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Fulltext Developing a home-based pulmonary rehabilitation programme for patients with chronic respiratory diseases in Malaysia: A mixed-method feasibility study

Chan SC, Patrick Engksan J, Jeevajothi Nathan J, Sekhon JK, Hussein N, Suhaimi A, et al.

J Glob Health, 2023 Oct 27;13:04099.
PMID: 37883199 DOI: 10.7189/jogh.13.04099

BACKGROUND: The COVID-19 pandemic has underscored the importance of remote healthcare and home-based interventions, including pulmonary rehabilitation, for patients with chronic respiratory diseases (CRDs). It has also heightened the vulnerability of individuals with underlying respiratory conditions to severe illness from COVID-19, necessitating exploration and assessment of the feasibility of delivering home - pulmonary rehabilitation (home-PR) programmes for CRD management in Malaysia and other countries. Home-based programmes offer a safer alternative to in-person rehabilitation during outbreaks like COVID-19 and can serve as a valuable resource for patients who may be hesitant to visit healthcare facilities during such times. We aimed to assess the feasibility of delivering a home-PR programme for patients with CRDs in Malaysia.
METHODS: We recruited patients with CRDs from two hospitals in Klang Valley, Malaysia to a home-PR programme. Following centre-based assessment, patients performed the exercises at home (five sessions/week for eight weeks (total 40 sessions)). We monitored the patients via weekly telephone calls and asked about adherence to the programme. We measured functional exercise capacity (6-Minutes Walking Test (6MWT) and Health-Related Quality-of-Life (HRQoL) (COPD Assessment Test (CAT)) at baseline and post-PR at nine weeks. We conducted semi-structured interviews with 12 purposively sampled participants to explore views and feedback on the home-PR programme. The interviews were audio recorded, transcribed verbatim, and analysed thematically.
RESULTS: We included 30 participants; two withdrew due to hospitalisation. Although 28 (93%) adhered to the full programme, only 11 (37%) attended the post-PR assessment because COVID-19 movement restrictions in Malaysia at that time prevented attendance at the centre. Four themes emerged from the qualitative analysis: involvement of family and caregivers, barriers to home-PR programme, interactions with peers and health care professionals, and programme enhancement.
CONCLUSION: Despite the COVID-19 pandemic, the home-PR programme proved feasible for remote delivery, although centre-based post-PR assessments were not possible. Family involvement played an important role in the home-PR programme. The delivery of this programme can be further improved to maximise the benefit for patients.

Matched MeSH terms: Respiration Disorders*
Fulltext Improving access to affordable quality-assured inhaled medicines in low- and middle-income countries

Stolbrink M, Chinouya MJ, Jayasooriya S, Nightingale R, Evans-Hill L, Allan K, et al.

Int J Tuberc Lung Dis, 2022 Nov 01;26(11):1023-1032.
PMID: 36281039 DOI: 10.5588/ijtld.22.0270

BACKGROUND: Access to affordable inhaled medicines for chronic respiratory diseases (CRDs) is severely limited in low- and middle-income countries (LMICs), causing avoidable morbidity and mortality. The International Union Against Tuberculosis and Lung Disease convened a stakeholder meeting on this topic in February 2022.METHODS: Focused group discussions were informed by literature and presentations summarising experiences of obtaining inhaled medicines in LMICs. The virtual meeting was moderated using a topic guide around barriers and solutions to improve access. The thematic framework approach was used for analysis.RESULTS: A total of 58 key stakeholders, including patients, healthcare practitioners, members of national and international organisations, industry and WHO representatives attended the meeting. There were 20 pre-meeting material submissions. The main barriers identified were 1) low awareness of CRDs; 2) limited data on CRD burden and treatments in LMICs; 3) ineffective procurement and distribution networks; and 4) poor communication of the needs of people with CRDs. Solutions discussed were 1) generation of data to inform policy and practice; 2) capacity building; 3) improved procurement mechanisms; 4) strengthened advocacy practices; and 5) a World Health Assembly Resolution.CONCLUSION: There are opportunities to achieve improved access to affordable, quality-assured inhaled medicines in LMICs through coordinated, multi-stakeholder, collaborative efforts.

