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How Lung Health Screenings Can Help Malaysians Quit Smoking

How Lung Health Screenings Can Help Malaysians Quit Smoking

Smoking has long been a significant health concern in Malaysia, with a high prevalence rate of 22.8% among adults. Tobacco use is the leading cause of preventable deaths in the country, with more than 20,000 Malaysians dying each year from smoking-related illnesses. One effective way to reduce smoking rates and improve public health is through lung health screenings. In this article, we’ll explore how lung health screenings can help Malaysians quit smoking, what they involve, and the benefits they offer.


Smoking is a major public health issue in Malaysia, with more than 20,000 deaths each year due to smoking-related illnesses. Lung health screenings can play a vital role in helping Malaysians quit smoking and improving their overall health. In this article, we’ll explore the benefits of lung health screenings, who should get screened, and how they can be used to promote smoking cessation。

Smoking in Malaysia: A Growing Concern

According to the Ministry of Health Malaysia ‘s National Health and Morbidity Survey 2015, it is estimated that there are 20000 deaths yearly attributed to smoking. Hence, it is no wonder that smoking-related diseases have been identified as a significant contributor to disability-adjusted life years and years of life lost among the Malaysian population.

The Importance of Lung Health Screenings

Lung health screenings can be an essential tool for detecting smoking-related illnesses early, when they are more treatable. These screenings can also help identify individuals at high risk of developing smoking-related illnesses and provide them with the support and resources they need to quit smoking. Early detection and intervention can significantly improve health outcomes and reduce healthcare costs associated with smoking-related illnesses.

What Are Lung Health Screenings?

Lung health screenings are non-invasive tests that assess lung function and detect early signs of smoking-related illnesses, such as lung cancer and COPD. These screenings typically involve spirometry tests, chest x-rays, and low-dose CT scans.

Who Should Get Lung Health Screenings?

Individuals who smoke or have a history of smoking are at higher risk of developing smoking-related illnesses and should consider getting screened regularly. The American Lung Association recommends annual lung health screenings for individuals aged 55-80 who have a 30 pack-year smoking history (i.e., they have smoked one pack a day for 30 years, two packs a day for 15 years, etc.). However, individuals with a lower smoking history may still benefit from screening.

Benefits of Lung Health Screenings

Lung health screenings offer several benefits, including early detection of smoking-related illnesses, improved health outcomes, and reduced healthcare costs. These screenings can also provide individuals with the motivation and support they need to quit smoking and make positive lifestyle changes.

How to Prepare for a Lung Health Screening

Individuals should wear loose, comfortable clothing and avoid wearing jewelry or other metal objects during the screening. They should also avoid eating heavy meals or exercising vigorously before the screening. It is important to inform the healthcare provider about any medications, allergies, or medical conditions before the screening.

What to Expect During a Lung Health Screening

During a lung health screening, a healthcare provider will perform a spirometry test to assess lung function, take a chest x-ray, and perform a low-dose CT scan. The spirometry test involves breathing into a device that measures lung capacity and airflow. The chest x-ray and CT scan produce images of the lungs and can detect early signs of smoking-related illnesses, such as nodules or masses.

Interpreting the Results of a Lung Health Screening

The results of a lung health screening can vary depending on the individual’s smoking history, age, and other risk factors. If the screening detects any abnormalities, the healthcare provider may recommend additional testing or refer the individual to a specialist for further evaluation.

Using Lung Health Screenings to Help Malaysians Quit Smoking

Lung health screenings can be a powerful tool for promoting smoking cessation in Malaysia. Individuals who receive a screening and learn that they have early signs of smoking-related illnesses may be more motivated to quit smoking and adopt healthier lifestyle habits. Healthcare providers can also use these screenings to provide individuals with the resources and support they need to quit smoking, such as smoking cessation counseling and medications.

