Nine out of 10 COPD cases are caused by smoking, as in the case of Thiagaraja who was diagnosed with this chronic respiratory disease after smoking for nearly 50 years. — NCSM
In Malaysia, some patients quit smoking immediately after a major health scare, often driven by fear.
Such “near-death” experiences can break the barrier to quitting, even among long-term and heavy smokers, says Universiti Malaya Medical Centre (UMMC) consultant respiratory physician Dr Vijayan Munusamy.
“The problem, however, is that relying on fear means patients often only quit when they are already seriously ill,” he says.
“Ideally, people should stop smoking much earlier to prevent disease.
“That remains a key challenge in smoking cessation.”
That was the case for 70-year-old Thiagaraja Munusamy, who ignored a persistent cough, yellowish phlegm and breathlessness for years, attributing them to getting older despite nearly 50 years of smoking.
During his annual medical check-ups, doctors routinely took chest X-rays and advised him to stop smoking.
As he was a long-term smoker, their main concern was lung cancer, although his X-rays did not show anything suspicious then.
Late last year (2024), after he had seen his general practitioner (GP) twice within six months for similar episodes of coughing and breathlessness, the GP put his foot down and strongly insisted that he see a respiratory specialist to rule out cancer.
When Thiagaraja finally saw a respiratory specialist, he was admitted to the hospital immediately for further investigations.
“My lungs were full of old phlegm that wouldn’t clear.
“I had nebulisers every few hours, medications, antibiotics and imaging,” he recalls.
The scans revealed black spots on both lungs, but fortunately, they were benign – it was chemicals from smoking.
“If I hadn’t gone for those procedures, it could have turned cancerous.
“I was lucky it was detected early.”
However, he was diagnosed with chronic obstructive pulmonary disease (COPD) and warned that continued smoking would rapidly worsen his condition and shorten his life.
Thiagaraja quit smoking that day itself.
“When you truly tell your mind and heart you want to stop, it becomes easier; it’s willpower,” he says.
Family support, especially from his grandchildren, played a major role.
“They monitored me closely.
“Every time I stepped outside, they’d ask, ‘What are you doing out there?’” he recalls, as they assumed he was going out to smoke.
Their relief when he finally quit made the journey easier.
Thiagaraja now only needs to use an inhaler when he feels congested.
“After a year smoke-free, I don’t cough as often, the wheezing has stopped, and phlegm is much less.
“I can walk and climb hills without panting,” he shares.
A critical lack
With limited diagnostic tools in primary care, Thiagaraja was referred to a specialist to determine his respiratory condition.
“Previously, GPs didn’t have the facilities to determine whether I had COPD, even though I was coughing frequently in the morning and at night, and producing phlegm of different colours,” he says.
Dr Vijayan explains that many patients like Thiagaraja are diagnosed by specialists rather than in primary care.
“COPD is often first identified in emergency departments because people tend to seek medical help only when they are already very ill,” he says.
“Many families try to manage symptoms such as coughs or fevers at home and only consult a doctor when the situation worsens.”
This reflects a gap in the healthcare system: accurate diagnosis requires both appropriate diagnostic tools and effective communication between patients and clinicians.
“Without spirometry – the gold standard test for diagnosing COPD – primary care cannot confirm the condition,” Dr Vijayan says.
According to the Health Ministry, only about 15% of public health clinics (klinik kesihatan) currently have access to spirometry.
Even in hospitals with outpatient clinics, this tool was unavailable until recently.
Efforts under the National Lung Health Initiative, including through collaborations with non-governmental agencies (NGOs), are now expanding access to spirometry at the primary care level.
Respiratory Medicine National Head Dr Mat Zuki Mat Jaeb says the Health Ministry aims to significantly improve coverage.
“We aim to have spirometry available in close to 50% of public health clinics by next year,” he says.
“Establishing functional spirometry services in primary care has helped identify many early COPD cases,” Dr Vijayan says.
“Just as diagnosing tuberculosis (TB) requires an X-ray, confirming COPD requires spirometry, because symptoms such as coughing can also be caused by infections like influenza, or allergic rhinitis.”
Thiagaraja, Dr Vijayan and Dr Mat Zuki were speaking to the media during a workshop on chronic respiratory diseases, organised by the Pace University Center for Global Health in partnership with WHO, in Kuala Lumpur from Nov 12 to 14 (2025).
