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BACKGROUND: Textile-sizing mill workers are exposed to various hazards in the sizing units during their working hours and are at risk of acquiring lung impairments due to the usage of sizing chemicals in the sizing process. OBJECTIVE: The main aim of this study is to assess the influence of cotton dust and sizing agents on lung function and breathing difficulties among Indian textile sizing mill workers. METHODS: This cross-sectional study was carried out at a textile-sizing mill from August 2022 to September 2022. A modified questionnaire based American Thoracic Society's standard was used to assess respiratory symptoms among sizing mill workers and the pulmonary function test was conducted Spirometry. The chi-square test was used to find the difference between respiratory symptoms and the t-test was used to find the difference between spirometric parameters. RESULTS: Textile sizing mill workers showed significant (P < 0.0001) decline in peak expiratory flow rate, forced vital capacity (FVC), ratio of FEV1 and forced vital capacity, and forced expiratory volume in 1 s (FEV1). There was an association between symptoms and duration of exposure to pulmonary abnormality. Sizing mill workers showed a significant decline in lung functions and an increase in pulmonary symptoms. As the service duration of exposure in terms of years increased, respiratory symptoms increased and spirometric abnormality also increased. CONCLUSION: This study confirms that sizing agents such as polyvinyl alcohol (PVA), emulsifier, wax, carboxymethyl cellulose (CMC), and starch used in sizing mills are also responsible for respiratory illness and lung impairment among textile workers. [ABSTRACT FROM AUTHOR]

Background: The leather industry stands as one of India's burgeoning sectors, boasting significant manpower. Workers in the finishing sector, particularly those involved in polishing, face heightened risks due to exposure to formaldehyde, aniline, and resins, which can lead to respiratory complications. Aims and Objectives: The aims and objectives of the study are to determine the small airway obstruction in asymptomatic finishing sector workers of a leather factory. Materials and Methods: The current study was a cross-sectional study conducted in a leather factory located in Chennai, Tamil Nadu. A random sample of 60 workers was drawn from different sectors of a leather factory. Basic demographic details, smoking history, nature of work, exposure to irritants along with duration, and respiratory symptoms were collected. All workers were subjected to spirometry as per ATS guidelines and the results were analyzed. Association between length (years) of exposure, respiratory symptoms, and spirometry impairment among the workers were analysed. Results: Out of 60 samples, 38 were exposed to irritants and 22 were not exposed to irritants. Out of 38, 25 had small airway disease, seven had large airway obstruction, one had a restrictive pattern, and five had normal spirometry. 42.1% of them were asymptomatic. Conclusion: Small airway obstruction is notably prevalent, especially among asymptomatic workers in the polishing sector. Prolonged exposure is associated with the development of large airway obstructive disease. This study underscores the importance of continuous monitoring for airway diseases in occupationally exposed workers, advocating for timely preventive and protective measures to curb disease progression. [ABSTRACT FROM AUTHOR]

BACKGROUND: Mine workers face various health risks from occupational hazards, notably dust-related pulmonary dysfunction. This dysfunction is also attributed to diverse risk factors and health conditions. Despite the variety of underlying mechanisms, conflicting evidence persists regarding hypertension as a potential risk factor for such dysfunction. OBJECTIVE: To determine the predictors of pulmonary dysfunction vis-à-vis the hypertension status of mine workers. METHODS: We conducted a cross-sectional study among 444 mine workers from ten open-cast mines in Gujarat state (western part of India) from November 2020 to February 2022. We collected data on demographics, occupation, addiction, and comorbidities, including measurements like anthropometry, blood pressure, blood sugar, haemoglobin, and lipid levels. Hypertension was confirmed based on self-reported history and/or onsite blood pressure measurement, while pulmonary functions were assessed using a spirometer (expressed as forced expiratory volume in the first second FEV1 and forced vital capacity FVC). Multiple linear regression analysis was performed to determine the significant predictor of FEV1 or FVC vis-à-vis the hypertension status after adjusting for confounding variables. In addition, we assessed the effect of anti-hypertensive medications on pulmonary dysfunction. RESULTS: A total of 41% (95% CI: 36-45%) of mine workers were suffering from hypertension. On multiple linear regression, only being a male and work experience duration were the significant predictors of FEV1 [0.900 (0.475-1.092), p=<0.001; -0.029 (-0.034 - -0.021, p=<0.001] and FVC [1.088 (0.771-1.404), p=<0.001; -0.031 (-0.038 - -0.024, p = 0.001] respectively. While unadjusted analysis indicated hypertension led to FEV1 and FVC reduction, this effect lost significance after adjusting for confounders. Nevertheless, subgroup analysis revealed those on antihypertensive medications had reductions in FEV1 and FVC by -0.263 (95% CI: -0.449 - -0.078, p = 0.006) L and -0.271 (95% CI: -0.476 - -0.067, p = 0.009) L respectively. CONCLUSION: In our study among mine workers, alterations in lung function (FEV1 and FVC) on spirometry were predicted by gender and duration of work experience, while hypertension did not serve as a predictor. It is noteworthy that antihypertensive drugs were found to reduce lung functions on spirometry, highlighting the need for further research. [ABSTRACT FROM AUTHOR]

This study aims to investigate the pulmonary functions and respiratory symptoms of workers in the neem oil extraction industry in Tamil Nadu, India, who are exposed to neem oil dust and chemicalsin their occupational environment. Fifty male workers from the exposed group and 50 male workers from the non-exposed group to neem dust and chemicals were investigated for this study. A modified respiratory assessment questionnaire based on the American Thoracic Society (ATS) standard and portable hand-held spirometry were used to assess their respiratory symptoms and pulmonary function. Respiratory symptoms such as coughing, sneezing, wheezing, and, nasal irritation are found to be higher in the exposed groups than in the controlled groups. The pulmonary function of exposed workers had doubled respiratory problems than the controlled groups, which indicates the impacts of dust and chemicals generated during neem oil extraction on workers' health. Forced expiratory volume in one second (FEV1)/forced vital capacity FVC)% was noted regarding the duration of exposure to neem oil dust (P < 0.001). Also, there was a high difference between the heavily exposed and the lightly exposed (P < 0.001). Hence, to mitigate these problems, the oil mill workers should be cautious and wear personal protection equipment during working hours, and it is recommended to have an exhaust ventilation system. [ABSTRACT FROM AUTHOR]

Background: Sculpting is a common occupation in India. However, there have been no studies from India on sculpting-related silicosis. Aims: The aims of this study were to evaluate- 1. awareness of disease related to sculpting. 2. Clinical, radiological, and physiological parameters in "sculpting workers" suffering from silicosis. Settings and Design: This was a retrospective evaluation of data collected during compensation visits for silicosis in workers of the sculpting industries. Methods and Material: The data were collected between January 2021 to April 2023. A total of 114 patients were evaluated. All patients underwent clinical evaluation including awareness about the disease, chest radiography, high-resolution computed tomography (HRCT) scan of the chest, and spirometry. Results: The majority of patients (109) (95%) did not use any personal protective equipment while at work and did not have any awareness regarding preventive measures. On chest radiography, small opacities (rounded or irregular) and large opacities were seen in 84 (73.7%) and 26 (22.8%) patients, respectively. The size of large opacities was significantly proportionate with duration of job (P = 0.019). HRCT chest was more sensitive compared to chest radiographs. 94 (82.4%) patients were having abnormal spirometric findings. Conclusions: The benefits of prevention of silica dust exposure and patient education considerably outweigh the benefits of early detection and treatment of silicosis, as there was an increase in the size of lesions with increasing duration of exposure. There should be a national health program on silicosis to protect worker's health. [ABSTRACT FROM AUTHOR]