Matched MeSH terms: Respiration Disorders*
Fulltext Home oxygen therapy

Lim KG

Med J Malaysia, 2001 Jun;56(2):141-2.
PMID: 11771072
Matched MeSH terms: Respiration Disorders/therapy*
Fulltext Genome Sequences of Two Pandoraea pnomenusa Isolates Recovered 11 Months Apart from a Cystic Fibrosis Patient

Ee R, Ambrose M, Lazenby J, Williams P, Chan KG, Roddam L

Genome Announc, 2015;3(1).
PMID: 25657265 DOI: 10.1128/genomeA.01389-14

Pandoraea is an emerging respiratory pathogen capable of causing chronic lung infections in people with cystic fibrosis (CF), but the clinical significance of this infection is ambiguous. We have sequenced and annotated the genomes of two multidrug-resistant Pandoraea pnomenusa isolates recovered 11 months apart from the same CF patient.

Matched MeSH terms: Respiration Disorders
The yield of flexible airway endoscopy in infants and children with severe airway problems under a physician-surgeon combined-care setting: our experience from 121 procedures

Asha'ari ZA, Abdullah F, Yusof S, Yusof RA

Clin Otolaryngol, 2015 Feb;40(1):52-6.
PMID: 25311812 DOI: 10.1111/coa.12328
Matched MeSH terms: Respiration Disorders/diagnosis*; Respiration Disorders/etiology*; Respiration Disorders/surgery
In vitro and in vivo mechanism of immunomodulatory and antiviral activity of Edible Bird's Nest (EBN) against influenza A virus (IAV) infection

Haghani A, Mehrbod P, Safi N, Aminuddin NA, Bahadoran A, Omar AR, et al.

J Ethnopharmacol, 2016 Jun 5;185:327-40.
PMID: 26976767 DOI: 10.1016/j.jep.2016.03.020

For centuries, Edible Bird Nest (EBN) has been used in treatment of variety of respiratory diseases such as flu and cough as a Chinese natural medicine.

Matched MeSH terms: Respiration Disorders
Fulltext Treatment of multiple-level tracheobronchial stenosis secondary to endobronchial tuberculosis using bronchoscopic balloon dilatation with topical mitomycin-C

Faisal M, Harun H, Hassan TM, Ban AY, Chotirmall SH, Abdul Rahaman JA

BMC Pulm Med, 2016;16(1):53.
PMID: 27080697 DOI: 10.1186/s12890-016-0209-1

Tracheobronchial stenosis is a known complication of endobronchial tuberculosis. Despite antituberculous and steroid therapy, the development of bronchial stenosis is usually irreversible and requires airway patency to be restored by either bronchoscopic or surgical interventions. We report the use of balloon dilatation and topical mitomycin-C to successful restore airway patency.

Matched MeSH terms: Respiration Disorders
Management of respiratory insufficiency

MANAVALAN AS

Med J Malaya, 1961 Dec;16:125-35.
PMID: 14469124
Matched MeSH terms: Respiration Disorders*
Fulltext Clinical effectiveness and components of Home-pulmonary rehabilitation for people with chronic respiratory diseases: a systematic review protocol

Uzzaman MN, Chan SC, Shunmugam RH, Engkasan JP, Agarwal D, Habib GMM, et al.

BMJ Open, 2021 10 12;11(10):e050362.
PMID: 34642195 DOI: 10.1136/bmjopen-2021-050362

