ALLERGY AND AIRWAY DISEASES

HBPR in COPD

Sarang Patil

E-mail: sarangspatil1@gmail.com

Introduction: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity, mortality. It is estimated that COPD contributes to almost 5% of deaths globally with 95% of deaths occurring in low and middle income countries. Pulmonary rehabilitation (PR) is a proven comprehensive and multidisciplinary therapeutic strategy to improve healthcare related quality of life (HRQoL) and health care utilization in patients with COPD; however, there are multiple barriers to PR including insufficient capacity, lack of access, patient inconvenience and cost. Therefore, affordable and easily accessible solutions to increase the availability and access of pulmonary rehabilitation are necessary. We hereby present a quality improvement project to examine the feasibility and effectiveness of PR delivered via Telehealth through a home-bound pulmonary rehabilitation program (HBPR) at City Hospital.

Aims and Objectives:

• 1. To study the effectiveness and feasibility of Home based pulmonary rehabilitation offered through telemedicine

• 2. To study the improvement in quality of life in COPD patients post home based pulmonary rehabilitation.

Methods:

Sample size: 50 patients

Duration of study: 12 weeks

Inclusion criteria:

• 1. Diagnosed COPD patient on medications

• 2. Patients with basic knowledge of using smart phone

• 3. Patients willing to spare 30 minutes per day

• 4. Patients consenting for the study.

Exclusion criteria:

• 1. Patients not consenting for the study

• 2. Patients with active pulmonary tuberculosis

• 3. Patients with recent history of myocardial infarction in past 3 months.

A home based pulmonary rehabilitation was designed and involved real-time 12 weeks interactive rehabilitation sessions with a pulmonologist. Baseline characteristics of 25 participants enrolled in our pilot study were collected between March 2021 and June 2021. Pre-program and post program assessments were performed. The primary outcome measure was the change in quality of life as evaluated by the chronic obstructive pulmonary disease (COPD) assessment test (CAT). Other outcomes included changes in functional ability, depression severity scales as well as utilization of health care services.

Results:

• 1. The mean age of participants in our study was 68 years

• 2. The mean FEV1 % predicted was 58.4±10.9

• 3. About 68% of enrolled patients had advanced COPD defined as GOLD stage D

• 4. Home based pulmonary rehabilitation resulted in clinically and statistically significant improvements in CAT scores (22.7±14.5, P<0.05)

• 5. Similarly, improvements were noted in the patient health questionnaire-9 ( PHQ-9) and Duke activity status index (DASI) scores as well as BODE indices

• 6. A trend towards reduced health care utilisation was observed but was underpowered to indicate clinical significance

• 7. The drop out rate was 10% and the overall satisfaction score with this new modality was 99%.

Conclusions: Home based Pulmonary Rehabilitation was an effective tool for increasing access to COPD pulmonary rehabilitation services and demonstrated improvements in quality of life measures. The low drop out rate indicates it is feasible to use it even in an elderly population, if familiarisation to the connection process and technical preparation are well explained.

Clinical Implications: HBPR offers a potential for convenience and easier accessibility of PR - Older population did not seem to be psychologically disconnected from the concept of e-health .Promising results on statistical and clinical significance of the effectiveness of home based pulmonary rehabilitation in HRQoL (dyspnea, exercise capacity) - Health care utilization reduction was noted but higher sample size needed to further comment - Drop out rate relatively low indicating the feasibility of administering the program.

Diagrams and chart:

Open label non blinded observational study on anti histaminic resistant chronic idiopathic urticaria in Western India

Subramanian Natarajan, Poonam Subramanian

E-mail: cnsubu@gmail.com

Introduction: Chronic Idiopathic Urticaria (CIU) is a chronic relapsing disease with hives for a period of six weeks or more. It has a significant impact on the physical and mental well being of patients.

Objectives: Open label non blinded observational study of over six hundred patients diagnosed with CIU was done. The aim of the study was to observe the 1. characteristics of patients of anti histaminic resistant CIU, 2. Efficacy of cyclosporin and any adverse events in the study population and 3. Prognosis and relapse rates of these patients at the end of one year.

Results: A total of six hundred and ten patients were diagnosed with CIU over a period of four years. Of these, forty seven patients (7.7%) were diagnosed with anti histaminic resistant urticaria. Of these, thirty patients (4.9%) took treatment with cyclosporin at the above dosages were included in group 1. Rest seventeen patients were in group 2 that were continued on anti histaminics. Patients in the cyclosporin group 1 showed a significant reduction of symptom score as compared with the group 2 at the end of six months. Lower need for corticosteroid therapy was noted in the cyclosporin group.

Conclusion: Cyclosporin in low doses is very useful in anti histaminic resistant urticaria with duration of therapy being six months. It is cost effective in low and medium income countries and easily available.

Limitations: This is a retrospective observational study and requires a large scale randomised prospective study to establish safe treatment alternatives for patients with anti histaminic resistant urticaria.

A cross-sectional study on predictors of correct technique of pressurised metered dose inhalers among patients with obstructive airway diseases

Jeeva Babu, Suresh Koolwal

Institute of Respiratory Diseases, SMS Medical College, Jaipur, Rajasthan, India. E-mail: jeevababuk@gmail.com

Background: Inhaler therapy forms the corner stone of the treatment of all obstructive airway diseases, with maximum use of it in control of Asthma and COPD. Correct inhaler technique is recommended for optimum care.

Methods: Hundred diagnosed patients of obstructive airway disease, aged ≥18 years from outpatient department on regular pMDI were recruited. A questionnaire containing 20 possible predictors was administered and pMDI technique with or without spacer was observed on 12-point steps, of which 4 were critical ones.

Results: 22% of patients did ≥10 steps correctly and 19% had no critical errors. Patients had a median of 6 correct steps (IQR4-9), and 1(IQR0-3) correct critical steps. Using univariate logistic regression, the predictors of ≥10 correct steps and no critical error (p<0.001) were age, locality, educational, occupation, medical practitioner follow up, number and duration of technique explanation, information from other sources, spacer use, anti-pneumococcal and anti-influenza vaccination, self-score and ease and effectiveness of inhaler use. Using multivariate logistic regression, technique self-score (p<0.004) was the only significant predictor for both the criteria.

Conclusion: Known predictors of correct pMDI use such as educational level and age were confirmed, while gender and marital status were not. Pneumococcal and influenza vaccination, self-score and spacer use were possible novel predictors. Patient’s self-assessment and effectiveness of inhaler correlated with actual performance. This information may be used to optimize inhaler technique which can then improve patient’s quality of life.

Study of microalbuminuria and its correlation with severity of disease in patients with chronic obstructive pulmonary disease

R. Sivasankari, Kolla Vinod, B. Archana, Parinita

Department of Respiratory Medicine, Rajarajeswari Medical College & and Hospital, Bengaluru, Karnataka, India. E-mail: inirah91@gmail.com

Background: Microalbuminuria (MAB) has been used as a parameter to assess the risk of cardiovascular events in an individual. Hypoxemia-induced endothelial dysfunction leads to microalbuminuria. Microalbuminuria is a marker of endothelial dysfunction and an important risk fator for cardiovascular events. The aim of this study was to observe the relationship of MAB in patients with chronic obstructive pulmonary disease (COPD) and to correlate MAB with different stages of COPD.

Materials: This is a prospective cross sectional study included 110 patients with COPD selected according to GOLD guidelines and Urine albumin creatinine ratio (UACR) more than 30 mg/gm represents microalbuminuria.

Methods: Pearson Co-relation test and ANOVA test were used for statistical analysis.

Results: Statistical analysis showerd that strong and statistically significant positive correlation of microalbuminuria with GOLD stagging (r=0.745, p = 0.001).

Conclusion: This study indicates that there is strong relationship of MAB in patients with COPD. Microalbuminuria was found to increase as the severity of COPD increases.

Prescription pattern of short-acting β2-agonists and oral corticosteroids in Indian asthma patients of GINA step 5: A subset analysis of Sabina India program

Waseem Siddiqui¹, Lata Sharma², Gagandeep Kaur¹, Prashant Agrawal¹, G. R. Vybhavakrishna¹, Sachin Joshi¹

¹Medical Affairs - Respiratory and Immunology, AstraZeneca Pharma India Pvt. Ltd, ²Department of Respiratory Medicine, KIMS Hospital, Hyderabad, Telangana, India. E-mail: waseem.siddiqui@astrazeneca.com

Background: Patients with asthma seeking symptom relief tend to overuse short-acting β2-agonists (SABA) and are often prescribed with oral corticosteroids (OCS). This subset analysis of SABINA program describes prescription patterns of SABA and OCS usage in asthma patients of GINA step 5 category.

Objective: To evaluate SABA and OCS prescription patterns in patients with GINA step 5 asthma.

Methods: This was a multi-centre, observational, cross-sectional study with retrospective data collection. Data were extracted from EMR of patients (aged >12 years), having >3 consultations with the same healthcare practitioners between March 2019 and January 2020. SABA prescriptions were categorized by the average number of SABA canisters prescribed whereas OCS prescriptions were described based on the dosage and duration in the last 12 months.

Results: The current study evaluated 56 patients classified as GINA step 5 asthma from the subset of 513 patients. Severe asthma was found to be more prevalent in elderly, female, and obese adults. The patients in study reported an average severe exacerbation of 2.01 in last 12 months. The study showed 59% of patients were over-prescribed SABA (≥3 canisters/year) with an average of 23 canisters/ year. Additionally, 68% of the patients were prescribed short course OCS, Asthma symptoms were well-controlled in 9%, partly controlled in 48% and uncontrolled in 43% of patients.

Conclusion: A significant percentage of patients with asthma in India has GINA step 5 asthma, who were over-prescribed SABA along with frequent OCS prescriptions. Educational programmes should be expanded to raise awareness and adoption of guideline-directed asthma management.

Correlation between red cell distribution width (RDW), and other clinical parameters in a cohort of COPD patients

Rennis K. Davis¹, Azhakath Suresh Abhay²

¹Department of DM Pulmonary Medicine, ²Department of Respiratory Medicine, Amala, Thrissur, Kerala, India. E-mail: rennis@rediffmail.com

Objectives: To assess the relationship between RDW and parameters like FEV1, Diffusion capacity of the lung for carbon monoxide (DLCO), mMRC dyspnea scale and any inter-relationship between the same parameters in moderate to severe COPD patients.

Methods: Prospective Cohort study done over 18 months with 86 COPDpatients included based on their severity as assessed by spirometric parameters. DLCO, mMRC dyspnea scale, RDW and FEV1 were assessed in these patients on two separate occasions three months apart. Chi square test was used for the statistical analysis and Spearman tests was used for correlational analysis.

Results: 76 were males (88.4%) and 10 were females (11.6%). The mean age of the patients was found to be 66.54 with a standard deviation of 8.97. Most of the patients belonged to 61-70 year age group (44.2 %). The mean RDW-CV was 14.152 at 0 month and 14.410 after the 3rd month. On correlation of RDW-CV and FEV1 in the first month, a positive correlation coefficient of 0.242 with a significant p value of 0.025 was seen. On follow up after 3 months also, a positive correlation coefficient of 0.215 with a significant p value of 0.047 was seen.

Comparing FEV1 with DLCO at 0 and 3 months, a positive correlation of 0.344 and 0.386 were obtained. The p value for these results were both 0.001. Regarding mMRC distribution, at 0 month, 52.3% of patients had an mMRC Dyspnea grade of 2, 22.1% had an mMRC Grade of 1. On follow up at the 3^rd month, 48.8% of patients had an mMRC Dyspnea grade of 3, 36% had an mMRC Grade of 2. The p value was 0.0001 and 0.001 at 0 and 3 months respectively. On comparing mMRC Dyspnea scale and FEV1, it was found that at 0 and 3 months a higher mMRC grade was associated with a lower FEV1 score with a significant p value of 0.0001 seen at both time periods. mMRC dyspnea scale and DLCO at 0 month showed a significant negative correlation coefficient of -0.51 with a p value of 0.0001. On follow up at 3 months, again a significant negative correlation coefficient of -0.41 was seen with a p value of 0.000143.

Conclusion: In our study, a positive correlation between RDW-CV and FEV1 was seen in our study, this was in contrast to other similar studies. However this correlation decreased over time, specifically three months. A significant correlation between RDW-CV and mMRC dyspnea Scale or between RDW-CV and DLCO, could not be established. A positive correlation was seen between FEV1 and DLCO, and a negative correlation between FEV1 and mMRC dyspnea scale which persisted over time. mMRC dyspnea scale showed a significant negative correlation with DLCO lasting over 3 months. So we conclude, RDW cannot be used as a biomarker for prognostification of COPD patients over a short time period of their overall treatment. More studies with longer follow up may be needed to establish the use of RDW-CV as a biomarker for disease severity in COPD patients.

Association of bronchiectasis with stable COPD in patients attending a tertiary care center in West Bengal

Hrishikesh Barui, Santanu Ghosh, Pronoy Sen

Department of Pulmonary Medicine, Burdwan Medical College, Burdwan, West Bengal, India. Email: baruihrishi05@gmail.com

Background: Persistent inflammation in COPD may result in bronchiectasis in some cases. However, there is insufficient data regarding this hypothesis from patients of eastern India. The aim of this study is to find out the proportion of previously undiagnosed bronchiectasis in COPD patients and to find out the functional effect of bronchiectasis in patients with stable COPD.

Methods: 110 consecutive stable COPD patients were enrolled for the study. All the patients were evaluated by history and clinical examination, spirometry, six minute walk test (6 MWT) and HRCT scan thorax. Patients were divided into two groups based on presence of bronchiectasis or not. Data were collected and the means of post bronchodilator FEV1 % predicted and 6-minute walk distance (6MWD) were compared between the two groups by independent T test.

Results: Bronchiectasis was present in 21.8% patients. The mean post bronchodilator FEV1% values and 6MWD in meters (30.21 ± 7.59 and 280.42 ± 10.40 respectively) in the COPD with bronchiectasis group were significantly lower than the group of COPD without bronchiectasis (53.09 ± 17.39 and 383.95 ± 46.45 respectively) (P=0.001 and 0.000).

Conclusion: Concomitant Bronchiectasis is associated with significant reduction of functional status in terms of increased severity of airflow obstruction and reduction in exercise capacity in COPD patients.

Gender differences in quality of life of stable chronic obstructive pulmonary disease patients attending a district medical college

Pronoy Sen, Santanu Ghosh, Hrishikesh Barui

Department of Pulmonary Medicine, Burdwan Medical College, Burdwan, West Bengal, India. Email: pronoy.sen@gmail.com

Background: Studies about gender difference in COPD patients were done and results showed more severe symptoms in female as compared to male COPD patients. But similar studies are very few in this country. This study was undertaken to assess quality of life of stable COPD patients and find out if there is any gender difference or not.

Methods: A cross sectional observational study was done with 110 consecutive patients of stable COPD, who were evaluated with CAT and SGRQ-C questionnaire after detailed history, clinical examination and spirometry. Data were collected and mean of CAT scores and all SGRQ-C scores (symptoms, activity, impact and total score) were compared among male and female groups by independent t-test.

Results: Female patients with COPD were mostly non-smokers who were exposed to biomass fuels (53.6%) whereas most of the men with COPD (88.9%) were smokers. Female group had worse quality of life in terms of statistically significant higher mean CAT score: (27.21±7.64 vs 23.59±5.91) (p= 0.007) and higher mean SGRQ-C symptoms score (68.38±19.39 vs 59.66±20.31) (p= 0.023) as compared to male group.

Conclusion: Gender difference is present in quality of life of stable COPD patients. Females are more prone to poor quality of life as compared to male counterparts.

Perceptions of patients and caregivers towards nebulization therapy for COPD: The first quantitative survey done in India

Harjit S. Dumra¹, Arjun Khanna^2,3, Sujeet Madhukar⁴, Sandeep More⁵, Meena Lopez⁵, Jaideep Gogtay⁵

¹Sparsh, Chest Disease Centre, Samved Hospital, Ahmedabad, Gujarat, India, ²Yashoda Superspeciality Hospital, Ghaziabad, Uttar Pradesh, India, Galaxy Hospital, New Delhi, India, ³Madhukar’s Clinic and Lung Hospital, Patna, Bihar, India, ⁴Cipla Ltd – Mumbai, Maharashtra, India. E-mail: drdumra@yahoo.co.in

Background: There is shortage of Indian data on nebulizer usage, patients’ and caregivers’ attitudes toward nebulization in COPD. This survey was designed to assess the attitudes and perceptions of Indian patients and caregivers towards nebulization for COPD management.

Methods: The survey was conducted from July-August 2019 among 103 COPD patients [>40 years] receiving home nebulization (>3 weeks), and their caregivers, to evaluate usage, satisfaction, perceived benefits and concerns with nebulizers.

Results: Overall, 54% patients used nebulizers for >8 weeks (occasionally/daily) and 27% patients used nebulizers daily for home maintenance basis. The main benefits of nebulizers perceived by patients were easier breathing (93%), ease of use (89%) and fewer doctor visits (86%) while caregivers cited reduced hospitalization (76%), easier breathing (75%) and better control on overall symptoms (73%). The main concerns raised by patients included short-term duration of effect (61%), social embarrassment (54%) and device being bulky and noisy (50%); while need for multiple use per day (45%) and social embarrassment (43%) were the key concerns cited by caregivers. Among patients who were earlier prescribed with inhaler therapy, 72% believed nebulizers gave long-term relief compared to inhalers. 61% patients stated that benefits with nebulizers outweighed the inconvenience associated with its use. Overall, 99% patients reported satisfaction with nebulizers.

Conclusion: This first of its kind survey revealed that COPD patients and their caregivers were satisfied with nebulizers, with reported benefits of reduced hospitalization, better symptom control and ease of use.

A study of prevalence of aerobic bacteria and fungi in sputum specimens of patients with post tubercular bronchiectasis

V. Ch.S. Sai Snigdha Sri Veeramalla, A. Ayyappa

Department of Pulmonary Medicine, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India. Email: v.sniggu@gmail.com

Background: Bronchiectasis is defined as abnormal, permanent and irreversible dilatation of bronchi. There is an established association between pulmonary tuberculosis and bronchiectasis. Patients with bronchiectasis colonize many aerobic bacteria and fungi and lead to an increase in exacerbations and decrease in quality of life.

Methodology: A Prospective observational study was conducted in department of Pulmonary Medicine, Andhra medical college, Visakhapatnam which included 50 patients of post tubercular bronchiectasis. All patients were subjected to HRCT, PFT and sputum culture.

Results: This study comprises of the 50 patients with bronchial colonization of aerobic bacteria being 78% and fungi being 2%. Out of the 50 patients 39 had bacterial growth, 2 had fungal growth and the rest 9 had no growth. Among the 39 patients 32%(n=16) had grown Pseudomonas aeruginosa, 24%(n=12) had Klebsiella pneumoniae , 16%(n=8) had Streptococcus species and rest 6%(n=3) had staphylococcus species. The decline of fev1 in patients colonized with Pseudomonas aeruginosa lead to a p value <0.01 ,in patients with Klebsiella pneumoniae with p value 0.5, patients with streptococcus species p value 0.34 and staphylococcus species p value 0.34.

Conclusion: This study signifies that prevalence of aerobic bacteria is common in patients with post tubercular bronchiectasis where Pseudomonas aeruginosa and Klebsiella pneumonia being most common. There is a significant decline in lung function in patients colonizing Pseudomonas aeruginosa.

A study of HRCT features and patient characteristics in COPD patients in tertiary hospital.(GMC Kota)

Gunjan Sharma, Anil Saxena, Babulal Bansiwal

E-mail: drdipanshujain@gmail.com

Background: COPD comprises a diverse group of clinical syndromes that share the common feature of limitation of expiratory airflow. Airflow limitation is due to obstruction in the smaller airways and Emphysema is the major pathological changes in COPD .The GOLD initiative defines COPD as “a disease state characterized by airflow limitation that is not fully reversible. The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases.” Variable HRCT features in COPD are air trapping ,emphysema, vascular attenuation ,distortion , mosaic pattern, increase thoracic cross sectional area, increase sterno-aortic diseases ,decrease tracheal index.

Objectives: 1 a prospective study of correlation between high resolution computed tomography features and patients characteristics in chronic obstructive pulmonary disease in a tertiary care centre.

Materials and Methods: This is a open label, prospective study was conducted in the new medical college and hospital on patient admitted and attending pulmonary OPD since July 2020 to Jun 2021 in GMC kota . age of 40 to 90 years COPD patient HRCT study parameter in our study are:

• 1. saber sheath trachea ( tracheal dimension is < 0.67 cm )

• 2. sterno- aortic distance distance from Posterior surface of sternum to anterior margin of aorta at carinal level

• 3. Thoracic cross-sectional area: (TCSA) was measured on HRCT images made 1 cm below the top of aortic arch.

Results and Conclusion: In our study all three quantitative HRCT variables are significantly associated with patient characteristics age, smoking pack year, %fev1, AQ30, and duration of illness.

Understanding the use of mucus clearance devices amongst Indian clinicians for COPD management: Mucico survey

Raja Dhar¹, Pralhad Prabhudesai², Rushika Shah³, Meena Lopez³, Jaideep Gogtay³

¹Department of Pulmonology, C K Birla Group of Hospitals, Kolkata, West Bengal, India, ²Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India, ³Department of Medical Affairs, Cipla Ltd, Mumbai, Maharashtra, India. E-mail: docaardee@yahoo.com

Background: COPD is characterized by excessive mucus production leading to cough, shortness of breath & wheezing. Limited data exists on use of mucus clearance devices for COPD management in India.

Objectives: To understand clinicians’ perceptions and gain insights into their use of mucus clearance devices for COPD management.

Methods: A questionnaire-based survey was administered to randomly selected clinicians treating COPD and using mucus clearance devices in India.

