Search

BackgroundIdentifying risk factors for poor outcomes can help with risk stratification and targeting of treatment. Risk factors for mortality and exacerbations have been identified in bronchiectasis but have been almost exclusively studied in European and North American populations. This study investigated the risk factors for poor outcome in a large population of bronchiectasis patients enrolled in India.MethodsThe European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) and Respiratory Research Network of India (EMBARC-India) registry is a prospective observational study of adults with computed tomography-confirmed bronchiectasis enrolled at 31 sites across India. Baseline characteristics of patients were used to investigate associations with key clinical outcomes: mortality, severe exacerbations requiring hospital admission, overall exacerbation frequency and decline in forced expiratory volume in 1 s.Results1018 patients with at least 12-month follow-up data were enrolled in the follow-up study. Frequent exacerbations (≥3 per year) at baseline were associated with an increased risk of mortality (hazard ratio (HR) 3.23, 95% CI 1.39–7.50), severe exacerbations (HR 2.71, 95% CI 1.92–3.83), future exacerbations (incidence rate ratio (IRR) 3.08, 95% CI 2.36–4.01) and lung function decline. Coexisting COPD, dyspnoea and current cigarette smoking were similarly associated with a worse outcome across all end-points studied. Additional predictors of mortality and severe exacerbations were increasing age and cardiovascular comorbidity. Infection with Gram-negative pathogens (predominantlyKlebsiella pneumoniae) was independently associated with increased mortality (HR 3.13, 95% CI 1.62–6.06), whilePseudomonas aeruginosainfection was associated with severe exacerbations (HR 1.41, 95% CI 1.01–1.97) and overall exacerbation rate (IRR 1.47, 95% CI 1.13–1.91).ConclusionsThis study identifies risk factors for morbidity and mortality among bronchiectasis patients in India. Identification of these risk factors may support treatment approaches optimised to an Asian setting.

Bronchiectasis is reported to be more frequent in females. There have been no large studies examining the impact of biological sex on disease characteristics, aetiology, severity, quality of life or management. Patients were prospectively enrolled from 2015 -2018 in 3 linked bronchiectasis registries in Australia, Europe and India. Disease information was collected, including quality of life (QoL-B). Analyses were conducted cross-sectionally using baseline data. 13859 patients were included from 29 countries. 57.6% were female. The highest proportion of females were in Australia (70.9%) and lowest in India (43.1%). Male sex was associated with bronchiectasis caused by COPD and TB; while female sex was associated with post-infectious bronchiectasis, asthma, connective tissue disease and NTM. Men had more severe disease as measured by the bronchiectasis severity index, but females more likely to be infected with Pseudomonas aeruginosa. Women had greater disease impact across multiple QoL-B domains including social, emotional and treatment burden domains. Cough and sputum purulence were more severe in women while men most frequently complained of wheeze and breathlessness. Men were significantly less likely to receive evidence based interventions including testing for immunodeficiency and ABPA, long term antibiotic treatment for frequent exacerbators, pulmonary rehabilitation and airway clearance techniques. Conclusion: There are striking sex differences in aetiology, severity, quality of life and treatment in patients with bronchiectasis

Actinomycosis is an indolent, slowly progressive infection caused by anaerobic or microaerophilic bacteria, primarily from the genus Actinomyces . Thoracic involvement is observed in approximately 15% of cases of infection with actinomycosis. Here, we present a case of a 61-year-old male who presented with recurrent endobronchial actinomycosis. The case is being presented because of its rarity on three counts – endobronchial involvement, which is uncommon, recurrence in different sites in the bronchial tree, which is even rarer and development of the disease following an endobronchial procedure.

Introduction: Allergic bronchopulmonary aspergillosis (ABPA) is a severe allergic inflammatory response to Aspergillus fumigatus and is often an unrecognized cause for bronchiectasis. Aims and Objectives: In this study, we aim to examine the burden of ABPA in the India bronchiectasis registry, the screening test perform and the phenotype characterization. Material and Methods: Among the 2197 cases of bronchiectasis enrolled in the Indian bronchiectasis registry, we examined the number of patients screened for ABPA and the proportion of screened positive ABPA cases. We also looked for phenotypic characterization using HRCT features, total IgE, eosinophil count, IgE and IgG specific to aspergillus and by skin prick test. Results: Out of 2197 cases of bronchiectasis cases register at 31 sites, only 387 (17%) cases were screened for ABPA 190 (49.1%) at 24 sites. Among these 190 cases, 99(52.1%) of all ABPA cases were male (mean age 44.85 ± 15.09 yr). 62.03% had the bronchiectasis for more than five years. Serum eosinophil count was raised in 115(60.5%) out of 146 (76.84%) cases. Raised IgG level was observed in 71 (74.74%) out of 95 (50%) cases. Specific IgE to aspergillus was raised in 117 (84.17%) out of 139 (73.16%) cases. Aspergillus skin prick test was tested positive in 83 (83%) out of 100 (52.63%) cases. Total IgE count was raised in 97 (54.19%) cases out of 179 (94.2%). Obstructive airways disease was found in 74 (52.5%) out of 141 (74.21%) cases tested by spirometry. The right middle lobe was involved in 66.32% cases in HRCT. Conclusion: Despite the universal screening for ABPA recommended by the ERS, only 17% were screened for ABPA of which 50% showed evidence of underline ABPA.

