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Pulmonary Rehabilitation (PR) is an essential and comprehensive intervention recommended in the management of people with chronic respiratory diseases (CRD). Scientific evidence suggests significant health benefits with respect to repeated hospital admissions, exercise tolerance and Health Related Quality of Life (HRQoL). However, the uptake and completion of PR programs are globally low. In order to understand the factors contributing to underutilization of PR, it is important to review and recognize the barriers to PR program. A literature search was conducted on Medline (PubMed) database. After reviewing the title and abstracts, full text articles were scrutinized for their relevance. Twenty-two studies involving factors affecting the uptake, participation and completion of PR program were included in this review. Reported barriers to PR were healthcare system, healthcare professional and patient related factors. Primary factors related to healthcare system and healthcare professionals were fewer PR centers, accessibility inconvenience, lack of awareness of PR program, low knowledge of referral process and lack of interdisciplinary teamwork. Difficulties faced by patients to take up and/or to complete PR programs were lack of transportation, co-morbidities, lack of perceived benefits, socio-economic status and lack of funding facilities. Identified and reported barriers resulted into discontinuity between knowledge of health benefits and utilization of PR service for patients with CRDs. Addressing the barriers would accelerate the healthcare professionals' referral and patients to avail the health benefits of rehabilitation service.

Background: India contributes to 32% of the total global disability-adjusted life years, due to chronic respiratory diseases. This has led to a high rate of health loss from these diseases. Antibiotics are commonly used in the management of respiratory disorders. With excellent tissue penetration, prolonged tissue persistence, and favorable side effect profile, macrolides are one of the best treatment options being recommended for respiratory, urogenital, dermal, and other bacterial infections. Still, there is a lack of clinical trial data on the use of macrolides in the management of respiratory chronic disease, and hence, there is a need for clinical guidance on their use in Indian setting. Methods: A systematic review of the literature was conducted on PubMed, Cochrane database, and Google Scholar. Existing guidelines, meta-analyses, systematic reviews, randomized controlled trials (RCTs), non-RCTs, landmark studies, and key-cited articles were selected. Recommendations were based on available evidence and expert panel's logical empiricism and consensus. Results and Discussion: This article discusses evidence-based and clinical practice based management of chronic respiratory conditions including chronic obstructive pulmonary disease, asthma, bronchiectasis, diffusive panbronchiolitis, and organizing pneumonia. The authors reviewed different respiratory conditions, role of macrolides in their management, adverse events and antimicrobial resistance associated with macrolides, evidence review of various clinical trials, guideline recommendations, and clinical recommendations.

Background: India has high prevalence of chronic respiratory diseases, especially bronchial asthma and chronic obstructive pulmonary disease (COPD). Both of these are also recognized as risk factors for severity and poor outcome of COVID-19 disease. It is assumed that COVID-19 outbreak as well as an effective lockdown might have affected the incidence and outcome of some of these. Methods: To substantiate above hypothesis, an online survey was mailed to 547 pulmonologists across the country; 314 (54.7%) responses were recorded in the given period. The survey included observations on incidence and outcome of common chronic respiratory diseases such as asthma, COPD and interstitial lung diseases (ILD) in predefined pre-COVID and during COVID period in a total of 24 questions. Results: It was observed that the reduction in incidence of outpatient department cases, acute exacerbations and hospitalization for asthma, COPD and ILD was statistically significant. The outcome of acute exacerbations of these chronic respiratory diseases was analyzed in terms of discharges from hospitals after satisfactory recovery and/ or mortalities. For COPD and ILD, it was not significantly affected during the COVID period. At the same time, a relatively higher proportion of acute asthma mortality was reported. A wide variation in nebulization practices was reported during this period. The doses of inhaled corticosteroids in asthma management were not affected. A wide variety of factors including effective lockdown, better quality of air and regular use of masks were probably responsible for reduced incidence of exacerbations of these chronic respiratory diseases. Conclusion: We conclude that while outpatient department visits, acute exacerbations and hospitalizations were significantly reduced during COVID-19 period, outcome of asthmatics was relatively unfavorable as compared to that of COPD and ILDs.