Results: 1214 clinicians (50% pulmonologists, 33% internists) participated in the survey. Majority (94.9%) reported using mucus clearance devices in up to 40% of their patients. Bronchiectasis (56.6% respondents) and COPD (40% respondents) were the most common indications for prescribing mucus clearance devices. Co-existing bronchiectasis (76.9% respondents) & chronic bronchitis (50.5% respondents) were cited as key reasons for prescribing mucus clearance devices in COPD. Mucus clearance devices were reported to be more effective in bronchiectasis than COPD (66.5% respondents for effectiveness in bronchiectasis vs 48.8% respondents for COPD). 54.2% clinicians cited 10-15 minutes twice a day as optimum frequency for using mucous clearance devices while 29.5% respondents opined it to be 10-15 minutes thrice a day. High cost (33.9% respondents) was cited as the main deterrent in the use of mucus clearance devices; other deterrents included teaching the correct technique to patient (22.9%), unavailability (20.3%) and patient’s unwillingness to purchase (18.7%).

Conclusions: Mucus clearance devices have a good acceptance among clinicians, but cost is a significant barrier. Co-existing bronchiectasis and chronic bronchitis are most important factors for prescribing mucus clearance devices in COPD patients.

Assessment of estimated glomerular filtration rate in patients with stable chronic obsructive pulmonary disease

Soumitra Mondal, Sibes Kumar Das

Department of Respiratory Medicine, Medical College, Kolkata, West Bengal, India. E-mail: soumitramondal.sm@gmail.com

Background: COPD is a systemic disease with systemic comorbidities. However studies to find out relation between COPD and renal system are scarce. This study was aimed to assess the relationship of eGFR with CAT Score, mMRC scale, 6 minute walking test (6MWT), and FEV₁ in COPD and to compare reduction of eGFR in different GOLD stages.

Methods: 240 stable COPD patients attending OPD were randomly selected between November 2019 and October 2020. Participants had spirometry, GOLD staging, CAT score, mMRC grading and 6MWT. Serum creatinine was obtained and eGFR calculated. The interpretation was made by comparing the result of eGFR and GOLD stages and with different parameters.

Results: In Patients with normal eGFR, the mean mMRC Score (mean±s.d.) was 2.0000± .8660, 6 minute walking distance (6MWD) 324.9767±47.0798 meter, and CAT score 14.2326± 6.0924.With reduced eGFR, the mean mMRC Score was 2.3243±1.1690, 6MWD 278.2973±75.9704 meter, and CAT scoring 19.3784± 9.0464.These were statistically significant (p=0.0145), (p<0.0001) and (p<0.0001) respectively. The negative correlation was found between eGFR vs. GOLD stages, Pearson Correlation Coefficient (r) was (-.014).

Conclusion: Reduction of eGFR was seen in stable COPD patients with higher GOLD stages. Patients with reduced eGFR had higher mMRC grade, increased CAT score and reduced 6MWD. So routine estimation of eGFR in patients of stable COPD is advocated to assess renal involvement.

Prevalence of pulmonary artery hypertension in chronic obstructive pulmonary disease

Dipanshu Jain, Anil Saxena, Suman Khangarot, Babulal Bansiwal

Department of Respiratory Medicine, Government Medical College, Kota, Rajasthan, India. E-mail: dipanshu22@gmail.com

Background: COPD is defined airflow limitation that is not fully reversible & it is a major cause of chronic morbidity and mortality in ourcountry. Itischaracterizedbyslowly progressiveairflowobstructionresultingindyspnea & exercise limitation with pulmonary arterial hypertension & right ventricular dysfunction.

Objectives: study the clinical profile of COPD patients and evaluate pulmonary hypertension by non-invasive methods

Materials and Methods: 200 patients were selected by history taking & symptoms, spirometry & other investigation were dividedinto 3 groups of mild, moderate & severe COPD based on PFT [GOLD Criteria 2020].

Results: 200 patients were divided into 3categories: mild (78 patients), moderate (86 patients) & severe (36 patients). The mean age of all patients was 66.4 years & majority were males (71%). In ECG, the most common abnormality observed was P- Pulmonale (69%) followed by Sinus tachycardia (59%). In the Echo study, the mean value of RV area, RA area, RVFWT were 20.5cm², 11.4cm² & 0.72cms respectively. The mean PAH & mean EF values in mild, moderate & severe categories were 59.3, 61.7, 64.8& 63.8, 59.1&57.8respectively.

Conclusion: In our study, the ECG, ECHO, XRAY were correlated with the increasing severity of COPD. In the ECG, P-Pulmonale was the most common. In the Echo, RVarea, RAarea & RVFWT&PAH values were significant & linearly increasing with the severity of the COPD whereas the EF values had a decreasing pattern.

Prevalence of allergic broncho-pulmonary aspergillosis in patients with bronchial asthma

Deepak Maheshwari, Harshita Rani, Rajendra Prasad

Department of Pulmonary Medicine, Era’s Lucknow Medical College, and Hospital, Lucknow, Uttar Pradesh, India. E-mail: dmdm5557@gmail.com

Introduction: Asthma is a heterogenous disease, usually characterized by chronic airway inflammation. There is a strong association of fungal sensitization and severity of asthma. Aspergillus species are ubiquitous fungi known to cause several respiratory manifestations. ABPA is the most clinically recognized form of hypersensitivity respiratory disorders.

Objective of Study: To evaluate the frequency of sensitization to aspergillus antigens and the prevalence of allergic bronchopulmonary aspergillosis (ABPA) in asthmatic patients.

Methods: 140 consecutive non-smoking out-patients with asthma (≥ 18 years) underwent skin prick test with aspergillus antigens, peripheral blood eosinophil count, measurements of total serum IgE level and specific IgE against aspergillus fumigatus, radiologic investigations and pulmonary function tests.

Results: 40 patients (28.6%) had a positive skin reactivity to Aspergillus antigens. 16 of these 40 patients (40%) met the diagnostic criteria of ABPA with an overall prevalence of 11.4% (16/140). Total serum IgE levels and specific IgE against Aspergillus Fumigatus were elevated significantly in all the patients. Mean Total IgE level 1994 ± 1013 in 40 patients, 1218 ± 786 in 16 patients, 7 case were diagnosed as ABPA-CB, 5 cases were ABPA-ORF, 4 cases were ABPA-S.

Conclusion: The prevalence of positive skin prick test for aspergillus fumigatus is 28.6% / and prevalence of ABPA is 11.4%.

Predictors of outcome of non-invasive ventilation in patients with chronic pulmonary airway diseases having acute/acute on chronic type 2 respiratory failure, a retrospective study

Pratiksha Moshe, D. J. Christopher, Richa Gupta

E-mail: prikabracs@gmail.com

Introduction: Noninvasive ventilation reduces the rate of endotracheal intubation and overall mortality in acute type 2 respiratory failure and is increasingly applied in respiratory intermediate care units. As per most recent guidelines (ERS/ ATS 2017) a trial of NIV is strongly recommended for all acute/ acute on chronic type 2 respiratory failures even in patients considered to require endotracheal intubation. However, inadequate patient selection and incorrect management of NIV increase mortality. We aim to identify factors that predict the failure of NIV in acute type 2 respiratory failure.

Aim: To study the Predictors of outcome of Non-Invasive ventilation in patients with Chronic Pulmonary Airway Diseases presenting with acute or acute on chronic type 2 respiratory failure.

Objectives:

• • To understand the factors that may cause increased failure of trial of Non-invasive ventilation in patients with Chronic Pulmonary Airway Diseases presenting with acute or acute on chronic type 2 respiratory failure.

Methods: The study was a retrospective observational cohort study where the data of all patients who presented with acute or acute on chronic type 2 respiratory failure over the last 5 years was collected and analyzed. All baseline characteristics and history, examination and relevant investigations were obtained from the online medical records on the clinical workstation and from the in patient files stored in the Medical records Department of Christian Medical College Vellore. Reversal of pH (>/=7.35) with clinical improvement was considered as a successful outcome, on the other hand if the patient has required Invasive ventilation or has died – it was be considered as a failure of NIV. Patients who were discharged against medical advice within 72 hours of treatment without reversal of pH and clinical improvement were also considered as failures. All the data collected was entered into EPIDATA and data analysis was done using STATA/IC 16.0. The variables were compared among those with positive and negative outcome with NIV using independent t-test and chi-square tests.

Results:

• • We obtained information from records of 268 patients, out of which 76 were excluded as per exclusion criteria. Out of a total of 192 patients admitted with acute or acute on chronic type 2 respiratory failure, 147 showed a successful outcome with non-invasive ventilation

• • The prevalence of failure with non-invasive ventilation was found to be 23%

• • Failure rate amongst males (26.5%) was higher than that amongst females (16.6%), however it was not statistically significant

• • Age of the patients did not show significant correlation with the outcome

• • Significant factors such as history of smoking, exposure to biomass fuel fumes and past history of tuberculosis did not affect the outcome of NIV

• • Amongst co-morbidities noted as diabetes, hypertension, ischemic heart disease and congestive cardiac failure, the latter was the only one responsible for a poorer outcome with non-invasive ventilation (60%, P= 0.004)

• • A higher BMI was significantly associated with more failure (P= 0.01), with the median value amongst failures being 26.7(±3.34 SD)

• • The results also showed that only 32% of the patients were vaccinated in the past, which however did not significantly affect their outcome after receiving NIV

• • The patients who had failed a trial of NIV showed lower serum albumin levels as compared to the ones who showed a successful outcome (P=<0.001)

• • When the pH in the arterial blood gas was compared amongst the two groups, it showed that amongst the failures, the blood gas after 4 to 8 hrs of therapy showed a pH lower than 7.30 while the success group had shown reversal (pH > 7.30).

Conclusion: The study has shown that certain factors may cause a higher rate of failure of trial of non-invasive ventilation. A higher Body Mass Index, low serum albumin, history of congestive cardiac failure and non-reversal of pH in arterial blood gas within the first 8 hours of therapy are factors that may cause increases chances of failure. In these groups, opting for invasive ventilation may be a better option. Since smokers and those exposed to biomass fumes did not show poorer outcomes with NIV as compared to non-smoker, even in people with history of smoking, a trial of NIV is a better option.

A study of prevalence and clinical relevance of hypersensitivity to cockroach and House Dust Mite (D. farinae) by skin prick test and its correlation with asthma severity

Jay Manchanda, Rajendra Prasad

Department of Pulmonary Medicine, ELMCH, Lucknow, Uttar Pradesh, India. E-mail- jaymanchanda96@gmail.com

Background: Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation. There is a strong association between cockroach and house dust mite and severity of asthma, and is known to cause sensitization in asthmatics.

Objective: To determine prevalence of cockroach and house dust mites sensitivity in bronchial asthma patients and its correlation with asthma severity.

Methods: Patients attending our OPD and IPD were screened for bronchial asthma and underwent spirometry to diagnose Asthma according to GINA guidelines 2021 following which patients were subjected to Skin prick test with extract of cockroach, house dust mite and other allergens. After 15 minutes, immediate sensitivity were assessed and compared. Grading was done and asthma severity score was determined in all patients.

Results: Skin prick test was performed in a total (n) of 80 patients, out of which, 36 were male and 44 were female. Skin prick test for cockroach 18.75% and House dust mite is 13.75%. According to asthma severity, 7 patients (46.66%) with mild asthma were sensitive to cockroach, 5 patients (33.3%) with moderate asthma and 3 patients (20%) with severe asthma were sensitive to cockroach. 2 patients (18.2%) with mild asthma, 3 patients (27.7%) of moderate asthma and 6 patients (54.54%) with severe asthma were sensitive to house dust mite.

Conclusion: Skin prick test for cockroach 18.75% and House dust mite is 13.75%. According to asthma severity score, severe cases in D.Farinae is more than cockroach.

Clinical comparison between biomass smoke and tobacco smoke exposed female COPD patients

Jay Manchanda, Rishabh Kacker, Rajendra Prasad

Department of Pulmonary Medicine, ELMCH, Lucknow, Uttar Pradesh, India. E-mail: jaymanchanda96@gmail.com

Background: Despite tobacco smoke is the environmental risk factor most frequently and clearly associated to COPD, exposure to biomass smoke has also been proposed as one of the main risk factors for developing the disease.

Objective: To compare clinical characteristics of biomass smoke and tobacco smoke exposed female COPD patients.

Methods: Female Patients who attended the OPD and indoor patients in our department were screened for COPD based on the presenting complaints. Spirometry was done to diagnose COPD according to GOLD guidelines 2021. Female COPD patients were then categorized into biomass smoke exposed and tobacco smokers and compared.

Results: 40 patients met the inclusion criteria for our study, of which 37 were biomass smoke exposed and 3 were tobacco smokers, Cough and breathlessness were present in all 40 patients, Sputum production was present in 3 patients (100%) in tobacco smokers and 30 patients (81%) in biomass smoke exposed group, Rhonchi and crepitations were present in no patients in tobacco smokers and 10 patients (37%) and 16 patients (43%) in biomass smoke exposed group respectively, Average exacerbations in last 1 year in tobacco smokers group were 1.6 and exacerbations in last 1 year in biomass smoke exposed group were 2.

Conclusion: Tobacco smoker group had similar symptoms, exacerbations and hospitalizations as in biomass smoke exposed group. Further study is ongoing for better understanding of the differences in characteristics of biomass exposed and tobacco smoker COPD female patients.

Predictors of change in lung function in Indian subjects with bronchiectasis

K. Savitha

Department of Respiratory Medicine, Christian Medical College and Hospital, Vellore, Tamil Nadu, India. E-mail: savi.aquarian@gmail.com

Introduction: Bronchiectasis is a common but neglected chronic lung disease. Most epidemiological data are limited to cohorts from Europe and the USA, with few data from low-income and middle-income countries. Little is known about the change in lung function over time and the factors that affect such change.

Methods: In a prospective observational cohort study, 156 subjects with bronchiectasis were studied over a period of 12 months, and spirometric values were recorded at baseline and 12 months later during follow up. Various variables including age, sex, aetiology, number of exacerbations, quality of sputum, organism isolated from sputum culture, performance of bronchial hygiene therapy and pulmonary rehabilitation was recorded to analyse factors that could be associated with change in lung function over time.

Results: The subjects were divided into 2 groups for analysis- those with increase in FEV1 and those with decrease in FEV1 over 12 months. Factors associated with decreased lung function were male sex (p= 0.003), and mucopurulent sputum (p= 0.037) with pseudomonas isolated in sputum culture and greater number of exacerbations. The subjects with improvement in FEV1 were found to have fewer exacerbations, and were practising airway secretion clearance techniques like bronchial hygiene therapy and pulmonary rehabilitation (however this was not statistically significant, p=0.105).

Conclusions: In bronchiectasis, decline in lung function has been associated with male sex, mucopurulent sputum with pseudomonas in culture and greater number of exacerbations.

Survey on the diagnosis and management approaches for COPD among patients with cardiovascular disease

Jagdish Mohan¹, Anand Menawat², Rushika Shah³, Meena Lopez³, Jaideep Gogtay³

¹Fortis Hospital, New Delhi, India, ²Satyam Hospital and Research Centre, Jodhpur, Rajasthan, India, ³Cipla Ltd, Mumbai, Maharashtra, India. E-mail: a51hauzkhas@gmail.com

Introduction: CVD and COPD are leading causes of death in India and both often co-exist. Appropriate management of co-morbid COPD in CVD patients is essential to improve outcomes. Limited data exist on co-management of these entities.

Objective: To understand perceptions and practices of physicians in India for diagnosis and management of co-morbid COPD in CVD patients.

Methods: A questionnaire-based survey was administered to randomly selected physicians treating CVD across India.

Results: 92 physicians participated. 51.1% physicians reported COPD being present in 11-20% of their patients while 31.4% opined that 21-40% had coexistent COPD. 96.7%, 95.7% and 97.8% of physicians reported on COPD being coexistent in up-to 40% of their heart failure, IHD and atrial fibrillation patients, respectively. 90.2% physicians were certain that risk of MI increases after a COPD exacerbation while 94.6% of the physicians reported that hyperinflation in COPD reduces cardiac output. 41.3% physicians cited persistent breathlessness in CVD patients on therapy, as a reason for COPD screening. Only 33.6% of the physicians used spirometry in addition to symptoms and physical examination to diagnose COPD. Only 59.8% of physicians reported prescribing inhaler therapy in all their COPD patients. ICS/ LABA combination was preferred as first-line therapy in COPD patients by 35.9% physicians of which formoterol/budesonide was the most favoured (44.6% respondents). Triple therapy was preferred as first-line therapy by 25% respondents.

Conclusions: Physicians perceive COPD as a common co-morbidity with cardiovascular diseases. However, COPD is under-evaluated and under-treated in cardiac patients in the real world.

An observational study to compare the diagnostic yield of AOS and conventional spirometry

Manish Singh, Vikas Marwah, C. D. S. Katoch, Gaurav Bhati

Department of Respiratory Medicine and Critical Care, Army Institute of Cardiothoracic Sciences, Pune, Maharashtra, India. Email: manish.6026@gmail.com

Background: Obstructive airway diseases are often diagnosed too late in its course, due to factors such as late presentation, inability to perform spirometry or contraindications. Early detection is of paramount importance in preventing the progression of diseases. Herein, we present a comparative study between AOS (Airwave oscillometry system) and conventional spirometry in patients with suspicion of obstructive airway disease, clinically.

Objective: To compare the diagnostic yield of AOS and conventional spirometry.

Methods: An observational comparative study was carried out on 105 patients who had clinical suspicion of an underlying obstructive airway disease to understand diagnostic yield by AOS and conventional spirometry in a tertiary care respiratory OPD in western Maharashtra.

Results: Diagnostic yield of conventional spirometry was 31.4% (33/105), whereas for AOS it was 48.5% (51/105). AOS could detect early obstruction in 18 patients (17.1%) with mean age of 62.89 year (SD – 6.597); p value – 0.011, mean height 170 cm (SD - 8.13); p value – 0.001, mean weight 70.56 Kg (SD – 14.308); p value – 0.006, with male preponderance 88.8% (16/18); p value – 0.001, current smokers 33.3% (6/18); p value – 0.003.

Conclusion: In our study, AOS has shown an additional diagnostic yield of 17.1%as compared to conventional spirometry. Thus, AOS has demonstrated the potential for being a screening tool for early detection of small airway diseases, an important component of many obstructive airway diseases.

Understanding the perceptions of electronic monitoring devices for asthma and COPD among clinicians in India: Encore survey

Sanjeev Nair¹, K. Praveen Valsalan², Vipra Hajare³, Meena Lopez³, Jaideep Gogtay³

¹Department of Pulmonary Medicine, Government Medical College, Thrissur, Kerala, India, ²Department of Pulmonary Medicine, Aster Medcity, Kochi, Kerala, India, ³Cipla Ltd, Mumbai, Maharashtra, India. E-mail: vipra.hajare@cipla.com

Background: Regardless of developments in pharmacotherapy in asthma and COPD, poor inhalation technique and non-adherence to prescribed treatment plan continue to be key reasons for suboptimal disease control.

Objectives: To understand the perceptions, expectations, and perspectives of clinicians towards electronic monitoring devices (EMDs) for management of asthma and COPD.

Methods: A self-reported digital questionnaire-based survey was conducted among randomly selected clinicians in India treating asthma and COPD.

Results: 1237 clinicians (52% pulmonologists, 30.4% internists) participated in survey. Patient compliance and education was rated (82.1% respondents) as the most important determining factor for success of inhalation therapy. Sub-optimal adherence was cited as a major problem by 70% respondents. The most common techniques used to assess adherence in asthma and COPD patients in clinical practice were dose counters (58.5% respondents) and number of inhalers bought in 1 or 3 months as per prescription (54.3% respondents). 83.8% of clinicians believed that using monitoring devices for inhaled medications can improve adherence and patient outcomes. Proposed key patient profiles for EMDs included suspected non-adherent patients (54.8% respondents), uncontrolled-COPD (48.3% respondents) and severe asthma (38.6% respondents). Dose reminders (72.7% respondents), actuation monitoring (68.1% respondents) and feedback on technique (57.2% respondents) were desired attributes cited for EMDs.

Conclusion: Sub-optimal adherence is a major problem perceived by clinicians managing asthma and COPD. Most physicians treating asthma and COPD believe that EMDs can be an appropriate option for monitoring adherence and improving outcomes in asthma and COPD.

Evaluation of one minute sit-to-stand test, six-minute-walk test and body composition analysis to assess exercise capacity in patients with chronic obstructive pulmonary disease

Vivek Kumar, Balakrishnan Menon, Vishal Bansal, Raj Kumar

Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, New Delhi, India. E-mail: v.94kumar@gmail.com

Background: Chronic obstructive pulmonary disease (COPD) is currently among the top three leading cause of death in the world. Values of high body fat and low fat free mass are independent predictors of all-cause mortality in COPD patients. Muscle weakness and atrophy lead to increased symptoms and exacerbations leading to frequent hospitalization. Field-testing like 6MWT aid in assessing exercise tolerance in COPD patients. Compared to 6-MINUTE-WALK-TEST (6MWT), One minute sit-to-stand Test (1MSTST) requires less space and time. This study compared 6MWT with 1MSTST for exercise capacity in COPD patients with body composition analyses.

Methods: This cross-sectional study included 93 moderate to severe COPD patients. Patients body composition was analysed. 6MWT, 1MSTST, and anthropometric skin fold thickness measurement were done and results were analysed.

Results: Out of 93 patients, 61(65.60%) were Moderate COPD and 32 (34.40%) were Severe COPD. Positive correlation was found between the parameters measured during 1MSTST and 6MWT (p<0.05) in both moderate and severe COPD. Fat Free Mass Index (FFMI) was comparable among moderate and severe COPD. No positive corelation between FFMI and 6MWT and 1MSTST were found (p>0.05).

Conclusion: 1MSTST and 6MWT were found strongly correlated in COPD patients regarding the assessment of physical status. Therefore, 1MSTST can be used in place of 6MWT for assessing exercise capacity in COPD patients. However, FFMI didn’t correlate well with the 6MWT and 1MSTST parameters.

Congenital diaphragmatic hernia as severe airway disease in elderly: A rare case report

T. L. Yashawanth, K. Sushma, T. A. Veerabhadraiah

Department of Pulmonary Medicine, District Hospital, Tumkuru, Karnataka, India. Email: dryash.madhu@gmail.com, sushma.k7488@gmail.com

Background: Congenital Diaphragmatic Hernia is believed to result from incomplete fusion of the pluripotent membrane, and the passage of abdominal content into the chest.