Background: Seed processing workers are exposed to dust particles generated during the processing of seeds, which can have adverse effects on their respiratory health. Aim: to estimate the prevalence and patterns of respiratory morbidity among seed processing workers in Hooghly district, West Bengal, India, and to explore their use of respiratory personal protective equipment (PPE). Methods: A cross sectional observational study was conducted in 5 seed processing plants from December 2022 to February 2023. A sample size of 129 workers was selected using probability proportionate to population size to select seed processing plants and simple random sampling to select workers at selected plants. Data on sociodemographic characteristics, occupational profile, substance use patterns, respiratory PPE use, and respiratory symptoms were collected through structured interviews. Spirometry was performed with a hand held tabletop spirometer (RMS Helios 401) to assess respiratory function. Results: 52.7% of participants reported at least one chronic respiratory symptom, while 17.1% had evident respiratory morbidity based on spirometry results, with most having restrictive patterns (10.1%). Multivariable regression analysis revealed that factors associated with respiratory morbidity included increasing work years of exposure [1.10 (1.02 1.18)], irregular use of respiratory PPE [4.36 (1.22 15.57)], and primary or below education level [6.09 (1.38 26.98)]. Conclusion: The study highlights the high prevalence of respiratory symptoms and morbidity among seed processing workers. It emphasizes the importance of implementing effective respiratory protection measures and raising awareness about occupational lung diseases in this industry. Further research and interventions are needed to improve the respiratory health and well being of seed processing workers. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Hypersensitivity pneumonitis (HP) is an inflammatory and/or fibrotic lung disease. The restrictive lung function with low diffusing capacity of carbon monoxide (DLCO) is common in interstitial lung diseases (ILD). There are limited data on pulmonary function test (PFT) in HP and its role for diagnosis is questionable. We analyzed the data of 152 HP patients for type of defect, lung volume, and DLCO. MATERIAL AND METHODS: The present study is a retrospective analysis of 152 patients at one of the tertiary chest institutes in India. All diagnosed cases with at least spirometry were included. PFT findings were classified and graded as obstructive, restrictive, and mixed patterns. The correlation of PFT was calculated with disease duration and 6MWT distance. RESULTS: The majority were female [106 (70%)], with a mean age of 47.8 ± 12.3 years. Spirometry with lung volume data were available for 97% patients. PFT was abnormal in 118 (80%) cases. Among the patterns of abnormality, the most common type was restrictive (74%) followed by mixed (15%) and obstructive (11%) with the majority in the severe to very severe grade. The mean total lung capacity (TLC) and residual volume (RV) were reduced, with the grade more severe when the pattern of abnormality was restrictive while the RV/TLC was higher suggestive of air tapping. DLCO data were available for 132 (87%) cases, with levels decreased in 67%. The severity of DLCO was highest when the pattern of abnormality was restrictive. One of the PFT parameters was abnormal in 137 (90%) cases, with isolated decreased DLCO levels seen in 16 (10%) cases. Forced vital capacity (FVC), TLC, and DLCO showed positive correlation with 6MWT distance (FVC r = .22, P = .02; TLC r = .28, P = .003; DLCO r = .30, P = .002). CONCLUSION: The PFT abnormality is seen in >80% of HP patients. All types of abnormality were seen, with the restrictive pattern being the most common. Isolated decreased DLCO levels were seen in 10% of cases. We advised to do full PFT for diagnosis and followup of HP. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease 2019 (COVID-19) virus has caused widespread Acute Respiratory Disease globally since 2020. Patients with evidence of lower respiratory illness either clinically or radiologically had moderate-to-severe illness. COVID respiratory and nonrespiratory symptoms (psychological and cognitive) noticed after 4–8 weeks of primary disease were called long COVID syndrome. Survivors of moderate-to-severe disease had a poor quality of life. The main objective of this retrospective study was to assess the role of outpatient pulmonary rehabilitation (PR) done in moderate-severe COVID-19 survivors who had symptoms after 4–8 weeks at Shaivam Lung Rehabilitation Centre, Ahmedabad. Methods: We analyzed the impact of PR on 30 patients' post-COVID-19 who were willing to participate during the ongoing pandemic. It was an outpatient 6–8 weeks of program designed to target respiratory and general muscle training, relaxation technique, nutritional counseling, occupational and psychological support. Patients were tested with of combination of self-assessment quality of life scale (adapted from short form 36 questionnaire), muscle training, dyspnea scale, and physical assessment. The standard objective assessment included oxygenation index (SpO2/FiO2 ratio), 6 min walk distance (6 MWD), Modified Medical Research Council (MMRC) score, manual muscle testing (MMT) along with pulmonary function testing. All these subjective and objective variables were tested pre- and post-PR program to assess the impact on defined parameters. Results: From December 2020 to March 2022, we studied the impact of PR on 30 out of 55 patients fitting into the inclusion criteria. Significant benefit was noted in subjective Short Form 36 (SF 36) score and objective (6 MWD, MMRC, oxygenation, MMT) quality of life post-PR program (P < 0.001). Improvement in spirometry was not statistically significant, indicating structural chronicity of COVID pulmonary fibrosis. Conclusion: PR is safe, effective, and feasible on an outpatient basis in COVID-19 survivors of illness with poor quality of life. Further research is required to prove its widespread benefit in such patients. [ABSTRACT FROM AUTHOR]

Background: Patients undergoing open abdominal surgery are the focus of this research, namely the effect of early mobilisation on postoperative pulmonary problems. Early mobilization is proposed as a potential intervention to enhance respiratory function and reduce the risk of PPCs. Purpose: The purpose of this study is to evaluate the impact of pre-operative mobilisation on the incidence of pulmonary complications in patients undergoing open abdominal surgery. Materials and Methods: This quasi-experimental study included 50 subjects who underwent open abdominal surgery at Saveetha Medical Hospital, SIMTS. Convenient sampling was used to select the participants. Measures of oxygen saturation (SPO2) and pulmonary function (FEV1) from a spirometer were employed as functional outcome indicators. After two weeks, participants were given a post-test to record their progress. Results: Data collected before and after early mobilisation exercise were analysed using a paired t-test. The experimental group showed significant improvements in SPO2, FIM, and FEV1 (P<0.0001), indicating higher values post-intervention. Post-test demonstrated higher statistical significance compared to pre-test. Conclusion: As a result, it was shown that early mobilisation Exercise is beneficial for reducing pulmonary complications after surgery. [ABSTRACT FROM AUTHOR]

Introduction and aim of the study: The diagnosis and treatment of interstitial lung diseases (ILD), a class of diffuse parenchymal lung disorders that are associated with significant morbidity and death, provide challenges to the clinician. Multidisciplinary discussions (MDD) between a clinician, radiologist, and pathologist are used to diagnose ILD. There is a lack of information on the use of composite prediction models such as the ILD Gap Index and the Composite Physiologic Index. The main objective of the study was to evaluate factors affecting adverse outcomes in interstitial lung diseases with idiopathic pulmonary fibrosis (IPF) and other non-IPF interstitial lung diseases at 6 months in a tertiary care centre. Material and methods: This was a retrospective cohort research carried out at a tertiary care centre at Howrah, a district of state West Bengal in India. The main inclusion criteria were to include all patients who had complete medical records after being diagnosed with ILD. Any patients who suffered from pulmonary TB or lung cancer were excluded. The study comprised 164 consecutive individuals with a multidisciplinary diagnosis of interstitial lung disease. At 6 months, clinical evaluation, spirometry and DLCO were performed on the patients. FVC reduction of less than 10% at 6 months and mortality were evaluated as outcome variables. Results: Idiopathic pulmonary fibrosis (IPF) affected 27.2% of the 164 patients who were evaluated, while non-IPF affected 72.8% of the patients. At a 6-month follow-up, 15.2% of patients died, with 72% having IPF. At 6 months, the FVC of 51.2% had decreased by 10%. Age more than 60, male gender, BMI 18,5, smoking, the presence of pulmonary hypertension, mean saturation more than 90%, percentage predicted FVC more than 50%, percentage predicted DLCO more than 40 per cent, 6-minute walk distance more than 250 m at diagnosis, UIP pattern in HRCT, CPI score more than 50, and ILD-GAP index more than 4 are factors associated with mortality in interstitial lung diseases. Age more than 60 years old and IPF group were variables linked with death in multivariate analysis using logistic regression in bivariate analysis, the same factors were linked to a reduction in FVC of more than 10% at 6 months, whereas in multivariate analysis, smoking history and an initial projected DLCO of less than 40% were significant. In interstitial lung disorders, the ILD Gap index is a better predictor of death than a composite physiologic index. (AURO 0.912 vs., CPI 0.856). Conclusions: Interstitial lung disease mortality indicators include age more than 60, idiopathic pulmonary fibrosis type, and FVC decline = 10% at 6 months and less than 50% at baseline. Prediction methods like composite physiologic index (CPI) and ILD Gap index aid prognosis and clinical decision-making. The ILD Gap index predicted mortality better than the composite physiologic index. The main objective of the study was to evaluate factors affecting adverse outcomes in interstitial lung diseases with idiopathic pulmonary fibrosis (IPF) and other non-IPF interstitial lung diseases at 6 months in a tertiary care centre. [ABSTRACT FROM AUTHOR]

Introduction: Obstructive airway diseases are a leading cause of respiratory morbidity and mortality worldwide, particularly Chronic Obstructive Lung Disease (COPD). The diagnosis of COPD is confirmed by a post-bronchodilator ratio of Forced Expiratory Volume in the first second (FEV1) to Forced Vital Capacity (FVC), i.e., FEV1/FVC <0.7. A repeat spirometry shows variability in a significant population. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recommends repeating spirometry on a separate occasion if the post-bronchodilator FEV1/FVC is between 0.6 and 0.8. Aim: To determine the proportion of patients with diagnostic stability in the FEV1/FVC ratio after two weeks. Materials and Methods: This study was a cross-sectional study conducted in the Department of Pulmonary Medicine, Government Medical College, Thiruvananthapuram, Kerala, India from January 2019 to December 2019. in which 155 clinically suspected COPD patients with an FEV1/FVC ratio between 0.6 and 0.8 were recruited. A repeat spirometry was conducted two weeks later. The two post-bronchodilator FEV1/FVC ratios were compared, and the proportion of patients with diagnostic stability was determined. Fisher's-exact test and Pearson's Chisquare test were used to compare categorical variables between groups. The statistical significance of differences between means of variables among different independent groups was analysed using independent sample t-tests. A p-value <0.05 was considered statistically significant. Results: The mean age of the study population was 63.02±9.80 years. In present study, 118 (76.13%) out of 155 patients had stability in diagnosis, while 37 (23.87%) patients experienced a change in their diagnosis after repeat spirometry. The use of Inhaled Corticosteroids (ICS) and a history of Coronary Artery Disease (CAD) were associated with diagnostic instability (p<0.05). Conclusion: In present study, 23.87% experienced a change in their diagnosis after repeat spirometry. Hence, repeat spirometry should be done on a separate occasion as suggested by GOLD guidelines in patients with FEV1/FVC ratios between 0.6 and 0.8. [ABSTRACT FROM AUTHOR]

