Background: Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes airflow obstruction which leads to hypoxia. Serum uric acid is increased in hypoxic states as well as in systemic inflammatory conditions. The purpose of the present study was to assess whether the higher value of serum uric acid corresponds with the severity of COPD as per spirometric classification of COPD. Material and methods: This cross-sectional study included 294 spirometry-diagnosed patients of COPD as per Global Initiative for Chronic Obstructive Lung Disease criteria. Serum uric acid levels were tested on all the patients. The patients with raised serum uric acid levels were further categorized according to severity COPD grade. Reference of normal serum uric acid levels among males was taken as 3.5−8.5 mg/dL and among females as 2.5−6.2 mg/dL. Results: In the present study of 294 patients, maximum patients, i.e., 59.5%, were in moderate COPD grade. The mean serum uric acid value in male subjects was 5.9 ± 2.066 mg/dL, while in female subjects the mean serum uric acid value was 6.31 ± 1.93 mg/dL. About 85 (22 males and 63 females) had serum uric acid values out of the normal range. In males, maximum (41.6%) were in severe COPD grade, whereas in females maximum (80.8%) were in moderate COPD grade. Severe COPD grade showed statistically significant (p = 0.037) association with raised serum uric acid levels in both male and female subjects. Conclusion: The study concludes that mean uric acid levels progressively increased as the COPD grade increased from I to IV. Since serum uric acid levels were raised in COPD patients mainly in the severe COPD grade, it serves as a useful parameter for assessing disease severity and hypoxemia in known COPD patients.

Background: Long-acting beta2-agonists (LABA) and inhaled corticosteroids require twice daily administration for effective treatment of bronchial asthma. This study aims to study the efficacy of fluticasone furoate/vilanterol (FF/VI) ICS/Ultra-LABA once-daily combination therapy in patients with bronchial asthma. Materials and methods: This prospective observational study included 120 spirometry-diagnosed patients of bronchial asthma who were given FF/VI combination therapy and underwent follow-up at 2, 4, and 8 weeks of therapy. Patients were assessed during the follow-up period for the efficacy of therapy based on spirometric values. Results: In the present study 61.7% were females and 38.3% were males. The commonest presenting symptom was cough present in 95% of patients followed by wheezing which was seen in 93.3% of patients and shortness of breath in 89.17% of patients. At 8 weeks of continuous therapy, only 5% of patients had a cough, 8.33% had wheezing and only 2.5% complained of shortness of breath. Forced expiratory volume (FEV) in one second (FEV1) at baseline, was 56.60 ± 1.26, and by the end of 8 weeks, it increased to 90.36 ± 11.38. Forced vital capacity (FVC) at baseline was 64.83 ± 12.63 and it increased to 91.8 ± 1035 at 8 weeks. Forced expiratory volume in one second (FEV1)/FVC at baseline was 63.31 ± 4.90 and it increased to 74.59 ± 3.19 at 8 weeks. Forced expiratory flow (FEF) 25–75% at baseline was 35.42 ± 14.74, and at 8 weeks of continuous therapy, it increased to 76.35 ± 8.85 and all these values were statistically significant (p < 0.05). The spirometric mean values were highly significant (p < 0.001) in between 2–4 weeks and 4–8 weeks. Conclusion: Therapeutic continuity of FF/VI combination therapy is significantly effective in improving both symptoms and spirometric values in bronchial asthma patients. The safety profile and improvements in lung function irrespective of dosing time (morning or evening) strongly emphasize strict adherence to continuous once-daily use of the inhaler FF/VI to fully reverse the condition.