Case Report: We report a case of Congenital Diaphragmatic Hernia in 45 years old male, known asthmatic since childhood presented to Department of Medicine with complaints of breathlessness on and off since 15 years. Chest X-ray shows gastric shadows suggesting bowel loops on left side and Dextrocardia. Pulmonary function test revels severe airway obstruction with Bronchodilator irreversibility. CT chest unmarks the presence of left diaphragmatic herniation of stomach, spleen and small bowel in chest with left lung collapse and mediastinal shift. 2D ECHO revels situs invertus and Dextrocardia. Patient managed conservatively at our Hospital and later referred to CTVS Department, where he got operated with Diaphragmatic Hernia reduction and repair with plication after reducing abdominal content through lateral thoracotomy. Post-operative chest X-ray shows good lung expansion with relief of symptoms.

Conclusion: With NO history of trauma and childhood onset asthma in elderly should be properly investigated for congenital diseases that affect the airways. Congenital Diaphragmatic Hernia can be diagnosed at the earliest with the simple, commonly available radiological tools, so that early diagnosis can be made and prevent mortality.

Study is to evaluate the technique in errors using prescribed inhalation devices in patients of COPD and BA

Anupa Stanley, Ashish Kumar Prakash, Bornali Datta, Anand Jaiswal

E-mail: akp_vpci@yahoo.com

Inhalational devices have become a mainstay treatment in COPD & BA patients. Various types of inhaler devices are currently being used. A variety of errors are observed while using various inhaler devices.

Aims and Objectives: Evaluate the technique in errors using inhalation devices in patients of COPD and BA.

Materials and Methods: An observational prospective study of 80 OPD patients fulfilling the inclusion criteria and evaluated for the knowledge of inhaler-technique.

Results and Observations: It was observed that maximum patients were using MDI with Spacer (31.3%), followed by patient using DPI (27.5%) then MDI (21.3%), and least with nebulizer (20%). Maximum error was observed while using MDI with spacer, followed by DPI, then MDI and Nebulizer usage had the least error while using it. It was observed that the 3 most common errors made while using MDI were firing device before start inhalation (52.9%), fast inhalation (47.1%), short breath hold(41.2%). The most common errors made while using DPI were “Insufficient acceleration (68.2%), “Not inhaling deeply enough (50.0%)” and “Poor seal around mouth piece (63.6%). Most common errors made while using MDI with Spacer were “Inhaler not shaken (52%)”, “Long delay before inhalation (68%)” and “fast inhalation (48%)” 3 most common errors made while using Nebulizer were “no Deep breathing throughout the treatment (62.5%)”, “Poor mask fitting (37.5%)”, and Improper cleaning 56.3%.

Conclusion: Demonstration of inhalational devices is critically important in managing COPD and bronchial asthma patients. Errors are committed by majority leading to poor control of the diseases. Elderly and illiterate patients need more focussed attention.

Study is to evaluate the technique in errors using prescribed inhalation devices in patients of COPD and BA

Anupa Stanley, Ashish Kumar Prakash, Bornali Datta, Anand Jaiswal

Medanta-The Medicity, Gurgaon, Haryana, India. E-mail: dranupastanley@gmail.com

Inhalational devices have become a mainstay treatment in COPD & BA patients. Various types of inhaler devices are currently being used. A variety of errors are observed while using various inhaler devices.

Aims and Objectives: Evaluate the technique in errors using inhalation devices in patients of COPD and BA

Materials and Methods: An observational prospective study of 80 OPD patients fulfilling the inclusion criteria and evaluated for the knowledge of inhaler-technique

Results and Observations: It was observed that maximum patients were using MDI with Spacer (31.3%), followed by patient using DPI (27.5%) then MDI (21.3%), and least with nebulizer (20%). Maximum error was observed while using MDI with spacer, followed by DPI, then MDI and Nebulizer usage had the least error while using it. It was observed that the 3 most common errors made while using MDI were firing device before start inhalation (52.9%), fast inhalation (47.1%), short breath hold (41.2%). The most common errors made while using DPI were “Insufficient acceleration (68.2%), “Not inhaling deeply enough (50.0%)” and “Poor seal around mouth piece (63.6%). Most common errors made while using MDI with Spacer were “Inhaler not shaken (52%)”, “Long delay before inhalation (68%)” and “fast inhalation (48%)” 3 most common errors made while using Nebulizer were “no Deep breathing throughout the treatment (62.5%)”, “Poor mask fitting (37.5%)”, and Improper cleaning 56.3%.

Conclusion: Demonstration of inhalational devices is critically important in managing COPD and bronchial asthma patients. Errors are committed by majority leading to poor control of the diseases. Elderly and illiterate patients need more focussed attention.

GOLD guidelines based classification of COPD subjects from rural background.

Samanvitha Vengaldas, Nagender Prasad Chenimilla, Satish Chandra Kilaru, Ramu Madire

Department of Respiratory Medicine, Prathima Institute of Medical Sciences, Karimnagar, Telangana, India. E-mail: samanvithavengaldas@gmail.com

Background: COPD is as prevalent in rural areas as in urban in India where very few studies have classified them based on GOLD guidelines and hence we have taken up this study to evaluate various risk factors, clinical characteristics and functional abnormalities among COPD subjects.

Materials and Methods: The present cross-sectional study was conducted at respiratory medicine department, Karimnagar, where 81 patients were enrolled having features of COPD. All subjects were evaluated by symptom questionnaire, spirometry, and 6MWT.

Results: The mean age was 59.01±9.94years with 70.3% males who had longer duration of disease (p=0.001). 62.9% of the patients were smokers, and all patients had either history of smoking / tobacco chewing/ Passive smoking or Biomass fuel exposure. 91.3% had cough and 88.8% dyspnea. Chest X-ray showed hyper inflated lung fields in 61.7%. Spirometry showed varying degrees of obstruction among all subjects, 8.6% had mild obstruction, 37.03% had moderate obstruction, and 54.3% had severe obstruction. 43.2% of the patients had ≥2 exacerbations/ year which had a significant correlation. On GOLD classification, 18.51% of patients were in group A, 30.8% and 20.9%, 29.6% in group B, C and D respectively. The mean 6MWD among groups was, in A 307±70 meters, in B 324±66.95 meters, in C 315±71 meters, in D was 291.86±72.6 meters. A positive significant correlation was observed between duration of COPD and grading on spirometry and between 6MWT grading and COPD grading.

Conclusion: GOLD guidelines aids in classification and management of rural COPD subjects.

A study of echocardiographic changes in COPD patients

Alwa Karuna Sree

Department of Respiratory Medicine. E-mail:karunareddy838@gmail.com

Background: Chronic obstructive pulmonary disease (COPD) has considerable effects on cardiac functions, including those of the right ventricle, left ventricle, and pulmonary blood vessels. Most of the increased mortality associated with COPD is due to cardiac involvement. Detection of CVD in early stage is important for therapeutic and prognostic implication.

Materials and Methods: A prospective study consisted of 50 COPD patients were selected and staged by PFT and evaluated by echocardiography.

Results: On evaluation of 50 COPD cases, its commonly seen in persons above 40 years of age i.e., in the 6^th and 7^th decade with mean age of 62± 8.93 years. 38% had normal echocardiographic parameters. Based on GOLD guidelines, the no.of Mild, Moderate, Severe and Very severe COPD patients participated in the study are 2, 11, 22 and 15 respectively.62% of study population were found to have ECHO changes. 62% of the study population had positive echo changes, which constituted 93.3% of very severe, 54.54% of severe and 18.18% of moderate cases. Mild cases had no positive echo findings.

Conclusion: ECHO, being rapid, non-invasive, portable, and easily available, can be routinely recommended for COPD patients as it is useful method for early detection of cardiovascular disease and better management. A more aggressive approach to treat the COPD patients can be taken s so that onset of Corpulmonale would be delayed.

Spontaneous pneumomediastinum in an undiagnosed asymptomatic bronchial asthma

Pranavi Amin, N. T. Awad, Sruthi Vijayan, Dipak

E-mail: pranavi.amin@gmail.com

• • Spontaneous pneumomediastinum is a rare self-limiting condition characterized by accumulation of air in the mediastinum in the absence of trauma. It occurs due to an increase in airway pressure due to triggers like asthma, coughing, vomiting, intense physical work, vomiting or valsalva maneuver leading to alveolar rupture which presents as retrosternal chest pain, subcutaneous emphysema and dyspnea

• • We present a 14 year old Male who was admitted with seizures and diagnosed with CNS tuberculoma for which he was started on anti tubercular treatment during which he developed Steven Johnson Syndrome and was managed accordingly. Subsequently, patient developed sudden increase in breathlessness which on further clinical and radiological examination revealed pneumomediastinum with subcutaneous emphysema. CT Chest also revealed mild pneumothorax. Spirometry later revealed very severe obstruction with no post bronchodilator reversibility with moderate restriction. Patient was treated symptomatically with bronchodilators and steroids and subsequently there was resolution of pneumomediastinum.

Correlation between serum uric acid and severity of airflow limitation in COPD according to gold guidelines

K. Sahithi, A. Sathya Prasad, A. Karuna, N. Premsagar

Department of Respiratory Medicine, Mamata General Hospital, Khammam, Telangana, India. Email id: sonykarnala@gmail.com

Background: Airway inflammation and imbalance between oxidant/ anti-oxidant mechanisms are postulated to play a major role in the pathogenesis and exacerbation of Chronic Obstructive Pulmonary Disease (COPD). Serum uric acid, the final product of purine degradation, has been shown to be increased in the hypoxic state as well as in systemic inflammation including patients with COPD.

Objective: Present study aims at establishing a correlation between serum uric acid and severity of airflow limitation in COPD according to GOLD guidelines.

Methods: This cross-sectional study included 50 patients with age above 40yrs and with an established diagnosis of COPD. Patients were subjected to pulmonary function test and serum uric acid.

Results: In the present study, the mean post-bronchodilator FEV₁ (predicted) of the study population was found to be 51.54 ± 20.4. Negative correlation (R value : - 0.77) between serum uric acid and post-bronchodilator FEV₁ (predicted) values was observed. Patients who come under GOLD-1 had a mean serum uric acid of 4.02 ± 0.91 mg/dl, GOLD-2 had 4.92 ± 0.95 mg/dl, GOLD-3 had 6.03 ± 1.03 mg/dl, GOLD-4 had 7.7 ± 0.55 mg/dl and was found to be statistically significant. (p-value<0.001).

Conclusion: Results of this study, combined with the well known fact that serum uric acid is a simple, non-invasive, widely and rapidly available routine blood test which is easy to interpret and at the same time, a cost effective biomarker, strongly suggests a possible role for serum uric acid in assessing severity of COPD.

A study of clinical, functional and inflammatory features of asthma COPD overlap patients in a cohort of patients with chronic obstructive pulmonary disease

D. Selvapandian, R. Pajanivel, R. Vimal Raj

Department of Pulmonary Medicine, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry, India. E-mail: chelseapandiyan@gmail.com

Background and Aim: Asthma and COPD are major problems for public health in many nations. Recently, research had highlighted that certain patients might have clinical symptoms of both asthma and COPD (Asthma-COPD overlap or ACO). The essential question remains largely unsolved whether the overlap between asthma and COPD represent persons with coexisting asthma and COPD or a new disease entity. Hence, the present study aimed to look at the clinical, functional and inflammatory characteristics of patients presenting with COPD and correlating these characteristics with patients having overlapping features (Asthma COPD Overlap).

Materials and Methods: The present study was a cross sectional-analytical study. It involves patients presenting with symptoms suggestive of obstructive airway disease attending the Pulmonary medicine clinic and/or admitted in pulmonary medicine ward in Mahatma Gandhi Medical College and Research Institute, Pondicherry. A total of125 patients were enrolled in the study and their Clinical assessment (mMRC grading), functional assessment (Spirometry,DLCO,6MWD) and inflammatory markers (AEC, S. IgE) were done.

Results: The mean ages of the patients were64.81±12.27 years. The gender distribution showed that 62.4% of male and 37.6% of female. 16.8% of COPD patients had ACO. Comparison of ACO and COPD groups showed clinical (mMRC), functional (Spirometry, DLCO, 6MWD) were lower in ACO group than COPD group. Whereas Inflammatory markers (Sr. IgE, AEC) were significantly higher in ACO group than COPD group.

Conclusion: The prevalence of ACO is 16.8% in COPD patients. Patients with ACO have more symptoms, comorbidities compared to COPD patients, which indicates an overall poor outcome.

To assess asthma control using act and PEFR as home monitoring tool

Chinkita Agrawal, Rajesh Agrawal, Rishi Saini

Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India. E-mail: drchinki94@gmail.com

Introduction: Asthmatic, if controlled may lead near normal life but if uncontrolled, will lead to irreversible bronchoconstriction. Control depends upon assessment tool, proper treatment and adherence.

Objective: To assess Asthma control using ACT and PEFR as home monitoring tool

Methods: A study was conducted in Rohilkhand Medical College, Bareilly from July 2021 to November 2021. 40 patients who had well controlled asthma on ACT at 6^th week were included in the study and randomly divided into 2 groups. Group I assessed the control by ACT and PEFR both at home and group II assessed their asthma control by ACT only. Both the groups were assessed at 6^th and 12^th week.

Results: At 6^th week, in group I, 70% patients had PEFR >80% of predicted as compared to only 20% patients in group II. At 12th week, we found that in group I 80% patients had PEFR >80% of predicted as compared to 45% patients in group II. At 6^th week, in group I, 75% patients showed good adherence to controller regimen as prescribed as compared to 50% in group II. At 12^th week, in group I, 70% patients showed good adherence to controller regimen as prescribed as compared to 60% in group II.

Conclusion: Our study suggests that patients who did home monitoring by ACT and PEFR both had good adherence and better clinical outcome as compared to those who did monitoring only by ACT.

To evaluate the subjective and objective parameters improvement in BA and COPD patients after correcting inhaler technique

Anupa Stanley, Ashish Kumar Prakash, Bornali Datta, Anand Jaiswal

Medanta Hospital, Lucknow, Uttar Pradesh, India. Email: dranupastanley@gmail.com

Inhalational devices have become a mainstay treatment in COPD & BA patients. Use of faulty inhaler technique is one of the main cause for uncontrolled symptoms.

Aims and Objectives: Evaluate the symptom control in patients of COPD and BA after correcting inhaler technique.

Materials and Methods: An observational prospective study of 80 OPD patients fulfilling the inclusion criteria and evaluated for the knowledge of inhaler-technique.

Results and Observations: After correcting the errors in the inhaler technique, we followed up our COPD patients after 3 months with a repeat MMRC dyspnea score and PFT.The MMRC score improved from 2.7+0.7 to 1.6 + 0.5 which was statically significant (Pvalue < .000) .The PFT also showed that FEV1 improved after correcting the inhalation technique (p value < .003) and this was statically significant followed up our asthma patients, 3 months later with ACT,MMRC and PFT to know the post intervention changes .In our study we found that there was a significant improvement in mean ACT score from 14.7+ 1.9 to 19.7+ 1.7.this was statically significant (p value <.000). MMRC score improved from 2.6+0.7 to 1.5+0.6 this was also statically significant (p value <.000), a0nd PFT showed that the mean FEV1 also improved post correction of inhalation technique at the 3 months. This was also statically significant (p value<.000).

Conclusion: Teaching patients how to inhale medication correctly not only improve control of the symptoms and also demonstrated objective improvement in pulmonary function of subject (BA and COPD) after correct use of inhalational devices.

Clinico-demographic profile of tropical pulmonary eosinophilia in a tertiary care institute of Bihar

Md Arshad Ejazi, Satyadeo Choubey, Manish Shankar, Dinesh Kumar

Department of Pulmonary Medicine, IGIMS, Patna, Bihar, India. Email: drarshad2k5@gmail.com

Background: Tropical pulmonary eosinophilia (TPE) is one of the eosinophilic lung diseases and it is associated with a hypersensitivity response to Wuchereria bancrofti and Brugia malayi’s microfilariae. Any systemic data regarding its clinical, demographic and radiological profile in patients pertaining to this part of the world is sparse.

Methods: This is an prospective observational study done over one year period in patients with TPE like features in a tertiary hospital of Bihar. After appropriate clinical and blood examination, absolute eosinophil count (AEC), serum total IgE, spirometry, Filarial Antigen and Filarial Antibody and chest radiology were done.

Results: Among 77 cases of TPE, 54 were males and 23 were females, in a ratio of 2.4:1. Majority of cases (55.9%), were less than 30 years of age. Most common clinical feature were cough 77 (100%), wheeze 70 (90.0%) and dyspnea 73 (94.8%). Filarial antibody was raised in all (100%) while antigen was positive in 74 (96.1%). Chest radiology were normal in 55 (71.4%), interstitial pattern 10 (13%) nodular 10(13%). Mean AEC and IgE ±SD were 6730.71+4671.12 and 7983.14 ±7279.60 kU/L respectively. Spirometric findings were mild restriction 25 (32.5%).

Conclusion: The prevalence of TPE is supposed to be higher in endemic areas and TPE should always be considered if patient presenting with breathlessness, wheezing or cough. Clinician should evaluate the patient in detail if patient is having raised eosinophil count (>3000/mm³) with increased IgE level (>1000 kU/L) along with clinical features. Timely diagnosis and treatment can cure the disease and prevent it’s complications.

Influence of prior pneumococcal vaccination on the severity of exacerbation in patients hospitalised with acute exacerbation of COPD

Aparna S. Nirmal, V. Anand, V. Rajesh, Jolsana Augustine, R. Divya, Melcy Cleetus

Department of Pulmonary Medicine, Rajagiri Hospital, Kochi, Kerala, India. E-mail: nirmalrose91@gmail.com, rajeshdhanya@rediffmail.com

Background: Acute exacerbations (AECOPD) are important events that punctuate the course of COPD and negatively impact the natural history. Prior pneumococcal vaccination may decrease the likelihood of COPD exacerbations. Vaccinated subjects, whenever they develop an exacerbation needing hospitalisation, tend to have milder disease and better outcomes.

Objectives:

• 1. To compare the severity of AECOPD in pneumococcal vaccinated versus unvaccinated subjects with regard to clinical parameters, occurrence of respiratory failure and pneumonia

• 2. To compare the need for assisted ventilation and ICU admission in pneumococcal vaccinated versus unvaccinated subjects with AECOPD.

Methodology: This was single centre cross sectional study. The study protocol was approved by the institutional ethical committee. Patients with a diagnosis of AECOPD needing hospitalisation were evaluated at the time of presentation. Prior pneumococcal vaccination status was ascertained. Subjects were grouped into vaccinated versus non vaccinated categories. Patients were assessed with the clinical features at presentation (fever, hemodynamic instability, altered mentation), arterial blood gas analysis, chest roentgenography, need for assisted ventilation and place of admission. Comparision between the two groups was done with chi- square test for qualitative and unpaired t – test for quantitative variables.

Results: 120 patients were enrolled in the present study, 60 patients each to the vaccinated and unvaccinated group. Unvaccinated patients were more likely to have fever, purulent sputum, multilobar consolidation, leucocytosis and elevated CRP than unvaccinated subjects, all of which were statistically significant (P < 0.05). The occurrence of respiratory failure was similar in both groups (55% Vs 60%; p value 0.137)), but need for ICU care (58% Vs 30%; p value 0.002) and assisted ventilation (60% Vs 43%; p value 0.05) were greater in the unvaccinated group.

Conclusions: In COPD patients hospitalised with an acute exacerbation, prior pneumococcal vaccination decreases the severity of exacerbation.

AECOPD episodes and its relation with glycemic control

Sanjay Sud

Department of Medicine, Konnagar Municipal Hospital, Chinsurah, West Bengal, India. E-mail: doctorsud70@gmail.com

Background and Objective: The outcomes for patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) having type 2 diabetes mellitus (T2DM) as a comorbidity is poor. However, data on the impact of the status of glycemic control and episodes of AECOPD suffered by these patients is insufficient. This study was aimed to find out the relationship between the glycaemic status and AECOPD.

Methods: 130 patients, all adults having T2DM with the comorbidity of COPD in addition were enrolled and followed up in the OPD on their visits seeking consultation for AECOPD episodes. This retrospective, real world, observational, non- interventional study was carried on for a period of 2 years (January 2019 to December 2020). The patients were divided into 3 groups A, B and C, according to mean HbA1c status (A < 7%, B ≥ 7% to ≤ 8 % and C > 8 % to ≤ 9.5 %). 21 patients were excluded from the data compiled as they did not report for follow up at the scheduled visits once every 3 months. All the patients got the necessary titrations for their glycemic status and rescue medications for their episodes of exacerbation of COPD.

Results: The retrospective data analyzed at the end of 2 years showed that patients in Group A had the highest percentage of AECOPD episodes (48%).

Conclusion: This study shows that factors other than glycemic control are also responsible for episodes of AECOPD in patients of T2DM and must be sought for.

The footslog of fatigue in COPD – Activity-provoked fatigue vs. the disease

Archit Krishna Manohar, N. Muthulakshmi, R. Prabhakaran

Department of Respiratory Medicine, Government Rajaji Hospital and Madurai Medical College, Madurai, Tamil Nadu, India. E-mail: architisd1@gmail.com

Background: Cardinal symptoms of COPD include dyspnea, cough, sputum, wheeze and chest tightness. Fatigue has now been added in the GOLD 2022 report. Fatigue poses as an activity limiting symptom in COPD. 6-minute walk test provokes sub-maximal effort in the patient which is equivalent to the effort put in while he/she does day-to-day activites.

Methods: 64 COPD patients visiting Respiratory Medicine OPD at Govt. Rajaji Hospital were studied. Fatigue was assessed by modified Borg scale at rest, patient made to perform 6 minute walk test and assessed again. Pre & post-test fatigue scores compared with FEV1%predicted and various other scores patient using Spearman’s RHO Correlation.

Results: Moderate correlation was identified between pre-test fatigue score and each of FEV1%predicted, 6-minute walk distance(r=-0.56), mMRC (r=0.47), CAT Score (r=0.64) and BODE Index (r=0.56). But post-test fatigue scores had a low level correlation only with FEV1%predicted (r=-0.34), mMRC (r=0.28), CAT Score (r=0.36) and BODE Index (r=0.36), (p<0.05).

