Low prevalence of obstructive lung disease in a suburban population of Malaysia: A BOLD collaborative study

Abstract

Background and objective: As a Burden of Obstructive Lung Disease (BOLD) collaboration, we studied the prevalence of chronic obstructive pulmonary disease (COPD) and its associated risk factors in a suburban population in Malaysia. Methods: Nonhospitalized men or women of age ≥ 40 years from a Penang district were recruited by stratified simple random sampling. Participants completed detailed questionnaires on respiratory symptoms and exposure to COPD risk factors. Prebronchodilator and post-bronchodilator spirometry conducted was standardized across all international BOLD sites in device and data quality control. Results: Of the 1218 individuals recruited for the study, 663 (340 men and 323 women) had complete questionnaire data and acceptable post-bronchodilator spirometry. The estimated population prevalence of Global Initiative for Chronic Obstructive Lung Disease (GOLD) ≥ stage I was 6.5% or 3.4% based on either fixed forced expiratory volume in 1 s/forced vital capacity ratio of <0.7 or National Health and Nutritional Examination Survey-derived lower limit of normal ratio while the prevalence of GOLD ≥ stage II was either 4.6% or 3.1%, respectively. Multivariate logistic regression analysis showed independent association between all stages of COPD with cigarette smoking pack years (adjusted odds ratio per 10-year increase: 1.73; 95% confidence interval: 1.09-2.75), use of biomass fuel for cooking (1.61; 1.10-2.36) and exposure to dusty job (1.50; 1.09-2.06). Conclusion: This study represented the first robust population-based epidemiology data on COPD for Malaysia. Compared with other sites globally, our estimated population prevalence was relatively low. In addition to cigarette smoking, use of biomass fuel and exposure to dusty job represented significant risk to the development of COPD.

Detailed Characterization of Hospitalized COPD Patients in Relation to Combined COPD Assessment by GOLD

“…The high degree of breathlessness, poor health-related quality of life and frequent exacerbations in our cohort may represent a more severe COPD disease that were not adequately addressed or treated in many of our patients. Such frequent exacerbation rates were also reported in other studies involving Malaysia [4,5]. The small number of first-time exacerbators indicates that hospitalized setting is not the ideal place to diagnose COPD early.…”

“…In collaboration with Burden of Obstructive Lung Disease (BOLD) initiative, we have recently estimated the COPD prevalence at 3.4% in a suburban population of Malaysia [4]. In a population-based survey of Asia-Pacific countries [5], over half of the interviewed COPD patients from Malaysia reported ≥one exacerbation in the past twelve months and many experienced negative impact on work and activities.…”

Letter from Malaysia

“…In collaboration with international Burden of Obstructive Lung Disease (BOLD), we published the first robust population-based COPD epidemiology data for Malaysia in 2016. 2 We showed that the estimated prevalence of airflow obstruction (principal COPD feature) of a local suburban area was low (3.4% and 6.5% based on NHANES-derived LLN criteria and fixed forced expiratory volume in 1 s/vital capacity (FEV 1 /VC) ratio, respectively) compared with most sites globally including Asian cities such as Guangzhou, Mumbai and Manila. This appeared to be so despite a similarly high Figure 1 The indelible ink on finger as proof of voting in the 2018 Malaysian general election.…”

Year in review 2016: Chronic obstructive pulmonary disease and asthma

“…For instance, Loh et al, in a population-based spirometric testing study in Malaysia reported a lower prevalence of COPD than expected. 4 Nevertheless, the long-term impact of an uncontrolled cigarette industry on an ageing population in Asian countries with large populations is a very grave concern.…”