INTRODUCTION: Chronic respiratory diseases (CRDs) are common and disabling conditions that can result in social isolation and economic hardship for patients and their families. Pulmonary rehabilitation (PR) improves functional exercise capacity and health-related quality of life (HRQoL) but practical barriers to attending centre-based sessions or the need for infection control limits accessibility. Home-PR offers a potential solution that may improve access. We aim to systematically review the clinical effectiveness, completion rates and components of Home-PR for people with CRDs compared with Centre-PR or Usual care.
METHODS AND ANALYSIS: We will search PubMed, CINAHL, Cochrane, EMBASE, PeDRO and PsycInfo from January 1990 to date using a PICOS search strategy (Population: adults with CRDs; Intervention: Home-PR; Comparator: Centre-PR/Usual care; Outcomes: functional exercise capacity and HRQoL; Setting: any setting). The strategy is to search for 'Chronic Respiratory Disease' AND 'Pulmonary Rehabilitation' AND 'Home-PR', and identify relevant randomised controlled trials and controlled clinical trials. Six reviewers working in pairs will independently screen articles for eligibility and extract data from those fulfilling the inclusion criteria. We will use the Cochrane risk-of-bias tool and Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to rate the quality of evidence. We will perform meta-analysis or narrative synthesis as appropriate to answer our three research questions: (1) what is the effectiveness of Home-PR compared with Centre-PR or Usual care? (2) what components are used in effective Home-PR studies? and (3) what is the completion rate of Home-PR compared with Centre-PR?
ETHICS AND DISSEMINATION: Research ethics approval is not required since the study will review only published data. The findings will be disseminated through publication in a peer-reviewed journal and presentation in conferences.
PROSPERO REGISTRATION NUMBER: CRD42020220137.

Matched MeSH terms: Respiration Disorders*
Targeting eosinophils in respiratory diseases: Biological axis, emerging therapeutics and treatment modalities

Lee LY, Hew GSY, Mehta M, Shukla SD, Satija S, Khurana N, et al.

Life Sci, 2021 Feb 15;267:118973.
PMID: 33400932 DOI: 10.1016/j.lfs.2020.118973

Eosinophils are bi-lobed, multi-functional innate immune cells with diverse cell surface receptors that regulate local immune and inflammatory responses. Several inflammatory and infectious diseases are triggered with their build up in the blood and tissues. The mobilization of eosinophils into the lungs is regulated by a cascade of processes guided by Th2 cytokine generating T-cells. Recruitment of eosinophils essentially leads to a characteristic immune response followed by airway hyperresponsiveness and remodeling, which are hallmarks of chronic respiratory diseases. By analysing the dynamic interactions of eosinophils with their extracellular environment, which also involve signaling molecules and tissues, various therapies have been invented and developed to target respiratory diseases. Having entered clinical testing, several eosinophil targeting therapeutic agents have shown much promise and have further bridged the gap between theory and practice. Moreover, researchers now have a clearer understanding of the roles and mechanisms of eosinophils. These factors have successfully assisted molecular biologists to block specific pathways in the growth, migration and activation of eosinophils. The primary purpose of this review is to provide an overview of the eosinophil biology with a special emphasis on potential pharmacotherapeutic targets. The review also summarizes promising eosinophil-targeting agents, along with their mechanisms and rationale for use, including those in developmental pipeline, in clinical trials, or approved for other respiratory disorders.

Matched MeSH terms: Respiration Disorders/immunology*; Respiration Disorders/metabolism; Respiration Disorders/physiopathology
Cardiorespiratory Progression Over 5 Years and Role of Corticosteroids in Duchenne Muscular Dystrophy: A Single-Site Retrospective Longitudinal Study

Trucco F, Domingos JP, Tay CG, Ridout D, Maresh K, Munot P, et al.

