Short-acting β2-agonist prescription patterns and clinical outcomes in Malaysia: A nationwide cohort of the SABINA III study

Introduction: SABINA III assessed short-acting β2-agonist (SABA) prescription patterns and their association with asthma-related outcomes globally. Herein, we examined SABA prescription and clinical outcomes in the Malaysian cohort of SABINA III. Methods: In this observational, cross-sectional study, patients (≥12 years) were recruited between July and December 2019 from 15 primary and specialty care centres in Malaysia. Prescribed asthma treatments and severe exacerbation history within 12 months prior and asthma symptom control during the study visit were evaluated. Associations of SABA prescription with asthma control and severe exacerbation were analysed using multivariable regression models. Results: Seven hundred thirty-one patients (primary care, n=265 [36.3%]; specialty care, n=466 [63.7%]) were evaluated. The prevalence of SABA over-prescription (≥3 SABA prescriptions/year) was 47.4% (primary care, 47.1%; specialty care, 47.6%), 51.8% and 44.5% among all patients and patients with mild and moderate-to-severe asthma, respectively. Altogether 9.0% (n=66) purchased SABA without a prescription; among them, 43.9% (n=29) purchased ≥3 inhalers. The mean (standard deviation) number of severe asthma exacerbations was 1.38 (2.76), and 19.7% (n=144) and 25.7% (n=188) had uncontrolled and partly controlled symptoms, respectively. Prescriptions of ≥3 SABA inhalers (vs 1–2) were associated with lower odds of at least partly controlled asthma (odds ratio=0.42; 95% confidence interval [CI]=0.27–0.67) and higher odds of having severe exacerbation(s) (odds ratio=2.04; 95% CI=1.44–2.89). Conclusion: The prevalence of SABA over-prescription in Malaysia is high, regardless of the prescriber type, emphasising the need for healthcare providers and policymakers to adopt latest evidence-based recommendations to address this public health concern

Recurrent Respiratory Tract Infection in a 24-Year-Old Female Secondary to a Foreign Body Aspiration

Foreign body aspiration (FBA) is a common problem necessitating prompt recognition and early treatment to minimize the potentially severe and sometimes fatal consequences. We presented a 24-year-old girl who was admitted for chronic cough and recurrent pneumonia associated with constitutional symptoms. She was feverish with a temperature of 39°C and had tachycardia and tachypnoea with an oxygen saturation of 98%. Investigations revealed leukocytosis. CXR showed right lower lobe consolidation, and CT thorax demonstrated collapse consolidation of the right middle and lower lobe, along with associated dilated segmental bronchioles and diffuse patch ground-glass opacity in both lung fields. Bronchoscopy revealed a pen cap at the entrance of the right lower lobe. Patient symptoms improved after removal of the foreign body. In patients with recurrent chest infection, the physician should check for the possibility of FBA and prompt for a referral to a tertiary center for further evaluation

Shrinking Lung Syndrome – A rare cause of recurrent dyspnoea in SLE / Hazlyna Baharuddin … [et al.]

Here we present a 24-year-old lady with systemic lupus erythematosus (SLE) whom we diagnosed with shrinking lung syndrome (SLS), a rare manifestation of SLE. The initial SLE manifestation was alopecia, thrombocytopenia, serositis and vasculitis. Anti-nuclear antibody (ANA), anti-double stranded DNA (dsDNA) antibody, anti-ribonucleic (RNP) and anti-Ro antibody were positive. A year after diagnosis, she started to develop intermittent dyspnea and was hospitalised on three occasions. Lung examinations revealed reduced breath sounds at both bases and dullness at the right base. Multiple chest radiographs showed bilateral raised hemi-diaphragms. Other investigations including CT pulmonary angiogram, high resolution CT of the thorax, ventilation-perfusion scan and echocardiogram were not significant. On the third hospital admission, we noticed bilateral small lung volumes in the previous high resolution CT scan. Inspiratory and expiratory chest radiographs were performed and showed minimal change in lung volumes and a diagnosis of shrinking lung syndrome (SLS) was made. Her SLE remained active with lupus nephritis despite multiple immunosuppression and she passed away two years later due to sepsis with multi-organ failure

The Use of Fuzzy Linear Regression Modeling to Predict High-risk Symptoms of Lung Cancer in Malaysia