Discussion: A substantial relationship exists between pretest scores of fatigue and each of the above scores which represent various components of COPD like airflow limitation, functional limitation, symptom severity and mortality. Only a weak relationship is found when post-test fatigue score is used instead, indicating presence of more fatigue even when disease is less severe.

Conclusion: Fatigue is a noteworthy symptom of COPD irrespective of the severity of disease. Modified Borg scale can be used in COPD to quantitatively assess fatigue. Further studies are needed to identify a new tools to assess fatigue in a patient objectively.

To study correlation of CAT score with PFT parameters (FEV1, RV/TLC, DLCO, and DLCO/VA) in COPD patients

R. Tripathi Awatansh, B. Mullerpattan Jai, A. Mahashur Ashok

E-mail: tripathiawatansh@gmail.com

Introduction: GOLD 2021 has recognized emphysema as a large subset of COPD which needs further evaluation. Air trapping and low diffusion are reported as independent risk factors for exacerbation and mortality amongst COPD patients. However, only a few studies have aimed to study the independent association of these determinants in COPD patients.

Methods: This is an observational study of 130 stable adult COPD patients visiting out-patient department at P. D. Hinduja Hospital. Enrolled patients were assessed by CAT, spirometry, lung volumes by plethysmography, and diffusion capacity of lungs to carbon monoxide (DLco). We assessed possible correlations between CAT score and PFT indices using Pearson’s correlation coefficient. Multivariate analysis was done to find their independent association with CAT score using linear regression.

Results: CAT score were negatively correlated with FEV1% (r= -0.454, p<0.001), DLCo% (r= -0.674, p<0.001), and KCO% (r= -0.416, p<0.001) whereas positively correlated with RV/TLC% (r= 0.42, p<0.001). On multivariate regression analysis, only FEV1% and DLco% showed a statistically significant negative correlation with CAT score (p <0.005). Variance (R 2) was 50.5. Each unit increase in CAT score was independently affected by 22.42 units decrease in FEV1% (coefficient = - 0.224; p=0.0003), and 9.4 units decrease in DLco% (coefficient = 0.0943; p=0.013).

Conclusion: Increasing CAT score directly correlates with a decline in diffusion capacity and increase in airflow limitation amongst the COPD patients. The DLco along with FEV1 independently affects CAT scores. 50% of the change in CAT score can be attributed to changes in these variables.

Role of sputum eosinophil and serum eosinophil counts in acute exacerbations of chronic obstructive pulmonary disease

Syed Musaib Ahmed, Subhakar Kandi, M. Ravindranath, D. S. Sowjanya

E-mail: drsyedmusaib@gmail.com

Background: The characteristics of COPD include chronic inflammation and structural changes in the respiratory tract, which are mediated by inflammatory cells and a complex cytokine network. Neutrophils are the predominant cell type involved in airway inflammation in COPD and account for >70% of sputum cells. However, ~20%–40% of patients with COPD show elevated eosinophil levels (>3%) in sputum and ~50%–70% show elevated eosinophil levels (≥2%) in serum. Titrating corticosteroid therapy according to eosinophil counts can help in guiding treatment and reduce exacerbation rates.

Objectives: To assess the role of sputum eosinophil and serum eosinophil counts in exacerbations of Chronic Obstructive Pulmonary Disease.

Methods: Data was collected from 60 patients admitted in the Respiratory Medicine Department of Kamineni Academy of Medical Sciences and Research Centre, Hyderabad, with an acute Exacerbation of COPD. All patients underwent necessary sputum and serum testing.

Results: 65% of patients had smoking related COPD while 35% had non-smoking related COPD. 30% of patients had a serum eosinophil count of >3% and 35% had a sputum eosinophil count of >3%. 46.1% of smoker COPD patients had eosinophilia while only 14.2% of non smoker COPD patients showed eosinophilic inflammation.

Conclusion: A significant subset of patients with COPD have eosinophilic inflammation in addition to neutrophilic inflammation. Eosinophilic inflammation is more prominent in smoking related COPD compared to non smoking related COPD. Assessment of sputum or serum eosinophilia may help in guiding corticosteroid treatment.

A case report of an unusual airway foreign body masquerading as non-resolving pneumonia in a COPD patient

Ganjam Yasaswini, Gangadhar Reddy Mallu, Mahesh Gudelli

Department of Pulmonology, Yashoda Hospitals, Secunderabad, Telangana, India. Email: yasasvini.ganjam@gmail.com

Background: Foreign-body tracheobronchial aspiration in adults is not rare especially in diseases that cause failure of airway protective mechanisms. The symptoms of this clinical entity can overlap with other respiratory diseases such as non resolving pneumonia, asthma, lung neoplasm etc. We are reporting a case of COPD with non-resolving right lower lobe pneumonia caused by an aspirated clove.

Case Study: A 63-year-old male patient known case of COPD presented with complaints of fever, cough and breathlessness for one week was initially evaluated and treated in a primary health care Centre as infective exacerbation. Chest X ray revealed opacity in Right lower zone in view of which empirical antibiotics were given for 10 days, despite which no radiological resolution was noted even after 1month. Sputum analysis was inconclusive and two consecutive sputum samples were negative for AFB. Patient was referred to our Centre for further management. CT chest showed centriacinar emphysema involving all lobes and RLL Consolidation on emphysematous lungs. Diagnostic bronchoscopy revealed impacted foreign body in RLL segments which was retrieved using cryoprobe.

Discussion: Patient later reports habitual chewing of clove overnight for cough suppression which was possibly aspirated into right lower lobe bronchus. Diagnostic bronchoscopy showed the foreign body which was not evident on CT as it is organic foreign body obstructing RLL basal segmental bronchi.

Conclusion: We cannot emphasize enough the role of diagnostic bronchoscopy in evaluation of a patient with non-resolving pneumonia. In this case, Rigid bronchoscopy and cryoextraction aided in therapeutic retrieval of foreign body.

Correlation of serum inflammatory markers and pulmonary function before and after home based pulmonary rehabilitation in moderate to severe chronic obstructive pulmonary disease patients – An interventional study

S. Gowthaman, S.Keerthivasan, R. Vani, T. Pudhumalar, V. Arunchandar

Department of Respiratory Medicine, Coimbatore Medical College Hospital, Coimbatore, Tamil Nadu, India. E-mail: gowthamansachin@gmail.com

Background: Chronic obstructive pulmonary disease (COPD) is associated with substantial morbidity. Pharmacologic therapy is associated with improvement in dyspnea, but with substantial costs. Pulmonary rehabilitation (PR) has been demonstrated to result in significant improvement in dyspnea, exercise capacity, psychological symptoms, and quality of life.

Methods: An interventional study conducted among 40 stable moderate and severe COPD patients who were randomly categorized into case and control groups with 20 on each arm. Demographic details, clinical history, smoking history were collected. Basic investigations and chest X-ray were done. Spirometry, 6MWD and CRP were done. Patients in case group underwent unsupervised home-based PR with simple exercises without any equipment for 6 weeks in addition to as needed salbutamol inhaler. Patients in control groups were on as needed salbutamol inhaler alone. Follow-up spirometry, 6MWD and CRP were done after 6 weeks in both group and compared.

Results: There is a statistically significant improvement in FEV1, 6MWD in case group while there is no significant change among the control group. CRP has decreased among cases but it was statistically non-significant.

Conclusion: Low cost, unsupervised HBPR can be effective in improving the exercise tolerance and functional capacity in resource limited settings. The effect of HBPR on systemic inflammatory markers in COPD patients is not significant.

Inhaled corticosteroids and COPD: When to use; What to expect?

Srishankar, Neeraj Gupta, Himanshu Mittal

E-mail: srishankarabairy2012@gmail.com

Background: Asthma COPD combined phenotype is the term used to collectively describe patients who have persistent airflow limitation together with clinical features that are consistent with both asthma and COPD. There is a paucity of information about the effectiveness of therapeutics for this subgroup. Patients with this combined phenotypes were frequently excluded from clinical studies involving asthma or COPD, which limits the generalization of findings from these trials to patients. In general, inhaled corticosteroids (ICS) are the cornerstone of the pharmacologic management of patients with persistent asthma, whereas inhaled bronchodilators are the therapeutic mainstay for patients with COPD. There are very few studies to suggest the effectiveness of ICS in improving the symptoms, pulmonary functions, IgE, serum and sputum eosinophils and FeNO in ACO populations.

Objective: We followed previously diagnosed Asthma-COPD combined phenotypes for 1 year in reference to change in functional parameters like FEV1 and bronchodilator reversibility as well as markers of eosinophilic inflammation like FeNO, blood and sputum eosinophils, serum IgE. Frequency of exacerbations and hospitalizations as a result of addition of ICS to inhaled bronchodilators were also noted.

Methods: This study is a type of prospective interventional study. A total of 171 patients of stable COPD were screened with a battery of tests to identify a subgroup of Asthma COPD combined phenotype. The criteria of this diagnosis were based on Sin et al (2016). 125 patients were found to have COPD alone and 46 patients were diagnosed as Asthma COPD Combined phenotype, out of which 3 patients could not be followed up. A total of such 43 diagnosed cases were then followed up over one year. These patients were added with a moderate dose of ICS (MDI Beclamethasone 800 mcg daily) to their optimum inhaled bronchodilators. History of any acute exacerbations were noted, follow up Spirometry along with reversibility ,FeNO, blood investigations like TEC and IgE were done and compared with their baseline values which were noted prior to initiation of ICS.

Results: Among the 43 study population , majority were of the age group between 60-69. Adding ICS to the bronchodilators in this subgroup for a period of one year improved their FEV1 by 182.1 ± 237.6ml and by 12% of its initial values(p value <0.001 and 0.005 respectively). Addition of ICS reduced the FeNO value by 52.53% of its initial value (p<0.001), reduced TEC in the blood by 31.5% (p<0.001), IgE by 9.8% (p= 0.030).The number of exacerbations reduced during this one year period in this subgroup but it was statistically insignificant.

Parameter	Baseline	At one year	Change observed	P
FEV1 (ml)	1206±488	1388±567.7	182.1±237.6	<0.001 (S)
Reversibility (ml)	316±138.8	363.4±221.3	47.33±163.6	0.065 (NS)
FeNO	27.47±30.57	13.09±22.45	14.37±18.68	<0.001 (S)
TEC (cells/cumm)	380.7±213.7	211.3±170.7	169.3±239.1	<0.001 (S)
Sputum eosiniphils (%)	1.53±1.24	1.35±0.53	0.18±1.27	0.345 (NS)
IgE (IU/ml)	592.9±729	429±664.4	163.9±479.8	0.030 (S)
Exacerbations	22	12

S: Significant, NS: Not significant

Conclusions: In patients with Asthma-COPD combined phenotypes, addition of ICS to bronchodilator will improve post bronchodilator FEV1, reduces markers of eosinophilic inflammation like Total eosinophil Count (TEC), Sputum eosinophils, Serum IgE and Fractional exhaled nitric Oxide. There were no significant reduction in exacerbations. Considering all the benefits, we conclude that ICS should be considered in addition to the inhaled bronchodilators in this subgroup of stable COPD patients.

Results from a COPD screening program conducted in 44 medical colleges across India

Deesha Ghorpade¹, Abhinav Dagar², Tariq Mahmood³, Malay Sarkar⁴, Sibesh Das⁵, R. G. Nautiyal⁶, Arti Julka⁷, Subhra Mitra⁸, Susmita Kundu⁹, Umarani¹⁰, Vishal Chopra¹¹, Rakhee Khanduri¹², Avinash Lamb¹³, Lokendra Dave¹⁴, R K Jenaw¹⁵, Bhargava Prasad Bathula¹⁶, Satya Prasad¹⁷, R. B. Ramdeoskar¹⁸, A Sai Kumar¹⁹, Indranil Halder²⁰, Surya Kant Tripathi²¹, Supriya Sarkar²², Santanu Ghosh²³, Sravan Kumar²⁴, Somanath Dash²⁵, C. R. Choudary²⁶, Rakesh Bhargava²⁷, Girija Nair²⁸, Vishwa Vijeth K²⁹, K. Anbananthan³⁰, P. Chakradhar³¹, Sunil Kohli³², K. N. Mohan Rao³³, B. Archana ³⁴, Himanshu Phople³⁵, Nilesh Datt³⁶, N K Sit³⁷, P. K. Agarwal³⁸, Anup Bannur³⁹, Kiran Rami⁴⁰, P. Yugandhar⁴¹, Sathish Chandra⁴², Keerthivardhan Kulkarni⁴³, S Raghu⁴⁴, Nalin Shah⁴⁵, Bhanu Rekha⁴⁶, Vinoth Kumar⁴⁷, Sapna Jitendra Madas¹, Vandana Vincent Das¹, Amit Karad⁴⁸, Sundeep Santosh Salvi¹

¹Chest Research and Training Pvt Ltd, Pune, Maharashtra, India, ²Kalpana Chawla Government Medical College, Karnal, Haryana, India, ³SRN Medical College, Varanasi, Uttar Pradesh, India, ⁴Indira Gandhi Medical College, Shimla, Himachal Pradesh, India, ⁵Calcutta Medical College, Kolkata, West Bengal, India, ⁶STM Medical College, Uttar Pradesh, India, ⁷R D Gardi Medical College, Ujjain, Madhya Pradesh, India, ⁸CNMCH, Kolkata, West Bengal, India, ⁹R G Kar Hospital, Kolkata, West Bengal, India, ¹⁰Raja Muthaiya Medical College, Chidambaram, Tamil Nadu, India, ¹¹Chest and TB Hospital, Patiala, Punjab, India, ¹²Jolly grant Hospital, Muzaffarnagar, Uttar Pradesh, India, ¹³G. M. C. H, Aurangabad, Maharashtra, India, ¹⁴Gandhi Medical College, Bhopal, Madhya Pradesh, India, ¹⁵SMS Medical College, Jaipur, Rajasthan, India, ¹⁶Anits Medical College, Visakhapatnam, Andhra Pradesh, India, ¹⁷Mamta Medical College, Khammam, Andhra Pradesh, ¹⁸Bharati Vidyapeeth, Pune, Maharashtra, India, ¹⁹Mallareddy Medical College, Hyderabad, Telangana, India, ²⁰JNM Hospital, Kolkata, West Bengal, India, ²¹KGMC, Lucknow, Uttar Pradesh, India, ²²Sagar Dutta Hospital, Kolkata, West Bengal, India, ²³Burdwan Medical College, Burdwan, West Bengal, India, ²⁴Kakatiya medical College, Warangal, Telangana, India, ²⁵GSL Medical College, Rajahmundry, Andhra Pradesh, India, ²⁶Dr. S N Medical College, Jodhpur, Rajasthan, India, ²⁷JNM College, Uttar Pradesh, Varanasi, Uttar Pradesh, India, ²⁸D. Y. Patil Hospital, Navi Mumbai, Maharashtra, India, ²⁹East Point Hospital, Bengaluru, Karnataka, India, ³⁰Thanjavur Medical College, Thanjavur, Tamil Nadu, India, ³¹Santharam Medical College, Nandyala, Andhra Pradesh, India, ³²Majedia Hospital, New Delhi, India, ³³Sapthagiri Medical Hospital, Bengaluru, Karnataka, India, ³⁴RR Hospital, Karnataka, Bengaluru, Karnataka, India, ³⁵Smt. Kashibai Nawale, Pune, Maharashtra, India, ³⁶LG Hospital, Ahmedabad, Gujarat, India, ³⁷Rampurhat Medical College, Rampurhat, West Bengal, India, ³⁸PMCH, Patna, Bihar, India, ³⁹SIIM Hospital, Bengaluru, Karnataka, India, ⁴⁰Sola Civil Hospital, Ahmedabad, Gujarat, India, ⁴¹AASRAM College, Eluru, Andhra Pradesh, India, ⁴²Pratima Institute Medical College, Karimnagar, Andhra Pradesh, India, ⁴³BLD Hospital, Vijayapura, Karnataka, India, ⁴⁴Guntur Medical College, Guntur, Andhra Pradesh, India, ⁴⁵Civil Hospital, Ahmedabad, Gujarat, India, ⁴⁶PSIMS, Gannavaram, Andhra Pradesh, India, ⁴⁷Stanley Government Medical College, Chennai, Tamil Nadu, India, ⁴⁸Cipla Ltd, Mumbai, Maharashtra, India. E-mail: deesha@purefoundation.in

Background: COPD is the 2^nd leading cause of suffering and death in India, yet a large number of patients remain undiagnosed because of under-use of spirometry. On the occasion of the World-COPD Day 2021, 44 medical colleges across India undertook a COPD screening program among patients visiting the respiratory medicine out-patient department (OPD) to study the burden of COPD and evaluate the efficacy of the modified OSCAR (COPD Screening Questionnaire) screening tool.

Methods: We developed a 9-item COPD screening tool (age, gender, smoking status, shortness of breath, cough, wheezing, chest tightness and long-standing history of asthma in addition to a peak flow meter (<250L/min for males and <200 L/min for females) that was modified from our community-based OSCAR screening tool. This was administered to 2440 consecutive patients visiting the respiratory OPD from 44 medical colleges. 42.4% (N=222) screen positive (score ≥ 8) cases underwent pre-and post-bronchodilator spirometry. 19.7% (N=37) screen negative (score<8) also underwent spirometry.

Results: The burden of COPD in respiratory medicine OPDs was 13% (3% - 86%). The modified-OSCAR COPD screening tool had a sensitivity of 85%, specificity of 33.3%, positive predicted value of 43.7% and negative predicted value of 78.6%.

Conclusion: Every 7^th patient visiting the respiratory OPD in medical colleges has COPD. The modified OSCAR COPD screening tool offers reasonable reliability, although additional studies are required to validate this. More medical colleges are invited to participate in this nationwide COPD screening program.

ABPA frequently exacerbates bronchial asthma: Missed out truth: A case report

T. L. Yashawanth, Saurabh Prakash, T. A. Veerabhadraiah

District Hospital, Tumakuru, Karnataka, India. E-mail: sp.saurabhprakash@gmail.com

Background: ABPA is a complex hypersensitivity reaction in response to colonization of the airways with aspergillus (most commonly- Aspergillus fumigatus) that occurs almost exclusively in patients with bronchial asthma or cystic fibrosis.

Case Report: We report a case of ABPA in a 46 years male patient, with a history of bronchial asthma for the last 6 years, who presented to our hospital with the complaints of- difficulty in breathing, cough with expectoration and chest pain for the last 6 months. Patient was on inhaled short acting beta agonist and corticosteroids and monteleukast for the management of bronchial asthma. Recurrent exacerbations of bronchial asthma were noted despite of patient’s compliance to medications. In our hospital the patient was re-evaluated in detail. On physical examination, the patient had bilateral coarse crepitations. Chest X-ray revealed- right upper zone and bilateral cystic changes over perihilar area. CT thorax was suggestive of- bilateral central bronchiectatic changes. Total serum IgE level was 1427 IU/ml and serum precipitins against A.fumigatus tested positive. So final diagnosis of ABPA in the background of bronchial asthma was made and the patient was started on tablet itraconazole 400mg once daily and tablet prednisolone 1mg/kg. The patient showed significant improvement in his symptoms after 2 weeks and thus the medications were tapered.

Conclusion: From this case we conclude that we should always rule out ABPA in a patient with recurrent exacerbations of bronchial asthma for early diagnosis and prompt treatment so as to prevent progression of disease to end stage pulmonary fibrosis.

Correlation of exercise induced desaturation (six minute walk test)and CT scan measured pulmonary artery: Aorta ratio in predicting pulmonary hypertension in COPD patients

S. Dhanalakshmi

Institute of Thoracic Medicine, Madras Medical College, Chennai, Tamil Nadu, India. E-mail: dhanapulmo1995@gmail.com

Background: EID (Exercise induced desaturation) due to the presence of Pulmonary hypertension is reported to be associated with acute exacerbation in patients with COPD. CT detected PA enlargement is independently associated with acute exacerbation of COPD.Hence it is important to detect COPD exacerbation early and minimize their severity.This study aimed to predict resting pulmonary hypertension by correlating six minute walk test desaturation with CT chest PA: A ratio.

Methods: Patients who are diagnosed with COPD attending THORACIC Medicine were included into the study.The assessment of BODE index assessment which include Body maas index,degree of airway obstruction-post bronchodilator spirometry (GOLD criteria),level of dysnea(using MMRC) and exercise capacity using 6 minute walk test(6MWT) has been done for all the study subjects. On CT CHEST the diameter of the Main Pulmonary artery at the level of bifurcation and the diameter of the Ascending Aorta was calculated to look for ratio and the ratio was correlated with ECHO findings. Finally the Comparison between six minute walk test desaturation and CT Chest findings was done in the study.

Results: One twenty COPD patients were enrolled in this study.There were 75( 62.5%) patients who had a PA: A ratio and desaturated during six minute walk test(P<0.005). This study has found the statistically significant correlation (P< 0.005) between exercise induced desaturation and CT Chest PA: A ratio.

Conclusion: A pulmonary artery to aorta ratio >1 is a reliable indicator of resting pulmonary hypertension in COPD patients and lowest Spo2 during 6MWT may predict CT measured PA: A ratio.

A case of recurrent sinusitis in a young female

T. Anantha lakshmi, V. Laxman Babu, J. Raghunath Reddy, Shirish

Department of Respiratory Medicine, Sunshine Hospital, Secunderabad, Telangana, India. E-mail: anushat.1108@gmail.com

Background: Kartagener syndrome, a subset of primary ciliary dyskinesia is a rare autosomal recessive disorder. The basic defect is in the structure of cilia thereby affecting their function. That leading to chronic recurrent respiratory tract infections and infertility in males and females. It is characterized by triad of chronic sinusitis, broncheictasis, situs inversus totalis.

Case Study: A 17 yr old female presented with cold, nasal discharge, cough, headache for which she was initially treated on OPD basis. But she again presented with high grade fever and cough with sputum. She had past history of recurrent episodes of sinusitis since her childhood. She had used multiple oral antibiotics every time. Later, on detailed evaluation she was found to have bronchiectasis, sinusitis, situs inversus totalis. A diagnosis of kartagener syndrome was made and started on treatment and chest physiotherapy. Her symptoms improved and is clinically better.

