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Electronic nicotine delivery systems were developed over a decade ago to simulate the experience of smoking, although with a lower exposure to toxins than in conventional smoking. However, they have their own unique profile of side effects, some of which can be life threatening. We report the case of a young male, who in a desperate bid to de-addict himself from smoking developed a serious adverse effect related to the e-cigarettes.

Background: Administration of local airway anesthesia is the principal determinant of procedural comfort during flexible bronchoscopy. However, the ideal method of administration is still unknown. In this study, we compared lignocaine administration using a spray catheter (SC) with “spray-as-you-go” technique. Methods: Patients undergoing bronchoscopy were randomized to receive airway anesthesia with 2% lignocaine through the SC (SC group) or “spray-as-you-go” technique through the working channel (WC group). The primary outcome parameter was cough count, and the secondary outcome parameters compared were need for sedation, operator-rated procedural satisfaction and cough, and patient-rated comfort on a Visual Analog Scale (VAS). Results: One hundred and thirty patients were randomized with comparable baseline parameters. The median (interquartile range [IQR]) cough count was 28 (19, 37) in the WC group and 15 (9, 23) in the SC group (P < 0.001). Requirement for sedation was lower in the SC group (5 vs. 18; P = 0.003). The mean (standard deviation [SD]) VAS score for operator-rated satisfaction was 66.5 (16.8) in the WC group and 80.6 (14.2) in the SC group; P < 0.001. The median (IQR) VAS score for operator-rated cough was 35 (23, 44) in the WC group and 18 (11, 28) in the SC group; P < 0.001. However, there was no difference in the patient-rated comfort VAS (mean [SD] of 66.4 [14.5] in the WC group and 69.9 [13.0] in the SC group; P = 0.07). Conclusion: Lignocaine instillation using the SC during bronchoscopy reduced cough, need for sedation, and improved operator satisfaction.

Background: Chronic pulmonary diseases are a major cause of morbidity and mortality in our country. Patients with chronic pulmonary diseases have been shown to benefit from pulmonary rehabilitation programs (PRP). The aim of this study is to evaluate the efficacy of an outpatient-based PRP in improving the health outcomes in case of patients with chronic pulmonary diseases. Materials and Methods: This was a prospective study of an outpatient-based PRP in 64 patients with chronic pulmonary diseases conducted over a 2 year period. The evaluations carried out at the baseline and at 4-6 weeks were spirometry, 6 min walk test (6MWT), St. George's Respiratory Questionnaire (SGRQ), Short Form-36 (SF-36), and Borg dyspnea scale. The PRP involved exercise training, education, and psychosocial/behavioral interventions. Statistical Analysis Used: The data were analyzed using SPSS package IBM company. The proportions were compared using Chi-square (c2 ) test. Results: Sixty-four patients with chronic pulmonary diseases were studied, out of which 30 (46.8%) had chronic obstructive pulmonary disease (COPD), 27 (42%) had chronic persistent bronchial asthma, 6 (9.4%) had restrictive lung disease (RLD), and 1 (1.5%) had bronchiectasis. There was a male preponderance of cases (71.3%). After the 6 week PRP, there was a significant improvement in the 6MWT, SGRQ, SF-36, and Borg dyspnea scale in all the patients and in the various subgroups of patients with COPD, asthma, and RLD. Besides, there was a significant change in pulmonary function and oxygen saturation in all the patients with asthma (P < 0.05) but not in those with COPD and RLD. Conclusion: An outpatient-based 6 week PRP in a tertiary care setting resulted in a significant improvement in exercise tolerance, dyspnea, and quality of life in those patients with a chronic pulmonary disease.