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Article ; Online: A 44-Year-Old Woman With Prolonged Fever and Mediastinal "Lymphadenopathy".

Fong, Isaac / Tang, Yiting / Salahudeen Mohamed, Haja Mohideen / Koh, Mariko Siyue

2023 Volume 163, Issue 2, Page(s) e73–e78

Abstract: Case presentation: A 44-year-old woman with a history of dyslipidemia and chronic anemia from uterine fibroids was admitted to the general medicine department of a tertiary hospital for a prolonged fever of 2 months' duration. The patient reported ... ...

Abstract	Case presentation: A 44-year-old woman with a history of dyslipidemia and chronic anemia from uterine fibroids was admitted to the general medicine department of a tertiary hospital for a prolonged fever of 2 months' duration. The patient reported multiple visits to her local general practitioner, with tympanic temperatures up to 38.2 °C, where she was treated with 2 courses of broad-spectrum antibiotics in view of associated sore throat, nonproductive cough, and generalized lethargy. Although her respiratory symptoms abated within a few days of her initial presentation, her fever and lethargy persisted. Initial chest radiograph was unremarkable. Subsequent CT scan of the thorax, abdomen, and pelvis detected an enlarged subcarinal lymph node measuring 3.7 cm × 1.7 cm and a mildly enlarged pre-carinal lymph node measuring 2.0 × 1.5 cm, with a mean attenuation of 66-77 Hounsfield Units (HU), and no central necrosis or calcification. No significant abnormalities were detected in the abdomen or pelvis. The patient was then referred to the respiratory department for further evaluation.
MeSH term(s)	Humans ; Female ; Adult ; Lethargy ; Fever/etiology ; Lymphadenopathy/diagnostic imaging ; Lymphadenopathy/etiology ; Lymph Nodes/diagnostic imaging ; Lymph Nodes/pathology ; Mediastinum/diagnostic imaging
Language	English
Publishing date	2023-02-08
Publishing country	United States
Document type	Case Reports
ZDB-ID	1032552-9
ISSN	1931-3543 ; 0012-3692
ISSN (online)	1931-3543
ISSN	0012-3692
DOI	10.1016/j.chest.2022.09.015
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Article: Managing adult asthma during the COVID-19 pandemic: A 2022 review and current recommendations.

Ong, Kheng Yong / Tiew, Pei Yee / Koh, Mariko Siyue

Annals of the Academy of Medicine, Singapore

2022 Volume 51, Issue 10, Page(s) 637–647

Abstract: Introduction: This review aims to examine asthma management during the COVID-19 pandemic.: Method: Relevant recommendations and articles were identified by respiratory professional societies and PubMed search using the terms "asthma" and "COVID-19", ... ...

Abstract	Introduction: This review aims to examine asthma management during the COVID-19 pandemic. Method: Relevant recommendations and articles were identified by respiratory professional societies and PubMed search using the terms "asthma" and "COVID-19", and examined for relevance and inclusion in this study. Results: Recommendations for the management of asthma have remained similar but are now supported by new evidence between the years 2020 and 2022. Patients with well-controlled, mild-to-moderate asthma are unlikely to be at increased risk of acquiring COVID-19 or having worse outcomes from COVID-19. All asthma patients should receive COVID-19 vaccination. Spirometry can be performed with the usual strict infection control procedures unless there is a suspicion of COVID-19. Mask-wearing and other health measures remain important for asthma patients. Conclusion: While previous recommendations were largely based on expert opinion, the tremendous amount of literature published since the pandemic first emerged 2 years ago has helped guide respiratory professional bodies to update their recommendations. This study provides a timely review of the various recommendations and can be used to guide healthcare professionals in managing asthma patients, as the world prepares for a future with COVID-19 becoming endemic. The long-term consequences of COVID-19 infection in asthma patients and the ripple effects of COVID-19 remain uncertain and deserve ongoing study.
MeSH term(s)	Adult ; Humans ; COVID-19 ; Pandemics/prevention & control ; COVID-19 Vaccines ; Asthma/therapy ; Asthma/epidemiology ; Infection Control
Chemical Substances	COVID-19 Vaccines
Language	English
Publishing date	2022-08-08
Publishing country	Singapore
Document type	Review ; Journal Article
ZDB-ID	604527-3
ISSN	0304-4602
ISSN	0304-4602
DOI	10.47102/annals-acadmedsg.202285
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Article: FDA Boxed Warning for Montelukast: Impact on Adult Severe Asthmatics?