Background: Bronchial asthma is a serious public health problem throughout the world. The main feature of asthma is episodic airway obstruction. In India, as there are poor medical facilities or infrastructure, overcrowded hospitals where management to control asthma becomes very difficult. In this study an, attempt is made to study and implement these components of GINA, systematically in management of bronchial asthma. Methodology: This study was conducted on 50 patients more than age 18 years with Asthma. Patients with breathlessness who showed FEV1 reversibility were enrolled in the study. Each patient on baseline visit, one month after baseline visit, and at three months after baseline visit underwent SPIROMETRY AND PEFR test. All patients assessed for asthma as per GINA guidelines and categorised as uncontrolled, partially controlled and controlled. Patients who were in category uncontrolled as per GINA, treated with oral tablet. Results: Mean age was 37.70±9.40 years. 10(20%) patients were patients with controlled asthma, 30(60%) patients were partially controlled. 10(20%) patients were uncontrolled. Out of 10 uncontrolled patients 7(70%) patients became partially controlled and 3 patients remained as uncontrolled. At second visit, out of 10 uncontrolled patients, 7 patients (70%) become partially controlled, 2 (20%) patients become controlled and only one patient (10%) remained as uncontrolled (Chi Square test P=0.0000, Significant). Mean FEV1 was 73.94 % at baseline visit. On visit 1, it increased significantly by 4.2% from baseline visit. On visit 2, it increased significantly by 6.8% from baseline visit. The Mean PEFR was 241.40 L/min at baseline visit. On visit 1, it increased significantly by 6.5% from baseline visit. On visit 2 increased significantly by 13.5% from baseline visit. There were 13 smokers (26%) enrolled in this study,3 patients (23.1%) were controlled asthma,7 patients(53.8%) were partially controlled asthma and 3 patients (23.1%) were uncontrolled asthma. At the end of second visit 9 smokers (69.2%) were controlled, 4(30.8%) remained as partially controlled. None of smoker remained in uncontrolled group. Conclusion: Obese patients after weight reduction, smokers after quitting smoking, patients had good control of asthma. URTI and change in weather are commonest risk factors for bronchial asthma. After following GINA guidelines in management of bronchial asthma FEV1 and PEFR showed significant improvement and good control of asthma in most of the patients. Systematic approach in Diagnosis, management and prevention as per GINA guidelines can improve morbidity, reduce exacerbation and give patients good quality of life. [ABSTRACT FROM AUTHOR]

Introduction: Six-min walk test (6MWT) is easy to use, the least expensive, and a quick measure of physical function and it reflects the capacity to perform our day-to-day activities hence quality of life can be assessed with 6MWT. This study was planned to assess the role of 6MWT in chronic respiratory disease patients and its association with spirometry-based functional grading at a rural tertiary care center of northern India. Materials and Methods: This was a hospital-based cross-sectional study done between December 2019 and July 2021. In this study, 110 patients were included as per inclusion and exclusion criteria. 6MWT and spirometry were conducted as per the American Thoracic Society/European Research Society recommendation using Spiropalm 6MWT and the association between 6MWT and spirometry was assessed. Results: A total of 110 chronic respiratory disease patients were included in the study. There were 69 (63%) males while 41 (37%) were females. Among study participants, chronic obstructive pulmonary disease patients were the most common 48 (43.6%) patients, followed by asthma 28 (25.5%), posttuberculosis sequelae patients 22 (20%), interstitial lung disease 9 (8.2%), and bronchiectasis 3 (2.7%) patients were found. There was a significant positive correlation of 6-min walk distance (6MWD) and % predicted 6MWD with spirometric parameters, forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and there was a significant positive correlation of 6MWD with FEV1% (predicted) also. 6MWD and % predicted 6MWD negatively correlated with FEV1/FVC and association between 6MWD and FEV1/FVC was not statistically significant and between % predicted 6MWD and FEV1/FVC, it was found statistically significant. Conclusion: The 6MWD traveled by chronic respiratory disease patients was significantly lower than the predicted 6MWD and 6MWD correlated with spirometric variables well. Therefore, it can conclude that 6MWT is a useful alternative of spirometry in the management of chronic respiratory disease patients in resource-limited settings. [ABSTRACT FROM AUTHOR]

BACKGROUND: Vehicular emissions on long-term exposure predispose metropolitan bus drivers to cardiorespiratory ailments. OBJECTIVE: To evaluate the cardiorespiratory risk of urban metropolitan bus drivers related to vehicular emission exposure. METHODS: Bus drivers (with service >5 years, n = 254) and their administrative controls (primarily engaged in indoor white collared jobs, n = 73) were recruited. Demographic, occupational and clinical details were collected through pre-validated standardized format. Pulmonary Function Test (PFT) and lipid profile were carried out with standard protocol. Risk for cardiovascular events for preceding 10-years was estimated with WHO/ISH risk prediction chart and QRISK3 score. Exposure assessments for particulate matter (PM) were performed for both groups while duty hours. RESULTS: Exposure of drivers to PM2.5 six times and PM10 five times higher in comparison to administration staff (PM2.5- 970.9 v/s 145.0μg/m3 TWA and PM10- 1111.7 v/s 233.8μg/m3 TWA). Bus drivers exhibited significantly higher prevalence of respiratory symptoms (dyspnea-25% v/s 6.8% and cough-20.1% v/s 9.8%) and compromised PFT (obstructive–21% v/s 5.7% and restrictive–4.2% v/s 2.9%) in comparison to controls. Multivariate regression statistics reveal a significant decline for FEV1/FVC and FEV25–75 % among bus drivers compared to controls, controlling the influence of physiological and environmental factors. The difference between predicted cardiac age and their respective chronological age was twice higher (8.3 v/s 4.3 years) among drivers compared to their administration staff. CONCLUSION: Bus drivers were exposed to high levels of outdoor air pollutants. Further, the drivers exhibited higher risk for ischemic attack and obstructive airway diseases as compared to administration staff. [ABSTRACT FROM AUTHOR]

Background and Purpose: Pressure symptoms are usually uncommon in multinodular goitre (MNG). Imaging modalities fail to define the functional air flow dynamics of the upper airway. The airway-related changes due to MNG can be understood using a Pulmonary function test (PFT). To address this lacuna, this study was conducted to compare the pulmonary function profile of patients undergoing total thyroidectomy with benign MNGs using a pre-operative and post-operative pulmonary function test using Spirometry and assessing if surgery had an impact on airway status with varying volumes of thyroid gland measured with ultrasound Methods: The study was conducted in a tertiary care centre in South India between 2019-2020. Twenty-five patients with MNG undergoing total thyroidectomy were included in the study population. PFT (Spirometry -- Lung volume & Flow volume loop) was performed preoperatively and was compared with post-operative PFT after 6 weeks of surgery. The desired variables -- Forced Vital Capacity (FVC), Forced expiratory volume in 1 second (FEV1), FEV1 ratio & Peak expiratory flow rate (PEFR) were analysed & interpreted to ascertain changes in respective values attributable to surgery. Results: Mean (MEDIAN)thyroid gland volume(cc) of 25 participants in our study was 50.28 ±50.03. Statistically significant improvement was observed in the FVC (Preoperative mean 2.16 ± 0.59 to post-operative mean 2.43 ± 0.78), FEV1 (1.79 ± 0.53 to 2.07 ± 0.69), PEFR (356.8 ± 101.4 to 388 ± 99.4). However, the change in FEV1/FVC ratio (0.83 ± 0.05 to 0.84 ± 0.05) did not approach statistical significance. The study showed that in patients without restrictive lung disease, there is a statistically significant improvement in airflow dynamics following total thyroidectomy, irrespective of the volume of the gland. Conclusion: Alleviating upper airway obstruction is an important facet of surgical intervention for thyroid disease. Early surgery to prevent progressive worsening of the degree of obstruction should be considered, irrespective of the volume of the thyroid gland for patients with intrathoracic goitre and in cervical MNG with pre-existing airway compromise. [ABSTRACT FROM AUTHOR]

Thoracotomy is used to manage a variety of medical conditions, including lung cancer, pulmonary infections, and chest injuries. Decortication surgery is indicated in the case of a thickened pleural layer leading to atelectasis of the underlying lung parenchyma. It is done to prevent further restriction of the lung parenchyma. Atelectasis, pleural effusion, pneumonia, and consolidation following decortication are common complications of the surgery. Physiotherapy following decortication helps in preventing damage to the lungs and also helps in maintaining and regaining good lung function postsurgery. This is a right-sided lung decortication thoracotomy surgical procedure where physiotherapy interventions were given preoperatively and early postsurgical care was taken for adequate lung expansion and to reduce respiratory complications following it. Incentive spirometer (4 times/day) with breath hold technique (3 s.) along with conventional physiotherapy interventions such as chest mobility exercise, breathing exercises, breath control techniques, and early mobilization in the form of long sitting at the end of a bed, high sitting, chair sitting, standing, walking, and stair climbing were improved in chest expansion, functional activities, rating of perceived exertion level, and reduced pain level. [ABSTRACT FROM AUTHOR]