Chest, 2020 10;158(4):1606-1616.
PMID: 32387519 DOI: 10.1016/j.chest.2020.04.043

BACKGROUND: Corticosteroids (CSs) have prolonged survival and respiratory function in boys with Duchenne muscular dystrophy (DMD) when compared with CSs-naïve boys.
RESEARCH QUESTION: The differential impact of frequently used CSs and their regimens on long-term (> 5 years) cardiorespiratory progression in children with DMD is unknown.
STUDY DESIGN AND METHODS: This was a retrospective longitudinal study including children with DMD followed at Dubowitz Neuromuscular Centre, Great Ormond Street Hospital London, England, from May 2000 to June 2017. Patients enrolled in any interventional clinical trials were excluded. We collected patients' anthropometrics and respiratory (FVC, FVC % predicted and absolute FVC, and noninvasive ventilation requirement [NIV]) and cardiac (left ventricular shortening function [LVFS%]) function. CSs-naïve patients had never received CSs. Patients who were treated with CSs took either deflazacort or prednisolone, daily or intermittently (10 days on/10 days off) for > 1 month. Average longitudinal models were fitted for yearly respiratory (FVC % predicted) and cardiac (LVFS%) progression. A time-to-event analysis to FVC % predicted < 50%, NIV start, and cardiomyopathy (LVFS% < 28%) was performed in CS-treated (daily and intermittent) vs CS-naïve patients.
RESULTS: There were 270 patients, with a mean age at baseline of 6.2 ± 2.3 years. The median follow-up time was 5.6 ± 3.5 years. At baseline, 263 patients were ambulant. Sixty-six patients were treated with CSs daily, 182 patients underwent CSs intermittent > 60% treatment, and 22 were CS-naïve patients. Yearly FVC % predicted declined similarly from 9 years (5.9% and 6.9% per year, respectively; P = .27) in the CSs-daily and CSs-intermittent groups. The CSs-daily group declined from a higher FVC % predicted than the CSs-intermittent group (P < .05), and both reached FVC % predicted < 50% and NIV requirement at a similar age, > 2 years later than the CS-naïve group. LVFS% declined by 0.53% per year in the CSs-treated group irrespective of the CSs regimen, significantly slower (P < .01) than the CSs-naïve group progressing by 1.17% per year. The age at cardiomyopathy was 16.6 years in the CSs-treated group (P < .05) irrespective of regimen and 13.9 years in the CSs-naïve group.
INTERPRETATION: CSs irrespective of the regimen significantly improved respiratory function and delayed NIV requirement and cardiomyopathy.

Matched MeSH terms: Respiration Disorders/etiology*; Respiration Disorders/prevention & control*
Fulltext Concealed Foreign Body Aspiration: A Master of Disguise

Pravin Sugunan, Netia Jeganathan, Philip Rajan Devesahayam

Malaysian Journal of Paediatrics and Child Health, 2020;26(1):29-32.
MyJurnal

Aspiration of a foreign body is rare in school-age children. This reports the 21-day journey of an 8-year-old girl who had a foreign body aspiration. She presented to our hospital after five days of respiratory distress. She subsequently required mechanical ventilation and was supported with triple inotropes. After 18 days, a foreign body was removed via rigid bronchoscopy, followed by a rapid recovery of the patient.

Matched MeSH terms: Respiration Disorders
Fulltext Pulmonary rehabilitation using mechanical insufflation-exsufflation therapy for spinal cord injury – two case studies in the University Malaya Medical Centre

Tan, J.H., Aishah A. Fauzi, Hasnan, N.

JUMMEC, 2017;20(2):31-33.
MyJurnal

There is a high incidence of 36% to 83% of respiratory dysfunction in patients with acute cervical spinal cord
injury. Complications arising from respiratory dysfunction remain one of the most common causes of morbidity
and mortality in the spinal cord injured population. Specialized pulmonary care and therapy can help individuals
with tetraplegia to maintain a stable respiratory status allowing active participation in active rehabilitation.
This would allow them to achieve rehabilitation goals of independent function and community reintegration.
Mechanical insufflation-exsufflation (MIE) therapy is an option for secretion management in individuals with
acute spinal cord injury. In this paper, we present our experience using MIE as an adjunct to management of
secretions in the spinal cord injured population at the University of Malaya Medical Centre.

Matched MeSH terms: Respiration Disorders
Fulltext Respiratory symptoms in tea mill workers

Naemah Tajol Arus, Suhaily Amran, Norhafsam Maghpor, Ahmad Sayuti Zainal Abidin, Nurzuhairah Jamil, Rochi Bakel, et al.

