This study estimated the potential public health and economic impacts of different COVID-19 vaccination strategies in Malaysia using an updated COVID-19 vaccine. A previously published Markov decision-tree model (2021-2022) was updated with the latest epidemiology data from Malaysia (October 2022-September 2023). This updated model was used to assess the outcomes of alternative vaccination strategies using the updated COVID-19 vaccine. Age-specific inputs were derived from Malaysian epidemiological data and published sources. The model projected health outcomes (cases, hospitalizations, and deaths) and economic outcomes (direct medical costs and productivity losses) across various age and risk categories. Vaccinating individuals aged 60 and above, as well as high-risk individuals aged 6months to 59years with vaccine coverage of 20%, was projected to prevent 91,824 infections, 1477 hospitalizations, and 53 deaths. The model estimated total savings of MYR 90.9 million in direct medical costs attributed to COVID-19 treatment and MYR 110.4 million in indirect costs attributed to COVID-19 illness. Expanding coverage among individuals aged 60 and above, as well as high-risk individuals of any age, to 50% could further increase the reduction in deaths, hospitalizations, infections, and costs by up to 150%. When considering recent updated epidemiology data and expected vaccination coverage, vaccination strategies appear to have a smaller impact, largely caused by the reduction in vaccine coverage. However, despite this, using an updated COVID-19 vaccine could still reduce the health and economic burden of COVID-19 in terms of cases, hospitalizations, deaths, direct medical costs, and indirect productivity losses in Malaysia, especially among high-risk populations and older adults.

Bronchiectasis is a chronic airway disease marked by recurrent infections, progressive inflammation, and declining pulmonary function. While pharmacologic therapies remain central to management, nonpharmacologic strategies-particularly nutrition and physical activity-are underutilized, despite growing evidence. This review examines the role of nutritional support and physical activity in managing bronchiectasis, highlighting their impact on frailty, systemic inflammation, and functional outcomes. Frailty is increasingly recognized in bronchiectasis, particularly in patients with comorbid nontuberculous mycobacterial lung disease (NTM-LD), where prevalence may exceed 40%. Malnutrition, low body mass index (BMI), and sarcopenia are associated with poorer lung function, increased hospitalizations, and mortality. Meanwhile, physical inactivity-measured by low step count and prolonged sedentary time-is a strong predictor of exacerbation risk and healthcare utilization. Evidence supports the use of high-calorie, protein-rich diets and resistance-based exercise training to improve muscle mass, immune function, and quality of life. Synergistic effects are observed when nutritional interventions are combined with pulmonary rehabilitation. However, barriers to implementation remain, including a lack of access, under-referral, and limited emphasis on guidelines. Nutritional and physical activity interventions offer measurable clinical benefits in bronchiectasis and should be integrated into routine multidisciplinary care. Future research should prioritize the validation of frailty screening tools, the implementation of effective strategies, and the development of policy mechanisms to expand coverage for dietetic and rehabilitation services.

Despite fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) being available for asthma treatment in the US (United states) since 2020, real-world evidence on its clinical and economic benefits in patients with asthma is lacking. This study aimed to assess the effectiveness of FF/UMEC/VI (100/62.5/25µg and 200/62.5/25µg) in US patients with asthma previously on inhaled corticosteroid/long-acting β2-agonists (ICS/LABA) using administrative claims data. Retrospective, longitudinal, pre-post study utilizing data from the Komodo Health database between 09/09/2019 and 12/31/2023. Eligible adults with asthma had been treated with ICS/LABA prior to FF/UMEC/VI initiation (index date: first FF/UMEC/VI prescription). Rates of moderate-severe exacerbations, asthma-related healthcare resource utilization, oral corticosteroid (OCS) and short-acting β2-agonist (SABA) use, and asthma-related medical costs were evaluated pre- (12months pre-index) and post-FF/UMEC/VI initiation (12months post-index). Statistical analyses involved rate ratios (RRs) from a Poisson regression model, odds ratios (ORs) from logistic regression models, and mean differences from linear regression models. Exploratory analyses stratified these results by pre-index ICS/LABA combination and FF/UMEC/VI index dose. In total, 17,959 patients were included. Following FF/UMEC/VI initiation, odds of having ≥ 1 exacerbation were reduced by 52% (OR [95% confidence interval (CI)] 0.48 [0.46, 0.50]; P < 0.001), rate of moderate-severe exacerbations reduced by 38% (RR [95% CI] 0.62 [0.61, 0.64]; P < 0.001) and asthma-related hospitalizations by 25% (RR [95% CI] 0.75 [0.68, 0.83]; P < 0.001). Odds of ≥ 1 OCS dispensing were reduced by 36% (OR [95% CI] 0.64 [0.62, 0.67]; P < 0.001) and ≥ 1 SABA canister use by 54% (OR [95% CI]: 0.46 [0.44, 0.48]; P < 0.001) post initiation; mean annualized asthma-related medical costs were reduced by $1115 ([95% CI] [$ -1771, $ -459]; P < 0.001). Both FF/UMEC/VI dosage groups had similar results. In patients who remain uncontrolled despite ICS/LABA treatment, escalating to FF/UMEC/VI is associated with reductions in asthma exacerbations, asthma-related hospitalizations, OCS use, SABA use, and asthma-related medical costs.