Context: The estimated prevalence of heart failure (HF) is around 1% of the total population in India which is close by to 8–10 million individuals. Due to metabolic and structural skeletal muscle dysfunctions, peripheral muscles are impaired in the early stages of chronic HF (CHF). In experiments on rats with CHF, biopsies of respiratory muscles revealed histological abnormalities, such as atrophy of type 1 diaphragm fibers, resulting in decreased respiratory muscle strength and endurance. Aim: To determine the strength of respiratory muscle and pulmonary function in individuals having Class II and Class III HF. Settings and Design: Descriptive, observational, case–control study design. Subjects and Methods: Subjects included 37 HF patients having Class II and Class III in one group and controls in another group. The respiratory muscle strength (maximal inspiratory pressure [MIP] and maximal expiratory pressure [MEP]) was evaluated using respiratory pressure meter (RPM) and pulmonary function (forced expiratory volume at the end of 1 s [FEV1] and forced-vital capacity [FVC]) assessment using spirometry-Schiller (micro RPM). Statistical Analysis Used: Median and IQR were used to describe the study variables MIP, MEP, FVC, and FEV1, and the Mann-Whitney U test to compare the study variables between the two groups. Results: The outcomes were interpreted as the median values. The MIP and MEP were 59 and 70 cmH2O, respectively, in HF as compared to 97 and 96 cmH2O in the control group, significant at P < 0.001. The FEV1 and FVC in HF were 114 and 88% sequentially as compared to 130 and 99% in the control group, significant at P < 0.05. Conclusions: The respiratory muscle strength and pulmonary functions are impaired in individuals having Class II and Class III HF. [ABSTRACT FROM AUTHOR]

Background and Objective: India, a highly heterogeneous country, has no common reference standards for predicting spirometry values, with very few recent studies from south India. This study aimed to create reference equations for rural south Indian adults, based on a population‑based survey in Vellore, south India and compare it with other equations from India. Methods: The data from 583 non‑smoking, asymptomatic participants (30 years and older) from a spirometry‑based survey for airflow obstruction (rural Vellore, 2018), were used to develop equations for FEV1, FEV1/FVC, and FVC. The dataset was divided for development (70%) and validation (30%), by gender. Differences between observed and predicted values were assessed using the new equations and comparisons made with other equations from India. Results: Predictions with Vellore rural equations were closest to the previous south Indian equations from urban Bangalore. However, the Bangalore equations led to overestimation of FVC values in males, and of both FEV1 and FVC values in females. Using the rural Vellore equations also led to a higher percent of males being classified as having airflow obstruction, compared to the Bangalore equations which underestimated airflow obstruction in this rural population. Comparison with previously derived Indian equations from other parts of the country showed pronounced variations. Conclusions: Our study reiterates the need for representative rural and urban studies of adults from various parts of India, to obtain region specific reference equations, given the wide variations in spirometry values in “normal” individuals, due to social heterogeneities of the Indian population and resulting complexities in defining normal. [ABSTRACT FROM AUTHOR]

Background: Both chronic bronchitis and emphysema are part of COPD. Having a productive cough at least three times a week for more than two years is diagnostic of chronic bronchitis. Methods: Outpatients and inpatients at the Department of Pulmonology, Shadan Institute of Medical Sciences, Hyderabad, Telangana, India, were the subjects of a prospective research conducted between June 2021 to May 2022. The research involves sixty participants. Results: However, a diagnosis of COPD requires the use of spirometry. The effects of COPD on one's health and quality of life can be measured using a CAT score. Even in a rural situation where most COPD patients do not have access to spirometry, both the 6MWT and the CAT score may be employed. Conclusion: The results of this study suggest that the 6-minute walk test can replace the FEV1 as a means of measuring COPD severity. Spirometry is not required in order to determine the severity of COPD every time. [ABSTRACT FROM AUTHOR]

Background and Aim: The 6-minute walk test (6MWT) is used to measure exercise capacity and assess prognosis in interstitial lung disease (ILD). In this study we aim to evaluate the correlation of outcomes of 6MWT with spirometry variables and DLCO in patients with interstitial lung diseases thereby corroborating 6MWT as reliable marker of functional assessment of ILD. Material and Methods: It is a hospital based descriptive observational study conducted over a period of one year. The study population comprises of 100 patients of interstitial lung disease who attended pulmonary clinic at Tertiary care Hospital of India. The information on sociodemographic status including age, sex, religion, occupation and residential place were noted. Further clinical assessment, lab investigations, radiographs, pulmonary function tests and 6 minute walk test were done the data was then subjected to statistical analysis. Results: The percentage predicted mean values for FEV1 and FVC are 1.90 (0.75) and 1.50 (0.60). Out of all 100 patients, 6MWD had a statistically significant negative correlation with age and statistically significant positive correlation with the height of the patient. Also 6MWD had positive correlation with weight (r-0.02) but thus cant correlation was not statistically significant. Borg scale dyspnoea had non-significant correlation with age, height and weight but had a statistically negative correlation with FVC and DLCO while it had a statistically significant positive correlation with FEV1. Conclusion: The conclusion drawn from our study is to emphasize the importance of six minute walk test in patients of ILD by virtue of its strong correlation with many of the objective parameters for detecting the functional status like spirometry variables and DLCO. [ABSTRACT FROM AUTHOR]

BACKGROUND: Paddy milling is the oldest and largest agro-processing industry in India. A large number of workers are employed in the rice mills where they are potentially exposed to dust. It has been shown that exposure to dust results in a high prevalence of respiratory diseases, such as asthma, chronic bronchitis, extrinsic allergic alveoli ties, toxic syndrome, and interstitial lung disease. OBJECTIVE: The aim of this study was to investigate the effect of dust on rice mill workers' health using lung function tests with comparison to an unexposed population. PARTICIPANTS: Two hundred eighteen rice mill workers (exposed volunteers) were randomly selected from 25 rice mills in Assam, India. Participants were 18-60 years with at least one year of work experience. Further, 377 volunteers who were not exposed to dust and having similar demographic characteristics also participated as a control group. METHOD: Pulmonary function tests were conducted for all participants by spirometry. The tests included forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC (%), peak expiratory flow (PEF) and forced expiratory flow during the middle half of a forced vital capacity (FEF25-75%). Values from exposed workers were compared with the unexposed volunteers. RESULTS: It was observed that the lung function parameters FVC, FEV1, PEF and FEF25-75% in exposed workers were significantly decreased compared with unexposed volunteers. There were also significantly decreased FVC, FEV1, FEV1/FVC%, PEF and FEF25-75% with increase in age and duration of dust exposure. It was further observed that 48% and 32% of the total male and female volunteers, respectively, had evidence of lung disease. Irrespective of gender, approximately 45% of mill workers had evidence of lung disease, of which 21% was restrictive and 24% was obstructive. CONCLUSION: Compared with unexposed controls, rice mill workers have a greater prevalence of respiratory disease based on pulmonary function tests. [ABSTRACT FROM AUTHOR]

BACKGROUND: Every complication arising among diabetic patients is secondary to vascular damage thereby affecting the blood supply and leading to ischemic tissue injury. AIM: To determine the difference in Pulmonary Function Tests parameters among diabetic and non-diabetic COPD patients. MATERIAL AND METHODS: This was a hospital-based case-control observational study. We included 103 (50 cases & 53 controls) patients who were diagnosed with COPD and aged more than 40 years. Cases were diabetic patients and controls were nondiabetic patients (based on HB1AC). The PFT was measured by Helios Spirometer subjected to postbronchodilator spirometry evaluation of FEV1, FVC, and FEV1/FVC. RESULTS: The mean FEV1 among the cases and control was 38.60 and 59.54, respectively, p= 0.0001. The mean FVC among cases was 64.46 and among controls was 72.15 (p-value = 0.0001). The mean Peak Expiratory Flow Rate among cases was 191.54 and the control was 257.39 (P-value = 0.0001). The mean FEV1/FVC ratio among cases was 0.59 and controls was 0.64 (P-value = 0.0001). There was a strong but negative correlation between FEV1 and HbA1C (r = -0.866; P-value =0.0001). CONCLUSION: PFT values were significantly lower among diabetic patients in comparison to non-diabetic COPD patients. Moreover, there was a strong and inverse relation between PFT and HbA1C. [ABSTRACT FROM AUTHOR]

Background: The relationship between the parameters of body mass index (BMI) and lung function has been established by numerous studies done earlier. Those studies have been done mainly on obese individuals, but only a very few studies have been done in people with normal BMI or overweight group. Our aim is to analyze the various spirometric variables, namely forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), forced expiratory flow (FEF 25%–75%), and peak expiratory flow rate (PEFR), with respect to increase in the BMI in otherwise normal healthy subjects. Methods: The present study design is a randomized experimental parallel-group study. Sixty individuals who were otherwise healthy without any respiratory illness were selected for this study. Their anthropometric measurements were taken. Based on WHO classification, the subjects were grouped as follows: Group I with a BMI of 18.5–24.9 as a normal weight group and Group II with a BMI of 25–29.9 as the overweight group. Using Medispiror, the spirometric variables were determined. Analysis of spirometric variables, namely FEV1, FVC, FEF 25%–75%, and PEFR, were all done using the appropriate statistical method. Results: The results showed that there was a significant decrease in all spirometric variables except PEFR with an increase in BMI. However, the decrease in FVC was relatively more than the decrease in FEV1. Conclusion: This study can be concluded that there is a significant decrease in spirometric variables, namely FEV1, FVC, and FEF 25%–75%, as the BMI increases even in normal individuals who are not obese. [ABSTRACT FROM AUTHOR]

