Displaying publications 1 - 20 of 26 in total

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  1. Salim H, Ramdzan SN, Ghazali SS, Lee PY, Young I, McClatchey K, et al.
    J Glob Health, 2020 Jun;10(1):010427.
    PMID: 32566166 DOI: 10.7189/jogh.10.010428
    Background: Supported asthma self-management improves health outcomes. However, people with limited health literacy, especially in lower-middle-income countries (LMICs), may need tailored interventions to enable them to realise the benefits. We aimed to assess the clinical effectiveness of asthma self-management interventions targeted at people with limited health literacy and to identify strategies associated with effective programmes.

    Methods: Following Cochrane methodology, we searched ten databases (January 1990 - June 2018; updated October 2019), without language restriction. We included controlled experimental studies whose interventions targeted health literacy to improve asthma self-management. Selection of papers, extraction of data and quality assessment were done independently by two reviewers. The primary outcomes were clinical (asthma control) and implementation (adoption/adherence to intervention). Analysis was narrative.

    Results: We screened 4318 titles and abstracts, reviewed 52 full-texts and included five trials. One trial was conducted in a LMIC. Risk of bias was low in one trial and high in the other four studies. Clinical outcomes were reported in two trials, both at high risk of bias: one of which reported a reduction in unscheduled care (number of visits in 6-month (SD); Intervention:0.9 (1.2) vs Control:1.8 (2.4), P = 0.001); the other showed no effect. None reported uptake or adherence to the intervention. Behavioural change strategies typically focused on improving an individual's psychological and physical capacity to enact behaviour (eg, targeting asthma-related knowledge or comprehension). Only two interventions also targeted motivation; none sought to improve opportunity. Less than half of the interventions used specific self-management strategies (eg, written asthma action plan) with tailoring to limited health literacy status. Different approaches (eg, video-based and pictorial action plans) were used to provide education.

    Conclusions: The paucity of studies and diversity of the interventions to support people with limited health literacy to self-manage their asthma meant that the impact on health outcomes remains unclear. Given the proportion of the global population who have limited health literacy skills, this is a research priority.

    Protocol registration: PROSPERO CRD 42018118974.

    Matched MeSH terms: Asthma/therapy*
  2. Chan PW, Hussain S, Ghani NH, Debruyne JA, Liam CK
    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/therapy
  3. Nivedita N
    Med J Malaysia, 1996 Mar;51(1):89-92.
    PMID: 10967985
    A study was undertaken to determine the assessment and management of adult asthmatic patients presenting to the Accident and Emergency department. The records of 50 consecutive adult asthmatic patients presenting to A & E with acute bronchial asthma between June 1993 to April 1994 were reviewed. Patients were also interviewed on their subsequent visit to hospital. Observations and measurements used to assess the severity of asthma were recorded with variable frequency--cyanosis 8%, inability to speak 2%, chest auscultation 64%, heart rate 10%, blood pressure 6%, respiratory rate 4%. The failure to record more objective measurements of severity of asthma and in particular extent of airflow obstruction is cause for concern. The drugs used to treat acute asthma in order of frequency were Beta agonists by nebuliser, 49 patients; intravenous aminophylline, 8 patients; and intravenous corticosteroids, 6 patients. 15 patients were admitted to the medical ward. The decision to admit patients appeared to be due to a lack of symptomatic improvement after treatment. Of the 35 patients who were discharged from A & E, 13 (37%) had an acute relapse within 10 days. None of the patients on discharge from A & E were given a short course of oral steroids or were advised an increase in steroid inhaler therapy. There was therefore a gross underuse of corticosteroids.
    Study site: Emergency department, Hospital Muar, Johor, Malaysia
    Matched MeSH terms: Asthma/therapy*
  4. 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/therapy
  5. Yong YV, Shafie AA
    Value Health Reg Issues, 2018 May;15:6-11.
    PMID: 29474180 DOI: 10.1016/j.vhri.2017.05.001
    BACKGROUND: Patients with asthma need long-term management to maintain optimal control. In addition to routine maintenance, urgent visits and hospitalizations may be required, as these patients are prone to acute exacerbations. The aim of this study was to estimate the costs of maintenance and acute exacerbation managements in patients with asthma in a suburban public hospital in Malaysia.

