'Raise awareness on pneumonia'

PETALING JAYA: There is a pressing need to raise awareness on pneumonia, say doctors.

The 2023 statistics showed that pneumonia overtook coronary heart disease as the main cause of death in Malaysia for the first time in two decades.

It accounted for 18,181 (15.2%) of all medically-certified deaths in 2023.

Lung Foundation of Malaysia chairman Prof Dr Roslina Abdul Manap said this showed a pressing need to amplify and diversify awareness of pneumonia in Malaysia.

“A comprehensive strategy that includes expanded public health campaigns, healthcare provider engagement, improved vaccine accessibility, community involvement and supportive policies is essential to effectively address this public health challenge.

“By implementing these measures, Malaysia can work towards reducing the impact of pneumonia and improving overall public health outcomes,” she said.

Pneumonia, she said, is an infection of the lower respiratory tract, involving the air sacs or alveoli where oxygen is absorbed into the body.

“When pneumonia occurs, these air sacs fill with fluid or pus, causing a low state of oxygen in the body (hypoxaemia), depleting organs of oxygen and potentially leading to organ failure.

“Hypoxaemia increases the workload on the heart, potentially leading to arrhythmias or heart failure, especially in patients with pre-existing cardiac conditions,” she said.

She said that a wide variety of organisms, including bacteria, viruses and fungi, can cause pneumonia and this can range in seriousness from mild to life-threatening.

According to Mayo Clinic in the United States, it could cause cough with phlegm or pus, fever, chills and breathing difficulties.

The Statistics Department, which released the 2023 data on causes of death in Malaysia last October, said there were 196,965 deaths recorded in 2023, of which 119,652 (60.7%) were medically-certified deaths.

“Pneumonia supersedes coronary heart disease as the principal cause of death for the first time in two decades, except in 2021 (Covid-19 infection),” the department said in a statement.

Coronary heart disease was the second highest cause of death in Malaysia in 2023 (15.1%).

Pneumonia was listed as the main cause of death for females with 7,815 cases (16.4%), and among those aged 60 and above (14,377 deaths, or 19.3%).

It is also the principal cause of death among the Chinese (16.4%).

Health professionals are of the view that pneumonia has become more “prominent” due to increasing willingness to attribute it as a cause of death in the post-Covid-19 pandemic years.

“Since the pandemic, there has been more awareness and a greater willingness among medical practitioners to attribute and report pneumonia as the cause of death,” Dr Roslina said.

Such measures could have led to an increase in the number of reported deaths due to pneumonia, she said.

“There is also an under-representation of coronary heart disease,” Dr Roslina said, attributing this to the fact that this disease can cause sudden death, and many deaths in a community setting are not medically certified.

Asked why women seemed more impacted, she explained that pneumonia is not inherently more common in women than in men.

“The risk of developing pneumonia depends on various factors, including underlying health conditions, lifestyle and immune system function, rather than gender alone,” she said.

Dr Roslina pointed out that pneumonia is the leading cause of death among those in the age group of 70 and above.

Without timely diagnosis and appropriate treatment, pneumonia can lead to death, she said.

“It is most serious for infants and young children, people over the age of 65, and those with health problems or weakened immune systems,” she said.

She added that those aged over 60 can reduce their chances of severe pneumonia by taking pneumococcal, influenza and Covid-19 vaccinations.

“Control of underlying diseases (comorbidities) such as diabetes mellitus, heart disease, asthma and high blood pressure is also important,” Dr Roslina said, emphasising on the importance of leading a healthy lifestyle.

Public health medicine specialist Prof Dr Sharifa Ezat Wan Puteh also voiced concern over the high fatality rate caused by pneumonia among women.

This may be due to late access to healthcare compared to men, she said.

“Another reason is women may have other comorbidities like diabetes, hypertension and obesity which will increase the risk of death among women with pneumonia,” she said.

She highlighted that one of the crucial early signs of pneumonia is cough.

Other signs are fever, difficulty in breathing and pain during breathing as the oxygen level may be slightly low, Dr Sharifa said.

“Some women who have limited access to healthcare will look for the treatment of cough and may delay treatment.

“This causes the pneumonia to get worse.

“It is imperative that those with symptoms like chronic cough should seek healthcare services, to check if they have underlying diseases like TB (tuberculosis), influenza and Covid-19,” she said.

Bacteria, she said, is the most common cause of pneumonia.