Resources for Quitting Smoking in Malaysia

There are several resources available in Malaysia for individuals who want to quit smoking. The Ministry of Health provides a national quitline, online resources, and support groups to help individuals quit smoking. Private healthcare providers and non-governmental organizations also offer smoking cessation programs and support services.


Lung health screenings can be a valuable tool for promoting smoking cessation and improving public health in Malaysia. By detecting early signs of smoking-related illnesses and providing individuals with the resources and support they need to quit smoking, these screenings can reduce the burden of smoking-related illnesses and improve health outcomes.

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COVID-19: Higher Risk for Smokers and Vapers

COVID-19: Higher Risk for Smokers and Vapers

When someone’s lungs are exposed to flu or other infections the adverse effects of smoking or vaping are much more serious than among people who do not smoke or vape.

Smoking makes COVID worse if you get it and smoking — and vaping — increase the risk of being infected and developing COVID-19.

As of April 28, 2020 there were 19 peer reviewed papers that had data on smoking and COVID disease progression, 17 from China, 1 from Korea, and 1 from the US.  Our peer reviewed meta-analysis of these 19 papers found that smoking was associated with more than a doubling of odds of disease progression in people who had already developed COVID. 

There have been several reports, mostly in non-peer reviewed preprints, reporting lower levels of COVID-19 infections among smokers than nonsmokers. This is a surprising finding because, based on what we know about the effects of smoking and vaping on immune function of the respiratory system, one would expect that smoking and vaping would increase risks of COVID infection.  A big problem with all the studies to date has been that they have been based on people who were tested, rather than samples drawn from the population as a whole.  Because of limited availability of tests in many places, the resulting samples are biased toward people who may already have symptoms.

On August 11, 2020, Shivani Mathur Gaiha and Bonnie Halpern-Felsher from Stanford and Jing Cheng from UCSF addressed this problem in a study that used a population-based sample of youth and young adults, “Association between youth smoking, electronic cigarette use and Coronavirus Disease 2019.  Among young people (ages 13-24) COVID-19 diagnosis was five times more likely among ever-users of e-cigarettes only, seven times more likely among ever-dual-users, and 6.8 times more likely among past 30-day dual-users.

These findings are particularly important as the case mix of people getting COVID is moving to younger people, perhaps reflecting increased exposures due to reduced social distancing and a lack of understanding about factors exacerbating COVID-related risk in this age group.



Smoking is associated with increased development of acute respiratory distress syndrome (ARDS) in people with a risk factor like severe infection, non-pulmonary sepsis (blood infection), or blunt trauma.   People who have any cotinine (a metabolite of nicotine) in their bodies – even at the low levels associated with secondhand smoke – have substantially increased risk of acute respiratory failure from ARDS. 

The recent excellent summary of the evidence on the pulmonary effects of e-cigarettes reported multiple ways that e-cigarettes impair lungs’ ability to fight off infections:

Effects on immunity

Reporting of respiratory symptoms by e-cigarette users suggests increased susceptibility to and/or delayed recovery from respiratory infections. A study of 30 healthy non-smokers exposed to e-cigarette aerosol found decreased cough sensitivity. If human ciliary dysfunction is also negatively affected, as suggested by animal and cellular studies, the combination of reduced coughing and impaired mucociliary clearance may predispose users to increased rates of pneumonia. Exposure to e-cigarettes may also broadly suppress important capacities of the innate immune system. Nasal scrape biopsies from non-smokers, smokers, and vapers showed extensive immunosuppression at the gene level with e-cigarette use. Healthy non-smokers were exposed to e-cigarette aerosol, and bronchoalveolar lavage was obtained to study alveolar macrophages. The expression of more than 60 genes was altered in e-cigarette users’ alveolar macrophages two hours after just 20 puffs, including genes involved in inflammation. Neutrophil extracellular trap (NET) formation, or NETosis, is a mode of innate defense whereby neutrophils lyse DNA and release it into the extracellular environment to help to immobilize bacteria, a process that can also injure the lung. Neutrophils from chronic vapers have been found to have a greater propensity for NET formation than those from cigarette smokers or non-smokers. Given that e-cigarettes may also impair neutrophil phagocytosis, these data suggest that neutrophil function may be impaired in e-cigarette users. [emphasis added]

