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The SABINA (SABA use IN Asthma) program was initiated to describe short-acting β2-agonists (SABA) prescription patterns and assess the impact of its over-prescription on exacerbation risk and asthma control. We evaluated SABA prescription patterns in patients with asthma in the Indian cohort of SABINA III. This multi-centre, observational, cross-sectional study included retrospective and real-time electronic data collection. Data were extracted from medical records of patients with asthma (aged >12 years) having >3 consultations with the same healthcare practitioners between March 2019 and January 2020. The data included prescriptions of SABA and other asthma treatments and over-the-counter (OTC) purchases of SABA. SABA prescriptions were categorized by the number of SABA canisters prescribed in the 12 months preceding the study visit. A total of 510 patients with asthma were included from specialist care (mean age 49.1 years; 57.65 females), with 8.2% classified with mild asthma and 91.8% with moderate-to-severe asthma. SABA as monotherapy and add-on to maintenance therapy was prescribed to 4.5% (n = 23) and 44.9% (n = 229) of patients, respectively. While ICS monotherapy and ICS/LABA were prescribed to 5.1% (n = 26) and 93.3% (n = 476) of patients, respectively. SABA was found to be over-prescribed (≥3 SABA canisters/year) among 23.9% of patients (n = 122). Additionally, 8% of patients (n = 41) purchased SABA OTC without prescription. Nearly one-fourth of patients with asthma in India were over-prescribed SABA. Educational programmes targeted at national and regional levels should be expanded to raise greater asthma awareness and encourage the adoption of guideline-directed asthma treatment plans among healthcare practitioners. [ABSTRACT FROM AUTHOR]

Asthma control is highly inadequate in India, with worse outcomes and poor adherence to inhaled corticosteroids (ICSs). As per the Global Initiative for Asthma guidelines, leukotriene receptor antagonist (LTRA) can be added when a low-to-moderate dose of ICS does not provide sufficient disease control. The combination of montelukast with its anti-inflammatory action and acebrophylline with its mild bronchodilator, anti-inflammatory, and mucolytic actions may be beneficial in patients with asthma. This manuscript aims to present an expert opinion to discuss the role of montelukast and acebrophylline combination in the management of asthma. An expert panel comprising nine specialists in respiratory medicine took part in a roundtable discussion to review the role of montelukast-acebrophylline combination in the management of asthma. A qualitative question-and-answer-based format was used to help facilitate the discussion. It was concurred that the montelukast and acebrophylline combination may be used if asthma symptoms remain uncontrolled with ICS and long-acting β2-agonists. This combination can also be preferred in patients with severe pulmonary obstruction along with allergic bronchopulmonary aspergillosis, in patients with asthma-chronic obstructive pulmonary disease overlap syndrome, and in patients with a history of smoking. There is adequate evidence for the role of montelukast and acebrophylline as individual drugs in asthma. However, evidence related to their combination therapy is lacking. The panel has reiterated the need for studies to evaluate the safety and efficacy of montelukast and acebrophylline combination in patients with asthma and its variants. [ABSTRACT FROM AUTHOR]

Introduction: Pathological cough in primary care is a significant concern. With a prevalence ranging from 5 to 10% in India, cough is the second most common symptom seen by general practitioners (GPs). The existing algorithms and tools that are available are generally meant for cough categorization in specialized fields; their limited adoption by GPs results in insufficient screening and categorization of cough, which results in the use of irrational fixed drug combination formulations., Objectives: Formulation of recommendations for GPs to enable them to appropriately screen and categorize cough for efficient management and avoid irrational treatments., Methods: An expert panel (seven experts specializing in pulmonology and internal medicine) held a virtual discussion to assess the necessity for cough categorization and develop user-friendly tools, along with a simplified format for history taking in cough evaluation and management. Panel discussions were based on a questionnaire that contained items related to the categorization of cough, assessment tools, and approaches to treating cough., Results: After deliberations, simplified clinical practice recommendations and assessment tools were developed by the experts to facilitate the categorization of cough into wet or dry categories, thereby helping in the symptom-based management of cough., Conclusion: By adhering to these principles and using assessment tools, primary care practitioners can optimize cough management, avoid irrational drug combinations, minimize potential risks, and improve patient well-being., (© Journal of the Association of Physicians of India 2024.)

Introduction: Pneumococcal diseases pose a significant public health concern in India, with substantial morbidity and mortality, with the elderly and those with coexisting medical conditions being most at risk. Pneumococcus was also seen to be one of the main reasons for co-infection, pneumonia and complications in COVID. Current guidelines recommend vaccination for specific adult populations, but there is a lack of uniformity and guidance on risk stratification, prioritisation and optimal timing., Methods: Nation Against Pneumococcal Infections - Expert Panel Opinion (NAP-EXPO) is a panel convened to review and update recommendations for adult pneumococcal vaccination in India. The panel of 23 experts from various medical specialties engaged in discussions and evidence-based reviews, discussed appropriate age for vaccination, risk stratification for COPD and asthma patients, vaccination strategies for post-COVID patients, smokers and diabetics, as well as methods to improve vaccine awareness and uptake., Outcome: The NAP-EXPO recommends the following for adults: All healthy individuals 60 years of age and above should receive the pneumococcal vaccine; all COPD patients, regardless of severity, high-risk asthma patients, post-COVID cases with lung fibrosis or significant lung damage, should be vaccinated with the pneumococcal vaccine; all current smokers and passive smokers should be educated and offered the pneumococcal vaccine, regardless of their age or health condition; all diabetic individuals should receive the pneumococcal vaccine, irrespective of their diabetes control. Strategies to improve vaccine awareness and uptake should involve general practitioners (GPs), primary health physicians (PHPs) and physicians treating patients at high risk of pneumococcal disease. Advocacy campaigns should involve media, including social media platforms., Conclusion: These recommendations aim to enhance pneumococcal vaccination coverage among high-risk populations in India in order to ensure a reduction in the burden of pneumococcal diseases, in the post-COVID era. There is a need to create more evidence and data to support the recommendations that the vaccine will be useful to a wider range of populations, as suggested in our consensus., (Copyright © 2024 Copyright: © 2024 Indian Chest Society.)

Considering a huge burden of chronic respiratory diseases (CRDs) in India, there is a need for locally relevant Pulmonary rehabilitation (PR) services. This cross-sectional survey was aimed to explore the interest, needs and challenges among various stakeholders for PR in Pune city, India. At the outpatient respiratory medicine department of a multi-speciality hospital in Pune, India, 403 eligible people with CRDs were invited to participate in the survey, of which 370 (92%) responded and agreed to participate. (220 males, mean ± SD age 56 ± 15 years). Out of the 370, 323 (87%) people with CRDs were keen to attend PR. In a multiple selection question, there was inclination towards paper-based manuals home-based (70%) and web-based (84%) programs. 207 healthcare providers (HCPs), including physicians, pulmonologists and physiotherapists involved in the care of people living with CRDs across Pune city were invited to participate in the survey. Out of the 207, (80%) of the HCPs believed that PR was an effective management strategy and highlighted the lack of information on PR and need for better understanding of PR (48%) and its referral process. The surveyed stakeholders are ready to take up PR, identifying specific needs around further knowledge of PR, modes of delivery, and referral processes, that could potentially feed the development of relevant PR programs in the Indian healthcare settings., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.