    METHODS: An activity-based microcosting approach was applied to estimate the unit cost of events from the hospital's perspective. First, activities and resources that were involved in each cost center were identified and valued against a suitable form of unit. Thereafter, the mean cost of each resource per event was calculated by dividing the product of the quantity of the resource used and the unit cost of the resource by the number of events. The mean cost per event was the sum of the cost of resources for all cost centers involved. The costs were expressed in 2014 US dollars ($) and Malaysian Ringgit (RM).

    RESULTS: Data were collected from 15 maintenance, 20 acute exacerbation, and 50 hospitalization events. The mean (±SD) cost of maintenance management was $48.04 (±10.10); RM154.68 (±32.52). The cost of acute exacerbation management in the Emergency Department was $13.50 (±2.21), RM43.46 (±7.10); and in the medical ward, the cost was $552.13 (±303.41), RM1777.86 (±976.98), per hospitalization event.

    CONCLUSION: The microcosting of management of asthma-related events provides more accurate estimates that could be used in local economic studies. However, its possible limited generalizability to other types of health care settings in Malaysia needs to be kept in mind.

    Matched MeSH terms: Asthma/therapy
  6. Kamaruzaman NA, Sulaiman SA, Kaur G, Yahaya B
    PMID: 24886260 DOI: 10.1186/1472-6882-14-176
    Honey is widely used in folk medicine to treat cough, fever, and inflammation. In this study, the effect of aerosolised honey on airway tissues in a rabbit model of ovalbumin (OVA)-induced asthma was investigated. The ability of honey to act either as a rescuing agent in alleviating asthma-related symptoms or as a preventive agent to preclude the occurrence of asthma was also assessed.
    Matched MeSH terms: Asthma/therapy*
  7. Loh LC, Teng CL, Teh PN, Koh CN, Vijayasingham P, Thayaparan T
    Med J Malaysia, 2004 Aug;59(3):335-41.
    PMID: 15727379
    Inefficient metered-dose inhaler (MDI) technique results in poor drug delivery, suboptimal disease control a possibility of inhaled medication overuse. The MDI technique of 134 government hospital and clinic followed-up adult asthmatic patients followed-up in a government hospital and a heath clinic was pragmatically assessed based on the 3 obligatory steps of adequate lip seal, appropriate hand-breath coordination and sufficient breath holding after inhalation. The relationship between technique efficiency and frequency of daily short-acting beta2-agonist (SABA) use via the MDI and asthma exacerbations over a 12-month period was also assessed. Fifty-six patients (42%) had inefficient MDI technique. All demographic and asthma-related variables between the 'efficient' and 'inefficient' technique groups of patients were comparable except for significantly longer mean years of MDI use in the 'efficient' technique group [mean (SD): 10 (7) vs. 7 (5); p=0.003]. There were no significant differences between the two groups in relation to frequency of daily SABA use or asthma exacerbations over the past 12 months. Despite having been available in Malaysia for a considerable period of time, the MDI device is still poorly handled by a large proportion of adult asthmatic patients. Changing to other more user-friendly devices or use of spacer devices to facilitate delivery should be considered for these patients.
    Study site: Hospital Tuanku Jaafar, Seremban, Negeri Sembilan; Klinik Kesihatan Seremban, Malaysia
    Matched MeSH terms: Asthma/therapy*
  8. Academy of Medicine of Malaysia
    Med J Malaysia, 1997 Dec;52(4):416-28.
    PMID: 10968121
    Matched MeSH terms: Asthma/therapy*
  9. Connett GJ, Lee BW
    BMJ, 1994 May 14;308(6939):1282-4.
    PMID: 8205023
    Though Western medicines and ideas about asthma have become popular in many Asian nations, local beliefs about treatment prevail. The multiracial society of Singapore shows a variety of beliefs about causes of asthma attacks (for example, the balance of yin and yang) and types of treatment--herbal remedies, inhaled versus eaten medicines, the influence of Ramadan. Many of the cultural practices mentioned are probably preserved among south east Asian minorities residing in the United Kingdom. Eastern treatments typically take a holistic approach to asthma and do not ignore the psychosomatic component of the disorder.
    Matched MeSH terms: Asthma/therapy*
  10. Kanesalingam R, Lu YS, Ong JJ, Wong SS, Vijayasingham P, Thayaparan T, et al.
    Med J Malaysia, 2003 Oct;58(4):587-93.
    PMID: 15190635