Studies in animals reinforce and help explain these human effects:

Two weeks of exposure to e-cigarette aerosol in mice decreased survival and increased pathogen load following inoculation with either Streptococcus pneumoniae or influenza A, two leading causes of pneumonia in humans. Furthermore, the aerosol exposure may lead to enhanced upper airway colonization with pathogens and to virulent changes in pathogen phenotype, as shown with Staphylococcus aureus. Thus, although more studies are needed, the animal data suggesting that vaping leads to an increased susceptibility to infection would seem to correlate with the population level data in young adult humans, whereby vapers have increased rates of symptoms of chronic bronchitis. [emphasis added]

A meta-analysis of the relationship between smoking and influenza found that smokers were more likely to be hospialized and admitted to the ICU.

The WHO has also concluded that, ” smokers are more likely to develop severe disease with COVID-19, compared to non-smokers” and provides a nice discussion of how smoking increases risk of COVID-19 by increasing the risk of heart, lung, and other diseases.

Dr. Nora Volkow, director of the National Institute on Drug Abuse, posted an article on her blog “COVID-19: Potential Implications for Individuals with Substance Use Disorders,” that stared off by saying

As people across the U.S. and the rest of the world contend with coronavirus disease 2019 (COVID-19), the research community should be alert to the possibility that it could hit some populations with substance use disorders (SUDs) particularly hard. Because it attacks the lungs, the coronavirus that causes COVID-19 could be an especially serious threat to those who smoke tobacco or marijuana or who vape.

She goes on to address other drug use and how COVID-19 could interact with them, including noting that

Vaping, like smoking, may also harm lung health. Whether it can lead to COPD is still unknown, but emerging evidence suggests that exposure to aerosols from e-cigarettes harms the cells of the lung and diminishes the ability to respond to infection. In one NIH-supported study, for instance, influenza virus-infected mice exposed to these aerosols had enhanced tissue damage and inflammation.

In addition, an article in Scientific American, “Smoking or Vaping May Increase the Risk of a Severe Coronavirus Infection,” summarizes how smoking and vaping affect the lungs and the immune system that is consistent with the view that using these products increases the risk of infection and worse outcomes.  CNN also has a good story, “How smoking, vaping and drug use might increase risks from Covid-19.”  KQED/NPR reports on a young man who developed COVID that may have been aggrevated by his vaping.  Fortunately, he recovered and has now stopped vaping.


The New York Times has a good story reporting that the Massachusetts AG put out an advisory urging people to stop smoking and vaping and pointed to resources to quit.

CDC, FDA, the Surgeon General, state health departments and everyone (including comedians, such as John Oliver who spent his whole show on the issue last weekend) working to educate the public on how to lower risk of serious complications from covid-19 should add stopping smoking, vaping, and avoiding secondhand exposure to their list of important preventive measures.

This would also be a good time for cities, states private employers and even individual families to strengthen their smokefree laws and policies – including e-cigarettes — to protect nonsmokers from the effects of secondhand smoke and aerosol on their lungs and to create an environment that will help smokers quit.

The California Department of Public Health has information on smoking, vaping and COVID here, as does the California Smokers’ Helpline.  Trinity Health is also urging people to stop smoking to protect against COVID-19.  FDA has said that vaping and smoking could increased COVID risks.  CDC lists smoking as one of the risk factors for COVID-19 because smoking depresses immune function.

UCSF has added smoking and vaping nicotine and cannabis to COVID-19 triage protocol.  Doing so will both improve patient care and, over the longer term, provide important information needed to quantfy how smoking and vaping impact COVID risks. 


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