Discussion: Most children with kartagener syndrome remain asymptomatic and few present in early age. This syndrome is characterized by ultra structural defect in cilia causing poor mucociliary clearance in the respiratory tract and impaired function of fallopian tubules and decreased sperm motility.

Conclusion: Early diagnosis of kartagener syndrome helps in early initiation of treatment, prevention of long term respiratory complications, address infertility and genetic counseling. In addition to medical management, these patients require continuous family, social and psychological support for good prognosis.

Role of bacteria in acute exacerbation of COPD: A study from Eastern India

Princia banu

Kalinga Institute of Medical Science, Bhubaneshwar, Odisha, India. E-mail: princiabanum@gmail.com

Background: Chronic obstructive pulmonary disease (COPD) is currently the 3^rd leading cause of death worldwide causing nearly 3.23 deaths. Acute exacerbations of COPD (AE COPD), particularly those due to bacterial infections are important events as they adversely impact health status, rate of hospitalization and disease progression. This study aims to determine the burden of bacterial and co-infections in acute exacerbations of COPD in eastern India.

Aims and Objectives: To study the incidence and pattern of bacterial and co-infections in patients presenting with acute exacerbation of COPD.

Materials and Methods: The study was conducted in association with Regional Medical Research Centre (ICMR), BBSR. It was a cross-sectional observational study. All patients admitted or attending the OPD as acute exacerbation of COPD were included in the study over a period of 18 months. A detailed clinical history was taken and physical examination was performed. Throat swabs were collected for viral RT-PCR at ICMR, Bhubaneswar while sputum samples/BAL samples were collected for bacterial cultures. The data about ventilator requirement, duration of hospital stay and outcome in every patient was recorded. Statistical analysis was done using Graphpad calculator.

Results: A total of 197 cases were included in the study out of which 138 (70.06%) were male and 59 (29.94%) were female. An etiological agent of infective exacerbation was detected in 108(54.82%) cases. A total of 46 (23.35%) had bacterial exacerbations; Klebsiella pneumoniae and Acinetobacter baumanii were most commonly isolated. In another 17 (8.62%) cases, both bacteria and virus were detected. Patients with bacterial exacerbation spent the highest no. of days in the hospital (7.52 ± 3.07 days). A total of 8(29.62%) with bacterial exacerbation and 7(53.84%) patients with a co-infection had requirement for respiratory support; 1(0.5%) patient with co-infection died.

Conclusion: Bacterial infection is a major cause of acute exacerbation of COPD. Sputum cultures can detect an organism in 40-60% cases. Gram negative bacteria are still the commonest cause of exacerbations with good response to antibiotics.

The coexistence of bronchial asthma in patients with bronchiectasis: A cross-sectional study

S. Nayantara, H. Alamelu, S. Mamatha, G. Anish

Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India. E-mail: nayantara_nayan@yahoo.co.in

Background and Objectives: To determine the co-existence of bronchial asthma in patients of bronchiectasis, and to compare the clinico-radiological profile between patients having only bronchiectasis and both bronchiectasis and bronchial asthma.

Materials and Methods: 67 patients who presented as Bronchiectasis (Clinical and radiological) to Respiratory Medicine Department at VIMS & RC, Bangalore from January 2020 to June 2021, were subjected to baseline investigations and spirometry/PEFR after informed consent. Statistical analysis was performed using SPSS 22 version software.The clinical and radiological profile were compared between the group having only bronchiectasis and those with bronchiectasis and asthma.

Results: Out of the 67 study patients, 55(82.08%) had only bronchiectasis & 12(17.91%) had bronchiectasis with bronchial asthma. Patients with Bronchiectasis & coexisting asthma had statistically significant increased symptoms of breathlessness, wheeze, running nose, sneezing, itching(P value <0.05). Similarly exposure to dust, fumes, pets was found to be more common in bronchiectasis with bronchial asthma group (P value >0.05). The mean age for onset of symptoms was found to be lower in the Bronchiectasis with bronchial asthma group. Patients in the Bronchiectasis with bronchial asthma group had a lower mean FEV1 value. Hyperinflation on chest radiograph was found to be 10.90% in bronchiectasis group, and 8.33 % in brochiectasis with bronchial asthma group. Bilateral bronchiectasis on CT thorax was common in both groups.

Conclusion: 17.91% of bronchiectasis patients had coexisting bronchial asthma. Hence a proper diagnosis can reduce the burden of patients suffering from more frequent exacerbations, with better optimized treatment options.

Six-minute walk test and its correlation with Spirometry in stable COPD patients

Akash Deep

Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India. E-mail: akashd.star9@gmail.com

Background: An impaired exercise tolerance, the main feature in chronic obstructive pulmonary disease (COPD), occurs due to multiple factors. The 6-minute walk test (6MWT) is easy to perform, well-tolerated, and more reflective of activities of daily living. The facility of spirometry is unavailable in many areas of India, where 6MWT can be done easily.

Aims and Objectives: This study aims to compare the six-minute walk distance (6MWD) with various demographic, clinical, and spirometry parameters.

Materials and Methods: A total of 118 consecutive stable COPD patients fitting the criteria were included in the study. Spirometry was performed in these patients before and after giving a short-acting bronchodilator. 6MWT was performed according to the ATS guidelines. All patients underwent the 6MWT after 10 minutes of spirometry. Statistical analysis was done using GraphPad calculator and SPSS 24.0.

Results: The majority of the patients were > 60 years of age (mean age ¼ 62.99 6.68 years) and comprised males and females in the ratio 5.9:1. Smoking was determined to be the most important predisposing factor for the development of COPD. There was a significant negative correlation between 6MWD, age, and smoking index (p ¼ 0.0075 and 0.0295 respectively). The 6MWD showed a significant positive correlation with FEV1 (in liters), FEV1 (%), FVC (in liters), and FVC (%). The 6MWD (meters) and % predicted 6MWD showed a significant negative correlation with a drop in SpO2 after the 6MWT (r ¼–0.36; p ¼ 0.000769, r ¼–0.3; p ¼ 0.004, respectively).

Conclusion: 6MWT can be used in cases of COPD where spirometry is unavailable as it correlates significantly with various parameters of the latter.

Cross-sectional study on association of metabolic syndrome with the severity of airflow obstruction in patients with chronic obstructive pulmonary disease

Krishnapriya S. Kumar

Department of Respirtory Medicine, SMS Medical College, Jaipur, Rajasthan, India. E-mail: krishna.skumarpriya@gmail.com

Background: Chronic obstructive pulmonary disease (COPD) is often associated with several extra-pulmonary systemic manifestations. Metabolic syndrome (MetS) is recognized by the findings of central obesity, hypertension, hypertriglyceridemia, atherogenic dyslipidemia and hyperglycemia. Objective of the study was to assess metabolic syndrome among COPD patients and its association with severity of airflow obstruction.

Materials and Methods: This cross-sectional study was carried out on COPD patients attending outpatient department at Institute of Respiratory Diseases, SMS Medical College, Jaipur during the year 2020–2021 and a total of 107 patients were enrolled. COPD and its severity was diagnosed according to latest GOLD guidelines, while NCEP-ATP III criteria was used for diagnosing MetS. Demographics, clinical data, lifestyle-related characteristics, fasting blood sugar (FBS) and lipid profile were obtained.

Results: Out of 107 patients, 65(60.75%) were males and 42(39.25%) were females. Mean age of the patients was 62.52 ± 10.1 years. The overall prevalence of MetS was 41.12% and most common in GOLD stage-2 (60.87%), followed by stage-1 (44.44%), followed by stage-4 (33.33%) and 20% in GOLD stage -3. Of the MetS components, only elevated FBS was significantly associated with severity of airflow obstruction. Significant factors associated with MetS in COPD patients were age, BMI, inhaled steroid, duration of smoking and GOLD II.

Conclusion: Development of metabolic syndrome in COPD patients, further intensify the burden of the disease. Hence screening for metabolic syndrome in all COPD patients will facilitate early detection which may help improve treatment outcomes.

Cross-sectional study on skin sensitivity to aeroallergens by skin prick test in bronchial asthma patients

Sumit Kumar Jain

Department of Respiratory Medicine, SMS Medical College, Jaipur, Rajasthan, India. E-mail: sumitjain1512@gmail.com

Background: Bronchial asthma (BA) is one of the most common allergic disorder. Aeroallergens are often implicated in BA. Identification of specific causative allergen is of paramount importance for further management.

Objective: This study aims (1) to find out the prevalence of various aero-allergens leading to BA through skin prick test (SPT), (2) to find out geographical distribution of aero-allergens.

Materials and Methods: Total 100 patients were collected from outpatient department and inpatient department of IRD. The diagnosis of BA was made according to the GINA guidelines. SPT was done with 49 different types of aeroallergens, which included 20 types of pollens, 8 types of fungi, 5 types of insects, 8 types of dusts, 4 types of danders, 2 house dust mites and 2 feathers.

Results: Out of 100 patients, 56 were males and 44 were females. The maximum numbers of patients (53%) were in age group of 21-30 years. BA associated with AR was found in 29%, while BA alone was found in 71%. A total of 4900 SPTs were done. The most common aeroallergen detected was pollens (in 65% patients) followed by insects in 58%, dusts in 34%, house dust mite in 31%, fungi in 16%, danders in 12% and feathers in 8%, respectively. There was significant positive correlation of number of allergens positive with both TEC and total IgE.

Conclusions: Our study showed that pollens were the most common allergen in BA patients. Identification of offending allergen helps in avoiding it and also guides immunotherapy.

Ultrasound assessed diaphragmatic function as a predictor of lung function and exercise capacity in a stable chronic obstructive pulmonary disease

Akshita, Deepak Aggarwal, Varinder Saini, Ravinder Kaur

Department of Pulmonary Medicine & Radiodiagnosis, Government Medical College and Hospital, Chandigarh, India. E-mail: akshitagupta2019@gmail.com, drdeepak@hotmail.com

Background: Spirometry and 6-minute walk test (6-MWT) are used for routine monitoring of chronic obstructive pulmonary disease (COPD) patients. However, these procedures are effort dependent and associated with risk of desaturation . Diaphragmatic ultrasound (USG) is a non-invasive modality that may be a useful adjunct in the monitoring of COPD. Hence, the study was conducted to evaluate ultrasonographic parameters of diaphragm and correlate them with spirometry and 6-MWT.

Methods: Twenty four subjects each of stable COPD patients and healthy controls were enrolled. COPD patients underwent routine blood investigations, spirometry and 6-MWT. All subjects underwent USG for diaphragmatic thickness at maximum inspiration and functional residual capacity and diaphragmatic excursion (during tidal breathing) were compared between the 2 groups. Also, these parameters were correlated with 6-MWT and spirometry values.

Results: Mean age of COPD patients and healthy controls was 63.4+8.9 and 61.5+7.7 yrs respectively (p=0.44). Majority of COPD patients were in stage II (n=17), grade B (n=10) and on triple drug therapy (n=9). On ultrasonography, the mean diaphragmatic excursion was lower in COPD patients as compared to healthy controls (15.6+0.9mm v/s 16.2+0.7 mm; p=0.03), however, there was significant difference in inspiratory and expiratory diaphragmatic thickness between the groups (p>0.05). Diaphragmatic excursion had a significant positive correlation with FEV1 & FVC [spearman rho 0.57 (p=0.003) & 0.49 (p=0.01) respectively] but not with 6-MWT distance (p>0.05).

Conclusion: Ultrasonographic assessment of the diaphragm may be useful tool for routine monitoring of stable COPD patients.

Correlation of serum vitamin d levels with COPD severity and exacerbations

Tanweer Ahmed

Department of Pulmonary Medicine, Gauhati Medical College and Hospital, Guwahati, Assam, India. E-mail: tanweerahmedamc@gmail.com

Background: Chronic Obstructive Pulmonary Disease (COPD) is a common respiratory disease and is a major cause of mortality and morbidity in the elderly population. Vitamin D is an essential nutrient and its deficiency has been associated with several chronic diseases including metabolic, cardiovascular, pulmonary, autoimmune diseases and etc. The objective of our study is to determine the relationship between serum vitamin D deficiency and disease severity in COPD patients.

Methods: One-hundred consecutive COPD patients, 76 males and 24 females over 40 years of age,diagnosed by spirometry were enrolled in the study. Functional status and disease severity were determined by post bronchodilator FEV1, Modified Medical Research Council (mMRC) grade, COPD Assessment Test (CAT) score,and number of exacerbation and hospitalization in last one year.Serum vitamin D level was estimated and was correlated with disease severity and exacerbations.

Results: Patients with grade 1 COPD had normal serum vitamin D levels. Among grade 2 COPD patients,majority (33%) had normal serum vitamin D levels, and 19% had insufficiency.Among grade 4 COPD patients,majority (12%) had vitamin D deficiency and 3% had insufficiency and among grade 3 COPD patients,majority (14%) had vitamin D deficiency and 10% had insufficiency.Patients with no exacerbation in last one year had sufficient vitamin D levels whereas in patients with 3-4 exacerbations majority (6%) had vitamin D deficiency and 5% had insufficiency.

Conclusion: Serum vitamin D deficiency and insufficiency were observed to be very common in patients with COPD and it also correlates with the disease severity and exacerbations.

A cross-sectional study to assess the correlation between vitamin d levels and lung function tests in asthma patients

Sudhini Sreeja Reddy¹, M. Narender², Sree Swathi², Ganapathy²

¹Department of Pulmonary Medicine, Osmania Medical College, Hyderabad, Telangana, India, ²E-mail: sreejapulmo@gmail.com

Introduction: Asthma is a heterogenous disease characterized by chronic airway inflammation. Vitamin D is responsible for immunomodulator effects on various host immune cells. There is evidence of prognosticating vitamin D deficiency as increased risk factor for asthma exacerbations.

Aim: To assess correlation between vitamin D levels and lung function tests in asthma patients,

Methodology: This is a cross-sectional study done on 50 asthmatic patients measuring vitamin D levels including single time measurement of Vitamin D [1,25 (OH2) D3] using fully automated Immunohistochemistry analyser (COBAS e 411 – ROCHI) using the principle of Electro Chemiluminescence Immune Assay (ECIA) and Liquid chromatography Tandem mass spectrometry and lung function tests using spirometry.

Results: Of 50 subjects, Vitamin D deficiency is seen in 46% (23\50), insufficiency is seen in 24% (12\50) and 30% (15\50) have normal sufficiency. In patients with asthma, 25(OH) D levels were positively correlated with FEV1/FVC, with p- value 0.009. Vitamin D levels are closely associated with FEV1 values with p- value of 0.076.

Conclusion: Vitamin D deficiency has overall public health implications, health education and creating public awareness regarding the ill-effects of Vitamin D deficiency will reduce hypovitaminosis D in the population. In view of significant relationship, showed in several studies, between asthma and its severity and pulmonary function test outcomes and exacerbations of asthma, measuring serum levels of Vitamin D could be considered in the routine assessment of bronchial asthma.

To compare the effectiveness of Eltgol and conventional postural drainage in promoting airway clearance in patients with bronchiectasis

R. Sangavi, R. Sridhar

Government Stanley Medical College, Chennai, Tamil Nadu, India. E-mail: sangavir108@gmail.com

Introduction: Bronchiectasis is a chronic lung disorder with impaired mucociliary clearance leading to mucus retention thereby causing chronic infection and inflammation. Hence, airway clearance techniques are important non-pharmacological management.

Methodology: This is a Prospective, randomised study done over a period of one year. Patients are randomly assigned to either perform ELTGOL or conventional postural drainage. Among the 70 subjects included in the study, 29 subjects in ELTGOL group and 28 subjects in Postural drainage group completed the study. 24 hour sputum volume, six-minute walk test, FEV1%, CAT score, mMRC dyspnea score during first visit and follow up visit were assessed.

Results: The mean age group was 54±13yrs and 31 patients were males (54.4%); 26 patients were females (45.6%). There was no significant differences in sputum volume between ELTGOL group and Postural drainage group both in first visit (p=0.140) and follow up visit (p=0.844).There was significant differences in 6MWT, FEV1%, CAT score, mMRC dyspnea score between first visit and follow up visit in both ELTGOL (p=0.0005) and Postural drainage group (p=0.0005)

Conclusion: ELTGOL technique is equally effective in clearing airway secretions in patients with bronchiectasis as compared to Postural drainage. It can be recommended as alternate technique to the patients with bronchiectasis. Both ELTGOL and Postural drainage plays an important role in improving severity of dyspnea, quality of life, exercise capacity and lung function.

A cross-sectional study on evaluaton of clinical, physiological and sputum characteristics in patients hopitalized with an exacerbation of bronchiectasis

Rajkumar Tamsha

Osmania Medical College, Hyderabad, Telangana, India. E-mail: trajukumar7@gmail.com

Introduction: Bronchiectasis is growing health burden both in India and globally. Frequent exacerbations are a significant cause of morbidity and mortality and may contribute to substantial socioeconomic costs manifest by increased hospitalisations and healthcare utilisation.

Objectives: To identify the common clinical presentation pattern, spirometry pattern and sputum characteristics in patients with an exacerbation of bronchiectasis.

Methodology: 71 patients with bronchiectasis exacerbation were assessed for the common clinical presentation pattern and subjected for spirometry and sputum characteristics examination.

Results: Out of 71 patients with bronchiectasis exacerbation, cough with expectoration was seen in 97% cases, breathlessness in 90% cases, fever in 62% cases, hemoptysis in 42% cases and chest pain in 35% cases. Sputum culture showed pseudomonas aeruginosa in 32.4% cases, no growth in 25.4% cases, Haemophilus influenza and Klebsiella pneumonia were found equally in 11.3% cases, Staphylococcus aureus in 8.5%, Streptococcus pneumoniae in 4.2% cases. Fungal culture showed candida and aspergillus in 2.8% and 7% cases. Spirometry showed that 33.8% cases had obstructive pattern, 16.9% had mixed pattern, 12.7% had restrictive pattern and 21.1% had normal pattern.

Conclusion: Bronchiectasis is a medical and social problem with significant morbidity and mortality. Patients hospitalized with bronchiectasis exacerbation are typically older with comorbidities and co-existing conditions. Prescence of Pseudomonas aeruginosa was a risk factor for repeated exacerbations, as was the history of asthma or COPD.

Surgical experience of traumatic major airway injury from a dedicated chest surgery centre

Harsh Vardhan Puri¹, Mohan Venkatesh Pulle², Sukhram Bishnoi², Belal Bin Asaf², Arvind Kumar²

¹Medanta – The Medicity, Gurgaon, Haryana, India, ²Institute of Chest Surgery, Medanta – The Medicity, Gurgaon, Haryana, India. E-mail: drharshvardhanpuri@gmail.com

Introduction: Tracheobronchial injuries are rare but potentially life threatening. Their successful diagnosis and treatment often require a high level of suspicion and surgical repairs unique to the given injury.

Methods and Patients: We reviewed our experience with 24 patients with tracheobronchial injuries treated over the past 9 years.

Results: Seventeen injuries were due to blunt trauma, 3 were due to penetrating trauma and 4 were iatrogenic during intubation or bronchoscopic procedures. All penetrating injuries were located in the cervical trachea whereas blunt injuries were more commonly located close to the carina. All tracheal injury patients required urgent measures to secure the airway. The diagnosis of blunt injuries was more difficult and required a high index of suspicion and the liberal use of bronchoscopy. The majority of the injuries were repaired primarily using techniques specific to the injury, and most patients returned to their normal activity soon after discharge.

Conclusions: A high level of suspicion and the liberal use of bronchoscopy are important in the diagnosis of tracheobronchial injury. A tailored surgical approach is often necessary for definitive repair.

Evaluation of clinical, radiological, physiological parameters, severity and quality of life in patients with bronchiectasis

A. S. Dhilnaz, Balakrishnan Menon, Raj Kumar

Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, India. E-mail: dilz.saj@gmail.com

Background: Bronchiectasis is a multidimensional disease associated with substantial morbidity and mortality. Bronchiectasis Severity Index (BSI) can be used to stratify patients into severity risk categories and to predict the probability of mortality.

Methods: This observational, cross-sectional study was conducted on 100 patients with radiologically confirmed bronchiectasis. The clinical, physiological, radiological parameters, severity and quality of life were assessed in patients with bronchiectasis.

Results: This study comprised of 27%, 40% and 33% of mild, moderate and severe bronchiectasis cases respectively. Cough, expectoration of sputum and breathlessness were the common symptoms and Obstructive pattern of airflow limitation was reported predominantly. Atleast one exacerbation in the previous year was seen in 82% of studied patients with 75.8% patients of severe disease having history of hospitalization in the last year. Pseudomonas was the most common organism isolated. Cystic bronchiectasis seen in 57.6% of patients with severe disease. The lowest Leicester Cough Questionnaire score was observed in patients with severe bronchiectasis. Age, number of exacerbations and number of hospital admissions had negative correlation with quality of life. A moderate positive correlation was observed between the percentage of post bronchodilator Forced Expiratory Volume in first second, the six minute walk distance and quality of life (p = 0.001).

Conclusion: The frequency of exacerbations, hospitalisations, and severity of airflow obstruction are associated with poor quality of life. Identification of high risk patients using BSI, who may benefit from agggressive therapy or intense follow up, helps to reduce healthcare resource utilisation and improve the patient outcome.

Simultaneous bilateral spontaneous pneumothorax with left bronchopleural fistula in Adult: A rare case Report

Varsha Raj Meena, Suman Khangarot, Anil Saxena

Department of Respiratory Medicine, Government Medical College, Kota, Rajasthan, India. E-mail: varshajipatan@gmail.com

Background: Simultaneous bilateral spontaneous pneumothorax is an extremely rare and potentially fatal condition. Patients usually have no relevant medical conditions. However, few cases may have certain risk factors such as smoking, being young, and male gender. We reported a case of a healthy male who presented with BPSP.

Case Presentation: A 40-year-old man presented with acute worsening shortness of breath overnight. Chest X-ray performed showed bilateral large pneumothorax with significantly compressed mediastinum. Chest tubes were placed bilaterally with immediate clinical improvement. However, the chest tubes continued to have an air leak without full lungs expansion on left side suggesting. Computed tomography scan without contrast of the chest revealed subpleural apical cysts in both upper lobes. The patient underwent instillation of autologous blood patch twice. The patient had been doing well no recurrence of pneumothorax.