Respiratory syncytial virus (RSV) is a public health concern, particularly among neonates/young infants, in individuals with chronic medical conditions, and for older adults. In contrast to children, limits in surveillance and substantial underreporting obscure the full impact of RSV infections on adults. A structured process for adult RSV disease decision-making can guide public health epidemiology and planning. Twelve experts from six Asian countries (Indonesia, Malaysia, Philippines, Singapore, Taiwan, and Thailand) participated in a modified Delphi consensus study to guide surveillance, diagnosis, and impact of RSV in adults in Asia. The expert recommendations could be organized into four themes: epidemiology and surveillance, diagnosis, high-risk groups, and healthcare utilization. The expert panel recommended strengthening RSV disease monitoring through integration within current influenza and COVID-19 surveillance systems. Furthermore, to standardize RSV case definitions, it was recommended that the RSV respiratory infection clinical criteria exclude fever. Although rapid antigen tests are employed as standard of care, polymerase chain reaction (PCR) testing should be utilized whenever feasible. Along with year-round testing in Asia to establish incidence, an adjustment factor of at least 2.2-fold was recommended to address the underestimation of RSV-related hospitalization rates based on single-specimen PCR testing. For all adults aged ≥ 75 as well as for those adults aged ≥ 60 with comorbid or immunocompromising conditions, or those residing in long-term care facilities, the experts recommended universal RSV vaccination (contingent upon vaccine licensure), and cost-effectiveness analyses should be used to inform region-specific policy decisions. Priority actions proposed for adult RSV infection and disease include streamlining diagnostic testing processes, launching disease awareness campaigns, and engaging public health authorities to advance prevention programs in coordinated efforts with policymakers and payers.

Emergency airway management is a lifesaving procedure but can be associated with significant risks, including hypoxia, hypotension, cardiac arrest, and death. Peri-intubation hypotension, reported in ≥ 40% of cases, is strongly associated with increased morbidity and mortality. While clinical guidelines emphasize the importance of preoxygenation and hemodynamic optimization prior to intubation, the latter remains poorly defined, with limited available data to guide evidence-based strategies to mitigate cardiovascular collapse during rapid sequence intubation. This review synthesizes current knowledge on the epidemiology, risk factors, and pathophysiology of peri-intubation hemodynamic deterioration. We review targeted strategies for hemodynamic optimization of physiologic parameters before intubation. These include volume expansion with fluid resuscitation, vasopressor utilization, selection of pharmacologic agents, invasive hemodynamic monitoring, and advanced preoxygenation techniques. In selected high-risk patients, we also discuss the potential role of extracorporeal membrane oxygenation as an adjunctive or rescue therapy. Our goal is to provide airway specialists with a comprehensive framework for mitigating cardiovascular collapse during emergent airway management and to stimulate further research into this high-risk and understudied domain.

Patients undergoing lung transplantation require regular monitoring to ensure that the transplanted lung(s) stay healthy. This is usually achieved through a combination of home spirometry combined with regular reviews in hospital outpatient clinics. Administering questionnaires remotely could reduce the need for regular hospital clinic visits. This study aims to investigate whether a remotely administered questionnaire combined with home spirometry can reduce the number of hospital clinic visits. Patients will be randomised to the intervention arm (questionnaire and home spirometry) or standard of care arm (home spirometry + clinic visit). Quality of life (StGeorge's Respiratory Questionnaire), health economic data and usage acceptability will be collected at the beginning and end of the study period. The primary outcome is to evaluate whether the number of hospital clinic visits are reduced in the intervention arm compared to the control arm. Secondary outcomes will evaluate the intervention influence on healthcare usage, the associated costs of service delivery and its environmental impact. ClinicalTrials.gov NCT05916495.

