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Background There have been limited reports looking into the care of patients with asthma exacerbations admitted to tertiary hospitals in Southeast Asia. This study aims to determine the extent in which the 2019 Global Initiative for Asthma (GINA) guidelines were being met. Methods A retrospective study of patients with asthma exacerbations admitted to the University of Malaya Medical Centre (UMMC) and Pantai Hospital Kuala Lumpur (PHKL), Malaysia from 1 July 2019 to 31 December 2019. Results There were significant numbers of patients with previous admissions for asthma in both centres, with almost 50% experiencing an exacerbation in the previous year. Approximately 75% of the patients considered their asthma to be controlled when asked, despite many of them having had a history of acute exacerbations in the previous year. When cross-checked, the level of GINA-defined asthma control remained low, with only 6.4% of the patients deemed to have good control, while asthma was partially controlled in 25.6% of the patients and uncontrolled in 68% of the patients. About 72.1% of the patients reported daytime symptoms, 65.1% of the patients reported night-time symptoms, 70.9% of the patients required frequent usage of rescue inhalers and 72.1% of the patients reported some limitation in their activity prior to the current asthma exacerbation. Almost a quarter of the patients who were admitted had severe or life-threatening exacerbations as defined by GINA. These patients had more hospitalizations in a year and were more likely to have previous admissions requiring non-invasive and invasive ventilation. They were also more likely to be on GINA Step 5 treatment, had a lower mean percent predicted FEV 1 and a higher baseline blood eosinophil count. Multivariate analysis revealed that baseline eosinophil count were independently associated with severe or life-threatening asthma exacerbations (odds ratio: 1.01, 95% confidence interval: 1.00–1.01, p=0.001). Failure to adhere to daily controller medications was high in this study (37.2%). Conclusion Although the management of asthma exacerbations in tertiary hospitals in Southeast Asia is largely congruous with international guidelines, there is room for improvement. As there is a marked discrepancy between patient-perceived and guideline-defined asthma control, efforts to increase awareness on the dangers of uncontrolled asthma are warranted.

adjustment for FEV 1 , age, sex, smoking pack-years, oxygen saturation, cardiovascular and respiratory admissions; cardiovascular medications and diabetes. Patients on short-acting bronchodilators only were used as the controls. Results A total of 5048 patients were included in the study with mean age at diagnosis of 69.4 years and mean follow-up of 4.0 years. 623 were on long-acting bronchodilators only, 3510 on long-acting bronchodilator and ICS; and 915 controls. Crude hazard ratios are shown in Table 1 Conclusions LABA monotherapy does not confer any mortality benefit but when used in combination with ICS reduces both allcause and cardiovascular mortality. In contrast, LAMA whether given alone or in combination with a LABA and /or ICS reduces both all-cause and cardiovascular mortality. This 'real-life' study suggests that LABA should perhaps not be given as monotherapy but only in conjunction with a LAMA or ICS.

PurposeThe objective of this pilot trial was to evaluate the safety and efficacy of AKL1, a patented botanical formulation containing extracts of Picrorhiza kurroa, Ginkgo biloba, and Zingiber officinale, as add-on therapy for patients with chronic obstructive pulmonary disease (COPD) and chronic cough.Patients and methodsThis randomized, double-blind, placebo-controlled trial enrolled male and female patients >18 years old with COPD and Leicester Cough Questionnaire (LCQ) score of <18. The 10-week study period comprised a 2-week single-blind placebo run-in period followed by add-on treatment with AKL1 or placebo twice daily for 8 weeks. The primary study endpoint was the change from week 0 to week 8 in cough-related health status, as assessed by the LCQ.ResultsOf 33 patients enrolled, 20 were randomized to AKL1 and 13 to placebo. Patients included 19 (58%) men and 14 (42%) women of mean (standard deviation [SD]) age of 67 (9.4) years; 15 (45%) patients were smokers and 16 (49%) were ex-smokers. The mean (SD) change from baseline in LCQ score at 8 weeks was 2.3 (4.9) in the AKL1 group and 0.6 (3.7) in the placebo group, with mean difference in change of 1.8 (95% confidence interval: −1.5 to 5.1; P=0.28). The St George’s Respiratory Questionnaire score improved substantially in the AKL1 treatment group by a mean (SD) of −7.7 (11.7) versus worsening in the placebo group (+1.5 [9.3]), with mean difference in change of −9.2 (95% confidence interval: −19.0 to 0.6; P=0.064). There were no significant differences between treatment groups in change from baseline to week 8 in other patient-reported measures, lung function, or the 6-minute walk distance.ConclusionFurther study is needed with a larger patient population and over a longer duration to better assess the effects of add-on therapy with AKL1 in COPD.

Background: There have been limited reports looking into acute asthma care for patients admitted to tertiary hospitals in Southeast Asia. This study aims to determine the extent in which the 2019 Global Initiative for Asthma (GINA) guidelines were being met. It highlights aspects of excellent clinical management and areas requiring improvement. Methods: A cross-sectional prospective study of patients with acute asthma exacerbations admitted to the University of Malaya Medical Centre (UMMC) and Pantai Hospital Kuala Lumpur (PHKL), Malaysia from 1st July 2019 to 31st December 2019. Results: Of 172 patients admitted, 67.4% were females. There was proper documentation of asthma control assessment (100%), baseline controller and reliever medications (100%), peak expiratory flow measurements (78%), and inhaler technique review (69.8%). However, there was poor documentation of written asthma action plans (25%). 51.2% had not been admitted in the previous year. At baseline, 90% of patients had been prescribed inhaled corticosteroid (ICS). However, 40.5% of patients were not compliant with controller medications. Based on the GINA assessment for asthma control, 68% had uncontrolled asthma. While 91.9% of patients had a previous diagnosis of asthma, only 48.8% of patients had objective testing to support the diagnosis. All patients with newly-diagnosed asthma (8.1%) were commenced on a corticosteroid-containing-inhaler. Conclusion: Although acute asthma management in tertiary hospitals in Southeast Asia is relatively congruous with international guidelines, there is room for improvement. As the majority of patients found to have uncontrolled asthma were non-compliant with their controller medications, efforts to increase awareness on the perils of uncontrolled asthma is warranted.

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