Tiew, Pei Yee / Tan, Karen Li Leng / Koh, Mariko Siyue

Annals of the Academy of Medicine, Singapore

2021 Volume 49, Issue 12, Page(s) 1029–1030

MeSH term(s)	Acetates/adverse effects ; Adult ; Cyclopropanes ; Drug Labeling ; Humans ; Quinolines/adverse effects ; Sulfides ; United States/epidemiology
Chemical Substances	Acetates ; Cyclopropanes ; Quinolines ; Sulfides ; montelukast (MHM278SD3E)
Language	English
Publishing date	2021-01-19
Publishing country	Singapore
Document type	Journal Article
ZDB-ID	604527-3
ISSN	0304-4602
ISSN	0304-4602
DOI	10.47102/annals-acadmedsg.2020409
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Article ; Online: Comparison of exacerbation phenotypes among patients with severe asthma.

Soenjoyo, Karina Ruth / Nadkarni, Nivedita / Koh, Mariko Siyue

Allergy and asthma proceedings

2020 Volume 41, Issue 4, Page(s) e67–e79

Abstract: Background: ...

Abstract	Background:
MeSH term(s)	Administration, Inhalation ; Adult ; Aged ; Anti-Asthmatic Agents/therapeutic use ; Asthma/drug therapy ; Asthma/physiopathology ; Disease Progression ; Female ; Forced Expiratory Volume ; Glucocorticoids/therapeutic use ; Hospitalization/statistics & numerical data ; Humans ; Influenza Vaccines/therapeutic use ; Male ; Middle Aged ; Phenotype ; Pneumococcal Vaccines/therapeutic use ; Prospective Studies ; Severity of Illness Index ; Singapore ; Vital Capacity
Chemical Substances	Anti-Asthmatic Agents ; Glucocorticoids ; Influenza Vaccines ; Pneumococcal Vaccines
Language	English
Publishing date	2020-06-30
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	1312445-6
ISSN	1539-6304 ; 1088-5412
ISSN (online)	1539-6304
ISSN	1088-5412
DOI	10.2500/aap.2020.41.200029
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Article ; Online: The mediating role of trust in physician and self-efficacy in understanding medication adherence in severe asthma.

Fan, Qianqian / Ong, Adriel Shao En / Koh, Mariko Siyue / Doshi, Kinjal

Respiratory medicine

2021 Volume 190, Page(s) 106673

Abstract: Objective: To investigate the relationships between beliefs about medication, trust in physician, self-efficacy, and medication adherence in severe asthma patients.: Methods: A sample of 117 patients with a diagnosis of Severe Asthma on Step 4 or 5 ... ...

Abstract	Objective: To investigate the relationships between beliefs about medication, trust in physician, self-efficacy, and medication adherence in severe asthma patients. Methods: A sample of 117 patients with a diagnosis of Severe Asthma on Step 4 or 5 of GINA assessment of control treatment ladder completed a one-time survey, including the shortened Medication Adherence Report Scale (MARS-5), Beliefs about Medicines Questionnaire (BMQ), Trust in Physician Scale (TIPS), and Self-Efficacy in Taking Medication (SEAMS). Results: Our study found that medication adherence was associated with trust in physician (p = 0.033); factor one of beliefs about medication - Necessity of taking medication (BMQ1-Necessity: p = 0.025); and two factors of self-efficacy in taking medication (SEAMS1-Difficulty: p = 0.001; SEAMS2-Uncertain: p = 0.005). Furthermore, two factors of self-efficacy and trust in physician together significantly mediated the relationship between beliefs about medication and medication adherence in a serial multiple mediator model. Conclusions: Beliefs about medication are fundamental in affecting asthma patients' trust in physician and self-efficacy, which in turn impact medication adherence. Clinical implications: Interventions being developed to improve medication adherence may benefit from emphasizing on asthma patients' concerns about overuse and harm of medication. In addition, education program targeting to improve provider-patient relationship could help with patients' confidence in taking medication.
MeSH term(s)	Anti-Asthmatic Agents/therapeutic use ; Asthma/drug therapy ; Female ; Humans ; Male ; Medication Adherence ; Middle Aged ; Physician-Patient Relations ; Self Efficacy ; Surveys and Questionnaires ; Trust
Chemical Substances	Anti-Asthmatic Agents
Language	English
Publishing date	2021-11-02
Publishing country	England
Document type	Journal Article
ZDB-ID	1003348-8
ISSN	1532-3064 ; 0954-6111
ISSN (online)	1532-3064
ISSN	0954-6111
DOI	10.1016/j.rmed.2021.106673
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Article ; Online: Healthcare utilization and health-related quality of life of severe asthma patients in Singapore.