    We studied the admission criteria and first 24-hour management of 62 asthmatic patients admitted from Accident and Emergency (A&E) department of a state hospital. Data was collected prospectively over a 6-month period from the doctors' medical records with reference to recommendations of the Malaysian Thoracic Society (MTS) on management of acute asthma. Peak Expiratory Flow Rate (PEFR) records were present in only 14.5% of the A&E notes and 54.8% of the ward notes. Most of these readings were below 75% of predicted normal values. Over half of the patients had records on ability to speak full sentences, and respiratory and pulse rates. Based on other records on criteria for life-threatening features (including arterial blood gases), 42% of patients studied had life threatening asthma exacerbations. Most received appropriate treatment as recommended by the MTS. We conclude that while most patients were admitted and treated appropriately, medical documentation regarding acute asthma assessment were inadequate in some.
    Study site: Hospital Tuanku Jaafar, Seremban, Negeri Sembilan, Malaysia
    Matched MeSH terms: Asthma/therapy*
  11. Fletcher MJ, Tsiligianni I, Kocks JWH, Cave A, Chunhua C, Sousa JC, et al.
    NPJ Prim Care Respir Med, 2020 06 17;30(1):29.
    PMID: 32555169 DOI: 10.1038/s41533-020-0184-0
    Asthma imposes a substantial burden on individuals and societies. Patients with asthma need high-quality primary care management; however, evidence suggests the quality of this care can be highly variable. Here we identify and report factors contributing to high-quality management. Twelve primary care global asthma experts, representing nine countries, identified key factors. A literature review (past 10 years) was performed to validate or refute the expert viewpoint. Key driving factors identified were: policy, clinical guidelines, rewards for performance, practice organisation and workforce. Further analysis established the relevant factor components. Review evidence supported the validity of each driver; however, impact on patient outcomes was uncertain. Single interventions (e.g. healthcare practitioner education) showed little effect; interventions driven by national policy (e.g. incentive schemes and teamworking) were more effective. The panel's opinion, supported by literature review, concluded that multiple primary care interventions offer greater benefit than any single intervention in asthma management.
    Matched MeSH terms: Asthma/therapy*
  12. Chisholm A, Price DB, Pinnock H, Lee TT, Roa C, Cho SH, et al.
    NPJ Prim Care Respir Med, 2017 Jan 05;27:16089.
    PMID: 28055000 DOI: 10.1038/npjpcrm.2016.89
    REALISE Asia-an online questionnaire-based study of Asian asthma patients-identified five patient clusters defined in terms of their control status and attitude towards their asthma (categorised as: 'Well-adjusted and at least partly controlled'; 'In denial about symptoms'; 'Tolerating with poor control'; 'Adrift and poorly controlled'; 'Worried with multiple symptoms'). We developed consensus recommendations for tailoring management of these attitudinal-control clusters. An expert panel undertook a three-round electronic Delphi (e-Delphi): Round 1: panellists received descriptions of the attitudinal-control clusters and provided free text recommendations for their assessment and management. Round 2: panellists prioritised Round 1 recommendations and met (or joined a teleconference) to consolidate the recommendations. Round 3: panellists voted and prioritised the remaining recommendations. Consensus was defined as Round 3 recommendations endorsed by >50% of panellists. Highest priority recommendations were those receiving the highest score. The multidisciplinary panellists (9 clinicians, 1 pharmacist and 1 health social scientist; 7 from Asia) identified consensus recommendations for all clusters. Recommended pharmacological (e.g., step-up/down; self-management; simplified regimen) and non-pharmacological approaches (e.g., trigger management, education, social support; inhaler technique) varied substantially according to each cluster's attitude to asthma and associated psychosocial drivers of behaviour. The attitudinal-control clusters defined by REALISE Asia resonated with the international panel. Consensus was reached on appropriate tailored management approaches for all clusters. Summarised and incorporated into a structured management pathway, these recommendations could facilitate personalised care. Generalisability of these patient clusters should be assessed in other socio-economic, cultural and literacy groups and nationalities in Asia.
