inhaled therapy compared with the group that was not concerned, respectively; P = 0.01).

    CONCLUSIONS: A significant proportion of parents whose children were on inhaled prophylaxis had concerns towards the use of inhaled therapy. Parental concern towards inhaled therapy appeared to increase the problem of non-adherence to treatment. Education for these parents will need to be addressed to improve asthma management in our patient population.

    Matched MeSH terms: Asthma/drug therapy*
  7. Lai CK, De Guia TS, Kim YY, Kuo SH, Mukhopadhyay A, Soriano JB, et al.
    J Allergy Clin Immunol, 2003 Feb;111(2):263-8.
    PMID: 12589343
    Few data on asthma management are available for the Asia-Pacific region.
    Matched MeSH terms: Asthma/drug therapy*
  8. Zainudin BM, Ismail O, Yusoff K
    Thorax, 1994 Mar;49(3):267-9.
    PMID: 8202885
    BACKGROUND: The benefit of adding theophylline to beta 2 agonists in acute asthmatic attacks has been debated frequently.
    METHODS: In an open randomised study 25 patients with severe acute asthma who presented to the emergency department were treated with either a combined nebulised salbutamol (5 mg/dose) and aminophylline infusion (0.6-0.9 mg/kg/hour), or nebulised salbutamol alone.
    RESULTS: The responses to treatment as measured by peak expiratory flow (PEF) and the time taken to achieve maximum PEF were similar in both groups. Side effects were observed more commonly in patients receiving the combined treatment.
    CONCLUSIONS: Nebulised salbutamol is equally efficacious in acute asthma when given alone or in combination with aminophylline.
    Study site: Emergency department, Hospital Kuala Lumpur, Malaysia
    Matched MeSH terms: Asthma/drug therapy*
  9. Zainudin BMZ
    Respirology, 1997 Mar;2(1):17-31.
    PMID: 9424402 DOI: 10.1111/j.1440-1843.1997.tb00051.x
    Asthma and chronic obstructive pulmonary disease (COPD) are two common illnesses that cause significant morbidity and mortality. Steroids are widely used in both conditions. They act through steroid or glucocorticoid receptors (GR) causing up or down regulation of protein synthesis resulting in an increase in lipocortin 1 and beta 2 adrenergic receptors, and decreased levels and activities of cytokines or cytokine receptors, which reduces the inflammatory process in the airways and decreases bronchial hyperreactivity. Consequently symptoms of airway obstruction are alleviated and lung function is improved. In asthma, steroids have been convincingly shown to be effective in the treatment of both acute exacerbations and chronic condition. In COPD, however, only a subset of patients seem to respond favourably to steroid therapy. Therapeutic trials are therefore recommended before committing to a long-term treatment in order to determine this subset of patients, as no markers of steroid responsiveness can be identified. The inhaled steroids currently available have a good safety profile with significant side effects occurring only occasionally. Such side effects are usually confined to the oropharynx, causing local irritation, candidiasis and dysphonia, which can be easily overcome. Biochemical abnormalities involving bone, adrenal, carbohydrate and lipid profiles have been noted with high doses of inhaled steroids; however, these have no significant clinical effects.
    Matched MeSH terms: Asthma/drug therapy
  10. Zainudin BM, Sufarlan AW
    Med J Malaysia, 1990 Sep;45(3):235-8.
    PMID: 2152085
    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
    Matched MeSH terms: Asthma/drug therapy*
  11. Zainal Z, Abdul Rahim A, Khaza'ai H, Chang SK
    Int J Mol Sci, 2019 Apr 10;20(7).
    PMID: 30974772 DOI: 10.3390/ijms20071764
    Synthetic therapeutic drugs for asthma, a chronic airway inflammation characterised by strong eosinophil, mast cell, and lymphocyte infiltration, mucus hyper-production, and airway hyper-responsiveness, exhibit numerous side effects. Alternatively, the high antioxidant potential of palm oil phytonutrients, including vitamin E (tocotrienol-rich fractions; TRF) and carotene, may be beneficial for alleviating asthma. Here, we determined the therapeutic efficacy of TRF, carotene, and dexamethasone in ovalbumin-challenged allergic asthma in Brown Norway rats. Asthmatic symptoms fully developed within 8 days after the second sensitization, and were preserved throughout the time course via intranasal ovalbumin re-challenge. Asthmatic rats were then orally administered 30 mg/kg body weight TRF or carotene. TRF-treated animals exhibited reduced inflammatory cells in bronchial alveolar lavage fluid. TRF- and carotene-treated rats exhibited notable white blood cell reduction comparable to that from dexamethasone. TRF- and carotene-treatment also downregulated pro-inflammatory markers (IL-β, IL-6, TNF-α), coincident with anti-inflammatory marker IL-4 and IL-13 upregulation. Treatment significantly reduced asthmatic rat plasma CRP and IgE, signifying improved systemic inflammation. Asthmatic lung histology displayed severe edema and inflammatory cell infiltration in the bronchial wall, whereas treated animals retained healthy, normal-appearing lungs. The phytonutrients tocotrienol and carotene thus exhibit potential benefits for consumption as nutritional adjuncts in asthmatic disease.
    Matched MeSH terms: Asthma/drug therapy*
  12. 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*
  13. Hasan SS, Capstick T, Zaidi STR, Kow CS, Merchant HA
    Respir Med, 2020 05 26;170:106045.
    PMID: 32843175 DOI: 10.1016/j.rmed.2020.106045
    The potential detrimental effects of steroids on the immune system to fight viral infections had always been a concern for patients on long term steroids in chronic conditions. A recent warning from WHO on systemic corticosteroid use amid COVID-19 raised suspicion among public and healthcare professionals regarding the safety of steroid use during the SARS-CoV-2 pandemic. The corticosteroids (inhaled and oral) are commonly prescribed in the management of asthma and COPD patients and any unsolicited changes in medications use may lead to potentially severe exacerbations and may risk patient lives. This article provides a critical review of clinical evidence and offers a detailed discussion on the safety and efficacy of corticosteroids in asthma and COPD patients, both with and without COVID-19.
    Matched MeSH terms: Asthma/drug therapy*
  14. Chan Y, Ng SW, Mehta M, Gupta G, Chellappan DK, Dua K
    Future Med Chem, 2020 11;12(21):1887-1890.
    PMID: 33054387 DOI: 10.4155/fmc-2020-0206
    Matched MeSH terms: Asthma/drug therapy
  15. Naing C, Ni H
    Cochrane Database Syst Rev, 2020 07 15;7:CD013268.
    PMID: 32668027 DOI: 10.1002/14651858.CD013268.pub2
    BACKGROUND: Asthma is a common chronic respiratory disease. People with asthma have inflammation of their airways that causes recurrent episodes of wheezing, breathlessness and chest tightness, with or without a cough. Statins possess multiple therapeutic effects, including lowering lipid levels in the blood. Statins are reported to have a potential role as an adjunct treatment in asthma. However, comprehensive evidence of the benefits and harms of using statins is required to facilitate decision making.

