Asthma is a common respiratory disease affecting up to 235 million people worldwide. The prevalence of asthma varies due to the difficulty in assessing its severity. The reported worldwide prevalence is between 5.2% and 9.4%. In Malaysia it is estimated to be 4.2% based on the third National Health and Morbidity Survey in 2006.
Asthma can develop at any stage in life including adulthood. The typical symptoms of asthma are cough, wheezing, breathlessness and chest tightness. These symptoms are a result of chronic airway inflammation, enhanced bronchial hyperreactivity and reversible bronchial obstruction. Due to the absence of typical wheezing and marked breathlessness in some patients, asthma is frequently misdiagnosed or underdiagnosed.
The Asthma Insights and Reality in Asia-Pacific (AIRIAP) study, which included Malaysia, showed a prevalence of persistent asthma at 23% in the Asia-Pacific Region. In this study, 51.4% of respondents reported daytime asthma symptoms while 44.3% had sleep disturbances caused by asthma. A total of 43.6% had a history of hospitalisation and attending an emergency room during the previous 12 months. What is more worrying is that only 13.6% reported using inhaled corticosteroids which is considered central to the treatment of underlying airway inflammation in asthma.
According to the WHO data published in 2014, asthma deaths in Malaysia reached 1,642 or 1.29% of total deaths. It is hoped that the Clinical Practice Guidelines (CPG) on the Management of Asthma in Adults will increase awareness and knowledge of those managing asthma, so that patients will be correctly diagnosed and started on the appropriate treatment.
The previous CPG on asthma was issued in 2002 and in the last 16 years, there have been many new developments especially in the treatment algorithm and the advent of new pharmacological treatment such as biologics as well as bronchoscopic treatment such as bronchial thermoplasty. Hospital Serdang was the first hospital in Malaysia and one of the first few centres in Asia to offer bronchial thermoplasty five years ago.
The new CPG emphasises the diagnosis and assessment of asthma, and treatment pathways for stable and acute asthma in all level of health care. An asthma self-management, which include written asthma action plan has been included to help both healthcare providers and patients in the management of the disease. The care of special groups such as asthma in pregnancy, occupational asthma and asthma with co-morbidities are discussed in detail. The different inhaler devices and the proper technique of using them are also featured.
In view of many developments in the management of asthma in adults, it is timely that this evidence-based CPG is developed for those who are directly or indirectly involved in the managing the respiratory condition. It is hoped that this will help to reduce the variation in clinical practice in asthma management and improve the care of asthma patients in Malaysia.
DATUK DR. NOOR HISHAM ABDULLAH
Director-General of Health Malaysia
3rd May 2018