Conclusion: Bilateral spontaneous Pneumothorax is a rare clinical condition that frequently occurs as a result of underlying lung disease. Due to its life-threatening nature, early diagnosis and appropriate treatment in SBSP case can save patient’s life.

A study of pulmonary function test in females with second hand smoking

K. Venkateswaran, R. Prabhakaran, R. Hariprasad, Rajesh Kumar, Senthil Kumar

Department of Respiratory Medicine, Madurai Medical College, Madurai, Tamil Nadu, India. E-mail: venkat19922014@gmail.com

Introduction: Second hand tobacco smoke (SHS) is a mixture of two forms of smoke: from the burning end of cigarettes, cigars or pipes as well as smoke exhaled by people who smoke. People who are exposed to SHS increase their chances of developing heart diseases and lung cancer by 25—30% and 20—30%, respectively. Second hand smoke exposure has also been reported to contribute to asthma flares or COPD pathogenesis.

Objective: To study spirometry pattern and its correlation with clinico radiological profile in females with second hand smoking.

Methods: 30 females who were relatives of smoker COPD patients living in the same house but do not have the history of tuberculosis, bronchial asthma or any debilitating disease like cardiac, hepatic and renal diseases were subjected to chest Xray and post bronchodilator spirometry. The results were analysed statistically.

Results: Most of the cases have obstruction pattern in spirometry. The common pattern seen is small airway obstruction. The most common symptom perceived is cough followed by dyspnoea on exertion (grade ii MMRC). Severity of Obstruction increases with additional biomass fuel exposure. Common radiological pattern seen is increased broncho vascular marking rather than hyperinflation.

Conclusion: Smoking cessation of men will reduce the incidence of female COPD. Symptoms perceived are more in females with minimal radiological changes and obstruction in spirometry.

Impaired glucose tolerance in COPD. Detect early, treat better

Pranay M. Walade, T. Pramod Kumar, G. Nalini G, V. Kartheek Rao

Department of Pulmonary Medicine, Government General and Chest Hospital, Hyderabad, Telangana, India. E-mail: pranaysinghw@gmail.com

Background: A major factor that complicates therapeutic approaches to the management of COPD is that it is frequently associated with comorbidities. One such frequent comorbidity is DM2 which is common in patients with COPD. Impaired glucose tolerance is frequently a precursor to the development of diabetes mellitus. Estimation of glucose tolerance by OGTT can help physicians recognize diabetes early among COPD patients which can prevent deterioration of the disease which accounts for high morbidity and mortality. The present study was therefore undertaken to elucidate the effect of impaired glucose tolerance on lung function in COPD patients.

Methods: The present study was conducted at the department of Pulmonary Medicine at Government General and Chest hospital, Hyderabad. 80 COPD patients attending the OPD were enrolled into the study. After detailed history and clinical examination, patients underwent PFT, six-minute walk test, OGTT.

Results: Out of 80 patients 38.8% of patients had impaired glucose tolerance and 12.5% of patients were reported as diabetics while 48.8% of patients had normal OGTT. IGT had a statistically significant negative impact on FEV1 and distance walked in six-minute walk test with p value of 0.00 and 0.03 respectively.

Conclusion: Impaired glucose tolerance has a negative impact on lung function. Early detection can prevent the development of diabetes which can further decline lung function.

Mass Lesions with cavity: A Rare Presentation of ABPA

Shivam Dixit, G. N. Srivastava

Institute of Medical Sciences, BHU, Varanasi, Uttar Pradesh, India. E-mail: shivamdixit724@gmail.com

Introduction: Allergic Bronchopulmonary Aspergillosis (ABPA) is a rare immune related pulmonary disorder that results from hypersensitivity to Aspergillus fumigatus. It can rarely present with lung mass. This case is about a misdiagnosed case of bronchogenic carcinoma which came out to be ABPA, thereby changing treatment and prognosis.

History: A 25 year old male presented with cough, dyspnoea and chest tightness since childhood, increased for last 1 month associated with massive hemoptysis for last 15 days. History of atopy to dust and smoke present.

Clinical Findings: Vitals showed tachypnoeia and tachycardia. On respiratory examinations, sign of respiratory distress were present, with increased tactile and vocal fremitus. Air entry was decreased bilaterally with polyphonic wheezes.

Diagnosis and Management: CT (on admission) showed right ULmass with cavity and left UL mass with B/L “Bronchus Cut Off sign” S/O bronchogenic carcinoma. CBC showed AEC=3634. Total S.IgE >1000 IU/ml. Asperillus IgE and IgG were positive. BAL was eosinophilic predominant with AFB negative. Biopsy was negative for malignancy. Patient was started on itraconazole and prednisolone 0.5 mg/kg. Patient symptomatically improved. Serial Xrays showed decrease in size of mass lesions.

Conclusion and Learning Points: Basic idea of reporting our case is its rarity in incidence with such rarest radiographic presentation. On revisiting history with young age in background of atopy lead to suspicion of ABPA before tuberculosis and malignancy. Emaculate clinical correlation of radiological finding should be corroborated for a successful diagnosis. Overemphasis on radiographical findings should be discouraged. Such misdiagnosis leads to stress to patient.

Evaluation of 2-minute vs 6-minute walk test in moderate and severe COPD

S. R. Pallavi, Nitin Goel, Raj Kumar

Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, India. E-mail: mailtopallavisr@gmail.com

Back ground: Six-minute walk test (6MWT) correlates with desaturation and informs prognosis in COPD patients. Patients, who are unable or unwilling to complete the test need an alternative to 6MWT. So, 2MWT was compared with 6MWT as an alternate tool for evaluation of moderate and severe COPD patients.

Methods: This descriptive, cross-sectional study was conducted in 114 COPD patients, attending OPD of Vallabhbhai Patel Chest Institute, New Delhi. Patients AGED ≥ 40 years with no exacerbation in last one month and with oxygen saturation of ≥ 85% at room air underwent 2MWT and 6MWT in random allocation and results were correlated with clinical and physiological parameters.

Results: Among 114 patients, 50 were severe COPD and 64 were moderate COPD. Oxygen desaturation, total walking distance, heart rate, respiratory rate, dyspnea and leg fatigue were evaluated. The difference in oxygen desaturation during the 2MWT and 6MWT was not significantly different in moderate and severe COPD patients (p> 0.05) and the data strongly correlated between the walk tests (r=0.869, p < 0.0001). Average walking distances were (148m &130 m) for moderate COPD and (432 m & 331m) for severe COPD on the 2MWT and 6MWT, respectively (r=0.776, p < 0.0001). Other measurements including heart rate, respiratory rate, dyspnea grade and modified Borg scale were also comparable between 2MWT & 6MWT. The 2MWT was equally effective in functional assessment and detecting exertional desaturation in both moderate and severe COPD.

Conclusion: Two-MWT can be used as a replacement for 6-MWT in moderate and severe COPD.

Predictors of exertional desaturation on walk tests

S. R. Pallavi, Nitin Goel, Raj Kumar

Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, India. E-mail: mailtopallavisr@gmail.com

Background: Various studies have shown that COPD patients with exertional desaturation during 6-minute walk test (MWT) have increased risk of mortality. Two MWT (2-MWT) has been found to be a valid predictor of exertional desaturation in COPD patients on 6MWT. In this study we analysed the predictors of exertional desaturation in COPD on 6MWT and 2MWT.

Methods: This descriptive, cross-sectional study was conducted in 114 COPD patients, attending OPD at Vallabhbhai Patel Chest Institute, New Delhi. Patients aged ≥ 40 years with no exacerbation in last one month and with oxygen saturation of ≥ 85% at room air underwent 2MWT and 6MWT in a random allocation. Desaturation risk was calculated with univariate and multivariate logistic regression analysis. Variables included in multivariate analysis were those that were significant at p <0.05 in univariate analysis.

Results: Among 114 COPD patients, 38(33.33%) and 34 (29.8%) showed desaturation in 2MWT and 6MWT respectively. Multivariate regression analysis was performed for various parameters like pack years, post-bronchodilator FEV1, post-bronchodilator FVC, post-bronchodilator FEV1/FVC, mMRC grade and total SGRQ score. Total SGRQ score was the single independent risk factor for desaturation in 6-MWT(p=0.04) and post-bronchodilator FEV1(%) in 2-MWT (P=0.007).

Conclusion: Quality of life and severity of obstruction are predictors of exertional desaturation in COPD.

The role of serum albumin, platelet lymphocyte ratio, and neutrophil lymphocyte ratio in pre treatment assessment and monitoring of treatment in patients with bronchiectasis

G. Reetu Singh, V. Vinod Kumar

Department of Pulmonary Medicine, Stanley Medical College, Chennai, Tamil Nadu, India. E-mail: reeturajkamal999@gmail.com

Study Background: Bronchiectasis is a pathological description of abnormally dilated, distorted, thick-walled medium sized bronchi, chronically inflamed and infected by bacteria. The severity scores have a role in identifying the course of disease progression, but are not effective in monitoring of treatment in patients with exacerbations. The identification of biomarkers in relation to the severity of the disease would serve as prognostic tool in assessing response to treatment.

Aim: To observe the relation of S.albumin, PLR, NLR with severity of Bronchiectasis based on the BSI score, in patients presenting with exacerbations and to identify their role as monitoring parameters in treatment of Bronchiectasis.

Methodology: The S.albumin, PLR, NLR is measured at the time of admission and compared with the BSI and FACED score for correlation with disease severity, are again measured post treatment after 2 weeks and 1 month to evaluate their effectiveness as monitoring parameters.

Results: S.Albumin and NLR correlated with severity of the disease showing statistical significance with p<0.005. The average value of S.Albumin was 2.9±0.5 and NLR 4.6±2.4 in severe disease. There was no statistical significance between PLR and disease severity. In post treatment period S.albumin and NLR showed statistically significant improvement compared to pretreatment values.

Conclusion: Neutrophil Lymphocyte ratio and Serum Albumin have proved to be useful biomarkers in assessing the severity of Bronchiectasis in patients presenting with exacerbation and also as monitoring parameters in assessing response to treatment.

Correlation between 6 minute walk test and pulmonary artery: Aorta ratio in CT chest of patients with chronic obstructve pulmonary disease in predicting pulmonary hypertension

S. Gayathri, S. P. Vengadakrishnaraj

Government Stanley Medical College, Chennai, Tamil Nadu, India. E-mail: drgaya1994@gmail.com

Introduction: Chronic obstructive pulmonary disease is a leading respiratory disease with increasing morbidity and mortality in India. Pulmonary hypertension is common complication which needs hospitalization, follow-up which increases economic burden of the country. Early diagnosis and intervention is essential to prevent morbidity and mortality. There is always a correlation between exercise induced de-saturation and pulmonary hypertension. Current study is intended to develop a screening tool to predict the risk of pulmonary hypertension in patients with stable COPD

Aim and Objectives: Aim of the study is to correlate the fall in saturation during six minute walk test with pulmonary artery: aorta ratio in patients with COPD so that six minute walk test can be used as a screening tool for COPD patients with pulmonary hypertension.

Methodology: This is a prospective observational study done among patients attending Government hospital of thoracic medicine and Stanley medical college from June 2020. The study includes 54 subjects. COPD diagnosis and staging done according to GOLD guidelines 2019. Six –minute walk test performed as per ATS guidelines 2002. CT chest done and PA:A ratio is calculated and correlated with exercise induced de-saturation

Results: Analysis of the study showed patients with severe and very severe COPD according to GOLD staging, who had a fall in saturation of >4% from baseline during 6 minute walk test had a significant positive correlation with PA:A ratio >1, which indicates presence of pulmonary hypertension. Echocardiography was normal in 80% of these patients. The mean distance covered by these patients were 335m. The fall in saturation also had a positive correlation with reduced post bronchodilator Fev1.

Conclusion: Exercise induced desaturation can be used for early prediction of pulmonary hypertension. 6minute walk, a simple, non-invasive tool can be used for preliminary screening in patients with COPD which can be performed on an outpatient basis.

A prospective study on role of blood eosinophils as biomarker to predict exacerbations and treatment responsiveness in chronic obstructive pulmonary disease patients

S. Nikhila, M. Narender, Sree Swathy, B. Ganapathy Reddy

Department of Pulmonary Medicine, Osmania Medical College, Hyderabad, Telangana, India. E-mail: nikhila.samalas@gmail.com

Background: Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable and treatable disease. Until recently, COPD was considered to be a mainly neutrophil-mediated inflammatory disease. However, a degree of eosinophil-associated airway inflammation can be present in both stable COPD and during COPD exacerbations.

Objective: To test the hypothesis that blood eosinophils predict chronic obstructive pulmonary disease exacerbations and treatment outcome.

Methods: This is a prospective study done on 80 COPD patients measuring ABSOLUTE EOSINOPHIL COUNT levels using Improved Neubauer chamber method and Fuchs-Rosenthal counting chamber method and lung function tests using spirometry.

Results: Of 80 subjects, eosinophilia is present in 18.8% and normal in 81.3%. Eosinophilia is present in 11.3% with previous 3 exacerbations and 6.3% with previous 4 exacerbations and 1.3 % with previous 5 exacerbations with p-value <0.05.

Conclusion: The present study reveals that eosinophilia has a significant effect to predict exacerbations in COPD. Patients with eosinophilia has more frequent exacerbations causing more decline in lung function. The present study analysis shows the relationship between blood eosinophil levels and reduction in the frequency of COPD exacerbations with ICS+LABA treatment.

Clinical, Aetiological, and Microbiological profile in patients with exacerbation of bronchiectasis presenting as acute respiratory failure

Prabhat Kumar, Lalit Singh, Yatin Mehta, Pradeep Nirala

Department of Respiratory Medicine, SRMS-IMS, Bareilly, Uttar Pradesh, India. E-mail: prabhat.pulmonary@gmail.com

Background: Bronchiectasis is defined as “abnormal, usually permanent, dilatation of the bronchi”. An exacerbation of bronchiectasis is defined as a clinical deterioration marked by three or more of symptoms of cough, sputum volume/ consistency, breathlessness, and hemoptysis, lasting at least for 48 hours. Acute worsening and respiratory failure leading to hospitalization is not uncommon among these patients and is often more associated with mortality than uncontrolled infection alone.

Methods: The study is an observational, cross-sectional study conducted in the Economically Weaker Section-IPD unit of the Respiratory Medicine Department of Shri Ram Murti Smarak Hospital, Bareilly over a period of one year. The study followed 55 patients of >18 years with known bronchiectasis.

Results: We concluded that, tuberculosis was the most common etiology (33.45%), followed by GERD (16.36%), bronchial asthma (13.75%), recurrent childhood infection (10.91%), while 25% had no known co-morbidity. Microbiological profile was suggestive of Pseudomonas (25%), Citrobacter freundii (13.64%), Streptocococcus pneumoniae (9.09%), E Coli (6.82%) Haemophilus influenza (6.82%) and Acinitobacter (4.55%). Maximum exacerbations which presented with acute respiratory failure (55.54%) were observed with pseudomonas colonization.

Conclusion: In the present study, we observed that exacerbations of bronchiectasis in the form of acute respiratory failure were more frequently associated with a past history of Tuberculosis and Bronchial Asthma. Additionally, Pseudomonas colonization appears to be a significant factor associated with acute worsening.

Vitamin d levels in children with allergic rhinitis and asthma in South India – A cross sectional study

Sanjeev Nair¹, Ravindran Chetambath²

¹Department of Pulmonary Medicine, Government Medical College, Thrissur, Kerala, India, ²Department of Pulmonary Medicine, Baby Memorial Hospital and Research Centre, Kozhikode Kerala, India. E-mail address: drsanjeevnair@gmail.com

Background: Allergic-rhinitis and Asthma are common diseases in childhood. It has been hypothesized that lower Vitamin-D levels may be responsible for the increasing prevalence of Asthma and Allergic-rhinitis, with studies from all around the world showing high prevalence of Vitamin D deficiency in children with asthma and allergic-rhinitis, but this isn’t documented in Indian patients.

Methods: A hospital-based cross-sectional study was done including children (<19years) in South India. Census-sampling was done and all children with a Pulmonologists diagnosis of Allergic-rhinitis and/or Asthma were included. Vitamin-D levels, Serum IgE and Absolute eosinophil count (AEC) were measured. Data were entered in MS-Excel and analysis done using EpiInfo7. Means, standard deviation (SD) and proportions were calculated. Correlation was done between Vitamin D and IgE, AEC and age of the children.

Results: 42 children were recruited. Mean age was 11.5years (SD-4.08years). 54.8% were females. 20(47.6%) had allergic-rhinitis alone, 16(38.1%) had asthma alone and 5(14.3%) had both. Mean AEC levels were 513.86/mm³ (SD-204.81 mm³) and mean IgE levels were 1348.83IU/ml (SD-717.64IU/ml). Mean Vitamin-D was 16.08ng/ml (SD-5.33ng/ml). Proportion of children with Vitamin-D classified as deficiency (<12ng/ml), insufficiency (12-20ng/ml) and sufficient (>20ng/ml) was 28.57%, 54.76% and 16.67% respectively. With a cut-off of normal as Vitamin-D>50ng/ml, only 4.76% had no deficiency. There was no statistically significant difference in the mean Vitamin-D in Children having allergic rhinitis, asthma or both. There was no correlation between Vitamin-D with the AEC levels or with the IgE levels.

Conclusion: Vitamin-D deficiency/insufficiency is very common in children with Allergic-Rhinitis and Asthma in South India.

Comparison of forced oscillometric technique and spirometry in patients of bronchial asthma

Pournami Balasundaran¹, Jitendra Kishore Bhargava², Sanjay Bharty², Brahma Prakash², Deep Pawar¹

¹School of Excellence in Pulmonary Medicine, Netaji Subash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India, ²Department of Respiratory Medicine, School of Excellence in Pulmonary Medicine, Netaji Subhash Chandra Bose Medical College and Hospital, Jabalpur, Madhya Pradesh, India. E-mail: pournamibalan@gmail.com

Background: Bronchial asthma is an airway disease the diagnosis of which still continues to be a clinical one. Several tests have been found to be useful but not a single test can be called as a gold standard. Hence the search for a better test is still on. Spirometry and FOT are non-invasive investigations but FOT has been less studied. Here, we attempted to compare spirometric and forced oscillometric technique (FOT) parameters in an Indian adult population suffering with asthma.

Methods: A total of 50 clinically diagnosed bronchial asthma patients were enrolled in our study who were sequentially assessed with spirometry and FOT. The parameters obtained in each were analyzed and compared for detecting the utility of FOT.

Results: The study enrolled 42 mild and 8 moderate asthmatic patients as per clinical severity. A comparison between FOT parameters with clinical and spirometric parameters revealed R5 was found to be a statistically significant variable with mean value of 7.19 + 14.32 in mild category and 15.85 + 24.5 in moderate and severe category. An increasing negative value was obtained for the parameter X5 in clinically mild and moderate asthmatics. A Significant correlation was found between spirometric and FOT parameters including FEV1, FVC, FEV1/FVC with R5, R20, predicted % of R5 and R5-20.

Conclusion: Spirometry and FOT may be used in the diagnosis of bronchial asthma hand in hand. In cases where the spirometry gives a normal report, FOT can be used additionally to identify changes in airway resistance for early diagnosis of asthma in adults.

Microbiological profile of bronchiectasis in adults in tertiary care hospital

D. Shiva Kumar, M. Sravan Kumar, P. Ravi

Kakatiya Medical College, Warangal, Telangana, India. E-mail: shivadharavath32@gmail.com

Background: Bronchiectasis is increasing in prevalence worldwide, yet current treatments available are limited to those alleviating symptoms and reducing exacerbations. The pathogenesis of the disease and the inflammatory, infective and molecular drivers of disease progression are not fully understood, making the development of novel treatments challenging. The dilated mucus filled airways promote bacterial over-growth followed by chronic infection, bronchial inflammation, lung injury and re-infection. Accurate pathogen identification and antimicrobial susceptibility allowing appropriate treatment, in turn, may break this vicious cycle.

Methods: Randomly selected patients with Bronchiectasis, sputum samples were subjected to gram staining and culture sensitivity.

Results: In a study of 106 patients, Sputum gram staining in 13 (12.3%) are gram positive, 73 (68.9%) are gram negative and 20 (18.9%) of the cases were sterile. Sputum culture shows most common organism isolated was Pseudomonas aeruginosa in 42 (39.6%) followed by Klebsiella Pneumoniae in 23 (21.7%), Streptococcus pneumoniae 8 (7.5%),Hemophilus influenza 5 (4.7%), Staphylococcus aureus 4 (3.8%), Moraxella 3(2.8%), Escherichia coli 1 (0.9%) and Acetobacter in 1 (0.9%) and the culture was sterile in 19 (17.9%).

Antibiotic sensitivity pattern for Pseudomonas aeruginosa revealed higher resistance to cotrimoxazole followed by Ciprofloxacin. Antibiotic sensitivity pattern for Klebsiella pneumoniae revealed higher resistance to Azithromycin followed by Ceftriaxone. Antibiotic sensitivity pattern for Streptococcus pneumoniae revealed higher resistance to Cotrimoxazole followed by Amoxycillin. Antibiotic sensitivity pattern for Hemophilus influenza revealed higher resistance to Gentamycin followed by Piperacillin tazobactam.

Conclusion: Understanding the local spectrum of lower respiratory bacteriology among patients with bronchiectasis will help in choosing the appropriate empirical therapy, pending culture results.

What are the direct and indirect costs of COPD in India?

