1.A Pilot Randomized Control Cross over Study Evaluating the Effectiveness and Safety of Mechanical Percussor Compared with Conventional Chest Physiotherapy in Adults with Productive Cough
Punithavathi Narayanan ; Ong Loke Meng ; Irfhan Ali Hyder Ali ; Mohd Izmi @ Ibrahim Ahmad ; Dharminy Thurairatnam ; Ang Ah Heong ; Hadzlinda Zainal ; Sivasangari Subramaniam
The Medical Journal of Malaysia 2014;69(1):16-20
Introduction: Conventional Chest Physiotherapy (CCPT)
remains the mainstay of treatment for sputum mobilization
in patients with productive cough such as bronchiectasis
and “Chronic Obstructive Airway Disease” (COPD). However
CCPT is time consuming requires the assistance of a
physiotherapist and limits the independence of the patient.
Mechanical percussors which are electrical devices used to
provide percussion to the external chest wall might provide
autonomy and greater compliance. We compared safety and
efficacy of a mechanical chest percusser devised by
Formedic Technology with conventional chest percussion.
Methods: Twenty patients (mean age 64years) were
randomly assigned to receive either CCPT or mechanical
percussor on the first day and crossed over by “Latin square
randomisation” to alternative treatment for 6 consecutive
days and the amount of sputum expectorated was compared
by dry and wet weight. Adverse events and willingness to
use was assessed by a home diary and a questionnaire.
Results: There were 13 males and 7 females, eight
diagnosed as bronchiectasis and 12 COPD. The mean dry
weight of sputum induced by CCPT (0.54g + 0.32) was
significantly more compared with MP (0.40g + 0.11); p-value
= 0.002. The mean wet weight of sputum with CCPT (10.71g
+ 8.70) was also significantly more compared with MP (5.99g
+ 4.5); p-value < 0.001. There were no significant difference
in adverse events and majority of patients were willing to
use the device by themselves.
Conclusion: The mechanical percussor although produces
less sputum is well tolerated and can be a useful adjunct to
CCPT
2.Assessing Airflow Limitation among Smokers in a Primary Care Setting
Chean Kooi YAU ; Irfhan Ali Hyder Ali ; Fairuz Fadzilah RAHIM ; Chin Jiunn SHENG ; Choi Xin LING ; Liew Kah WENG ; Tan Chia CHIA ; Tan Kean CHYE ; Ooi Siew TING ; Tan Hong JIN
Malaysian Journal of Medical Sciences 2018;25(3):78-87
Background: Many smokers have undiagnosed chronic obstructive pulmonary disease(COPD), and yet screening for COPD is not recommended. Smokers who know that they haveairflow limitation are more likely to quit smoking. This study aims to identify the prevalence andpredictors of airflow limitation among smokers in primary care.Methods: Current smokers ≥ 40 years old who were asymptomatic clinic attendees in aprimary care setting were recruited consecutively for two months. We used a two-step strategy.Step 1: participants filled in a questionnaire. Step 2: Assessment of airflow limitation using apocket spirometer. Multiple logistic regression was utilised to determine the best risk predictorsfor airflow limitation.Results: Three hundred participants were recruited. Mean age was 58.35 (SD 10.30) yearsold and mean smoking history was 34.56 pack-years (SD 25.23). One in two smokers were found tohave airflow limitation; the predictors were Indian ethnicity, prolonged smoking pack-year historyand Lung Function Questionnaire score ≤ 18. Readiness to quit smoking and the awareness ofCOPD were low.Conclusions: The high prevalence of airflow limitation and low readiness to quit smokingimply urgency with helping smokers to quit smoking. Identifying airflow limitation as an additionalmotivator for smoking cessation intervention may be considered. A two-step case-finding methodis potentially feasible.
3.Management of asthma in adults in primary care
Andrea Ban Yu-lin ; Azza Omar ; Chong Li Yin ; Hilmi Lockman ; Ida Zaliza Zainol Abidin ; Irfhan Ali Hyder Ali ; Jaya Muneswarao Ramadoo@Devudu ; Leong Swee Wei ; Mazapuspavina Md. Yasin ; Mohd Aminuddin Mohd Yusof ; Mohd. Arif Mohd. Zim ; Nor Azila Mohd. Isa ; Shamsuriani Md. Jamal ; Yoon Chee Kin ; Zul Imran Malek Abdol Hamid
Malaysian Family Physician 2018;13(3):20-26
Asthma is a chronic inflammatory disease of the airway which is often misdiagnosed and
undertreated. Early diagnosis and vigilant asthma control are crucial to preventing permanent
airway damage, improving quality of life and reducing healthcare burdens. The key approaches
to asthma management should include patient empowerment through health education and selfmanagement and, an effective patient-healthcare provider partnership.
