Allergic rhinitis and other comorbidities associated with asthma control in Thailand.

Background: Asthma and allergic rhinitis (AR) can coexist and cause disabilities. This study aimed to assess the association between AR, asthma control, asthma-related quality of life, and other comorbidities. Methods: A cross-sectional study was conducted in adults with asthma in six hospitals in Thailand. The outcomes were association of asthma control assessed by the asthma control test (ACT), AR, and asthma comorbidities. Not-well-controlled asthma was defined as ACT scores ≤22. The severity of AR was determined by visual analog scale (VAS). Severe AR was defined as VAS ≥5. Asthma-related quality of life (AQLQ), comorbidities, and total IgE were recorded. Results: A total of 682 asthmatic patients were included. Median (IQR) age was 58.0 (47.0-64.0) years. 69.9% were female. Not-well-controlled asthma was present in 44.7%. The prevalence of AR was 86.1%. Moderate/severe persistent AR was diagnosed in 21.7% and severe AR was diagnosed in 30.2% of the patients. Inhaled corticosteroid-containing regimens were prescribed in 97.7% of patients. Intranasal corticosteroid and antihistamine were prescribed in 65.7 and 31.7%, respectively. Patients with not-well-controlled asthma had higher body mass index, VAS scores, proportions of pollution exposure, aeroallergen sensitization, severe AR, nasal polyp, urticaria, food allergy, gastroesophageal reflux disease, depression and anxiety, peptic ulcer, and asthma exacerbations, but younger age, lower AQLQ scores, and lower FEV1. Correlation was found between AR severity and ACT (r = -0.461, p < 0.001), AQLQ (r = -0.512, p < 0.001), and total IgE (r = 0.246, p < 0.023). Multiple regression analysis revealed that ACT, AQLQ, and percentage of FEV1/FVC were significantly associated with severe AR. Conclusion: Allergic rhinitis is prevalent in Thai asthmatic patients. AR severity is associated with asthma control, quality of life, and pulmonary function. Comprehensive care is essential for patients with uncontrolled asthma, particularly when coexisting with conditions.

Guidelines for the management of asthma in adults: Evidence and recommendations.

The multidisciplinary experts in Thailand developed an asthma management recommendation that was relevant to low-middle income countries (LMICS). Populations level consideration about asthma management is emphasized. The healthcare systems, access to and availability of treatments as well as the asthma populations vary from country to country in LMICS. The feasibility in clinical practice for implementation is also a major issue. For these reasons, the practice guidelines that are relevant to local contexts are essential to improve better asthma control. Furthermore, integrative and collaboration between asthma experts and the public health sector to implement and discriminate such guidelines will help to achieve these challenging goals. The topics covered include the current asthma situation in Thailand and the Asia-Pacific region, the definition of asthma, asthma diagnosis, assessment of asthma patients, asthma treatment - both pharmacological and non-pharmacological, management of asthma exacerbation, management of asthma comorbidities, treatment of asthma in special conditions, severe and uncontrolled asthma, Thai alternative medicine and asthma, and asthma and coronavirus disease-19 (COVID-19).

Prevalence of melioidosis in patients with suspected pulmonary tuberculosis and sputum smear negative for acid-fast bacilli in northeast Thailand.

The clinical and radiological features of pulmonary melioidosis can mimic tuberculosis. We prospectively evaluated 118 patients with suspected pulmonary tuberculosis who were acid-fast bacilli (AFB) smear negative at Udon Thani Hospital, northeast Thailand. Culture of residual sputum from AFB testing was positive for Burkholderia pseudomallei in three patients (2.5%; 95% confidence interval [CI] 0.5-7.3%). We propose that in melioidosis-endemic areas, residual sputum from AFB testing should be routinely cultured for B. pseudomallei.

Outcome of medical thoracoscopy.

BACKGROUND: Medical thoracoscopy is a common procedure for pulmonologists working in Europe but is still unpopular in South East Asia with few medical centers in Thailand performing this procedure. We report our outcome of medical thoracoscopy based upon 10 years experience. MATERIAL AND METHOD: Medical thoracoscopy was first performed in our unit in 1998. The early indication was undiagnosed pleural effusion. Other indications which were empyema, pneumothorax and talc pleudrage were carried on for the last 3 years. The patients' demographic data, indication for medical thoracoscopy, procedures, complication and outcome were recorded and analyzed separately. RESULTS: During 1998 to 2007, there were 142 procedures of medical pleuroscopy performed. There were 86 procedures for the indication of undiagnosed pleural effusion. The diagnostic yield was 95.2%. The malignancy was recovered by thoracoscopy in 45.35% of procedure. For indication of talc pleurodesis, there were 22 patients with 3 who had early failure of pleurodesis because of trapped lung. After mean follow up of 124 days, 17 patients did not have recurrence of pleural effusion. 15 patients who had loculated pleural effusion were done medical thoracoscopy. Operations were successful in only 6 patients. For indication of pneumothorax 5 out of 6 procedures were successful after mean follow up of 167 days. In 12 empyema patients, mean hospital admission was 9.1 days after thoracoscopy. There was no serious complication from the procedure. DISCUSSION: There are many indications for medical thoracoscopy and the experience of the performer is the important factor determining success of the procedure. In undiagnosed pleural effusion, our result was comparable to other studies in the past in which the rate of malignancy was around 40-60%. The result of talc pleudrage was also comparable with the need to improve the diagnosis of trapped lung to prevent the unnecessary medical thoracoscopy. The result was excellent in patients who came for pleurodesis indicated in pneumothorax also in empyema but number of patient was still low. The problem was in loculated pleural effusion from malignancy which showed high failure rate. The early pleurodesis in malignant pleural effusion before it became loculated should be considered. CONCLUSION: Outcome of medical thoracoscopy varies from various indications. The success rate was high and decreasing in undiagnosed pleural effusion, pneumothorax, empyema and talc pleurodesis in malignant effusion. Great skill was needed to perform medical thoracoscopy in loculated malignant pleural effusion