Background: India has high prevalence of chronic respiratory diseases, especially bronchial asthma and chronic obstructive pulmonary disease (COPD). Both of these are also recognized as risk factors for severity and poor outcome of COVID-19 disease. It is assumed that COVID-19 outbreak as well as an effective lockdown might have affected the incidence and outcome of some of these. Methods: To substantiate above hypothesis, an online survey was mailed to 547 pulmonologists across the country; 314 (54.7%) responses were recorded in the given period. The survey included observations on incidence and outcome of common chronic respiratory diseases such as asthma, COPD and interstitial lung diseases (ILD) in predefined pre-COVID and during COVID period in a total of 24 questions. Results: It was observed that the reduction in incidence of outpatient department cases, acute exacerbations and hospitalization for asthma, COPD and ILD was statistically significant. The outcome of acute exacerbations of these chronic respiratory diseases was analyzed in terms of discharges from hospitals after satisfactory recovery and/ or mortalities. For COPD and ILD, it was not significantly affected during the COVID period. At the same time, a relatively higher proportion of acute asthma mortality was reported. A wide variation in nebulization practices was reported during this period. The doses of inhaled corticosteroids in asthma management were not affected. A wide variety of factors including effective lockdown, better quality of air and regular use of masks were probably responsible for reduced incidence of exacerbations of these chronic respiratory diseases. Conclusion: We conclude that while outpatient department visits, acute exacerbations and hospitalizations were significantly reduced during COVID-19 period, outcome of asthmatics was relatively unfavorable as compared to that of COPD and ILDs. [ABSTRACT FROM AUTHOR]

Background: India contributes to 32% of the total global disability-adjusted life years, due to chronic respiratory diseases. This has led to a high rate of health loss from these diseases. Antibiotics are commonly used in the management of respiratory disorders. With excellent tissue penetration, prolonged tissue persistence, and favorable side effect profile, macrolides are one of the best treatment options being recommended for respiratory, urogenital, dermal, and other bacterial infections. Still, there is a lack of clinical trial data on the use of macrolides in the management of respiratory chronic disease, and hence, there is a need for clinical guidance on their use in Indian setting. Methods: A systematic review of the literature was conducted on PubMed, Cochrane database, and Google Scholar. Existing guidelines, meta-analyses, systematic reviews, randomized controlled trials (RCTs), non-RCTs, landmark studies, and key-cited articles were selected. Recommendations were based on available evidence and expert panel's logical empiricism and consensus. Results and Discussion: This article discusses evidence-based and clinical practice based management of chronic respiratory conditions including chronic obstructive pulmonary disease, asthma, bronchiectasis, diffusive panbronchiolitis, and organizing pneumonia. The authors reviewed different respiratory conditions, role of macrolides in their management, adverse events and antimicrobial resistance associated with macrolides, evidence review of various clinical trials, guideline recommendations, and clinical recommendations. [ABSTRACT FROM AUTHOR]

Pulmonary Rehabilitation (PR) is an essential and comprehensive intervention recommended in the management of people with chronic respiratory diseases (CRD). Scientific evidence suggests significant health benefits with respect to repeated hospital admissions, exercise tolerance and Health Related Quality of Life (HRQoL). However, the uptake and completion of PR programs are globally low. In order to understand the factors contributing to underutilization of PR, it is important to review and recognize the barriers to PR program. A literature search was conducted on Medline (PubMed) database. After reviewing the title and abstracts, full text articles were scrutinized for their relevance. Twenty-two studies involving factors affecting the uptake, participation and completion of PR program were included in this review. Reported barriers to PR were healthcare system, healthcare professional and patient related factors. Primary factors related to healthcare system and healthcare professionals were fewer PR centers, accessibility inconvenience, lack of awareness of PR program, low knowledge of referral process and lack of interdisciplinary teamwork. Difficulties faced by patients to take up and/or to complete PR programs were lack of transportation, comorbidities, lack of perceived benefits, socio-economic status and lack of funding facilities. Identified and reported barriers resulted into discontinuity between knowledge of health benefits and utilization of PR service for patients with CRDs. Addressing the barriers would accelerate the healthcare professionals' referral and patients to avail the health benefits of rehabilitation service. [ABSTRACT FROM AUTHOR]