Lung cancer is the most prevalent cancer in the world, accounting for 12.2% of all newly diagnosed cases in 2020 and has the highest mortality rate due to its late diagnosis and poor symptom detection. Currently, there are 4,319 lung cancer deaths in Malaysia, representing 2.57 percent of all mortality in 2020. The late diagnosis of lung cancer is common, which makes survival more difficult. In Malaysia, however, most cases are detected when the tumors have become too large, or cancer has spread to other body areas that cannot be removed surgically. This is a frequent situation due to the lack of public awareness among Malaysians regarding cancer-related symptoms. Malaysians must be acknowledged the highrisk symptoms of lung cancer to enhance the survival rate and reduce the mortality rate. This study aims to use a fuzzy linear regression model with heights of triangular fuzzy by Tanaka (1982), H-value ranging from 0.0 to 1.0, to predict high-risk symptoms of lung cancer in Malaysia. The secondary data is analyzed using the fuzzy linear regression model by collecting data from patients with lung cancer at Al-Sultan Abdullah Hospital (UiTM Hospital), Selangor. The results found that haemoptysis and chest pain has been proven to be the highest risk, among other symptoms obtained from the data analysis. It has been discovered that the H-value of 0.0 has the least measurement error, with mean square error (MSE) and root mean square error (RMSE) values of 1.455 and 1.206, respectively

The Use of Fuzzy Linear Regression Modeling to Predict High-risk Symptoms of Lung Cancer in Malaysia

Lung cancer is the most prevalent cancer in the world, accounting for 12.2% of all newly diagnosed cases in 2020 and has the highest mortality rate due to its late diagnosis and poor symptom detection. Currently, there are 4,319 lung cancer deaths in Malaysia, representing 2.57 percent of all mortality in 2020. The late diagnosis of lung cancer is common, which makes survival more difficult. In Malaysia, however, most cases are detected when the tumors have become too large, or cancer has spread to other body areas that cannot be removed surgically. This is a frequent situation due to the lack of public awareness among Malaysians regarding cancer-related symptoms. Malaysians must be acknowledged the highrisk symptoms of lung cancer to enhance the survival rate and reduce the mortality rate. This study aims to use a fuzzy linear regression model with heights of triangular fuzzy by Tanaka (1982), H-value ranging from 0.0 to 1.0, to predict high-risk symptoms of lung cancer in Malaysia. The secondary data is analyzed using the fuzzy linear regression model by collecting data from patients with lung cancer at Al-Sultan Abdullah Hospital (UiTM Hospital), Selangor. The results found that haemoptysis and chest pain has been proven to be the highest risk, among other symptoms obtained from the data analysis. It has been discovered that the H-value of 0.0 has the least measurement error, with mean square error (MSE) and root mean square error (RMSE) values of 1.455 and 1.206, respectively

The Use of Fuzzy Linear Regression Modeling to Predict High-risk Symptoms of Lung Cancer in Malaysia

Lung cancer is the most prevalent cancer in the world, accounting for 12.2% of all newly diagnosed cases in 2020 and has the highest mortality rate due to its late diagnosis and poor symptom detection. Currently, there are 4,319 lung cancer deaths in Malaysia, representing 2.57 percent of all mortality in 2020. The late diagnosis of lung cancer is common, which makes survival more difficult. In Malaysia, however, most cases are detected when the tumors have become too large, or cancer has spread to other body areas that cannot be removed surgically. This is a frequent situation due to the lack of public awareness among Malaysians regarding cancer-related symptoms. Malaysians must be acknowledged the highrisk symptoms of lung cancer to enhance the survival rate and reduce the mortality rate. This study aims to use a fuzzy linear regression model with heights of triangular fuzzy by Tanaka (1982), H-value ranging from 0.0 to 1.0, to predict high-risk symptoms of lung cancer in Malaysia. The secondary data is analyzed using the fuzzy linear regression model by collecting data from patients with lung cancer at Al-Sultan Abdullah Hospital (UiTM Hospital), Selangor. The results found that haemoptysis and chest pain has been proven to be the highest risk, among other symptoms obtained from the data analysis. It has been discovered that the H-value of 0.0 has the least measurement error, with mean square error (MSE) and root mean square error (RMSE) values of 1.455 and 1.206, respectively

Protocol for a systematic review of the associations between inflammatory markers and lung function, muscle force and exercise capacity in people with COPD

