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The aim of the present study was to find out efficacy of cognitive behavior therapy, as an adjunct to standard pharmacotherapy, in bronchial asthma. In a random­ized two-group design with pre-and post assessments, forty asthma patients were randomly allotted to two groups: self management group and cognitive behavior therapy group. Both groups were exposed to 6-8 weeks of intervention, asthma self management program and cognitive behavior therapy. Assessment measures used were-Semi structured interview schedule, Asthma Symptom Checklist, Asthma di­ary, Asthma Bother Profile, Hospital Anxiety & Depression Scale, AQLQ and Peak Expiratory Flow Rate. Within group comparison showed significant improvement in both groups at the post assessment. Between group comparisons showed that CBT group reported significantly greater change than that of SM group. Cognitive behavior therapy helps in improving the managment of asthma.

Objectives: To ascertain the validity of anatomic diagnostic protocol in determin­ing the etiology of chronic cough in tropics and a cost analysis of the protocol to ascertain effective ways of managing patients with chronic cough. Methods: A prospective, descriptive, study of non-smoking patients with chronic cough. All patients were evaluated by a validated anatomic diagnostic protocol. The diagnostic protocol was modified to include sputum examination for acid-fast bacilli, absolute eosinophil count and stool examination. The final diagnosis was based on radiological, laboratory findings and a successful response to therapy. Results: Eighty-seven consecutive patients with chronic cough were evaluated from February 2000 to February 2002 using the modified diagnostic protocol. The mean age ±S.D. was 35.00±11.85 years. Forty-nine patients were males. Etiology of chronic cough was established in 86 (99%) patients. Cough resolved in 99% of patients after successful diagnosis and treatment. The three most common causes were Postnasal drip syndrome (PNDS), 52%, Asthma, 41%, and Loeffler's syn­drome, 8%. Pulmonary tuberculosis was confirmed in 5% of patients. Hence, 13% of patients had conditions more prevalent in the tropics. Gastroesophageal reflux disease (GERD) was seen in 6%. Rare causes of chronic cough included congestive cardiac failure (CCF) 2%. Cough was due to multiple causes in 15%. The average cost per patient was Rupees (RS) 878.55 (1US$=RS 45). However if we use the pro­tocol proposed at the end of study the average cost per patient will be RS 743.55. Using the modified diagnostic protocol 90% of patients were diagnosed with mini­mal investigations making it cost effective. Conclusion: The three most common causes of chronic cough in the tropics are different from the west. Pulmonary tuberculosis and Loeffler's syndrome are more prevalent and need to be considered. Using a modified diagnostic protocol etiology of chronic cough can be determined successfully in tropical countries in most patients. A cost effective way of evaluating cough has been proposed.

Nutritional status affects outcome in acute illnesses. Weight loss is associated with poor lung functions and outcome in chronic obstructive pulmonary diseases (COPD). There is not much data on the effects of nutritional status on hospital outcome in patients with acute exacerbation of COPD. This study was conducted to address this issue. Twenty five patients with COPD admitted with acute exacerbation in a tertiary care teaching hospital in Southern India were studied. Lung functions were as­sessed by spirometry. Nutritional status was assessed using anthropometric mea­sures {body mass index (BMI), mid-arm circumference (MAC), triceps skin-fold thickness (TSF) and fat free mass (FFM)}. Resting energy expenditure (REE) was measured using indirect calorimetry. Hospital outcome was determined by mortal­ity, number of days to improve subjectively and number of days to discharge. Patients with a lower BMI, MAC and TSF took a longer time to recover. REE was found to be lower in patients with weight loss unlike the Western patients. On multivariate analysis, only a lower BMI was associated with a longer time to re­covery. Thus, nutritional status is an important predictor of hospital outcome in patients with COPD.