Lim, Gerard Nicholas / Allen, John Carson / Tiew, Pei Yee / Chen, Wenjia / Koh, Mariko Siyue

The Journal of asthma : official journal of the Association for the Care of Asthma

2022 Volume 60, Issue 5, Page(s) 969–980

Abstract: Background: Notwithstanding unequivocal consensus on the disproportionate effect of severe asthma (SA) on asthma morbidity, healthcare utilization, quality of life, work impairment and socioeconomic burden, the burden of SA patients in Singapore has not ...

Abstract	Background: Notwithstanding unequivocal consensus on the disproportionate effect of severe asthma (SA) on asthma morbidity, healthcare utilization, quality of life, work impairment and socioeconomic burden, the burden of SA patients in Singapore has not been appraised. Objectives: To determine the burden of disease and extent of quality of life impairment in SA patients in Singapore. Methods: A cross-sectional analysis of SA patients seen in Singapore General Hospital (2020-2021) to investigate emergency healthcare utilization, oral corticosteroid (OCS) burden and health-related quality of life (HRQoL) with primary endpoint EuroQoL-5 Dimension three-level (EQ-5D-3L) scores. The empirical measurement properties of the EQ-5D utility index in SA were comprehensively assessed through multivariate regression analyses. Results: A total of 336 SA patients were recruited, 51.2% of SA patients had at least one acute healthcare resource utilization during the previous year, with 25.6% of patients having an emergency healthcare visit to the hospital. Overall mean (SD) EQ-5D-3L and EQ-5D-3L utility scores in SA patients were 6.22 (1.51) and 0.77 (0.30), respectively. EQ-5D utility scores were 0.14 lower in uncontrolled vs controlled asthma and 0.09 lower in the presence of severe exacerbation, whereas barely changed by maintenance OCS dose and airflow limitation. Conclusion: SA patients were found to have high disease burden, high healthcare resource utilization and OCS use, low biologics usage, poor HRQoL and utility in comparison with other chronic diseases.
MeSH term(s)	Humans ; Quality of Life ; Singapore/epidemiology ; Cross-Sectional Studies ; Surveys and Questionnaires ; Asthma/drug therapy ; Patient Acceptance of Health Care
Language	English
Publishing date	2022-09-14
Publishing country	England
Document type	Journal Article
ZDB-ID	603816-5
ISSN	1532-4303 ; 0277-0903
ISSN (online)	1532-4303
ISSN	0277-0903
DOI	10.1080/02770903.2022.2114086
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Article ; Online: Individualised risk prediction model for exacerbations in patients with severe asthma: protocol for a multicentre real-world risk modelling study.

Lee, Tae Yoon / Sadatsafavi, Mohsen / Yadav, Chandra Prakash / Price, David B / Beasley, Richard / Janson, Christer / Koh, Mariko Siyue / Roy, Rupsa / Chen, Wenjia

BMJ open

2023 Volume 13, Issue 3, Page(s) e070459

Abstract: Introduction: Severe asthma is associated with a disproportionally high disease burden, including the risk of severe exacerbations. Accurate prediction of the risk of severe exacerbations may enable clinicians to tailor treatment plans to an individual ... ...

Abstract	Introduction: Severe asthma is associated with a disproportionally high disease burden, including the risk of severe exacerbations. Accurate prediction of the risk of severe exacerbations may enable clinicians to tailor treatment plans to an individual patient. This study aims to develop and validate a novel risk prediction model for severe exacerbations in patients with severe asthma, and to examine the potential clinical utility of this tool. Methods and analysis: The target population is patients aged 18 years or older with severe asthma. Based on the data from the International Severe Asthma Registry (n=8925), a prediction model will be developed using a penalised, zero-inflated count model that predicts the rate or risk of exacerbation in the next 12 months. The risk prediction tool will be externally validated among patients with physician-assessed severe asthma in an international observational cohort, the NOVEL observational longiTudinal studY (n=1652). Validation will include examining model calibration (ie, the agreement between observed and predicted rates), model discrimination (ie, the extent to which the model can distinguish between high-risk and low-risk individuals) and the clinical utility at a range of risk thresholds. Ethics and dissemination: This study has obtained ethics approval from the Institutional Review Board of National University of Singapore (NUS-IRB-2021-877), the Anonymised Data Ethics and Protocol Transparency Committee (ADEPT1924) and the University of British Columbia (H22-01737). Results will be published in an international peer-reviewed journal. Trial registration number: European Union electronic Register of Post-Authorisation Studies, EU PAS Register (EUPAS46088).
MeSH term(s)	Humans ; Longitudinal Studies ; Asthma/epidemiology ; Asthma/drug therapy ; Cost of Illness ; Multicenter Studies as Topic
Language	English
Publishing date	2023-03-09
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2022-070459
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Article ; Online: Predictors of persistent poor control and validation of ASSESS score: Longitudinal 5-year follow-up of severe asthma cohort.

