Roslina Abdul Manap

Insights, attitudes and perceptions about asthma and its treatment: Findings from a multinational survey of patients from 8 Asia-Pacific countries and Hong Kong

The Asthma Insight and Management (AIM) survey was conducted in North America, Europe, the Asia‐Pacific region and Latin America to characterize patients’ insights, attitudes and perceptions about their asthma and its treatment. We report findings from the Asia‐Pacific survey.

Clinical and high resolution computed tomography characteristics of patients with rheumatoid arthritis lung disease

Introduction:  Rheumatoid arthritis (RA) is a systemic disease of unknown cause. A variety of pulmonary disorders have been described in association with RA. Among the most common are interstitial lung disease (ILD) and bronchiectasis.

Understanding the true burden of COPD: the epidemiological challenges.

According to the World Health Organization (WHO), an estimated 3 million people die due to chronic obstructive pulmonary disease (COPD) every year, making it the fourth leading cause of death in the world. Around 90% of these deaths occur in lowand middleincome countries, with India and China alone estimated to account for 66% of total global COPD mortality. By 2020, it is anticipated that COPD will become the third leading cause of death in the world. The largest number of deaths will be in the South East Asian region, where mortality due to COPD is expected to grow by 160%, totalling more than the combined numbers of deaths due to malaria, tuberculosis and HIV/AIDS. However, these data may well underestimate the problem. Tan et al. estimated COPD prevalence in the Asia Pacific region to be 6.3%, compared to the rate of 3.9% extrapolated from WHO data. Similarly, COPD prevalence in China was found to be 2.5 times greater than that estimated by WHO. Despite this apparently huge burden, there are few good quality epidemiological studies on COPD prevalence in South East Asia. For several decades the major health burden has been communicable diseases such as tuberculosis, malaria and HIV/AIDS; governments, lay people and physicians have been slow to recognise the impact of COPD. Yet with the increasing morbidity and mortality from COPD – which has already overtaken most communicable diseases as a leading cause of death – there is now a need for more intensive research and analysis of the epidemiology of COPD in this region. In this issue of the PCRJ, McKay and colleagues report a systematic review on the prevalence of COPD in India. India is one of the largest countries in Asia with an estimated population of over 1.2 billion, where small increases in the percentage prevalence of a disease can translate into large increases in the number of cases. This huge population is exposed to a large number of COPD risk factors. Tobacco smoking rates in India vary from 13.3% to 59.5% amongst men and 0.2% to 22% amongst women. Around 70% of smokers in India smoke ‘bidis’ instead of cigarettes, which contain crude tobacco (0.15–0.25g) loosely packed in hand-rolled dried leaves of tendu (Diisopyros melanoxylon). The smoke from bidis contains 5 times more tar than the smoke from cigarettes, making bidi smoking a far greater risk factor for COPD than cigarette smoking. But more importantly, over 70% of homes in India use biomass fuel for cooking and heating, which again poses a greater risk factor for COPD than tobacco smoking. The prevalence of other risk factors such as early childhood lower respiratory tract infections, post-pulmonary tuberculosis, chronic poorly controlled asthma, poor socioeconomic status and a growing ageing population is also very high. McKay et al. reviewed a total of 16 papers on COPD prevalence published from 1980 onwards. Disappointingly, they could not identify a single study that provided a rigorous estimate of COPD prevalence using a relatively standard spirometry-based definition, and were therefore unable to perform a meta-analysis. Five of the 16 studies examined the prevalence of chronic bronchitis as a surrogate for COPD using validated questionnaires, while the remaining studies defined COPD using less traditional and non-standard methods. The results of this study beg some important questions: • What are the standard research tools and methodology needed to define COPD in population studies? • And why has a country like India not been able to conduct such a study? Unlike asthma (a term coined by Hippocrates over 3000 years ago), COPD is a relatively new disease that has undergone remarkable changes in its terminology over the last 350 years. In the early 1800s, the terms ‘bronchitis’ (introduced by the British physician Charles Badham) and ‘emphysema’ (introduced by the Frenchman Laennec) were proposed. For the next 100 years ‘emphysema’ was used largely by American physicians, and ‘chronic bronchitis’ by the British, and in Understanding the true burden of COPD: the epidemiological challenges

Predictors' Factors of Nutritional Status of Male Chronic Obstructive Pulmonary Disease Patients

Chronic obstructive pulmonary disease (COPD) is a systemic disease that leads to weight loss and muscle dysfunction resulting in an increase in mortality. This study aimed to determine the prevalence rate of malnutrition and nutritional status and also factors associated with nutritional status. A total of 149 subjects were involved in the cross-sectional study. The study was conducted at two medical centers in Kuala Lumpur, Malaysia. The results of the study showed that malnutrition was more prevalent (52.4%) in the subjects with severe stages of COPD as compared to mild and moderate COPD stages (26.2%) (P < 0.05). Fat-free mass depletion as assessed using fat-free mass index (FFMI) affected 41.9% of the subjects. Plasma vitamin A, peak expiratory flow (PEF), and handgrip were the predictors for body mass index (BMI) (R 2 = 0.190, P < 0.001). Plasma vitamin A and force expiratory volume in one second (FEV1) were the predictors of FFMI (R 2 = 0.082, P = 0.007). BMI was the predictor of respiratory factors, that is, FEV1% predicted (R 2 = 0.052, P = 0.011). It can be concluded that there is a need to identify malnourished COPD patients for an appropriate nutrition intervention.