Journal of Occupational Safety and Health, 2015;12(1):221-225.
MyJurnal

In the recent years, an extensive number of scientific researches on occupational diseases have been done to
identify occupations at high risk of inducing diseases. There are many categories of occupational diseases, and unitary
of them are occupational respiratory diseases. This study was conducted in a tea factory located in Cameron Highlands,
Malaysia, with an output of 600,000.00 kg per annum. Its objective was to evaluate respiratory diseases among the
workers, conducted via questionnaires, interviews and lung functional tests. A total of 38 workers participated in this
study, 19 in the exposed group and 19 in the control group. The most common chronic symptoms for the exposed
group are wheezing, dyspnea (short of breath) and phlegm. The result shows that, among the tea processing workers,
the exposed group suffer from respiratory diseases.

Matched MeSH terms: Respiration Disorders
Cardiorespiratory findings in epilepsy: A recent review on outcomes and pathophysiology

Akyüz E, Üner AK, Köklü B, Arulsamy A, Shaikh MF

J Neurosci Res, 2021 09;99(9):2059-2073.
PMID: 34109651 DOI: 10.1002/jnr.24861

Epilepsy is a debilitating disorder of uncontrollable recurrent seizures that occurs as a result of imbalances in the brain excitatory and inhibitory neuronal signals, that could stem from a range of functional and structural neuronal impairments. Globally, nearly 70 million people are negatively impacted by epilepsy and its comorbidities. One such comorbidity is the effect epilepsy has on the autonomic nervous system (ANS), which plays a role in the control of blood circulation, respiration and gastrointestinal function. These epilepsy-induced impairments in the circulatory and respiratory systems may contribute toward sudden unexpected death in epilepsy (SUDEP). Although, various hypotheses have been proposed regarding the role of epilepsy on ANS, the linking pathological mechanism still remains unclear. Channelopathies and seizure-induced damages in ANS-control brain structures were some of the causal/pathological candidates of cardiorespiratory comorbidities in epilepsy patients, especially in those who were drug resistant. However, emerging preclinical research suggest that neurotransmitter/receptor dysfunction and synaptic changes in the ANS may also contribute to the epilepsy-related autonomic disorders. Thus, pathological mechanisms of cardiorespiratory dysfunction should be elucidated by considering the modifications in anatomy and physiology of the autonomic system caused by seizures. In this regard, we present a comprehensive review of the current literature, both clinical and preclinical animal studies, on the cardiorespiratory findings in epilepsy and elucidate the possible pathological mechanisms of these findings, in hopes to prevent SUDEP especially in patients who are drug resistant.

Matched MeSH terms: Respiration Disorders/diagnosis; Respiration Disorders/physiopathology; Respiration Disorders/therapy
Combined transnasal and transoral endoscopic approach to a transsphenoidal encephalocele in an infant

Tan SH, Mun KS, Chandran PA, Manuel AM, Prepageran N, Waran V, et al.

Childs Nerv Syst, 2015 Jul;31(7):1165-9.
PMID: 25712744 DOI: 10.1007/s00381-015-2667-9

This paper reports an unusual case of a transsphenoidal encephalocele and discusses our experience with a minimally invasive management. To the best of our knowledge, we present the first case of a combined endoscopic transnasal and transoral approach to a transsphenoidal encephalocele in an infant.

Matched MeSH terms: Respiration Disorders/etiology
Fulltext Respiratory symptoms and pulmonary function of workers employed in textile dyeing factory in Turkey

Sibel O, Beyza A, Murat K, Fatma E, Göksel K, Sevin B

Med J Malaysia, 2012 Aug;67(4):375-8.
PMID: 23082444

Dyes are known to be a causative agent of occupational asthma exposed to them. We evaluate respiratory symptoms among textile. The study population comprised 106 exposed workers and control (unexposed) group. Data were collected by a questionnaire. Pulmonary Function Tests (PFTs) were performed. Among the exposed workers 36.8% defined phlegm. Respiratory symptoms were not significantly different between two groups. The employment duration of the exposed workers with phlegm was longer than those without phlegm (p = 0.027). The mean % predicted of forced expiratory flow (FEF) 25-75 of the exposed workers was found to be significantly lower than the control (unexposed) group (p = 0.01). Our study suggests that textile dyeing might cause respiratory symptoms at workers.