COPD is the second leading cause of death in India. The guidelines for early detection of COPD were released by the Government of India in 2019. However, due to the COVID-19 pandemic, its implementation could not be optimal. Diagnosis of COPD is based on the presence of respiratory symptoms, the presence of exposure to risk factors, and the presence of poorly reversible airflow obstruction as assessed using a spirometer. Spirometers are currently available only at a few district hospitals. The existing guidelines expect the patient to visit the Rural hospital/ Community Health Centre, which does not have a spirometer or a pulmonary medicine specialist. Also, it is not feasible or accessible for patients to visit the district hospital to get diagnosed. The current study will be implemented to determine the prevalence, annual incidence of COPD and asthma, quality of life, and nutritional status of COPD and asthma patients. The novelty of this implementation research, which will be conducted in collaboration with Zilla Parishad (i.e., Government), Pune district, is the empowerment of an Accredited Social Health Activist (ASHA), a peripheral health worker to screen all individuals using a peak flow meter and confirmation of the diagnosis at health and wellness center (HWC). An accredited Social Health Activist (ASHA) will take relevant history to suspect COPD and asthma in 30+-year-old adults, and she will refer the suspected cases to the Community Health Officer (CHO) at the Health and Wellness Center. The CHO/ Medical officer of PHC will initiate the appropriate treatment after confirming the diagnosis using a portable spirometer. The difficult-to-diagnose patients with comorbidity and acute exacerbations will be referred to the nearest higher center, i.e., Primary Health Centre (PHC) or Community Health Centre (CHC), where a primary care physician is available. The ASHA workers will provide two follow-ups to these patients in a year, depending on the severity, to ensure compliance with the treatment. Thus, early diagnosis and appropriate treatment of COPD and asthma at the community level may help to reduce the episodes of acute exacerbations., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Gothankar et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Azithromycin has immunomodulatory actions, and its beneficial effects have been demonstrated in asthmatic adults. Data on children are limited.Research Question: Does the addition of oral azithromycin to standard therapy in children with poorly controlled asthma improve asthma control compared with standard treatment alone?Study Design and Methods: This open-label randomized controlled trial included children (5-15 years of age) with poorly controlled asthma defined by Asthma Control Test (ACT) and Childhood Asthma Control Test (CACT) score of ≤ 19. They were randomized to receive azithromycin (10 mg/kg) three times weekly for 3 months along with standard treatment or standard treatment alone. The primary outcome was the ACT and CACT scores at 3 months. Secondary outcomes were asthma control according to Global Initiative for Asthma (GINA) guidelines, the number of exacerbations, change in spirometry parameters, change in fractional exhaled nitric oxide (Feno) level, positive throat swab results, and side effects.Results: The trial included 120 children (89 boys; 60 in each group). The mean ± SD age was 9.9 ± 3 years. The baseline parameters were similar between the groups. Mean ± SD ACT and CACT scores (available for 115 children) at 3 months of intervention were 21.71 ± 2.17 vs 18.33 ± 2.19 (P < .001) in the azithromycin and control groups, respectively. The numbers of children with well-controlled asthma according to GINA guidelines were 41 of 56 vs 10 of 56 in the azithromycin and control groups, respectively (P < .001). The median number of exacerbations requiring emergency visit and steroid use were fewer in the azithromycin group: 0 (interquartile range [IQR], 3) vs 1 [IQR, 6]; P < .001). No difference was found in Feno level, spirometry parameters, positive throat swab results, and adverse effects between the groups.Interpretation: The use of azithromycin in children with poorly controlled asthma resulted in improved asthma control and reduced exacerbations.Trial Registry: Clinical Trials Registry - India; No.: CTRI/2019/06/019727; URL: www.ctri.nic.in. [ABSTRACT FROM AUTHOR]

Background: Hairdressers undergo extensive and prolonged exposure to a variety of chemical substances present in the air in their salons. Although in low concentrations, the various products used for hair care are harmful as most of these products generate chemical aerosols during different procedures. These aerosols which have irritant or sensitizing effects on respiratory mucosa have been found to enter into the airways. Aim: The aim of this study is to assess the impairment of lung function in hairdressers in Gangtok. Method: This is a cross-sectional, comparative study conducted on 50 hairdressers and 50 age- and sex-matched non-hairdresser comparison group. The sampling technique used was simple random sampling. Permission from Institutional Ethical Committee was obtained before beginning the study. A standard questionnaire was used to record the respiratory symptoms. The pulmonary function parameters of the subjects were measured using portable spirometer HELIOS 720. Results: All the parameters were decreased in hairdressers and almost all the differences were statistically significant. FEV1 (P = 0.023) and FEV1/FVC ratio (P < 0.05) were reduced significantly. FEF25-75% and PEFR were also significantly reduced (P < 0.05 in both parameters). FVC was also reduced in hairdressers, but it was not statistically significant (P = 0.342). Conclusion: Hairdressers undergo exposure to different chemicals in their workplace and carry the risk of decreased pulmonary function. [ABSTRACT FROM AUTHOR]

Introduction: During the refining and packing of tea, a very fine dust is formed which is called the tea fluff. Exposure to this fluff has been reported to cause ventilatory defects on chronic exposure. Objective: To determine the association between air quality of the different work sections of tea gardens and the ventilatory functions of the workers. Methodology: An observational analytical study with cross sectional design was conducted on 400 apparently healthy individuals working in different sections of 4 tea gardens. Data on sociodemographic characters of the population, particulate matter (PM) and air quality (AQI) was recorded. All participants underwent spirometric evaluation. Results: The mean (SD) age of the study population was 37.8 (8) years. Most (67%) of the study participants were females. The participants were engaged in the job for a mean (SD) of 4.7 (2.7) years. The median distribution of PM2.5, PM 10 and AQI are progressively higher from the garden section to the dry section. A significant correlation between FVC and PM2.5 and PM10 is seen. FEV1 and FEV1/FVC shows a significant correlation with all air quality parameters while FEF25-75 is correlated to none of them. Comparison of the three models to predict the spirometric variables show that even after adjustments, the FEV1 is significantly associated with air quality parameters, FEV1/FVC is significantly associated with the air quality parameters and age while the FEF25-75% is dependent on the age of the participant. Conclusion: There is a strong correlation between the ventilatory parameters and the cumulative exposure of PM2.5, PM10 and AQI, which persists even after adjustment for confounders. [ABSTRACT FROM AUTHOR]

Context: After completion of treatment, a proportion of pulmonary tuberculosis (TB) (PTB) patients experience lung function impairment (LFI) which can influence their quality of life. Aim: This study was aimed to determine the prevalence of LFI in patients treated for PTB and the associated factors. Settings and Design: A cross-sectional study was conducted among patients treated for PTB in eight primary health centers in Puducherry. Subjects and Methods: The study was carried out among 118 patients. Those aged 18 and above whose PTB treatment outcomes were declared as cured or completed between 2018 and 2019 were included. Demographic data, respiratory symptoms before TB diagnosis, comorbidities, and chest radiography findings before TB treatment were collected. All participants underwent spirometric tests before and after dilatation with salbutamol nebulization. Statistical Analysis: Multivariable analysis identified smear-negative TB and indoor exposure to biomass for cooking as significant independent risk factors for LFI. Results: Of 118 participants interviewed, 70.3% were male and the median age of the participants was 47.7 years. The prevalence of LFI was 62.7% (95% confidence interval: 53.3–71.4). Conclusion: LFI was frequent in patients treated previously for TB. Creating awareness about the possible LFI among these patients along with the awareness for seeking health care for this condition is the need of the hour. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the inter-rater reliability of desktop spirometry in adult patients with type 2 diabetes mellitus (T2DM) attending public sector hospital in Panchkula, India. Methods: Thirty eligible participants with T2DM completed study at government hospital, Panchkula from February 2019 to August 2019. The study was having co-relational design. Pulmonary function test (PFT) was performed twice by each participant through desktop spirometer. T2DM patients aged between 40-64 years with diabetes duration ≥ 1 year were included into the study. Statistical analysis was done using SPSS version 21 and Microsoft excel. Results: Of 30 participants, the mean age of the participants was 51.537.5 ± years. There were 19 (63.33%) females and 11 (36.7%) males. Mean difference between test-retest came out to be 0.08, 0.035, and -0.93 for Forced Vital Capacity (FVC), Forced expiratory volume in 1st second (FEV1) and % FEV1/FVC respectively. The difference was not significant for FEV1 and % FEV1/FVC with p-value=0.270 & 0.340 respectively. However, it was significant for FVC with p-value=0.030. Intraclass correlation was 0.959, 0.94, and 0.89 for FVC, FEV1 and % FEV1/FVC respectively. Minimal detectable change was 0.3, 0.3, and 8 for FVC, FEV1, FEV1/FVC respectively. Conclusion: This can be concluded from the results that desktop spirometer has good absolute and relative reliability. Therefore, it can be used at the primary health care setting for the evaluation of pulmonary functions of adult patients with T2DM. [ABSTRACT FROM AUTHOR]