S. Madas¹, J. Londhe², K. Mudliar¹, K. Powar², N. Dhadge³, S. Gaikwad⁴, M. Modi⁵, B. Pawar⁶, M. Bargaje⁷, G. Godbole⁸, P. Khatavkar⁹, Y. Agrawal¹⁰, H. Pophale¹¹, Y. Badhe¹², S. Toke¹³, S. Salvi¹

¹Pulmocare Research and Education Foundation, Pune, Maharashtra, India, ²Chest Research Foundation, Pune, Maharashtra, India, ³Central Health System, Pune, Maharashtra, India, ⁴B.J. Medical College, Sassoon General Hospital, Pune, Maharashtra, India, ⁵Ruby Hall Clinic, Pune, Maharashtra, India, ⁶Deenanath Mangeshkar Hospital, Pune, Maharashtra, India, ⁷Bharati Hospital and Research Centre, Pune, Maharashtra, India, ⁸Smt. Kashibai Nawale Medical College and General Hospital, Pune, Maharashtra, India, ⁹KEM Hospital, Pune, Maharashtra, India, ¹⁰Aditya Birla Hospital, Pune, Maharashtra, India, ¹¹Shreeyash Hospital, Pune, Maharashtra, India, ¹²MIMER Medical College, Pune, Maharashtra, India,¹³Muktai Speciality Clinic, Pune, Maharashtra, India. E-mail: sapnamadas@purefoundation.in

Background: COPD is the 2nd leading cause of deaths and DALYs in India affecting an estimated 50 million people. We aimed to study the direct and indirect costs of COPD among patients from the city of Pune in India and used these to estimate the total economic burden of COPD in India.

Methods: 350 (male and female) doctor diagnosed and spirometry confirmed COPD patients on medications for at least one year were randomly recruited from different hospital settings in a stratified manner – private (60%), semi-private (17%) and government (23%) clinics/hospitals. 1-year retrospective expenditure on direct costs (physician consultation, Investigations, drugs and hospitalization costs), indirect costs (travel, workdays lost and professional caretaker cost) and cost associated with co-morbid conditions were collected.

Results: The mean age of the 350 COPD patients (70%-M, 30%-F) was 66.0±9.1 years. Patients visiting private clinics and semi-private clinics spent (Median, IQR) 20,124 (10,241-42,037) INR/annum and 31,354 (12,628-53,885) INR/annum respectively. Patient’s visiting Govt. Hospital (Cost to patients + Hospital related cost) spent 14,605 (6,802-23,387) INR/annum. The costs towards hospitalizations, medicines, doctor’s fees, investigations were 40%, 31%, 6% and 3%. Indirect costs accounted for 12% and 8% expenditure was associated with co-morbid costs. When extrapolated to the national figure of 55 million (60% visiting private clinics, 17% semi-private clinics and 23% government clinics was 103.8 thousand crore Rupees.

Conclusion: COPD causes an economic loss of >100 thousand crore rupees per annum in India. It is important to formulate appropriate policy decisions to reduce the health-related costs COPD in India.

Prevalence and correlates of osteoporosis in chronicobstructive pulmonary disease patients

B. Gowthami, J. K. Mishra, Deepak Kumar Shah, G. N. Srivastava

Department of T.B. and Respiratory Diseases, IMS, BHU, Varanasi, Uttar Pradesh, India. E-mail: gowthamiravi93@gmail.com

Background: Chronic Obstructive Pulmonary Disease (COPD) is a chronic inflammatory airway disease characterized by progressive airflow limitation and chronic respiratory symptoms caused by airway and/or alveolar abnormalities due to exposure to noxious particles/gases. It is associated with various systemic co-morbidities, one of which being osteoporosis. Osteoporosis and its related fractures are common and have a significant impact on respiratory functions and quality of life in patients with COPD. The objective of this study is to study the prevalence of osteoporosis in COPD patients and to define various risk factors associated with reduced Bone Mineral Density (BMD) in COPD.

Methods: The study was done in department of T.B. & Respiratory diseases of a tertiary care hospital. 100 cases of COPD diagnosed by spirometry according to GOLD criteria were included in this cross-sectional study conducted over a period of 2 years. A thorough clinical history was taken, and patients were subjected to BMI measurement, CAT Questionnaire, DXA scan of lumbar spine and total hip to determine BMD and vitamin D3 levels. A WHO definition of osteoporosis was applied and patients with a T score of >-2.5 standard deviation were diagnosed to have osteoporosis. Statistical analysis was done using SPSS software, association of osteoporosis were done using chi-square test, risk factors identified by univariate and multivariate regression analysis.

Results: Out of 100 patients, 52 patients (52%) had Osteoporosis and 22 patients (22%) had osteopenia. Majority of the patients who had osteoporosis were found to be in stage III (n=27, 51.9%) and stage IV (n=23, 44.2%). It was also observed that patients with lower BMI (n=20,38.4%) had higher prevalence of osteoporosis compared to overweight patients. On univariate analysis, it was observed that risk factors for osteoporosis were older age, female sex, longer disease duration, higher number of exacerbations, low BMI, vitamin D deficiency and severity of COPD. After using multivariate logistic regression analysis, stage IV COPD, number of exacerbations>2, steroid cumulative dose >1000mg, use of high dose of Inhalational corticosteroid were found to be significant risk factors for osteoporosis in COPD patients.

Conclusion: In the present study, prevalence of osteoporosis was 52% and osteopenia was 22%.Thus, high clinical suspicion and early diagnosis and treatment is required in evaluation of osteoporosis in COPD patients so that the quality of life can be improved in these patients.

Is Under-Use of Inhaled Corticosteroids for Asthma in India responsible for over 42% of Global Asthma Deaths?

Sundeep Salvi, Sapna Madas, Deesha Ghorpade, Swapnil Gadhave, Monica Barne

Pulmocare Research and Education Foundation, Pune, Maharashtra, India. E-mail: sundeepsalvi@gmail.com

Background: According to the 2019 Global Burden of Disease (GBD) Report, India contributes to an estimated 12.9% of global asthma cases (34.3 million), but a disproportionate 42.3% of all global asthma deaths, India leads the world in Asthma DALYs. We hypothesized that the disproportionate increase in asthma deaths and suffering in India could be due to under-use of inhaled corticosteroids.

Methods: Using the estimated number of asthma cases in each state and union territory in India from the 2019 GBD data, we calculated the expected sales of inhaled corticosteroids (ICS) for asthmatics in India. State-wise actual sales of ICS in India were obtained from IQVIA. We also correlated ICS sales versus asthma deaths and DALYs across different states.

Results: The total amount of ICS sales in India obtained from IQVIA was 26.4 million versus the 384.16 million expected sales, which is only 6.8% of the required estimated sales. When we correlated state-wise actual sales of ICS in India versus asthma mortality and DALYs (per 100,000 population), we found a significant negative correlation for asthma deaths (R = -0.56; p<0.001) and asthma DALYs (R = -0.61; p<0.001).

Conclusion: There is a significant under-use of inhaled corticosteroids among asthmatics in India, which is associated with increased deaths and suffering. Policy makers, health care providers, public health researchers, asthma sufferers and the people at large need to take cognizance of this and undertake appropriate measures, such as creating awareness and ensuring availability and regular use of ICS by asthmatics in India.

Functional disability among women living with chronic obstructive pulmonary disease in pune

Meenakshi Bhakare¹, Shruti Sahasrabudhe², Gauri Godbole³, Sundeep Salvi²

¹Department of Respiratory Medicine, Symbiosis Medical College for Women, Symbiosis University Hospitals and Research Centre, Symbiosis (Deemed Univeristy), Pune, Maharashtra, India, ²Department of Clinical Research, Symbiosis Medical College for Women, Symbiosis University Hospitals and Research Centre, Symbiosis (Deemed Univeristy), Pune, Maharashtra. India, ³Department of Respiratory Medicine, Shrimati Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India. E-mail: hod.respiratorymedicine@smcw.siu.edu.in

Background: According to the Global Burden of Disease 2019 Report, women contribute to 44.6% of COPD disability adjusted life years in India, most of whom are due to long-term exposure to indoor biomass smoke. COPD symptoms are significantly associated with poor quality of life and functional disability. We aimed to study the six-minute walk distance (6MWD) among female patients with COPD attending the respiratory clinic of a tertiary care teaching hospital in Pune.

Methods: 220 consecutive women visiting the respiratory OPD having COPD confirmed on Spirometry were administered the CAT and mMRC questionnaires and performed the 6-minute walk test according to ATS/ERS standards. The 6-minute walk distance was compared with the CAT and mMRC scores.

Results: The mean age of the COPD women was 59.1 ± 10 years. The mean 6MWD was 298 ± 77 metres(m) and the mean CAT 15.81±6.5. The mean (SD) distance covered by the participants based on mMRC classification was 0: 375±7, 1: 364.36±77.98, 2: 305.65±78.64, 3: 287.19±71.11 and 4: 245.23±121.61. The 6MWD showed a negative correlation with the CAT score [r = -0.42] and the mMRC score [r = -0.44].

Conclusion: Biomass-smoke exposed women have significant functional disability as demonstrated by the 6MWD which correlated with the CAT score and mMRC score.

What is the level of non-compliance of spacers among asthma and COPD patients and what are the factors that drive it?

Swapnil Gadhave¹, Malay Sarkar², Abhay Uppe³, Girija Nair³, Babaji Gewade⁴, Deependra Rai⁵, D. J. Christopher⁶, Saibal Moitra⁷, Rajesh Swarnakar⁸, Surya Kant Tripathi⁹ Kirti Mudliyar¹, Sapna Madas¹, Sundeep Salvi¹

¹Pulmocare Research and Education Foundation, Pune, Maharashtra, India, ²Indira Gandhi Medical College and Hospital, Shimla, Himachal Pradesh, India, ³D. Y. Patil University School of Medicine, Navi Mumbai, Maharashtra, India, ⁴Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India, ⁵All India Institute of Medical Sciences, Patna, Bihar, India, ⁶ Christian Medical College, Vellore, Tamil Nadu, India, ⁷Allergy and Asthma Research Centre, Kolkata, West Bengal, India, ⁸Getwell Hospital and Research Institute, Nagpur, Maharashtra, India, ⁹King George’s Medical University, Lucknow, Uttar Pradesh, India. E-mail: swapnil@purefoundation.in

Background: Spacers are very important accessory devices that ensure better drug delivery and deposition into the lungs when using a pMDI. They also reduce side-effects associated with inhaled steroids. We aimed to find out spacer compliance and factors responsible for non-compliance among asthmatic and COPD participants.

Methods: 52 asthmatic and 53 COPD subjects who were prescribed the use of a spacer along with pMDI for at least 15 days underwent an interviewee-administered questionnaire that captured the level of compliance and the factors associated with non-compliance.

Results: 61.5% of the asthmatic subjects and 71.7% of the COPD subjects were compliant with the use of spacer while using the pMDI. The reasons given by the 38.5% and 28.3% non-compliant asthmatic and COPD subjects, respectively, were – inconvenient to carry (65.7%), difficult in understanding how to use it correctly (25.7%), lack of confidence (17.1%), belief that spacers were not useful (37.1%), uncomfortable to use in front of others (34.3%) and difficulty in assembling, cleaning and maintaining (11.4%). 11.4% said they could not afford to buy the spacer.

Conclusion: One-third of asthmatic and COPD participants were non-compliant with the use of spacer device. Inconvenience and difficulty in using the device were cited as the most common reasons for non-compliance.

A comparative study on use of NIV with modafinil versus NIV only in acute hypercapnic exacerbation of COPD patients

Frank Mohan¹, P. Chakradhar Reddy¹

¹Santhiram Medical College, Nandhyal, Andhra Pradesh, India, E-mail: vfrankjoe@gmail.com

Introduction: Chronic Obstructive Pulmonary Disease is now one of the top three causes, accounting for 6% of all deaths globally. Advanced COPD patients have repeated admissions due to exacerbations with hypercapnic respiratory failure (HRF) with average stay of 8–11 days. NIV is the usualtreatment. Modafinilused in narcolepsy has action on the central nervous system with effect on respiratory drive via the brain stem.

Methodology: An observational cohort study performed over 6 months in the ICU of a tertiary care teaching hospital in Nandhyal, AP. 50 patients of moderate to severe hypercapnic (>50 mmHg) exacerbation patients of COPD were recruited and allocated to either NIV with Modafinil (n=25) or only NIV (n=25).Modafinil200mg and NIV with IPAP and EPAP minimum to maximal pressures were –12-20 and 4-10cm of h2o respectively were used.

Results: The mean age was 62 yrs, mean BMI was 26.7 kg/m2 and 54 patients (75%) were male. The decrease in co2 to normal (<45 mmhg) after 48,72,96 and 120 hrs in NIV with Modafinil versus NIV only, were 16,36,72,92% versus 8,24,48,64%and invasive ventilation required in 8% versus 24 % respectively.

Conclusions: This study shows modafinil has role even in acute hypercapneac respiratory failure in addition to NIV in the outcomeof COPD patients.

Montelukast in children under-five with recurrent wheeze: An observational study

Rashmi Ranjan Das, Amit Kumar Satapathy, Joseph John, Samarendra Mahapatro

Department of Pediatrics, All India Institute of Medical Science, Bhubaneswar, Odisha, India. E-mail: rrdas05@gmail.com

Background: Children under-five years of age often develop wheezing, and out of them nearly one-third develop recurrent wheeze subsequently. Montelukast is a leukotriene antagonist that is often prescribed by paediatricians for treatment of recurrent wheeze in children. However, studies have shown variable results regarding its benefits. We conducted this study to evaluate the role of montelukast and factors affecting the outcome in under-five children with recurrent wheeze.

Methods: This observational study was conducted over 3 years period at AIIMS Bhubaneswar. Children with recurrent wheeze in age groups of 6 months to 5 years taking Montelukast were evaluated. Diagnoses based on symptoms of recurrent wheeze triggered by various allergens were made. Follow-up data were recorded at 1, 3, and 6 month. Labelling of control (controlled, partially controlled, or uncontrolled) was made as per GINA guidelines. Factors affecting treatment response to Montelukast were analysed.

Results: Of 207 children taking Montelukast, complete follow-up data were available for 184. At the end of 6 months, 69% had controlled, 7% had partially controlled, and 24% had uncontrolled symptoms. Factors associated with poor symptom control were: onset of wheezing before 6 month age, presence of other allergic symptoms (rhinitis, atopic dermatitis), family history of atopy, presence of eosinophilia, and prior hospitalization with acute exacerbation. Side effects were not significant.

Conclusions: Montelukast is a good drug that was effective in symptom control in more than two-third children with recurrent wheeze. Underlying factors as mentioned above could result in poor response to treatment.

Higher prevalence of IGE sensitisation against pyroglyphid mites in persistent asthma patients attending tertiary health care centre, Telangana

Anvesha tummala, T. Pramod Kumar, G. Nalini, G. Sravan, V. Karthik

Department of Pulmonary Medicine, Osmania Medical College, Hyderabad, Telangana, India. E-mail: anveshatummala@gmail.com

Background: Bronchial asthma is on rise worldwide including developing countries like India. In India alone, roughly 15% of the people suffer from bronchial asthma. Allergic asthma is one of the phenotypes which is characterized by airway hyperresponsiveness to inhaled allergens. The optimal management of allergic diseases requires the identification of the allergic sensitivities of the patient. In view of increasing evidences of increased indoor allergen sensitization from different parts of India due to rapid urbanization, there is a need to screen for sensitization to indoor allergens to prevent further exposure and reduce symptomatic periods. The present study was conducted in persistent bronchial asthma patients attending tertiary health care centre in Telangana.

Materials and Methods: Diagnosed cases of persistent asthma (as per GINA guidelines) attending OPD & IPD, willing to give consent for examination fulfilling the inclusion and exclusion criteria are given questionnaire and patients were tested with purified extracts of 36 various indoor and fungal allergens by skin prick test with good positive and negative controls. Skin prick test was performed with proper standardized techniques based on the history obtained from questionnaire

Results: Out of 100 patients, 80% patients were sensitised to a total of 26 allergens. Like most of the studies, the most common indoor allergen group was house dust mites followed by dust allergens and fungi. Dermatophagoides pteronyssinus was the most common allergen followed by Dermatophagoides farinae.

Bacteriological profile in sputum and their antibiogram among the patients of acute exacerbation of COPD

G. Lavanya, V. Nookaraju, Y. Gayathri Devi, B. Padmaja

Department of Pulmonary Medicine, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India. E-mail: lavanyag0023@gmail.com

Background: Chronic Obstructive Pulmonary Disease (COPD) is an important cause of disability and death globally and scenario has been infact worsened. Acute Exacerbation of COPD (AECOPD) is associated with airway inflammation resulting in increased air trapping, further obstruction of airways and deterioration of gas diffusion. Bacteria are responsible for 30 – 35 % of exacerbations.

Objectives: To determine the bacteriological pathogens causing AECOPD and their antibiotic susceptibility pattern.

Methods: This is a prospective study comprising of 160 patients diagnosed with AECOPD. Before starting on antibiotics all patients sputum was sent for culture and sensitivity. All patients were instructed to collect early morning, deep coughed sputum into sterile sputum container.

Results: The present study reveals that total 160 cases, 67% were males and 33% were females. Out of 160 patients, 48.7% had positive sputum culture and rest 51.3% had negative sputum culture report. The most common organisms isolated were gram negative bacilli (71%) and gram positive bacilli (29%). Klebsiella pneumoniae

(26.7%) was the commonest bacteria isolated followed by Pseudomonas aueroginosa

(22.2%) and Streptococcus pneumoniae (20%). The drug sensitivity testing revealed that 100% of the isolates were sensitive to Colistin and Polymyxin-B followed by carbapenems (86 %), Ciprofloxacin (80%), Gentamycin (75%).

Conclusion: AECOPD is more common in adult males above the age of 50 years secondary to smoking practices. With continuously changing bacterial flora of AECOPD, choice of antibiotic should be based on the local bacterial resistance pattern. Periodic studies to identify probable agents and their antibiotic sensitivity pattern would assist in formulating a cost effective antibiotic strategy reducing the emergence of drug resistance.

A study of correlation between asthma control test and lung function parameters

Antiha Elaiyalwar, Rowhit Yanamadala

E-mail: anithaelaiyalwar@gmail.com

Introduction: Asthma control is the extent to which symptoms of asthma observed in patients and reduction in symptoms after treatment. Simple screening tools are available to assess asthma control. Asthma control test is a simple numerical scoring system that can be easily used on a routine basis. Latest GINA guidelines stress that asthma control is the main objective of asthma treatment. In this COVID pandemic situation there is a hesitancy in performing and undergoing pulmonary function tests among physicians and the patients. Hence in this study was planned to correlate the asthma control test values with FEV1 and other parameters like PEFR, AEC and serum magnesium.

Methods: This study was conducted at Department of Pulmonary Medicine, SRM Hospital & Research centre, Chennai. It is a retrospective cross-sectional observational study. Patients of Bronchial Asthma in line with GINA Guidelines were included in the study. AIMS and OBJECTIVES: To study the correlation between asthma control test and FEV1, To study the correlation between asthma control test and other parameters like Peak expiratory flow rate, Absolute eosinophil count and Serum magnesium.

Results: Asthma control test had positive correlation with FEV1 with a spearman’s correlation of 0.2758 and P value of 0.0414 which was statistically significant. The spearman’s correlation between Asthma control test and AEC was -0.4583 with a P value of 0.00043, which was significant. The correlation of asthma control test with serum magnesium was 0.3414 with a p value of 0.010.

Conclusion: Asthma control test score had a significant positive correlation with FEV1 and serum magnesium levels. It also had significant negative correlation with Absolute eosinophil count (inflammatory marker). Hence Asthma control test can be used as tool for treatment response in the current COVID pandemic situation and also in resource limited settings.

A prospective study of thyroid dysfunction and clinical profile in COPD patients in a tertiary care centre

Gunjan Shrma, Anil Saxena, Varsha

E-mail: drdipanshujain@gmail.com

Introduction: COPD is a chronic systemic disease affecting the vital organ systems in the body, since it is not confined to affect only the respiratory system. Among the Endocrinological disorders, Thyroid disease is quite common among COPD individuals. Hypothyroidism adversely affect the quality of life in COPD individuals. Severity of hypothyroidism linearly correlates with muscle weakness & myopathy.

Objectives: A prospective study of thyroid dysfunction and clinical profile in COPD patients.

Methodology: This present study will be conducted on 100 adult COPD.Patients were made to undergo pulmonary function tests, for 3 times at every 15 minutes interval and best of 3readings was taken. The Forced Vital Capacity (FVC), Forced Expiratory Volume at the end of one second (FEV1), FEV1/ FVC ratio were recorded.

Results: A total of 100 cases of COPD were evaluated, of which 61 (61%) were observed to be having thyroid disorders. Hypothyroidism was diagnosed in 55 cases and hyperthyroidism in 6 cases.

Conclusion: The results of this study indicate that thyroid disorders are frequent in patients with chronic obstructive pulmonary disease patients. The thyroid functions were at lower normal range in patients with COPD. Hence COPD patients have higher prevalence of hypothyroidism.

A study of clinical, physiological and radiological features among various phenotypes of COPD

Amirul Haque, Gajendra Vikram Singh, Santosh Kumar, Sachin Kumar Gupta

Department of TB and Respiratory Diseases, S. N. Medical College, Agra, Uttar Pradesh, India. E-mail: amihaq2202@gmail.com

Background: Chronic obstructive pulmonary disease (COPD) is now one of the top three causes of the death worldwide and 90% of these deaths occur in low- and middle-income countries. Non-smokers COPD exhibit a different phenotypic variation and it also forms a major chunk in overall COPD burden. Important risk factors leading to COPD in Non-smokers are Biomass Fuel Exposure, Occupational exposure to dust and chemical fumes, Air pollution, chronic asthma and childhood pulmonary infections.

Methods: A prospective cross-sectional study was done and Total 104 patients were enrolled after spirometry who were having FEV1/FVC ratio < 0.7(GOLD Criteria) and were divided into 2 groups on the basis of smoking history. Patients were evaluated for Demographical profile, Clinical symptoms, Physiological changes and Radiological changes.

Results: In our study we found that Non-smoker COPD is 39.4% in overall COPD patients. Female patients were higher in Non-smoker group (68.3 vs 23.8%, P=0.001). Mean age was higher for smoker COPD patients (62±9 vs 58.5±13.5, P=.0001). Cough with expectoration was predominant feature reported followed by breathlessness in non-smokers COPD (56 vs 36%) vs smokers (20 vs 60%) P<.001. Patients were having severe breathlessness in smokers in comparison to non-smokers (76% vs 56%). On Chest Xray and HRCT hyperinflation and emphysema was more common in smokers (66 vs 48%,P<.o2).