    Matched MeSH terms: Asthma/therapy*
  13. Ismail IH, Licciardi PV, Tang ML
    J Paediatr Child Health, 2013 Sep;49(9):709-15.
    PMID: 23574636 DOI: 10.1111/jpc.12175
    The increasing prevalence of allergic disease has been linked to reduced microbial exposure in early life. Probiotics have recently been advocated for the prevention and treatment of allergic disease. This article summarises recent publications on probiotics in allergic disease, focusing on clinical studies of prevention or treatment of allergic disease. Studies employing the combined administration of pre-natal and post-natal probiotics suggest a role for certain probiotics (alone or with prebiotics) in the prevention of eczema in early childhood, with the pre-natal component of treatment appearing to be important for beneficial effects. On the other hand, current data are insufficient to support the use of probiotics for the treatment of established allergic disease, although recent studies have highlighted new hope in this area. Probiotic bacteria continue to represent the most promising intervention for primary prevention of allergic disease, and well-designed definitive intervention studies should now be a research priority.
    Matched MeSH terms: Asthma/therapy
  14. Mokhtar N, Chan SC
    Med J Malaysia, 2006 Mar;61(1):125-7.
    PMID: 16708752 MyJurnal
    Complementary Medicine (CM) usage amongst asthmatic patients was studied. Eighty-eight patients, selected by systematic random sampling in two public polyclinics in April/May 2004, were interviewed. They completed a structured pre-tested questionnaire. Forty-one percent were using CM, majority (64%) together with conventional therapy. Eighty-one percent did not inform their physicians of their CM usage. More Malays were using CM which included nutritional supplements, herbs, yoga, homoeopathy, reflexology and massage.
    Matched MeSH terms: Asthma/therapy*
  15. 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)
    Matched MeSH terms: Asthma/therapy*
  16. Azizi BHO, Zulkifli HI, Kasim S
    J Asthma, 1995;32(6):413-8.
    PMID: 7592244 DOI: 10.3109/02770909409077752
    We performed a hospital-based study to examine a hypothesis that indoor air pollution was associated with acute asthma in young children living in Kuala Lumpur City. A total of 158 children aged 1 month to 5 years hospitalized for the first time for asthma were recruited as cases. Controls were 201 children of the same age group who were hospitalized for causes other than a respiratory illness. Information was obtained from mothers using a standardized questionnaire. Univariate analysis identified two indoor pollution variables as significant factors. Sharing a bedroom with an adult smoker and exposure to mosquito coil smoke at least three nights in a week were both associated with increased risk for asthma. Logistic regression analysis confirmed that sharing a bedroom with an adult smoker (OR = 1.91, 95% CI 1.13, 3.21) and exposure to mosquito coil smoke (OR = 1.73, 95% CI 1.02, 2.93) were independent risk factors. Other factors independently associated with acute asthma were previous history of allergy, history of asthma in first-degree relatives, low birth weight, and the presence of a coughing sibling. There was no association between asthma and exposure to kerosene stove, wood stove, aerosol mosquito repellent, type of housing, or crowding. We conclude that indoor air pollution is an avoidable factor in the increasing morbidity due to asthma in children in a tropical environment.
    Matched MeSH terms: Asthma/therapy
  17. Sreetharan SS, Prepageran N, Razak A, Valuyeetham KA
    Med J Malaysia, 2003 Jun;58(2):290-3.
    PMID: 14569753
    Aerodigestive amyloidosis is a rare disorder characterized by fibrillar protein deposition in the aerodigestive tree. We present a case of a 19-year-old Chinese gentleman whose diagnosis was initially missed as he presented with features suggestive of severe bronchial asthma and was intubated and ventilated. He subsequently presented 2 years later with severe stridor and required emergency tracheostomy. Current literature is reviewed for the histopathology, common clinical features, radiological findings and treatment options for aerodigestive amyloidosis.
    Matched MeSH terms: Asthma/therapy
  18. Dua K, Chellappan DK, Singhvi G, de Jesus Andreoli Pinto T, Gupta G, Hansbro PM
    Panminerva Med, 2018 Dec;60(4):230-231.
    PMID: 30563304 DOI: 10.23736/S0031-0808.18.03459-6
    Matched MeSH terms: Asthma/therapy
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