Nocardiosis is an uncommon gram-positive bacterial infection caused by aerobic actinomycetes of the genus Nocardia. It can be localized or systemic and is regarded as an opportunistic infection that is commonly seen in immunocompromised hosts. We report a case of disseminated nocardiosis caused by Nocardia cyriacigeorgica in a patient with underlying malignancy in whom the clinical presentation was highly suggestive of a metastatic disease.

Tracheomalacia is one of the rarest etiologies of chronic cough. Herein, we present the case of an elderly woman with chronic cough who on detailed evaluation was found to have focal (localized) tracheomalacia due to compression by an aberrant right subclavian artery (arteria lusoria). The absence of dysphagia in this patient also deserves particular mention.

Introduction: The diagnosis of Asthma and COPD at Primary care level in India is limited by lack of access to spirometry. Aims and Objectives: To determine the correlation of Peak flow recording and lung volumes on a portable mini-spirometer with the lung volumes measured by spirometry in patients with COPD and Asthma. Methods: A hospital based cross-sectional study was done at 2 tertiary care hospitals among patients diagnosed as COPD or Asthma based on a pre-&post-bronchodilator spirometry. A trained health worker performed performed measurements using a peak flow meter (Breath-O-meter®) as well as a mini-spirometer (COPD6®). The FEV1 / FVC values by spirometry were correlated with the values of peak flow and with the FEV1/FEV6 measured by the mini-spirometer. The sensitivity and specificity of the mini-spirometer (FEV1/FEV6 Results: 148 patients with obstructive airway disease were included. There was poor correlation for the PEFR with the FEV1/FVC on spirometry and for the FEV1/FEV6 or the FEV1 measured on a portable mini-spirometry with the FEV1/FVC or the FEV1 respectively on spirometry. A cut-off of Conclusions: Our study findings suggest that PEFR may be a good screening tool, whereas the mini-spirometer may be used as a diagnostic test in resource limted settings

Introduction: Though patients with advanced lung adenocarcinoma have a poor prognosis, molecular targeted therapy may improve outcomes. Moreover, the incidence of this disease among women is rising. So, a study on the molecular and clinical profile of adenocarcinoma lung in women is of chief importance. Aims: To find out the prevalence of EGFR (Epidermal Growth Factor Receptor) and ALK(Anaplastic Lymphoma Kinase) mutations among Indian women with adenocarcinoma lung and to evaluate clinical features and exposure to risk factors. Methods: All women with adenocarcinoma lung, including outpatients and inpatients, from May 2014 to May 2016, were included in this study. Lung adenocarcinoma was diagnosed by history, physical examination, chest X-ray, HRCT (High Resolution Computed Tomography) chest, histopathologic and cytologic examination and immunohistochemistry. All selected patients underwent analysis for EGFR and ALK mutations. The percentages of women positive for these mutations were calculated. Case record forms were used to evaluate clinical features and exposure to risk factors. The data were analysed and all the categorical variables were expressed in frequency(n) and percentage(%). Results: Out of the 31 patients with lung adenocarcinoma, 11 were positive for EGFR mutations and five, for ALK mutations. Thus, the prevalence of EGFR and ALK mutations were 35.48% and 16.13%, respectively. Conclusion: This study reveals a higher EGFR mutation prevalence in lung adenocarcinoma patients compared to that of populations of European descent. It is also comparable to the findings from the studies in other Asian populations. It also reveals a higher ALK mutation prevalence than what is reported in the literature.

Tracheomalacia (TM) refers to loss of tracheal rigidity and resulting susceptibility to collapse. It is usually an incidental finding during investigations of other illness. The main symptoms are dyspnoea, cough, sputum production and hemoptysis. Most cases are considered as respiratory infection and are treated symptomatically. Acquired TM results from damage to trachea due to various conditions such as inflammation, chronic pressure, or medical/surgical procedures. The diagnosis is done by end-expiratory dynamic tracheal imaging, which demonstrates typical crescentric narrowing of trachea and reduced antero-posterior diameter

Although diaphragmatic anomalies such as an eventration and hiatus hernia are commonly encountered in incidental chest X-ray imaging, the presence of concomitant multiple anomalies is extremely rare. This is all the more true in adults. Herein, we present the case of a 75-year-old female, while undergoing a routine chest X-ray imaging, was found to have eventration of right hemidiaphragm along with a hiatus hernia as well.

Background Common causes of exacerbations in chronic obstructive airway disease (COPD) are due to infections by respiratory viruses and bacteria. Influenza vaccine and pneumococcal vaccine have demonstrated decrease in infective exacerbations in this population. Methods In this prospective study over 2 years, 146 COPD patients confirmed by spirometry in accordance with GOLD criteria and who received both influenza and pneumococcal polysaccharide vaccine were compared with 146 unvaccinated controls. Number of acute exacerbations, hospitalizations, ICU admissions, need for invasive mechanical ventilation, mortality difference for 1 year following vaccination were compared. Results In vaccinated group there was statistically significant reduction in number of exacerbations of COPD, requirement of hospitalization, ICU admissions and mortality which is depicted in the table. Requirement of mechanical ventilation was higher among cases compared with controls more so among GOLD 3 and 4, which is statistically significant. COPD Vaccinated Unvaccinated P value Number of exacerbations 3.23 4.5