Conclusion: Non-smoker phenotype is common in females, younger age presentation, less severe symptoms, less radiological changes.

Electrolyte imbalance -A disparaged entity in acute exacerbations of COPD

R. Nandhini, M. Saravanan, P. Arulkumaran, P. M. Ramesh

Government Thiruvotteswarar Hospital of Thoracic Medicine, Government Kilpauk Medical College, Chennai, Tamil Nadu, India. E-mail: nandhiniravikumar1996@gmail.com

Aim and Objective: To characterize the pattern of serum electrolyte abnormality among patients with acute exacerbation of copd admitted in our hospital which are often missed but they contribute to a great deal of mortality and morbidity among copd patients with acute exacerbations.

Materials and Methods: This is a cross sectional observational study done among copd patients admitted with acute exacerbation in our hospital. Study was conducted among patients of both sexes who were above 40 yrs. of age. Patients with congestive cardiac failure, liver failure, renal failure and non cooperative patients are excluded from the study. After admission each patient is assessed by history and clinical examination. Serum electrolytes (sodium and potassium) are measured on admission.

Results: 50 copd patients admitted with exacerbations were studied. Among 50 cases,29 (58%) had electrolyte abnormality,21 (42%) had normal level. Among 29 cases, isolated hyponatremia in13 (26%),isolated hypokalemia in10 (20%), isolated hypernatremia in 3 (6%),isolated hyperkalemia in in3 (6%).16 cases (32% ) had combined abnormality. Age distribution-40-50 yrs (10 cases-20%), 51-60 (25cases-50%), 61-70 (12 cases-24%),>70 (3case-6%). Sex distribution-male 36 cases (72%),female 14 cases (28%).About 15 cases(30%) had severe abormality(hyponatremia-6, hypokalemia-7,Hyperkalemia-1,combined-1) for which correction was done.

Conclusion: There are numerous factors contributing to electrolyte imbalance(sodium and potassium) in COPD acute exacerbation patients which include chronic hypoxia, hypercapnia, cor pulmonale, use of diuretics, SIADH, malnutrition ,poor intake, use of steroids and bronchodilators. Hence it is important to identify electrolyte level and treat the abnormality if present as it adds on to significant reduction in morbidity and mortality among the copd patients with acute exacerbations.

Oxygen Desaturation in 6MWT as risk factor to study various outcomes in COPD patients

Shringi Sameeksha¹, V. K. Jain¹, M. Mishra¹, L. Maan¹

¹Department of Respiratory Medicine, M. G. Medical College & and Hospital, Jaipur, Rajasthan, India. E-mail: sameekshashringi@gmail.com

Background: Desaturation during 6 minute walk test in stable COPD patients of various spirometry grading is an important tool for predicting various outcomes i.e. acute exacerbations, frequency of hospitalizations, mortality.

Materials and Methods: Stable COPD cases of various spirometry grading attending OPD of Depart. Of Respiratory Medicine at MGMC, Jaipur those desaturated during 6 minute walk test were 36 out of 110 total stable COPD cases, with baseline spo2 >90% ,age >40 years & no exacerbations in past 6 weeks.

Results:

Mean age higher & Mean 6 minute walk distance less (179+58 m) in desaturated cases

• 1) Male predominance with majority smokers

• 2) Females desaturated more than males

• 3) Desaturation higher in higher grades

• 4) Among desaturated all had A/E with frequency 1-3 in 1 year follow up & of higher grades.

• 5) Rate of hospitalization more in desaturated cases

• 6) Mortality higher in desaturated cases with higher spirometry grades.

Conclusion: Our study concluded that about 1/3rd patients of COPD are having desaturation during 6MWT which is highly prevalent in smokers & more in female smokers possibly due to dual effect of biomass exposure & smoking. The high prevalence of desaturation is also related with severe and very severe spirometry grading. Patients who desaturate during 6MWT are more likely to have various serious outcomes i.e. increase frequency of A/E, more hospitalization and high mortality with highest cause of death due to respiratory failure type 2. In our study desaturation during 6 MWT is found to be good predictor of hospitalization, exacerbations and mortality. The desaturation during 6 MWT is important non invasive clinical parameter to judge various serious outcomes of diseases as mentioned above & prognosis therefore it should be followed in follow up clinical practise for better management and to judge future progression of disease.

A prospective comparative study comparing the outcome of HFNO Therapy VS NIV in COPD patients with hypercapnic respiratory failure admitted in a tertiary care centre

Pratheeb Kumar¹, R. Sridhar¹

¹Department of TB and RD, Stanley Medical College, Chennai, Tamil Nadu, India. E-mail: cmpk123@gmail.com

Aim: To compare the outcome of HFNO vs NIV in copd patients with hypercapnic respiratory failure.

Methodology: The patients were assigned randomly into two groups.one set of patients of received HFNO delivered continuously at a flow rate of 40-50 lit/min with FiO2 in the range of 30% to 40%. The other group received NIV (BIPAP).Both set of patients received therapy with corresponding devices till weaning off. Those who fail to respond to therapy were shifted to other suitable alternative therapies. A serious of AGBA was also performed.

Results: A total of 44 patients,22 in the NIV(BIPAP) and 22 in the HFNO group.In NIV there were 2 failures and in HFNO 3 failures.so the patients who were weaned off - 20 in NIV and 19 in HFNO. There was no significant differences found over the failure rates (p=0.226) and in increase in pH ( p=0.244) and decrease in pCO2 (p=0.801) at the time of discharge and recovery time between the two groups(p=0.240). There was siginificant statistical difference in the improvement of respiratory rate and pO2 between the two groups (p=0.0003) and (p=0.003) which showed that patients on HFNO showed better improvements. However patients on NIV (BIPAP) experienced more discomfort and intolerance compared to the HFNO group.

Conclusion: Among COPD patients with mild to moderate type 2 respiratory failure, the use of HFNO over NIV (BIPAP) didn’t result in increased rates of failure and there was also no difference in the improvement of pH and pCO2. However patients on HFNO better tolerated it and had significant improvement in respiratory rate and pO2 compared to NIV at the end of treatment.

Swyer James macleod syndrome in adulthood: A rare presentation of a rare lung disease

Maninder Singh, J. K. Mishra, Akhilesh Tiwari

Institute of Medical Sciences, BHU, Varanasi, Uttar Pradesh, India. E-mail: dr.manindersigh117@gmail.com

Background: Swyer James MacLeod Syndrome is a rare lung disease arising as a complication of recurrent respiratory infections in childhood characterized by unilateral hyperlucent lung. First reported by Swyer and James in 1953 in a young child, then by MacLeod in a series of nine patients in 1954. Recurrent injury by infections cause functional hypoplasia of bronchial vasculature imparing growth of affected lung.

Case Study: A 65-year-old woman with history of recurrent infections in childhood presented with shortness of breath for 1 month and cough for 1 month, with history of yearly chest infections for past 3 years. Examination revealed reduced air entry on the right, basal crepts on left side. CXR showed hyperlucency on right lung field. HRCT thorax bewrayed areas of decreased lung attenuation with reduced calibre of segmental pulmonary branches in right upper lobe, air trapping with oligemia, bronchiolitis obliterans.

Discussion: SJMS was described in small or normal sized affecting lung but in our case it is large sized hyperlucent lung. Furthermore, in most cases diagnosis occurs in childhood but patient remained asymptomatic for >60years.

Conclusion: Large hyperlucent lung may be the affected lung in SJMS. Patient with SJMS may remain asymptomatic, and present in adulthood.

Clinico-radiological parameters affecting the quality of life in patients with bronchiectasis

G. Divya, Ravula Sarika, Somanath Dash, Kondala Rao

GSL Medical College, Rajahmundry, Andhra Pradesh, India. E-mail id:gavinidivya13@gmail.com

Background: Bronchiectasis is a chronic respiratory disorder due to which patients experience significant morbidity. Consequently, the quality of patient’s life is jeopardized.

Aim of the Study: The present study is aimed to assess the respiratory quality of life in relation to various clinical and radiological parameters of patients.

Objectives:

• 1. Assess the clinical profiles of patients

• 2. Assess radiological types and extend of bronchiectasis

• 3. Assess the respiratory quality of life by using St George Respiratory Questionnaires (SGRQ)

• 4. Relate the clinical and radiological profile with the respiratory quality of life.

Methods: We conducted hospital based cross sectional study and recruited 40 patients, who were diagnosed as bronchiectasis clinically and radiologically. Clinical presentations and extent of the disease in HRCT were observed. The respiratory quality of life was estimated, using the SGRQ questionnaire. Statistical analysis was done to check relationships between these variables.

Results: In this study we found a significant correlation of BMI, severity of airway obstruction and radiological extent of the disease with the quality of life in bronchiectasis patients.

Conclusion: We conclude that the structural changes leading to obstruction in bronchiectasis patients affect the quality of life. Patients with lower BMI and low FEV1 percentage had effect on their quality of life. The respiratory quality worsen with higher degree of structural changes in the lungs.

International, prospective real-world study of mepolizumab in patients with severe asthma at one year: Realiti-A

Charles Pilette¹, Giorgio Walter Canonica^2,3, Rekha Chaudhuri⁴, F. Eun-Hyung Lee⁵, Jason Kihyuk Lee⁶, Carlos Almonacid Sanchez⁷, *Aanchal Gvalani, Rafael Alfonso-Cristancho⁸, Rupert Jakes⁹, Aoife Maxwell¹⁰, Robert Price¹¹, Peter Howarth¹²

¹Cliniques Universitaires Saint-Luc and Institute of Experimental and Clinical Research, UCLouvain, Brussels, Belgium, ²Department of Biomedical Sciences, Humanitas University, Milan, Italy, ³Personalized Medicine, Asthma and Allergy Clinic, Humanitas Research Hospital, Milan, Italy, ⁴Gartnavel General Hospital and University of Glasgow, Glasgow, UK, ⁵Emory Vaccine Center, Emory University, Atlanta, GA, USA, ⁶Evidence Based Medical Educator, Toronto Allergy and Asthma Clinic, Toronto, ON, Canada, ⁷H. Ramce Based Medical Educator, ⁸Value Evidence and Outcomes, GSK, Collegeville, PA, USA, ⁹GSK, London, UK, ¹⁰Real World Study Delivery, Value Evidence and Outcomes, Global Medical, GSK, Stevenage, Hertfordshire, UK, ¹¹GSK, Stevenage, Hertfordshire, UK, ¹²Global Medical, Global Specialty and Primary Care TA, GSK House, Brentford, Middlesex, UK, *Medical Affairs, GSK India. E-mail: aanchal.a.gvalani@gsk.com

Background: Mepolizumab improves asthma control in patients (pts) with severe asthma in clinical trials, but real-world data is limited. The aim is to assess real-world clinical outcomes in pts initiating mepolizumab treatment.

Methods: REALITI-A is a 2y, international, prospective, single-arm, observational cohort study enrolling pts with severe asthma, newly prescribed mepolizumab 100mg SC. 1y pre-exposure exacerbation data availability was a prerequisite. Primary endpoint: rate of clinically significant exacerbations (CSEs; requiring oral corticosteroids [OCS] and/or emergency room [ER] visit/hospitalisation). Exacerbations requiring ER visit/hospitalisation and maintenance OCS (mOCS) were key secondary endpoints; investigator-determined treatment-related adverse events (TRAEs) were collected. Our interim analysis includes all pts at 1y follow-up (median 366days).

Results: 822 treated pts included (mean age, 54.0y; 63% female; geometric mean blood eosinophil count, 353cells/µL; smoker: former/current 40%, never 60%; 39% on mOCS). CSEs reduced from 4.28 (pre-) to 1.23 (post-exposure) events/y (RR: 0.29 [95%CI 0.26,0.32]). Exacerbations requiring hospitalisation/ER visits reduced from 0.95 to 0.23 events/y (RR: 0.24 [0.20,0.29]). mOCS dose data were available for 298 (baseline) and 222 (wk53–56) pts. Median mOCS dose reduced from 10 (baseline) to 2.5mg/day at wk53–56; 43% (95/222) stopped mOCS by wk53–56. 85 (10%) pts had on-treatment TRAEs, 6 (<1%) serious on-treatment TRAEs; 1 fatal (hepatic cancer).

Conclusions: This real-world study of mepolizumab in pts with severe asthma shows clinical effectiveness with marked reductions in CSE and mOCS use.

Funding: GSK [²⁰⁴⁷¹⁰] Previously presented at ERS 2021, Eur Respir J. 2021;58 (Suppl 65):PA3539.

Cross-sectional study of pulmonary arterial hypertension among patients of chronic obstructive pulmonary disease at IRD, SMS Medical College, Jaipur

S. Carishma, Suresh Koolwal, Govind S. Rajawat, Santosh Hammigi

SMS Hospital, Jaipur, Rajasthan, India. E-mail: carish.s.01@gmail.com

Background: Pulmonary arterial hypertension is a common complication in COPD,increasing the mortality and morbidity of patients.

Aims and Objectives: To study the prevalence of pulmonary artery hypertension (PAH) in COPD patients and to correlate its association with stages of COPD and Six minute walk test.

Materials and Methods: This cross-sectional study is conducted in 100 COPD patients diagnosed by spirometry, severity and staging was determined according to Global Initiative for Chronic Lung Disease (GOLD) classification criteria. Screening two-dimensional echocardiography was done to assess pulmonary artery hypertension. Excercising capacity of patients was assessed by 6MWT.

Results: Out of 100 patients, PAH was present in 72 cases consisting of mild grade 25(25%),moderate grade 26(26%),severe grade(21%).In GOLD A stage, there were 4 cases of mild PAH and stage B contained 16 cases of mild PAH and 3 cases of moderate PAH. Stage C included 2,9,1 cases of mild ,moderate and severe cases of PAH respectively. Stage D comprised 3 mild PAH, 14 moderate PAH cases and 20 severe cases. Patients with mild PAH covered more six minute walk distance than patients with severe PAH.

Conclusions: PAH is a common complication in COPD. Therefore incooperating early cardiac screening and six minute walk test in all COPD patients will be helpful in the assessment of prognosis, morbidity and mortality.

A cross-sectional study of the prevalence of non-eosinophilic bronchial asthma phenotypes in patients attending a rural tertiary care centre

Sharanya Amburay, Jereen Varghese, S. Sreekaanth, Satish Mededi, Viswambhar Vallabhaneni, R. Ragulan

Department of Respiratory Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Tamil Nadu, India. E-mail: sharanyaamburay@gmail.com

Aim: To study the prevalence of non-eosinophilic bronchial asthma phenotypes in patients attending a rural tertiary care centre in Ammapettai, Tamil Nadu.

Methodology: This is a cross-sectional study among 69 patients with bronchial asthma attending the Department of Respiratory Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai, a tertiary care hospital, over a period of 12 months. All diagnosed bronchial asthma patients were evaluated and then subjected to total and differential leucocyte count, along with sputum cytology.

Results/Discussion: Using these parameters, the prevalence of non-eosinophilic phenotypes was assessed and it was found that 12 patients had neutrophilic, and 46 patients had eosinophilic phenotype.

Conclusion: Our study provides an insight into non-eosinophilic bronchial asthma phenotypes in a rural population that may be appropriately applied in developing nations and in formulating patient-centric treatment plans for the same. It also uses sputum cytology along with leucocyte count for differentiating non-eosinophilic phenotypes which will further aid in tailoring treatment for individual patient needs. Further studies with higher sample size and follow-up for outcomes and related factors will give information and better understanding, and in turn help furthering the interest in these bronchial asthma phenotypes.

Assessment of cognitive functions in patients with chronic obstructive pulmonary disease

Kurudamannil Hitesh Cheran, K. Sreeram Kumar, Somanath Dash, K. Kondala Rao

GSL Medical College, Rajahmundry, Andhra Pradesh, India. E-mail: hitesh2cheran@gmail.com

Background: Chronic airflow limitation, is characteristic of COPD caused by mixture of small airway disease and parenchymal destruction leading to irreversible loss of lung function. The brain, in particular, may be vulnerable to the systemic effects of COPD. This may include cognitive derangement and gradual deterioration of mental function. This study was intended to observe the relationship between COPD and cognitive impairment.

Method:

A cross sectional case control descriptive study.

Study group-62 (44 males, 18 females).

Age-matched healthy control- 62 (46 males, 16 females).

Spirometry, CAT scoring, MMRC grading, smoking indices, number of exacerbations of the study group were correlated with Mini Mental Status Examination scoring (MMSE) of study group and healthy control group was also compared.

Results:

• • COPD group had a higher risk for cognitive impairment, compared to the control group

• • Higher age, prolonged duration of symptoms, low socio economic status, prolonged duration of smoking, high smoking index, higher grades of dyspnea, more degree of obstruction, more symptoms and more exacerbations are contributing factors for impairment in cognitive function in patients with COPD.

Conclusion: These factors can be considered as predictors of future cognitive derangement in COPD patients. While history taking and clinical examination, physician should consider these factors and take appropriate actions to prevent the patients from landing in severe disability.

Spirometric parameters, exacerbation, and hospitalization in relation to the status of asthma control: An appraisal

Shuvam Ghosh¹, Debkanya Dey², Srijita Sen¹, Sayanti Karmakar¹, Sudip Ghosh¹, Parthasarathi Bhattacharyya¹

¹Institute of Pulmocare and Research, Kolkata, West Bengal, India, ²ICMR-SRF, Biotechnology and Dr. B. C Guha Centre for Genetic Engineering and Biotechnology, University of Calcutta, Kolkata, West Bengal, India. E-mail: shuvamg.ghosh@gmail.com

Background: Asthma control is one of the major targets of the disease for management. Understanding the status of control in relation to variables of airflow limitation in spirometry seems important.

Methods: We recorded (following ethical clearance) the demographic, clinical, spirometric data (FVC, FEV1, FEV1/FVC, FEF25-75) and history of exacerbation and / or hospitalization along with the results of Asthma Control Test and Asthma Control Questionnaire of asthmatics attending to our out-patient department. The GINA defined control status as “controlled”, “partially controlled” or “uncontrolled” were determined prospectively in the new patients and the initial thirty plus patients’ from each group were statistically analysed with one-way Anova and Chi square test using GraphPAD (version 8) in order to compare amongst the groups.

Results: Out of uncontrolled (n=32), partially-controlled (n=37), and controlled (n=30) subjects included, there was no difference in age, BMI and spirometric variables. However, among the groups, the ACT score (13.94±3.31, 18.65±260, 22.93±1.81) and the ACQ score (24.25±5.23, 20.8±4.46, 14.00±2.72) were significantly different (p value <0.0001 for both). The uncontrolled group had significantly higher exacerbation rate (56.25%) compared to the partially controlled (51.35%) and the controlled group (10%); (p value =0.0002). The events of hospitalisation in uncontrolled asthma has shown a higher trend.

Conclusion: There has been no significant difference in lung function amongst the different categories of asthma control. Exacerbations appears to be related significantly to the “control” status while hospitalisations have been found higher in uncontrolled asthma.

A rare case of bronchiectasis in autoimmune polyglandular syndrome type-1

Anitha S. Menon, S. Subramanian, N. Nalini Jayanthi

Department of Respiratory Medicine, SRM Medical College Hospital and Research Centre, Kanchipuram, Tamil Nadu, India. E-mail: dranithamenon10@gmail.com

Background: Lung diseases are very rare in patient with autoimmune polyglandular syndrome type-1. APS type-1 is caused by mutation in the autoimmune regulatory gene on chromosome 21 and is inherited in an autosomal recessive manner.

Case Study: A 21-year-old male patient presented with complaints of hemoptysis, chronic cough with expectoration for past 8 years and dyspnea on and off for past 8 years, loss of weight and loss of appetite for past 2 months. Patient has history of recurrent hospitalization with similar complaints for the past 8years. Patient had history of diffuse hyperpigmentation for past 8years. Routine blood investigation showed hyponatremia and hyperkalemia. Detailed endocrine evaluation showed features suggestive of APS. CT chest was done showed cystic bronchiectasis changes with interlobular septal thickening in bilateral lung fields.

Discussion: Severe respiratory manifestations in APS are likely to be related to the detection of autoantibodies against a potassium channel regulator expressed in the terminal bronchiolar epithelium. Only four cases of bronchiectasis with APS were reported in literature.

Conclusion: The possibility of pulmonary autoimmunity in APS should always be considered and distinguished it from concurrent obstructive lung disease or lower respiratory tract of infection. Steroids play a major role in improving respiratory symptoms in bronchiectasis with APS.

Detection of small airways disease by Impulse Oscillometry among smokers and non-smokers with normal spirometry

Ketan N. Malu, Jai Mullerpattan, Ashok Mahashur

Department of Respiratory Medicine, PD Hinduja Hospital, Mumbai, Maharashtra, India. E-mail: ketannmalu@gmail.com

Background: Smoking is recognized to be the most important risk factor for development of COPD. Small airways ( <2 mm) are the major site of resistance to airflow in obstructive lung disease and pathological changes could occur in the absence of spirometry impairment. Impulse oscillometry (IOS), an effort-independent technique, has the advantage of high sensitivity in detecting small airway resistance and elastance directly.

Objectives: The primary objective of the study was to detect the prevalence of small airways disease (SAD) using IOS in smokers and non-smokers with normal spirometry and its correlation with quality of life (CAT score).

Methods: This was a prospective, cross sectional study which included smokers (current/past) with smoking history of >10 pack years with no evidence of COPD on spirometry. The presence of SAD on IOS was calculated by measuring the R5-R20 values and was correlated to the CAT scores.

Results: 102 subjects were included with 51 smokers and 51 non-smokers. The mean age was 49.5yrs with male predominance (77.5%). Mean BMI was 27. 31.37% of smokers and 5.89% non-smokers had presence of SAD on IOS despite normal spirometry (p=0.0005). Higher pack year history correlated significantly with development of SAD on IOS (P=0.0001). Mean CAT scores in subjects with and without SAD was 11.79 and 4.69 respectively. Higher pack year history correlated with worse CAT scores. (p<0.001).

Conclusion: Presence of small airways disease is an indicator of early COPD. Impulse oscillometry is more sensitive in diagnosing SAD in patients with normal spirometry and help lead to early intervention.