Background: Cigarettes constitutes various harmful substances like Nicotine which leads to diseases like COPD (Chronic obstructive pulmonary disease), atherosclerosis, and other respiratory and cardiopulmonary disease. This may leads to wheezing, frequent coughing with or without sputum, increased breathlessness and reduced endurance of respiratory muscles. The main objective of the study is to identify more significant effect of Chest proprioceptive neuromuscular facilitation and Breathing Exercises on pulmonary function and chest expansion in male Smokers. Method: This comparative study was executed on 50 subjects based on the criteria of the study, which were randomly divided into Group A & B. Subjects in Group A received chest proprioceptive neuromuscular facilitation technique but subjects in Group B received breathing exercises for 2 weeks. Pulmonary functions were assessed by Spirometry and chest expansion was measured at axillary level, nipple level and Xiphisternum level by measuring tape. All measurements were taken at the baseline and on the last day of 2nd week. Independent t-test and paired t-test were used to analyse the data. Conclusion: More significant improvement in terms of pulmonary functions and Chest expansion was observed in group A who received chest proprioceptive neuromuscular facilitation in contrast to group B that received breathing exercises. [ABSTRACT FROM AUTHOR]

Objective: Present study aims to look into age and sex variation of spirometric lung function among Asian Indian children aged 10-18 years and how much Global Lung Initiative (GLI)-South East Asian (SEA) spirometric reference equations are well fitted in the same ethnic children. Materials and Methods: The study was conducted among 136 rural Asian Indian children, West Bengal, India. All spirometric variables were categorized into sex and age, i.e., G-I (10-12 years), G-II (13-15 years), and G-III (16-18 years) Result: With few exceptions, the GLI-predicted and baseline value of spirometric variables significantly varied with sex and age. Percentile distribution showed that FVC and FEV1 were increased with age in both boys and girls but during adolescence, the growth of lung volumes were higher in boys than girls until the age of 18 years and thereafter a certain increment in baseline lung volumes were noted in girls. The mean (SD) Z-score of spirometric variables based on GLI SEA reference equations were exceeded from the acceptable range. The deviation was considerably larger in girls and younger children. Discussion: Spirometric lung function are highly dependent on height, age, sex and ethnicity. Besides, there are some other confounding factors which may have an influence on variation of lung function. In the present study, GLI-SEA reference equation was not fit with rural Asian Indian children. A large extensive quality control data is necessary for Asian Indian children to develop suitable spirometric reference equations which will facilitate diagnosis of respiratory impairment and monitoring disease progression. [ABSTRACT FROM AUTHOR]

Introduction: Bedside pulmonary function tests are simple, reproducibleand can be performed even in sick, bedridden patients. This study was done to assess the roleof bedside pulmonary function tests, in patients with stable COPD and their comparison with standard spirometry. Materials& Methods:A cross sectional, observational study conducted on diagnosed out-patients of COPD in a tertiary care hospital. Spirometry, Oslen modified match test, Sabrazes single breath count, Sabrazes breath holding test, Forced expiratory time was done on all patients. Spirometry values were correlated with bedside tests. Results:Out of total 105 patients, 94 patients could not count >30 with single breath. This was correlated with spirometric values but not significant.26 patients who were able to hold breath for more than 25 seconds had positive correlation with spirometric parameters but not significant.81 patients had forced expiratory time of > 6 seconds, it was found to have positive correlation with the spirometric parameters, FEV1 actual (0.99 ± 0.19 L), FEV1 % predicted (33.29 ± 8.54 %), FVC actual (1.80 ± 0.36 L), FVC %predicted (47.29 ± 10.54%). This was statistically significant (P <0.01). Conclusion:Forced expiratory time (FET) more than 6 seconds correlates with spirometric values and it can be proposed as surrogate marker for the assessment of lung function in clinically suspected COPD patients where spirometry is not feasible. [ABSTRACT FROM AUTHOR]

Construction work is common all over the world. Construction workers are exposed to various physical, chemical, biological and ergonomic hazards that may directly affect respiratory health. Aim of the study was to assess construction workers' pulmonary function and compare pulmonary function with healthy volunteers. This cross-sectional study was carried out in the Department of Physiology ARMCH & RC, Solapur, India from March 2022 to March 2023 on construction workers (n=25) and healthy subjects (n=25). Pulmonary function assessment in both groups was done using a Spiro Excel machine spirometer. The comparison was made between both groups for frequency of respiratory symptoms, spirometry pattern, and spirometry values. Statistical software used unpaired t-test and chi-square test. A normal pattern was observed in 40.0% of healthy subjects compared to 72.0% of construction workers (p<0.05). Restrictive and mixed patterns were evident in 4.0% and 1.0%, respectively, in healthy volunteers compared to 11.0% and 3.0% in construction workers (p<0.05). Statistical difference was seen in all lung function parameters, i.e. FVC, FEV₁, FEV₁/FVC%, FEF 25.0-75.0%, PEFR except MVV between both groups. In conclusion the construction workers are at risk of respiratory function derangement. This derangement is in the form of increased frequency of respiratory symptoms, restrictive & mixed patterns and decreased spirometry values of various parameters.

Background: Stone quarrying activities generate dust and fine particulate matters of silica and heavy metals. The prolonged exposure to suspended particulates leads to fatal respiratory complications. Occupational pulmonary complications are poorly characterized among quarry workers in Tamil Nadu. Objectives: This study aims to assess pulmonary function and determine the associated risk factors among quarry workers. Materials and Methods: A comparative, cross-sectional study was conducted from April 2014 to January 2015 among workers at seven stone quarries in Chennai and residents within a 5 Km radius. Pulmonary function tests (PFT) and sputum analysis were done. Results: Overall, 670 participants were enrolled in the study, with a median age of 37 years. Comparatively, the mean PFT measures were significantly lower in quarry workers with a higher proportion of airflow obstruction and tuberculosis infection. Conclusion: The risk of airflow obstruction among quarry workers increased with smoking and longer duration of work years in quarry. [ABSTRACT FROM AUTHOR]

Background and Aim: Bronchial thermoplasty (BT) is a treatment option for patients with severe asthma. BT involves controlled delivery of radiofrequency energy using a bronchoscopic catheter, thereby reducing bronchial hyperreactivity. Herein, we describe our experience on the safety and efficacy of BT in severe asthma. Methods: This was a retrospective multicenter study of subjects who underwent BT at four centers across India. Results: We included 36 subjects (mean ± standard deviation [SD] age, 50.9 ± 11.5 years, women [69.44%]) undergoing 105 BT treatment sessions. All the subjects met the American Thoracic Society/European Respiratory Society criteria for severe asthma, 22.2% were requiring oral maintenance glucocorticoids. The mean ± SD baseline %predicted forced expiratory volume in one second (FEV1) was 62.07 ± 18.54. The median interquartile range (IQR) annual asthma exacerbation rate in the year preceding BT was 3.5 (1–10). We encountered intraprocedural complications in 7 (6.7%) sessions. An exacerbation of asthma following BT occurred in 6 (5.7%) procedures. We observed a significant improvement in the asthma control test and the asthma control questionnaire scores following BT. The quality of life (asthma quality of life questionnaire) also significantly improved. We noted a significant reduction in the number of exacerbations following BT (median [IQR], 3 [1–10] per year pre-BT versus 0.5 [0–3] per year post-BT, P < 0.001). No significant change occurred in the %predicted FEV1 following BT. Conclusion: BT is a feasible treatment option in patients with severe asthma. More extensive studies are required to establish the efficacy of BT in real-life settings. [ABSTRACT FROM AUTHOR]

Background & objectives: Chronic obstructive pulmonary disease (COPD) is a major public health problem in India. Its magnitude is particularly high among the elderly. Old age and comorbidity may lead to misdiagnosis and under treatment of this condition. COPD is not curable; however, various forms of treatment can help control symptoms and improve the quality of life. Most of the earlier studies lacked uniformity in definitions, designs, methodology and reporting techniques. Studies based on spirometry are only a few. Understanding the current prevalence and associated factors of COPD is important for planning control strategies. Hence, this study was conducted to determine the prevalence of COPD and associated factors among the elderly. Methods: In this community-based study among 449 elderly persons in a rural area, information regarding socio-demographic details, selected health conditions and exposure to risk factors was recorded. The assessment of airway obstruction was done by using a portable spirometer (MIR Spirolab). The diagnosis of COPD was based on the GOLD criteria. The association of COPD with sociodemographic and other variables was analysed by the multivariate logistic regression. Results: Acceptable spirometry findings were available for 392 (87.3%) participants. The prevalence of COPD was 42.9 per cent (95% confidence interval 37.9-47.7%). The prevalence was 54.5 per cent among men and 33.4 per cent among women. Smoking, higher age group and low body mass index were significantly associated with COPD. Interpretation & conclusions: The prevalence of COPD was found to be high among the rural elderly in this study. Interventions aimed at cessation of smoking and preparedness of health systems for diagnosis and management of COPD are hence required. [ABSTRACT FROM AUTHOR]

