Chronic obstructive pulmonary disease (COPD) is a clinical syndrome encompassing a group of chronic, progressive, and debilitating respiratory conditions, that are characterized by incompletely reversible airflow limitation. Within the Asia-Pacific region, prevalence estimates have been derived using various protocols and study methods, and there is little data on the impact of COPD exacerbations. This study aimed to provide a comprehensive picture of the current prevalence and burden of COPD in this region. A population-based survey was conducted in nine Asia-Pacific territories between 01 February 2012 and 16 May 2012. Overall, 112,330 households were screened to identify eligible subjects (aged ≥40 years, with a physician diagnosis of COPD, chronic bronchitis or emphysema, or with identifiable symptoms of chronic bronchitis). Out of a sample of 69,279 individuals aged ≥40 years, 4,289 subjects with COPD were identified. Data were collected via face-to-face interviews or by fixed-line telephone, using a structured questionnaire. A total of 1,841 completed questionnaires were analyzed. The overall estimated COPD prevalence was 6.2%, with 19.1% of subjects having severe COPD. In the 12 months prior to the survey, nearly half of all subjects (46%) had experienced exacerbations, and 19% had been hospitalized as a result of their condition. When subjects were asked about the impact of their condition on employment, 23% said their condition kept them from working, and 42% felt that their condition limited their ability to work or their activities. Of those who reported taking prescription drugs, 20% did not know the name of the drugs they were taking. Prescription of oral corticosteroids was common, with 44% of subjects having used these during the previous year to manage their respiratory symptoms; in contrast, inhaler use was low (25%). Only 37% of subjects had taken a lung function test, and the majority (89%) of those tested did not know their test results. Across the Asia-Pacific territories surveyed, the prevalence of COPD is high, indicating a substantial socioeconomic burden. Our findings suggest that there is considerable room for improvement in the management of COPD, and highlight a need to enhance patient and physician education in the region.

Data regarding treatment outcomes among childhood TB patients are lacking in Malaysia. The present study aimed to evaluate the treatment outcomes and predictors of unsuccessful treatment outcomes among childhood TB patients in four TB high-burden states of Malaysia. This was a retrospective cohort study conducted at 13 healthcare centers in four states of Malaysia, namely, Sabah, Sarawak, Selangor, and Penang. During the study period, a total of 8932 TB patients were enrolled for treatment at the study sites, of whom 206 (2.31%) were children. The majority of the childhood TB patients were female (52.9%) and belonged to the age group of 6–10 years (42.7%). Pulmonary TB accounted for 70.9% of childhood TB. Among childhood PTB patients, 50% were sputum smear negative. One hundred and seventy-eight patients (86.4%) were successfully treated (87 were cured and 91 completed treatment). Among 28 (13.6%) patients with unsuccessful treatment outcomes, 13 (6.3%) died, 3 (1.5%) failed treatment, 9 (4.4%) defaulted, and 3 (1.5%) were transferred out. Multivariate analysis revealed that patients’ age (5–14 years) (OR = 0.279, p-value = 0.006) and male gender (OR = 0.390, p-value = 0.046) had a statistically significant negative association with unsuccessful treatment outcomes. The prevalence of childhood TB in the current study was comparable to the recently published national estimates. The study sites reached the WHO target of treatment success. Special attention to patients with identified risk factors can improve treatment outcomes.

This cross-sectional, observational, questionnaire-based survey was aimed to evaluate the differences in the practice pattern of pulmonologists (PLs;76), physicians (PYs;208) and general practitioners (GPs;154) in Nepal, Sri Lanka and Malaysia while managing COPD patients. For diagnosis most PLs (87%) used spirometry along with patient history and clinical features, followed by PYs (70%) and GPs (50%). All specialties considered symptoms followed by exacerbation history while selecting treatment. Maximum PLs (65%) preferred to prescribe inhalation therapy in every COPD patient, vs PYs (50%) and GPs (56%). For COPD management, most PYs preferred SABA or SABA/SAMA, LAMA+LABA & LAMA+LABA/ICS in GOLD-A, -C and -D, respectively. LAMA/LABA and LAMA/LABA/ICS, were the preferred choice of treatment in GOLD-B and -D, respectively. pMDI with or without spacer was the most preferred device among GPs (78%) whereas PLs and PYs preferred pMDIs and DPIs, equally. 51% PLs and 64% PYs prescribed home nebulization, however, most prescribed it in 70% of their patients had good treatment adherence (defined as >80%). Poor inhaler technique and high cost were found to be the commonest reason for non-adherence. Advice for smoking cessation was the most routinely offered non-pharmacological treatment options. 58% PLs evaluated inhalation technique on every visit, followed by 37% GPs and 36% PYs. There are opportunities to improve the use of diagnostic tools for COPD across specialties. Poor inhaler technique and non-adherence to the treatment remain important reasons of poor outcomes in COPD patients.