    OBJECTIVES: To assess the benefits and harms of statins as an adjunct therapy for asthma in adults and children.

    SEARCH METHODS: We searched for studies in the Cochrane Airways Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE Ovid SP and Embase Ovid SP, from their inception dates We handsearched the proceedings of major respiratory conferences. We also searched clinical trials registries for completed, ongoing and unpublished studies, and scanned the reference lists of included studies and relevant reviews to identify additional studies. The search is current to 7 February 2020.

    SELECTION CRITERIA: We included randomised controlled trials (RCTs) with a parallel-group design that assessed statins for at least 12 weeks' duration. We considered all participants with a clinical diagnosis of asthma to be eligible, regardless of age, sex, disease severity and previous or current treatment. We planned to include studies reported as full text, those published as abstract only, and unpublished data.

    DATA COLLECTION AND ANALYSIS: Two review authors independently screened and selected the studies, extracted outcome data and intervention characteristics from included studies, and assessed risk of bias according to standard Cochrane methodological procedures. We resolved any disagreement through discussion.

    MAIN RESULTS: We found only one trial involving a total of 60 people living with asthma. The trial compared the effect of atorvastatin with a placebo (dummy treatment containing lactose) in treating people with chronic asthma. The trial did not report data for the primary outcomes or adverse events. There was uncertainty about the relative effect on forced expiratory volume in one second (FEV1) and peak expiratory flow (PEF) in the atorvastatin group compared with the placebo group. The study did not report serious adverse effects for the interventions. The included study had internal discrepancies in its reported data.

    AUTHORS' CONCLUSIONS: The evidence was of very low certainty, so we are unable to draw conclusions about the effectiveness and safety of statins to treat asthma. High-quality RCTs are needed to assess the effect of statins on people with asthma. Well-designed multicentre trials with larger samples and longer duration of treatment are required, which assess outcomes such as adverse events, hospital utilisation and costs, to provide better quality evidence. Future studies that include subgroups of obese people with asthma are also required.