Background/Aims: Mucus hypersecretion and altered lung functions leads to adverse clinical outcomes in chronic obstructive pulmonary disease. The aim of this study was to compare the effects of the Lung Flute and threshold positive expiratory pressure devices on sputum quantity and pulmonary functions in chronic obstructive pulmonary disease patients. Methods: A total of 50 patients with chronic obstructive pulmonary disease were randomly divided into two groups. Group 1 used the Lung Flute device and group 2 used a threshold positive expiratory pressure device. Sputum quantity was measured post-intervention on a daily basis. Forced expiratory volume in the first second, forced vital capacity, and peak expiratory flow rate were evaluated on day 1 and day 6. Results: The mean sputum quantity in group 1 was 11.40 ml and it was 11.04 ml in group 2. Between-group comparison demonstrated a significant improvement in forced expiratory volume in the first second for group 1 compared to group 2 (P<0.005). Conclusions: The Lung Flute was found to be slightly more effective than the threshold positive expiratory pressure device for airway clearance and also had a positive effect on pulmonary functions in patients with chronic obstructive pulmonary disease. [ABSTRACT FROM AUTHOR]

Interstitial lung diseases (ILDs) are a frequently occurring pulmonary manifestation in patients of connective tissue diseases (CTD). Detailed understanding of this subset of lung diseases is vital, hence the study was conducted to analyze the clinico-radiological characteristics of CTD-ILD. The present study was conducted between March 2017 to February 2018 at a tertiary care teaching hospital from western India. A total of 100 patients having respiratory symptoms suggestive of ILD, who were either diagnosed cases of CTD or had clinical manifestations of underlying CTD, were included in the study. Twentyseven percent of patients belonged to age group 41-50 years and 78% were females. Chief respiratory complaints were dyspnea and cough. Clubbing was present in 29% patients. The most common CTDs were rheumatoid arthritis (RA) (26%), systemic sclerosis (SSC) (21%), mixed connective tissue disorder (MCTD) (19%) and Sjogren's syndrome (SS) (16%). Restrictive defect on spirometry was seen in 58% cases and was most significant among patients with RA (65%) and SS (62%). Pulmonary arterial hypertension was seen in 40% cases and was most evident in MCTD (78%) and SSC patients (58%). Chest radiograph was normal in 47% of subjects. Most common radiological pattern on high resolution computed tomography (HRCT) thorax was non-specific interstitial pneumonia (42%) followed by usual interstitial pneumonia (21%). ILD is a common manifestation of CTD. Work-up for an underlying CTD should be offered to all ILD patients and vice versa. [ABSTRACT FROM AUTHOR]

Context: A total of 20% of Chronic Obstructive Pulmonary Disease(COPD) patients are non-smokers due to preventable causes, such as biomass fuel exposure, post tuberculous sequelae, occupational exposure, air pollution, persistent chronic asthma, and genetic predisposition. Aims: To compare smokers and non-smokers with COPD. Settings and Design: An observational study was conducted at a tertiary care hospital on 60 patients diagnosed with COPD, (GOLD criteria), who were divided into smoker and non-smoker groups. Subjects and Methods: Demographic data, clinical profile, smoking history, and radiological data were collected and compared. Exclusion criteria were individuals having active pulmonary tuberculosis and reversible air flow limitations. Statistical Analysis Used: Using STATA 14.2, quantitative and qualitative data were presented using descriptive statistics. Results: A total of 100% of smokers were male, whereas 70% of non-smokers were female. Compared to non-smokers (16.67%), smokers (26.6%) presented with higher grade of dyspnea. A statistically significant difference was seen with more smokers diagnosed as severe (40%) and very severe (30%) COPD compared to non-smokers with mild (16.67%) and moderate (46.67%) COPD (P < 0.012), Post bronchodilator FEV1 among smokers (42.63) compared to non-smokers (56.63) (P < 0.01) and decrease in FEV1 as the grade of dyspnea increased (P < 0.002). Compared to 36.67% in non-smokers, 70% smokers showed emphysematous x-rays. Conclusions: In our study we found majority of non-smokers to be female, and smokers had a higher grade of dyspnea, more severe COPD, lower post bronchodilator FEV1, and more emphysematous changes on x-rays. [ABSTRACT FROM AUTHOR]

BACKGROUND: Welding is one of the most hazardous professions across the globe. Several risk factors are associated with Indian unorganized welding units such as welding gases, fumes and dust particles resulting in various respiratory health problems. OBJECTIVE: The objective of the present study is to examine the prevalence of respiratory symptoms, their associated factors and lung function impairment amongst the welders of the unorganized sector in India. METHODS: A cross-sectional study was conducted across 283 welders of age group 18–55 years from Punjab, India who responded to the interviewer-administrated respiratory symptoms questionnaire. Also, the lung function parameters of 50 male welders (exposed group) and 50 male non-welders (control group) working in the same environment were evaluated. RESULTS: The prevalence of respiratory symptoms such as chronic cough (38.86%), phlegm (38.86%), shortness of breath (33.56%), wheezing (32.15%), chest tightness (36.40%,) and sputum (34.27%) was reported by the welders. The observed mean values of forced vital capacity (FVC), forced expiratory volume in 1s (FEV1) and FEV1/FVC ratio of welders were (3.37±0.175), (2.59±0.16) and (76.63±6.16) respectively and that of non-welders were (3.70±0.15), (3.05±0.25) and (82.49±7.62) respectively. CONCLUSIONS: The welders were found to be at significant risk of developing pulmonary diseases. Long working hours, low level of education, hazardous working conditions, lack of implementation of safety laws make welders more vulnerable to health risks. The welders of Indian unorganized sector work without any technical training related to welding and safety. Proper orientation sessions about the workplace hazards and to maintain hygiene at their workplace should be organized. Welders must be provided with Personal Protective Equipment (PPE). Welders should take proper health check-up and medication to sustain healthiness [ABSTRACT FROM AUTHOR]

Background: Chronic obstructive pulmonary disease (COPD) contributed significantly to burden of diseases in India, with missed, incorrect, and delayed diagnosis in primary care. We conducted a rapid evidence synthesis, to summarize the evidence on accuracy of the screening tests for COPD in primary health care on request form State Health Resource Centre, Chhattisgarh. Methods: Considering the rapid nature of decision making, our approach was to first search for existing systematic reviews. We identified one existing systematic review on the topic with the search conducted until 2014. We updated the review by searching in two major databases screened, title/abstracts, and full texts of studies as per eligibility criteria and extracted relevant data. A narrative synthesis was conducted. Results: We retrieved 7,007 and included five new studies, to add to 10 studies of the existing systematic review. Overall, 13 studies assessed diagnostic accuracy of screening questionnaires [e.g., COPD Diagnostic Questionnaire (CDQ)], five assessed handheld flow meters (COPD6 and PICO-6), and four assessed the combination of both the tests. The CDQ questionnaire using a score threshold ≥16.5 or >17 demonstrated comparatively a higher sensitivity both in pooled result for ever-smokers [87.5% (95% CI 83.1--90.9%)] and among the adults >35 years [73.8--93% (95% CI 69--98%)] when compared to a different score threshold of CDQ and other questionnaires. Handheld flow meters reported a pooled high sensitivity of 79.9% (95% CI 74.2--84.7%) in ever-smokers and 87.9% in adults with age >35 years. Conclusions: The need for better diagnosis of COPD in primary healthcare can be addressed by using of COPD Diagnostic Questionnaire alone or in combination with hand-held flow meters. There is scope for more implementation research on the domain. [ABSTRACT FROM AUTHOR]

Introduction: Low Vitamin D levels have been associated with Chronic Obstructive Pulmonary Disease (COPD) and acute exacerbations. Objectives: There is a paucity of data on Vitamin D and COPD, its severity and exacerbations in populations that are exposed to sunlight regularly with high levels of physical activity most of their lives. Methods: Serum levels of 25‐OH‐Vitamin‐D were assessed in 100 COPD subjects and 100 age‐ and gender‐matched controls from the rural community‐based MUDHRA cohort in South India. Levels of <20 ng/mL were defined as Vitamin D deficiency. Smoking habits, occupation, Charlson co‐morbidity index, Standard of living index(SLI), body mass index(BMI), 6‐minute walking distance were examined for associations with logistic regression between controls and COPD subjects. Unconditional logistic regression was used to examine the association with exacerbation of COPD. Results: Vitamin D deficiency was observed in 64.5% (95%CI 57.7–70.8) of the subjects in spite of regular exposure to sunlight. Subjects with COPD had higher risk of Vitamin D deficiency (Adjusted OR: 5.05; 95%CI 1.4–17.8) as compared to controls. Amongst subjects with COPD, Vitamin D deficient subjects were three times more likely to have exacerbations in the previous year (Adjusted OR:3.51; 95%CI 1.27–9.67) as compared to COPD subjects without Vitamin D deficiency. Levels of Vitamin D <20.81 ng/mL and <18.45 ng/mL had the highest levels of combined sensitivity and specificity for COPD and acute exacerbation of COPD (AECOPD) respectively. Conclusion: In a rural population exposed to sunlight many hours a day throughout their lives, low Vitamin D levels were associated with COPD and exacerbations of COPD. [ABSTRACT FROM AUTHOR]

Background: The polyurethane foam (PUF) mattress-making workers are exposed to isocyanates which are known respiratory toxicants and cause effect on pulmonary volumes and flows. Thus, the study was with a rationale to measure the changes in pulmonary flow and volumes due to isocyanates among PUF mattress-making workers. Materials and Methods: The study included 183 male workers from seven PUF making units of western and northern India. Using the interview technique as a tool for data collection, demographic and occupational details of the subjects were recorded on the predesigned and pretested pro forma. The mean of spirometric parameters was compared using one-way ANOVA and t-test. The relation between spirometric parameters and anthropometric parameters was analyzed using the correlation coefficient. Results: The spirometry showed that out of 183 participants, 165 (90.2%) subjects had normal spirometry, 13 (7.1%) had restrictive impairment, and 4 (2.2%) had obstructive impairment. All the mean spirometric values showed a declining trend with increasing age, while only forced expiratory volume in first second and forced vital capacity25%--75% showed a declining trend with increasing duration of employment. The spirometric measurements had a negative correlation with age and positive correlation with height. Conclusion: The spirometric values representing the airway flow were affected. The associated factors include age and duration of exposure. [ABSTRACT FROM AUTHOR]