This study was undertaken in COVID-19 patients treated with and without Paxlovid™ (Paxlovid) in an outpatient setting to determine hospitalization from the community. This retrospective secondary data observational cohort study was conducted between February and November 2022. All patients diagnosed by polymerase chain reaction for COVID-19 and at risk of COVID-19 disease progression were offered Paxlovid in the outpatient setting. Potential associations between Paxlovid use and likelihood of hospitalization, antibiotic use, and other clinical outcomes were explored using regression models as appropriate (i.e., logistic, multinomial, ordinal), adjusted for World Health Organization risk classification. Of 3011 COVID-19 patients offered Paxlovid, 2005 (67%) were treated with Paxlovid and 1006 (33%) chose not to take treatment. There was no evidence of a difference between groups in terms of vaccination status, viral load, age, or gender, although more patients of Arab ethnicity chose not to take treatment (p < 0.001). There were fewer hospital admissions in the group that took Paxlovid (p < 0.001). Some evidence of a reduction in the number of hospitalizations was found when adjusted for World Health Organization risk category (adjusted odds ratio [aOR] 0.60, 95% confidence interval [CI] 0.45-0.77), and a reduction was similarly found for the number of hospitalizations among patients with readmission (aOR 0.47, 95% CI 0.26-0.84). A reduction in the odds of antibiotic use was observed in the treated group for any cause (aOR 0.80, 95% CI 0.67-0.94) and specifically for COVID-19 (aOR 0.58, 95% CI 0.44-0.77). Paxlovid treatment reduced hospitalization and antibiotic use, indicating its benefit in reducing severe outcomes and healthcare burden and supporting its use for reducing severe outcomes in COVID-19 patients. ClinicalTrials.gov identifier, NCT06291831.

Dry powder inhalers (DPIs) have a 20-40-fold lower carbon footprint compared to pressurized metered-dose inhalers (pMDIs). Switching from pMDI to DPI is therefore beneficial from an environmental perspective, but many health care professionals are concerned that this may worsen treatment outcomes in asthma and chronic obstructive pulmonary disease (COPD). We analyzed patient outcomes and carbon footprints of switching inhaler treatment from pMDI to DPI. We performed a post hoc analysis on clinical outcomes data from a 12-week real-world, non-interventional study of adult patients with asthma or COPD who switched treatment from pMDI to the budesonide-formoterol Easyhaler DPI. Clinical end points included asthma control test (ACT), Mini-Asthma Quality of Life Questionnaire (Mini-AQLQ), lung function tests, and reliever use (asthma), and COPD assessment test (CAT), and modified Medical Research Council dyspnea scale (mMRC) (COPD). In the carbon footprint calculation, we used estimates from the Montreal Protocol for pMDI and for DPI the estimate as reported. Among all 237 patients (142 asthma, 95 COPD) by switching their treatment clinical improvements were observed in all the outcome measures (p < 0.001). Furthermore, the need for reliever medication decreased among patients with asthma (p < 0.001). The amount of estimated kg CO2e emissions per year for maintenance treatment was 97.0% lower for the DPI than for pMDI. For reliever medication among patients with asthma, it was 99.6% lower. Among them, the emission savings could amount to approximately 131kg CO2e annually. This is of similar magnitude, as individual high-impact environmental actions such as eating a plant-based diet or purchasing green energy. Our results show that disease control was maintained among patients with asthma or COPD when they switched from pMDI to DPI, while the carbon footprint of inhaler treatment was reduced.

Sleep disorders, including snoring and obstructive sleep apnea (OSA), are significant health concerns. OSA affects an estimated 4million (8.5%) individuals in Vietnam, with 2.3million suffering from moderate-to-severe conditions. Despite the high prevalence, underdiagnosis and limited accessibility to sleep diagnostics remain challenges. This study aims to assess the feasibility and effectiveness of a guided, self-administered home sleep study using a level3 diagnostic model. A cross-sectional multicenter survey conducted from September 2023 to March 2024 included healthcare professionals (HCPs) across Vietnam. Participants completed questionnaires (Epworth Sleepiness Scale, STOP-BANG), and high-risk individuals underwent respiratory polygraphy using ApneaLink Air devices. Standardized instructions and technical support were provided remotely by trained technicians. Out of 1721 participants, 21.9% were diagnosed with OSA, comprising mild (32.4%), moderate (19.6%), and severe cases (9.2%). Prevalent symptoms included insomnia (22.2%), daytime sleepiness (40.7%), and memory decline (49.4%). Technical issues were minimal, supporting the feasibility of this approach. A level3home sleep study model is effective for large-scale OSA screening. Integrating such approaches into public health initiatives can enhance early diagnosis and treatment access, reducing OSA-related health and economic burdens. Graphical abstract available for this article.