Matched MeSH terms: Respiration Disorders/chemically induced*
Fulltext Obesity: basic science and medical aspects relevant to anaesthetists

Cheah MH, Kam PC

Anaesthesia, 2005 Oct;60(10):1009-21.
PMID: 16179047 DOI: 10.1111/j.1365-2044.2005.04229.x

Obesity is becoming a major public health problem throughout the world. It is now the second leading cause of death in the United States and is associated with significant, potentially life-threatening co-morbidities. Significant advances in the understanding of the physiology of body weight regulation and the pathogenesis of obesity have been achieved. A better understanding of the physiology of appetite control has enabled advances in the medical and surgical treatment of obesity. Visceral or abdominal obesity is associated with an increased risk of cardiovascular disease and type 2 diabetes. Various drugs are used in the treatment of mild obesity but they are associated with adverse effects. Surgery has become an essential part of the treatment of morbid obesity, notwithstanding the potential adverse events that accompany it. An appreciation of these problems is essential to the anaesthetist and intensivist involved in the management of this group of patients.

Matched MeSH terms: Respiration Disorders/etiology
Review of air pollution and health impacts in Malaysia

Afroz R, Hassan MN, Ibrahim NA

Environ Res, 2003 Jun;92(2):71-7.
PMID: 12854685

In the early days of abundant resources and minimal development pressures, little attention was paid to growing environmental concerns in Malaysia. The haze episodes in Southeast Asia in 1983, 1984, 1991, 1994, and 1997 imposed threats to the environmental management of Malaysia and increased awareness of the environment. As a consequence, the government established Malaysian Air Quality Guidelines, the Air Pollution Index, and the Haze Action Plan to improve air quality. Air quality monitoring is part of the initial strategy in the pollution prevention program in Malaysia. Review of air pollution in Malaysia is based on the reports of the air quality monitoring in several large cities in Malaysia, which cover air pollutants such as Carbon monoxide (CO), Sulphur Dioxide (SO2), Nitrogen Dioxide (NO2), Ozone (O3), and Suspended Particulate Matter (SPM). The results of the monitoring indicate that Suspended Particulate Matter (SPM) and Nitrogen Dioxide (NO2) are the predominant pollutants. Other pollutants such as CO, O(x), SO2, and Pb are also observed in several big cities in Malaysia. The air pollution comes mainly from land transportation, industrial emissions, and open burning sources. Among them, land transportation contributes the most to air pollution. This paper reviews the results of the ambient air quality monitoring and studies related to air pollution and health impacts.

Matched MeSH terms: Respiration Disorders/etiology
Fulltext Gastro-oesophageal reflux in children with severe respiratory symptoms--clinical spectrum and management

Norzila MZ, Azizi BH, Deng CT, Zulfikar A, Devadass P, Tai A

Med J Malaysia, 1996 Mar;51(1):93-8.
PMID: 10967986

Respiratory symptoms in children may be associated with underlying gastro-oesophageal reflux (GOR). We reviewed the case notes of 20 children who presented to us from June 1993 to June 1994 with respiratory symptoms and GOR. The patients consisted of 16 Malays, two Chinese and two Indians with equal number of males and females. Their age at diagnosis was less than one year in 17 patients. The earliest age at presentation was at the third day of life. All patients had major respiratory manifestations i.e. recurrent wheezing, recurrent cough and pneumonia. In addition, three patients had stridor and six patients had apparent life threatening episodes (ALTE). Fourteen patients required ventilation because of respiratory failure. Diagnosis of GOR was based on clinical grounds supported by barium oesophagogram in seven patients and ultrasound examination in 11 patients. Eight patients were fundoplicated because of ALTE and recurrent severe bronchospasm. On follow up, 14 patients had hyperactive airways requiring inhaled bronchodilator and steroid therapy.

Matched MeSH terms: Respiration Disorders/etiology*

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