    Matched MeSH terms: Asthma/drug therapy*
  16. Wong LY, Chua SS, Husin AR, Arshad H
    Fam Pract, 2017 09 01;34(5):564-573.
    PMID: 28472499 DOI: 10.1093/fampra/cmx028
    Background: Although clinical guidelines are available for the management of asthma, this health condition is still poorly managed in many countries.
    Objectives: To assess the effects of a Pharmacy Management Service (PharMS) on asthma control of adult patients.
    Methods: This study comprised of a cluster randomised controlled trial (RCT) that was conducted from April 2014 to July 2015 at four government health clinics. The control participants received usual pharmacy service, while the intervention participants were recruited into the PharMS. Each participant was monitored for 6 months, and the outcome measures included asthma control using the Asthma Control Test (ACT), inhaler technique using a checklist and medication adherence using the Malaysian Medication Adherence Scale.
    Results: A total of 157 participants were recruited: 77 in the control and 80 in the intervention group. At the end of the study, 90% of the intervention participants achieved well-controlled asthma compared to 28.6% in the control group (P < 0.001). The differences in the proportion of participants with correct inhaler technique was also significant, with an adjusted effect size of 0.953 (P < 0.001). In addition, the intervention participants showed significantly higher medication adherence than the control group (92.5% versus 45.5%, P < 0.001). The Generalised Estimated Equation analysis further confirmed that the PharMS (P < 0.001) was significantly related to an improvement in the ACT scores.
    Conclusion: A community-based asthma management program, the PharMS, that provided asthma education and skill training by a trained pharmacist, resulted in positive and significant improvements in clinical and management outcomes of adult asthma patients.
    Matched MeSH terms: Asthma/drug therapy*
  17. Mohd Isa NA, Cheng CL, Nasir NH, Naidu V, Gopal VR, Alexander AK
    Med J Malaysia, 2020 07;75(4):331-337.
    PMID: 32723990
    INTRODUCTION: As the first point of contact for those presenting with asthma symptoms, primary healthcare plays a crucial role in asthma management. This is a nationwide study of assessment of asthma symptom control and adherence to asthma medication among outpatients in public health clinics in Malaysia.

    METHODS: This is a prospective, observational multicentre study (ASCOPE; NCT03804632). Data on asthma control, assessment of control symptoms, and adherence to treatment were collected from medical records and interviews of patients. The level of asthma control was assessed using the Global Initiative for Asthma (GINA) Assessment of Symptom Control. Adherence of patient to medication for asthma was assessed through interview of patients using four questions adapted from the Malaysian Medication Adherence Scale.

    RESULTS: Among the 1011 patients recruited, 416 (41%) had well controlled asthma, 388 (38%) were partly controlled, and 207 (21%) had uncontrolled asthma. Majority (81%) had mild asthma and all patients were on asthma medication. Most patients did not have spirometry data (97%) but underwent peak flow rate measurements (98%). Poor adherence occurred at all levels of asthma control but was worst among those with uncontrolled asthma. This was statistically significant across all four questions on adherence (p<0.05). For example, more patients with uncontrolled asthma forgot doses (56%) or stopped treatment (39%) than those with well-controlled asthma (44% and 27%respectively).

    CONCLUSIONS: Among Malaysian primary care patients with asthma, less than 50% had well-controlled asthma, and low adherence to treatment was common. More effort is needed to improve asthma control among patients in Malaysia, including those with mild asthma.
    Matched MeSH terms: Asthma/drug therapy*
  18. Dokbua S, Dilokthornsakul P, Chaiyakunapruk N, Saini B, Krass I, Dhippayom T
    J Manag Care Spec Pharm, 2018 Nov;24(11):1184-1196.
    PMID: 30362920 DOI: 10.18553/jmcp.2018.24.11.1184
    BACKGROUND: Current evidence of the effects of pharmacy services on asthma outcomes are not conclusive, since most pharmacy services comprise a variety of interventions.

    OBJECTIVE: To assess the effect of a service containing self-management support delivered by community pharmacists to patients with asthma.

    METHODS: A systematic search was performed in the following databases from inception to January 2017: PubMed, Embase, Cochrane Library's Central Register of Controlled Trials, CINAHL (Cumulative Index to Nursing and Allied Health Literature) Plus, International Pharmaceutical Abstracts, and PsycInfo. Original studies were selected if they met the following criteria: (a) provided by community pharmacists; (b) the intervention service included the essential components of asthma self-management; (c) included a usual care group; and (d) measured control/severity of asthma symptoms, health-related quality of life (HRQOL), or medication adherence.

    RESULTS: Of the 639 articles screened, 12 studies involving 2,121 asthma patients were included. Six studies were randomized trials, and the other 6 were nonrandomized trials. Patients with asthma who received a self-management support service by community pharmacists had better symptom control/lower severity compared with those receiving usual care (standardized mean difference [SMD] = 0.46; 95% CI = 0.09-0.82) with high heterogeneity (I2=82.6%; P = 0.000). The overall improvement in HRQOL and medication adherence among patients in the asthma self-management support group was greater than for those in the usual care group with SMD of 0.23 (95% CI = 0.12-0.34) and 0.44 (95% CI = 0.27-0.61), respectively. Evidence of heterogeneity was not observed in these 2 outcomes.

    CONCLUSIONS: Self-management support service provided by community pharmacists can help improve symptom control, quality of life, and medication adherence in patients with asthma.

    DISCLOSURES: This study received financial support from Naresuan University's Faculty of Pharmaceutical Sciences Research Fund. Two authors, Saini and Krass, have studies that were included in this review. However, they were not involved in the processes that could bias outcomes of the present study, that is, quality assessment and meta-analysis. The remaining authors have declared no conflicts of interest.

    Matched MeSH terms: Asthma/drug therapy*
  19. 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
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