Introduction The prevalence of chronic obstructive pulmonary disease (COPD) has been on the rise, with acute exacerbation of COPD associated with the highest burden and multiple pulmonary and systemic consequences. People with COPD have been found to have an abnormal response of systemic inflammation. To date, although limited, there are studies that suggest negative associations between inflammatory markers and important clinical outcomes such as exercise capacity and muscle force. This protocol aims to systematically review the evidence for (i) the associations between inflammatory markers and lung function, muscle force and exercise capacity and (ii) the influence of other factors (eg, hospitalisation, exercise programme) on the level of inflammatory markers in people with COPD.Methods and analysis Scopus, PubMed, Cochrane, Web of Science and ProQuest will be searched from database inception to February 2023 using PEO search strategy (Population: adults with COPD; Exposure: inflammatory markers; Outcomes: lung function, muscle force and exercise capacity). Four reviewers working in pairs will independently screen articles for eligibility and extract data that fulfilled the inclusion criteria. Depending on the design of the included studies, either Cochrane risk-of-bias version 2 or the Newcastle-Ottawa Scale tools will be used to rate the methodological quality of the included studies. Effect sizes reported in each individual study will be standardised to Cohen’s d and a random effects model will be used to calculate the pooled effect size for the association.Ethics and dissemination Ethical approval is unnecessary as this study will only use publicly available data. The findings will be disseminated through publication in peer-reviewed journals and conferences.PROSPERO registration number CRD42022284446

Asymptomatic Lymphocytic Interstitial Pneumonia with Extensive HRCT Changes Preceding Sjogren’s Syndrome

Lymphocytic interstitial pneumonia (LIP) is a rare condition, commonly associated with Sjogren’s syndrome (SS). We report a 53-year-old woman with an incidental finding of an abnormal chest radiograph. LIP was diagnosed based on high-resolution computed tomography and lung biopsy, but treatment was not initiated. Six years later, she developed cough and dyspnoea, associated with dry eyes, dry mouth, and arthralgia. While being investigated for the respiratory symptoms, she developed cutaneous vasculitis and was treated with 1 mg/kg prednisolone, which resulted in the improvement of her respiratory symptoms. Physical examination revealed fine bibasal crepitations, active vasculitic skin lesions, and a positive Schirmer’s test. Investigations revealed a restrictive pattern in the pulmonary function test, stable LIP pattern in HRCT, and positive anti-Ro antibodies. She was treated with prednisolone and azathioprine for 18 months, and within this time, she was hospitalised for flare of LIP, as well as respiratory tract infection on three occasions. During the third flare, when she also developed cutaneous vasculitis, she agreed for prednisolone but refused other second-line agents. To date, she remained well with the maintenance of prednisolone 2.5 mg monotherapy for more than one year. The lessons from this case are (i) patients with LIP can be asymptomatic, (ii) LIP can precede symptoms of SS, and (iii) treatment decision for asymptomatic patients with abnormal imaging or patients with mild severity should be weighed between the risk of immunosuppression and risk of active disease

Bronchoscopic Features and Morphology of Endobronchial Tuberculosis: A Malaysian Tertiary Hospital Experience

The diagnosis of endobronchial tuberculosis (EBTB) is difficult as it is not well visualized radiologically, and bronchoscopy is not routinely performed for tuberculosis (TB) patients. Bronchoscopic characterization via endoscopic macroscopic features can speed up the diagnosis of EBTB and prompt immediate treatment. In this study, we identified the clinical and bronchoscopic morphology of 17 patients who were diagnosed with EBTB from 2018 to 2020. Demographics, radiological, microbiological and histopathological data were recorded. Endobronchial lesions were classified according to Chung classification. The diagnosis was made based on a histopathological examination (HPE) of endobronchial biopsy, and/or positive ‘Acid-fast bacilli’ (AFB) microscopy/Mycobacterium tuberculosis (MTB) culture on microbiological examination of bronchial alveolar lavage (BAL) and/or positive MTB culture on endobronchial biopsy specimens. Furthermore, EBTB was predominant in young women, age 20 to 49 years old, with a male to female ratio of 1 to 2. Underlying comorbidities were found in 53% of the patients. Cough, fever and weight loss were the main symptoms (23.5%). The indications for bronchoscopy are smear-negative TB and persistent consolidation on chest radiographs. Consolidation was the main radiological finding (53%). An active caseating lesion was the main EBTB endobronchial subtype (53%). The leading HPE finding was caseating granulomatous inflammation (47%). All patients showed good clinical response to TB treatment. Repeated bronchoscopy in six patients post TB treatment showed a complete resolution of the endobronchial lesion. EBTB bronchoscopic characterization is paramount to ensure correct diagnosis, immediate treatment and to prevent complication