Tiew, Pei Yee / Tay, Tunn Ren / Chen, Wenjia / Price, David B / Ong, Kheng Yong / Chotirmall, Sanjay H / Koh, Mariko Siyue

The journal of allergy and clinical immunology. Global

2023 Volume 3, Issue 1, Page(s) 100188

Abstract: Background: Longitudinal predictors of persistent poor asthma control in severe asthma (SA) cohort remain scarce. The predictive value of the asthma severity scoring system (ASSESS) in the SA cohort outside the original study and in the Asian population ...

Abstract	Background: Longitudinal predictors of persistent poor asthma control in severe asthma (SA) cohort remain scarce. The predictive value of the asthma severity scoring system (ASSESS) in the SA cohort outside the original study and in the Asian population is unknown. Objective: We sought to determine the 5-year longitudinal outcome of patients with SA and validate the use of ASSESS score in predicting future outcomes in SA. Methods: A prospective longitudinal observational study of patients with SA attending the multidisciplinary specialist SA clinic of the Singapore General Hospital from 2011 to 2021 was conducted. The number of exacerbations and asthma control test results were recorded yearly for 5 consecutive years. The ASSESS score was computed at baseline, and the area under the receiver-operating characteristic curve for predicting persistent poor asthma control was generated. Results: Of the 489 patients recruited into the study, 306 patients with 5-year follow-up data were analyzed. Seventy-three percent had type 2 inflammation with increased overall exacerbations over 5 years (rate ratio, 2.55; 95% CI, 1.31-4.96; Conclusions: Bronchiectasis and gastroesophageal reflux disease are predictors for persistent poor asthma control and targeted traits for precision medicine in SA. The ASSESS score has a good prediction for persistent poor asthma control over 5 years.
Language	English
Publishing date	2023-11-20
Publishing country	United States
Document type	Journal Article
ISSN	2772-8293
ISSN (online)	2772-8293
DOI	10.1016/j.jacig.2023.100188
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Article ; Online: Letter from Singapore.

Chotirmall, Sanjay H / Koh, Mariko Siyue

Respirology (Carlton, Vic.)

2017 Volume 23, Issue 2, Page(s) 228–229

MeSH term(s)	Humans ; Pulmonary Medicine/organization & administration ; Respiratory Tract Diseases/diagnosis ; Respiratory Tract Diseases/epidemiology ; Respiratory Tract Diseases/therapy ; Singapore
Language	English
Publishing date	2017-11-02
Publishing country	Australia
Document type	Letter
ZDB-ID	1435849-9
ISSN	1440-1843 ; 1323-7799
ISSN (online)	1440-1843
ISSN	1323-7799
DOI	10.1111/resp.13210
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Article ; Online: Economic burden of asthma in Singapore.

Finkelstein, Eric A / Lau, Eden / Doble, Brett / Ong, Bennett / Koh, Mariko Siyue

BMJ open respiratory research

2021 Volume 8, Issue 1

Abstract: Background and objective: Up-to-date economic burden of asthma in Singapore is currently unknown.: Methods: We quantify the per capita and total annual costs of asthma for adults and children by level of symptom control (uncontrolled, partly ... ...

Abstract	Background and objective: Up-to-date economic burden of asthma in Singapore is currently unknown. Methods: We quantify the per capita and total annual costs of asthma for adults and children by level of symptom control (uncontrolled, partly controlled, and well controlled) via a cross-sectional online survey administered to a national web panel. Participants were asked about healthcare utilisation, days missed from work, and reduced productivity due to their symptoms. These values were then monetised and multiplied by prevalence estimates of adult and child asthmatics to generate total costs. Results: A total of 300 adults and 221 parents of children with asthma were included in analysis. The total annual cost of adult asthma was estimated to be SGD 1.74 billion (US$1.25 billion) with 42% coming from the uncontrolled group, 45% from the partly controlled group, and 13% from the well-controlled group. For children, the total cost is SGD 0.35 billion (US$0.25 billion), with 64%, 26% and 10% coming from each group respectively. Combined, the annual economic burden of asthma in Singapore is SGD 2.09 billion (US$1.50 billion) with 79% due to productivity losses. Conclusion: Poorly controlled asthma imposes a significant economic burden. Therefore, better control of disease has the potential to generate not only health improvements, but also medical expenditure savings and productivity gains.
MeSH term(s)	Adult ; Asthma/epidemiology ; Child ; Cost of Illness ; Cross-Sectional Studies ; Health Care Costs ; Humans ; Singapore/epidemiology
Language	English
Publishing date	2021-03-15
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2736454-9
ISSN	2052-4439 ; 2052-4439
ISSN (online)	2052-4439
ISSN	2052-4439
DOI	10.1136/bmjresp-2020-000654
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