4.Personalised management of Chronic Obstructive Pulmonary Disease (COPD): Malaysian consensus algorithm for appropriate use of inhaled corticosteroid (ICS) in COPD patients
Nurhayati Mohd Marzuki ; Mat Zuki Mat Jaeb ; Andrea Ban ; Ahmad Izuanuddin Ismail ; Irfhan Ali Hyder Ali ; Mohd Razali Norhaya ; Azlina Samsudin ; Mona Zaria Nasaruddin ; Rozanah Abd Rahman ; Mohd Arif Mohd Zim ; Razul Md. Nazri B Md Kassim ; Yoke Fong Lam ; Aishah Ibrahim ; Noor Aliza Mohd Tarekh ; Sandip Vasantrao Kapse
The Medical Journal of Malaysia 2020;75(6):717-721
Background: Regarding the long-term safety issues with the
use of inhaled corticosteroids (ICS) and the clinical
predominance of dual bronchodilators in enhancing
treatment outcomes in chronic obstructive pulmonary
disease (COPD), ICS is no longer a “preferred therapy”
according to the Global Initiative for Chronic Obstructive
Lung Disease except on top of a dual bronchodilator. This
has necessitated a change in the current therapy for many
COPD patients.
Objective: To determine a standardised algorithm to
reassess and personalise the treatment COPD patients
based on the available evidence.
Methods: A consensus statement was agreed upon by a
panel of pulmonologists in from 11 institutes in Malaysia
whose members formed this consensus group.
Results: According to the consensus, which was
unanimously adopted, all COPD patients who are currently
receiving an ICS-based treatment should be reassessed
based on the presence of co-existence of asthma or high
eosinophil counts and frequency of moderate or severe
exacerbations in the previous 12 months. When that the
patients meet any of the aforementioned criteria, then the
patient can continue taking ICS-based therapy. However, if
the patients do not meet the criteria, then the treatment of
patients need to be personalised based on whether the
patient is currently receiving long-acting beta-agonists
(LABA)/ICS or triple therapy.
Conclusion: A flowchart of the consensus providing a
guidance to Malaysian clinicians was elucidated based on
evidences and international guidelines that identifies the
right patients who should receive inhaled corticosteroids
and enable to switch non ICS based therapies in patients
less likely to benefit from such treatments.
5.Misdiagnosis of community-acquired pneumonia in patients admitted to respiratory wards, Penang General Hospital
Ang Choon Seong ; Kelvin Beh Khai Meng ; Yeang Li Jing ; Chin Yuen Quan ; Khor Inn Shih ; Yoon Chee Kin ; Irfhan Ali bin Hyder Al
The Medical Journal of Malaysia 2020;75(4):390-
Introduction: Pneumonia continues to be as one of the top
causes of hospitalisations and deaths in Malaysia despite the
advancement in prevention and treatment of pneumonia. One
of the possible explanations is the frequent misdiagnosis of
pneumonia which had been reported elsewhere but such data is
not available locally.
Objectives: This is an audit project aiming to evaluate the
proportion of misdiagnosis among hospitalised communityacquired pneumonia (CAP) patients in the Respiratory wards
of Penang General Hospital based on their initial presentation
data, and their associated outcomes.
Methods: We reviewed the medical notes and initial chest
radiographs of 188 CAP patients who were admitted to
respiratory wards. Misdiagnosis was defined as cases which
lack suggestive clinical features and/or chest radiograph
changes. In-hospital mortality and length of stay (LOS) were
the outcomes of interest.
Results: The study found that 38.8% (n=73) of the hospitalised
CAP patients were misdiagnosed. The most common
alternative diagnosis was upper respiratory tract infection
(32.8%, n=24). There was no statistical difference between
misdiagnosis and CAP patients in the demographic and clinical
variables collected. In terms of outcomes, misdiagnosed
patients were discharged earlier (mean LOS= 3.5±3.28 days vs.
7.7±15.29 days, p=0.03) but the in-hospital mortality difference
was not statistically significant (p=0.07).
Conclusions: One third of our CAP admissions were
misdiagnosed. Although initial misdiagnosis of CAP in our
study did not show any increase in mortality or morbidity, a
proper diagnosis of CAP will be helpful in preventing
inappropriate prescription of antibiotics and unnecessary
admission.