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Asthma is a major health problem globally that affects people across all the age groups. The prevalence of asthma is increasing worldwide, especially in the low- and middle-income countries. Asthma is controlled with inhaled corticosteroid (ICS) with as-needed or daily low-dose therapy. A step-up therapy to daily combination treatment with low- or medium-dose ICS/long-acting β-agonist (LABA) may be required for those with persistent symptoms. Asthma control levels are low despite the availability of many therapies. The efficacy of inhaled asthma therapy is dependent on the efficiency and reliability with which the drug is delivered to the lungs. Combination of an ICS and a LABA in a single inhaler is a safe, effective, and convenient treatment option for asthma management. Fluticasone and formoterol in combination ensure high potency action against anti-inflammation and rapid bronchodilation, and is a well-established ICS-LABA dual therapy. Rapid bronchodilator action of formoterol and fluticasone’s long-term action against inflammation are vital clinical attributes for optimal asthma maintenance treatment. Fluticasone/formoterol combination therapy is an efficacious and safe alternative treatment option for patients with moderate to severe asthma. The combination of the two in a single inhaler is beneficial with regards to ease of administration and patient compliance.

Background and Objectives: Depression is an important comorbid condition of chronic obstructive pulmonary disease (COPD). There is a risk of undertreatment for depression in patients with COPD as depressive symptoms, including suicidal tendencies, can erroneously be conceptualized as an understandable reaction to COPD and not as signs of an independent depressive disorder. The exact prevalence of depression in COPD patients among the Indian population is unknown. Aim: This study aims to know the prevalence of depression in COPD patients attending tertiary care hospital. Materials and Methods: A total of 120 COPD patients were enrolled in the study according to Global initiative for COPD (GOLD) criteria 2015. They were screened for depression as per Beck's depression score. Results: Eighteen patients in stage 1, 66 patients in stage 2, 29 patients in stage 3, and 7 patients in stage 4 of the COPD were enrolled. The prevalence of depression in the study population was 55%. Conclusion: The prevalence of depression in COPD is very high. The factors associated with depression in COPD patients were the duration of the disease, body mass index, GOLD stage, and smoking. Duration of the disease and smoking was the most significant factors associated with depression in COPD. Patients with COPD should be screened for depression and those with higher depression score should undergo further evaluation. Further studies involving larger number of subjects from several centers are required to study the prevalence of depression in Indian patients with COPD.

Background: Chronic obstructive pulmonary disease (COPD) is associated with important chronic comorbid diseases, including diabetes, hypertension and cardiovascular diseases. As very limited data is available in India, the aim of the present study was to determine the relationship between COPD and the common, chronic comorbid conditions of diabetes mellitus (DM), hypertension (HTN), and cardiovascular diseases (CVD) and also to determine how these affect the clinical course of COPD. Methods: All the COPD cohorts diagnosed as per Global Initiative for Chronic Obstructive Lung Disease-2013 (GOLD-2013) criteria were screened for DM, HTN, and CVD as per stipulated national and WHO guidelines. Results: The prevalence of DM, HTN, and CVD in the 2432 COPD subjects was 25.94%, 37.25%, and 13.93%, respectively. In multivariate analyses, very severe COPD was associated with a higher risk of DM (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.2–2), HTN (OR 1.6, 95% CI 1.4–1.9), and CVD (OR 2.5, 95% CI 1.9–3.0). Conclusion: A significant relationship was found between COPD and the presence of comorbid DM, HTN, and CVD. It was also found that subjects with advanced COPD were more likely to have at least two of these conditions and hugely affect the outcome of the disease. These findings suggest that the presence of COPD could provide a rationale to look for other comorbid disease and, conversely, that the presence of DM, HTN, or CVD might be the basis for the assessment of patients for airflow limitation and COPD as the tobacco smoking and advancing age were common risk factors.

Background and Objectives: Tobacco smoking has been established as a major risk factor for chronic obstructive pulmonary disease (COPD) in women of developing countries, but emerging evidence suggests that biomass fuel is an important risk factor as well. The primary objective of the study was to find the true prevalence of COPD in Indian women exposed to biomass fuel using spirometry. We also aimed to find the determinants of underdiagnosis of COPD in these participants. Methods: Women with a history of exposure to biomass fuel for ＞10 years were screened for COPD using spirometry following all standard protocols as per GOLD/ATS/ERS definitions. Results: Of the 2868 women screened, a total of 529 (18.4%) women were confirmed to have COPD in which 123 (4.2%) were “Women with known COPD” and 406 (14.2%) “Women with new COPD”. The mean age at the time of Diagnosis was 61±5.2 and 47±3.6 respectively. The duration of exposure to biomass fuel had a great impact on the risk of COPD with OR 1.2, 95% CI (1.1-1.9) for patients with 10-15 years exposure and OR 2.9, 95% CI (2.5-3.1) for exposure ＞25 years, p＜0.001. Conclusion: The prevalence of COPD among women exposed to biomass fuel is very high. A strong correlation was found between the risk of COPD and the duration of exposure along with the age at which the exposure to biomass fuel begins. Underdiagnosis of COPD was frequent in women due to the lack of the availability of spirometry, lack knowledge of hazards of biomass fuel, a low level of education and the ignorance of the health care provider being the important determinants of underdiagnosis.