Background: Flexible foam industry largely uses 2,4 and 2,6 Toluene di-isocyanate as main raw materials and chronic exposure to its result in occupational asthma. The exposure to di-isocyanates might be higher due to the usage of obsolete technology, hand-mixing methods and working in confined spaces with insufficient local exhaust ventilation systems in developing countries. Exposure studies in flexible foam industries have not been done in developing countries. Objective: The present cross-sectional study was conducted to evaluate toluene di-isocyanate (TDI) exposures and respiratory health of the workers working in the seven flexible polyurethane foam industries located in Western India during 2010-2013. Method: A total of 128 personal air samples collected and evaluated for total TDI concentration using improved Occupational Safety and Head Administration method number 42. Then 194 workers were covered for complete clinical examination and spirometry for assessing respiratory health. Results: In all, 17.83% of air samples exceeded the ACGIH TWA-TLV of 0.005 ppm for TDI. Though only 11 (5.6%) workers had respiratory complaints, the spirometry revealed that 19 (9.8%) and four (2.1%) had restrictive and obstructive type of pulmonary function impairment, respectively. Conclusion: The TWA concentration of TDI exceeded at raw material storage, mixing, foaming, block cutting and curing areas in four out of seven industries even in the presence of local exhaust systems. The respiratory health effect is less when compared to exposure to TDI, suitable preventive and control measures were suggested based on the study findings to the stakeholders to prevent the increase of respiratory health effects. [ABSTRACT FROM AUTHOR]

Background: There is increasing concern of ambient air pollution as a global threat to humans. The most prominent effect of air pollution is on lung function. The air pollution causes decline in lung function amongst high exposure populations. There are some most vulnerable groups who are chronically exposed to ambient air pollution like traffic policemen, roadside hawkers, Banjara community in India, E-Rickshaw drivers etc. Methods: A cross sectional study was conducted in East Delhi, India. Spirometry was done for roadside hawkers having high exposure to ambient Air pollution and working daily for 6-8 hours for the last more than 3 years. The low exposure group was taken from personnel working inside offices. The spirometry parameters of both the groups were compared. Student 'T' test was applied for statistical analysis with the help of SPSS software. Results: Comparison of FVC, FEV1 and FEV1/FVC ratio among two groups revealed lower values for the high exposure group which was statistically significant. Among high exposure group the mixed pattern of ventilation defect was observed. Among low exposure group normal pattern of lung function was observed. Conclusion: Roadside hawkers are a vulnerable group to ambient air pollution resulting in their lower values of lung function parameters with resultant mixed ventilator defect and consequently high risk for development of respiratory diseases in the future. [ABSTRACT FROM AUTHOR]

Background: Chronic obstructive pulmonary disease (COPD) is the second leading cause of mortality in India; however, there are no programs for COPD in India at primary care level. Kerala became the first state in India to implement a program at primary care for COPD, called the Step Wise Approach to Airway Syndrome program. Objective: The objective of the study was to evaluate and document the implementation status of a program for obstructive airway disease (OAD) in Trivandrum district of Kerala state in India and compare the treatment characteristics of patients with OAD seeking care from the centers implementing and not implementing this program for OADs. Methods: A cross-sectional study was done as early evaluation of a program for OAD implemented in Kerala state, India, from October 2018 to February 2019. Results: A reflection of the health-seeking behavior due to better facilities at the FHCs. There was no difference in the hospital visits or emergency department visits between the two groups. However, there was a statistically significant difference in the average number of visits per patient to health center for taking injectable drugs and visits for nebulization. Forty-nine (94%) of the COPD and 36 (100%) of the asthma patients underwent spirometry from implementing center itself. A higher proportion of patients receiving care from implementing centers (30.9%) never had to buy inhalers from outside. Conclusion: This is the first time that a public health programme for chronic respiratory disease management at primary care level was evaluated in India. The study has provided valuable insights on the need for strengthening the training for health care providers as well as patient education in bringing about a change in patient attitudes. [ABSTRACT FROM AUTHOR]

Rural population-based estimates of airflow obstruction based on spirometry are unavailable from southern India. This study assessed the prevalence of spirometry-defined airflow obstruction in Vellore, Tamil Nadu. A cross sectional survey was done in nine villages, among adults aged ≥30 years, where previous cardiovascular surveys had been conducted (1994, 2011). Population proportional to size sampling was used to select 20 clusters, with sampling from all streets proportional to the number of households. One person randomly selected per household was interviewed for symptoms and risk factors. A respiratory therapist performed pre and post bronchodilator spirometry on all, following American Thoracic Society criteria. Airflow obstruction was defined as pre-bronchodilator Forced Expiratory Volume 1 s/Forced Vital Capacity (FEV1/FVC) < Lower Limit of Normal (LLN, derived from local prediction equations) and compared to other criteria. Of 1015 participants, 787 completed technically acceptable spirometry. The prevalence of airflow obstruction was 9.0% (95% CI: 5.8%–9.6%, 71). Fixed obstruction (post bronchodilator FEV1/FVC < LLN) was 4.6% (95% CI: 3.1%–6.1%, 36), and 4.1% (95% CI: 2.7%–5.5%, 32) using post bronchodilator FEV1/FVC < 70%. The GOLD criteria missed 56% (40) of those with airflow obstruction, of which 87.5% were females. Although 63.4% with airflow obstruction had moderate to severe disease, 82.2% were not on treatment and only 48.9% reported symptoms in the previous year. This study estimates prevalence of airflow obstruction based on spirometry in rural southern India. Despite significant impairment on spirometry, majority were undiagnosed, and half did not report symptoms. [ABSTRACT FROM AUTHOR]

The prevalence of both Obesity and Asthma is increasing worldwide. Various epidemiological data has linked obesity with the development and severity of asthma in children. The aim of this study was to assess if any relationship exists between obesity and asthma in children. The study population included school children aged 5 to 18 years. A total of 320 asthma cases and 300 controls were included in our study. Association analysis of obesity and asthma based on epidemiological basis was measured. Out of 320 cases, 61 children were found to have moderate persistent asthma. Out of 61 moderate persistent asthma cases, 50 children were selected randomly and divided into two groups. Group I included 25 obese moderate persistent asthmatics and Group II included 25 non-obese moderate persistent asthmatics. Forced expiratory volume in one second (FEV1), Forced vital capacity (FVC), Forced expiratory flow (FEF25–75%), Peak expiratory flow (PEF) were measured with spirometry and Peak expiratory flow meter. Statistical analysis was done by Odds ratio and p value. Out of 320 cases, 97 were obese and 223 were non-obese. Out of 300 controls, 46 were obese and 254 were non-obese. Exposure rate for cases and controls were 30.31% and 15.33% respectively. Odds ratio was 2.40. χ2 value was 19.56 with p value < 0.05.FEV1, FVC, FEF25–75%, PEF for Group-1 were 66.3 ± 9.9, 63.5 ± 4.2, 54.2 ± 5.7, 67.4 ± 8.4 respectively and FEV1, FVC, FEF25–75%, PEF for Group-2 were 74.07 ± 3.5, 77.4 ± 7.2, 60.1 ± 2.1, 71.6 ± 2.4 respectively and p values were < 0.001, < 0.001, < 0.001, < 0.05 respectively which is statistically significant. Children who are obese are more likely to develop severe asthma than those who were not obese. [ABSTRACT FROM AUTHOR]

Objective: Post-operative care is management of patients after any surgery. The main goal of post-operative care is to prevent complications i.e. atelectasis and infection. The other objective is early healing of the surgical incision and return of patient to a state of health. About 17% to 88% of people in postoperative duration will have decreased lung volumes. This decreased lung volume problem can be solved with use of incentive spirometry in postoperative period on Day 1. Incentive spirometer is perioperative respiratory therapy given to postoperative patients to improve lung volume of patients and hasten recovery of patients also. The main aim of study were to identify effect of Incentive spirometry on postoperative patient's recovery. Method: It was pre-experimental study with pretest-posttest design only, which was done on post-operative patients at All India Institute of Medical Sciences (AIIMS), Rishikesh. Results: Majority (52%) of participants were 41 to 50 years age group. Male and female ratio for participants were 46:54. Paired 't' test p value i.e. 0.00* with CI [0.72, 1.03] showed that on Pretest and Day 3 Performance level on incentive spirometry of participants showed a significant value, which indicate that spirometer enhance recovery of post-operative patients by increasing their lung volumes. Conclusions: This study revealed that incentive spirometry is effective in improving of pulmonary function among post-operative patients, which further improves blood circulation and hasten early recovery of surgical wound. This spirometry should be integral part of Post-operative care. All nurses who are involved in Postoperative units should encourage patients to do it on regular basis and document it as a vital sign. Good compliance to incentive spirometry can improve better outcome of patient's. [ABSTRACT FROM AUTHOR]