What are the Antioxidant Status Predictors’ Factors among Male Chronic Obstructive Pulmonary Disease (COPD) Patients?

Imbalance between antioxidant and oxidative stress is a major risk factor for pathogenesis of some chronic diseases such as chronic obstructive pulmonary disease (COPD). This study aimed to determine antioxidant and oxidative stress status, and also theirs association with respiratory function of male COPD patients to find the antioxidant predictors’ factors. A total of 149 subjects were involved in a cross-sectional study. The study was conducted at two medical centers in Kuala Lumpur, Malaysia. Results of the study showed that plasma vitamin C was low in most of the subjects (86.6%). Total antioxidant capacity was the lowest in COPD stage IV compare to other stages (p < 0.05). Level of plasma vitamin A (p= 0.012) and vitamin C (p= 0.007) were low in malnourished subjects. The predictors for total antioxidant capacity were forced vital capacity (FVC) % predicted and intake of β-carotene (R2= 0.104, p= 0.002). Number of cigarette (pack/year) and smoking index (number/year) were not associated with total antioxidant capacity of this COPD population. Plasma oxidative stress as assessed plasma lipid peroxidation (LPO) was only positively correlated with plasma glutathione (p= 0.002). It might be a need to evaluate antioxidant status especially in older COPD patients to treat antioxidant deficiency which is leading to prevent COPD progression.

Efficacy of Ascorbic Acid (Vitamin C) and/N-Acetylcysteine (NAC) Supplementation on Nutritional and Antioxidant Status of Male Chronic Obstructive Pulmonary Disease (COPD) Patients

Antioxidant therapy has a potential to be introduced as therapeutic modality for chronic obstructive pulmonary disease (COPD) patients. This study aimed to determine the effect of antioxidant supplementation [ascorbic acid and N-Acetylcysteine (NAC)] on nutritional and antioxidant status in male COPD patients. A parallel and single blind randomised controlled clinical trial (RCT) was conducted at two medical centers in Kuala Lumpur, Malaysia. Seventy-nine subjects were recruited and randomly divided into four trial arms (i.e., NAC, vitamin C, NAC+vitamin C and control groups) for six mo. The primary outcome was changes in body mass index by estimating power of 90% and significance level of p<0.05. Repeated Measure ANOVA showed that there was a significant interaction effect on BMI (p=0.046) and carbohydrate intake (p=0.030), especially in the NAC group. Plasma glutathione (GSH) increased significantly in all intervention groups, especially in vitamin C (p=0.005). A single supplementation of NAC or vitamin C improved nutritional and antioxidant status of subjects.

Marijuana “bong” pseudomonas lung infection: a detrimental recreational experience: Marijuana “bong” seudomonas lung infection

The use of Cannabis sativa, also known as marijuana, is believed to have dated back to thousands of years B.C. More than 200 decades later, it remains a popular recreational psychoactive substance that can be smoked through a water pipe. We report a case of marijuana smoking via a “bong” device, which has resulted in severe Pseudomonas aeruginosa necrotizing pneumonia treated with conservative medical therapy. This case highlights the importance of recognizing that life‐threatening pneumonia can potentially be linked to marijuana and “bong” usage. Complicated cases should be considered for early surgical intervention.

Gene expression profiles predict survival of patients with advanced non-small cell lung cancers

A large variation in prognosis is observed despite the use of clinical prognostic factors in patients with advanced non-small cell lung cancer (NSCLC). It is likely that this variation is due to the different biological properties of the tumour cells. In this work we aimed to identify gene signature that could predict survival in advanced NSCLC. Total RNA was extracted from five 5 μm-thick sections of the FFPE using the High Pure RNA Paraffin Kit (Roche). RNA amplification was performed using WT-Ovation™ FFPE RNA Amplification System V2 (NuGen). The amplified cDNA was then labelled and hybridised onto Illumina HumanRef-8 v3.0 Expression BeadChips. Microarray data analysis was subsequently performed using Genespring GX version 9.0. Out of 75 FFPE samples, only 32 had sufficient RNA quality and quantity for microarray gene expression analysis. Patients were grouped into long and short survival groups based on the time to cancer-related death. After normalization and filtration, 19,002 genes were selected for differential gene expression analysis. A total of 440 genes differed significantly between the long and short survival groups (ANOVA, p < 0.05, with Benjamini and Hochberg False Discovery Rate multiple testing correction). Unsupervised Hierarchial Clustering with Pearson correlation and average linkage identified two broad clusters of patients corresponding to the long and short survival. Thirteen genes were selected based on the TTest, 2-fold expression changes, principal components analysis and univariate Cox regression analysis and risk scores were calculated for each patient. These gene signatures were independent predictors of survival. The model was validated with a published microarray data from 130 patients with NSCLC. Using Gene Set Analysis (GSA), we found certain biological processes including metastasis and chemotherapy resistance were up-regulated in the short survival group while TID pathway and MAPKKK cascade were enriched in the long survival group. As the conclusion, there is several distinct gene expression profiles associated with survival of patients with advanced stage NSCLC. Survival outcomes in advanced NSCLC could be predicted based on a 13-gene signature.