INTRODUCTION: Bronchial asthma is one of the most common chronic diseases in the world affecting around 5% of the world's population. More simple and inexpensive tools are required to assess asthma control, especially in resource-poor countries where pulmonary function tests are not feasible. The effectiveness of asthma control test (ACT) in assessing asthma control and its correlation with asthma severity is unknown. AIM: The aim of this study is to evaluate the effectiveness of ACT in assessing asthma control and its relation to the severity of asthma by comparing with a global initiative for asthma (GINA) classification. MATERIALS AND METHODS: In a tertiary care hospital, 106 bronchial asthma patients were enrolled. All patients underwent clinical evaluation, spirometry to assess the severity according to the GINA classification and were given ACT questionnaire to assess asthma control. Patients were further followed by two visits 3 months apart. Correlation between the ACT and GINA classification was assessed at each visit. RESULTS: ACT was able to give sensitivity of 82.3%, specificity of 69.4%, positive predictive value (PPV) was 56%, and negative predictive value (NPV) was 89.2% at the first visit (P CONCLUSIONS: ACT with high sensitivity, specificity, and PPV, could be a potential alternative diagnostic tool in assessing asthma severity even without aid of a spirometer or a peak flow meter.

There is growing evidence that tobacco smoking is an important risk factor for tuberculosis (TB). India, with a population of 1.26 billion, has the highest number of both TB patients and smokers. The convergence of these two important health hazards is likely severely affecting India's TB control programs. This study was carried out to determine the prevalence of smoking in newly diagnosed pulmonary TB patients and the impact of smoking on disease outcomes in a tertiary care hospital. All patients newly diagnosed with pulmonary TB as per the Revised National Tuberculosis Program of India (RNTCP) 2013 criteria were enrolled in the study. On the basis of their self-reported smoking status, the participants were classified as never smokers, current smokers, and ex-smokers. Patients were started on anti-TB treatment and were followed for 2 years. Among the 2350 subjects (1,758 males and 592 females), 1,593 patients (67.78%) were never smokers. Current and ex-smokers numbered 757 (32.21%), of which 751 (31.95%) were males and 6 (0.26%) were females. Smoking was associated with more extensive lung disease, lung cavitation, and positive sputum smear and culture results at baseline. In both current smokers and ex-smokers, sputum smears and cultures were significantly more likely to remain positive after 2 months of treatment. Ex-smokers and current smokers had significantly high rates of defaults, treatment failures, and relapses. The prevalence of smoking is very high in TB patients. Tobacco smoking is associated with a considerably increased risk of advanced and more severe disease in the form of lung cavitations, positive sputum smear and culture results, and slower smear and culture conversion after initiation of treatment. Smoking has a great negative effect on treatment completion, cure rates, and relapse rates in patients with pulmonary TB.

Background Chronic obstructive pulmonary disease (COPD) is a very common lung disease most often related to history of smoking. It becomes more prevalent with increasing age but remains under-diagnosed and under-treated in the elderly population. Under diagnosis of COPD is universal in elderly patients because of multiple pathology, difficulty with measurement of lung function, under-reporting of symptoms and reduced perception of dyspnoea. However the screening of the elderly (age >60 years) is not performed routinely even when they are symptomatic. Objective The study was undertaken to screen elderly subjects with dyspnoea and/or reduced exercise tolerance for COPD. Study design A cross sectional hospital based study. Methods A total of 1000 elderly subjects were screened for COPD using standard spirometry as per GOLD guidelines. Diagnostic evaluation and classification of patients as “no COPD”, “new COPD” and “known COPD” were done by panel of experts which included a Pulmonologist, Cardiologist, General Physician and Physiotherapist. Subjects were categorized as mild, moderate, severe and very severe COPD based on FEV 1 (forced expiratory volume in 1st sec) values. Results Of the total 1000 elderly participants screened, 596 (59.6%) were classified as having no COPD, 228 (22.8%) with new COPD and 176 (17.6%) with known COPD. Among the total 228 of new COPD patients 27 (11.8%), 176 (77.4%), 5 (2.1%) and 20 (8.7%) were having mild, moderate, severe and very severe COPD respectively as per GOLD guidelines. Similarly of the total 176 subjects with known COPD, 9 (5.1%), 136 (77.3%), 0 (0%) and 31 (17.6%) were having mild, moderate, severe and very severe COPD respectively. Conclusion An active screening for COPD in elderly subjects with dyspnoea or reduced exercise tolerance leads to diagnoses of substantially more new patients with COPD.