Aim and background: Frailty is a multidimensional syndrome of physical and cognitive impairments predisposing patients to increased risk of hospitalizations and poorer health-related quality of life. We conducted this study with the aim of comparing the frailty phenotype (FP) and short physical performance battery (SPPB) methods for the assessment of frailty in chronic obstructive pulmonary disease (COPD). Materials and methods: This is a descriptive cross-sectional study conducted in 150 stable COPD patients. Frailty was assessed using the FP and SPPB methods, followed by a comparative evaluation of the two methods. Results: The prevalence of frailty was 51.33% (n = 77) by the FP method and 21.33% (n = 32) by SPPB. Frail patients in both groups had the lowest post-bronchodilator forced expiratory volume in 1 second (FEV1) (%) (p < 0.0001). The median St. George's Respiratory Questionnaire (SGRQ) score was highest in the Frail group by the FP method [43.21 (32.116–58.338)] and pre-frail group by SPPB [43.47 (30.913–59.02)] (p = 0.007). The association between FP and SPPB was significant but with poor inter-rater kappa agreement (0.196, p = 0.0001). Frailty phenotype method showed a significant positive correlation, whereas SPPB had a significant negative correlation with duration of dyspnea (r = 0.3; r = –0.269), frequency of exacerbations (r = 0.498; r = –0.548), mMRC score (r = 0.525; r = –0.408), CAT score (r = 0.478; r = –0.52) and pack-years of smoking (r = 0.301; r = –0.278). Six-minute walk test (6MWT) distance had a significant association with frailty (p < 0.0001) by both methods. Conclusion: Frailty phenotype is a more sensitive method of frailty assessment in COPD compared to SPPB and correlates better with the severity of the disease. However, both methods showed a significant positive correlation with distance covered in 6MWT. Clinical significance: The FP and SPPB both identified a group of stable COPD patients with frailty. Our study underscores the importance of early identification and timely intervention to prevent deconditioning of muscular and cardiovascular systems which can otherwise progress to frailty.

Tobacco use is a global epidemic. Smoking claims more than 8 million lives annually across the globe. Further, it even poses a threat to nonsmokers who are exposed to cigarette smoke. Tobacco is most commonly used in the form of cigarette smoking across the world. The COVID-19 pandemic has impacted smoking habits, leading to visible differences in smoking rates. The current paper highlights and discusses alternative forms of smoking. Undoubtedly in the recent years, there is an advent of forms of alternative smoking, and a variety of tobacco products have been gaining popularity beyond traditional cigarettes. These products are preferred widely by the youth. Noteworthy to mention, these alternatives raise concerns about potential health risks and addiction. There is a paucity of research on the impact of alternative form tobacco usage on human health. The paper will provide an impetus for the researchers to explore further on the perspective of alternative forms of tobacco. It will also provide some essential leads to implement measures to mitigate the impact of alternative forms of tobacco usage on human health.

Aspergillus is a saprophytic fungus that causes various respiratory illnesses in humans, depending on their immune status. It often manifests as saprophytic growth in pre-existing lung lesions termed aspergilloma or as allergic diseases in atopic individuals. It may also lead to persistent chronic inflammation known as chronic pulmonary aspergillosis in individuals with pre-existing pulmonary diseases or to angioinvasive infections in immunocompromised patients. Endobronchial aspergilloma (EBA) is an uncommon clinical entity characterized by the noninvasive colonization of Aspergillus in the bronchus, typically occurring in cases of pre-existing endobronchial lesions or malignancies, as reported in the literature. Here, we present a case of a middle-aged male who was initially diagnosed with EBA through endobronchial cryobiopsy. However, further cryobiopsy of the deeper area and cryoextraction of the entire tissue growth revealed the presence of underlying metastatic endobronchial renal carcinoma. Therefore, whenever EBA is identified, we should consider the possibility of underlying or coexisting malignancies.

Aim and background: Non-Hodgkin lymphoma (NHL) is the most common hematological malignancy, and diffuse large B-cell lymphoma (DLBCL) is the most frequent subtype. It is a highly aggressive B-cell lymphoma resulting in the clonal proliferation of a germinal or post-germinal malignant B cell. The diagnosis is confirmed by biopsy of the affected node/extra-nodal site. Pleural involvement in lymphoma has a diverse presentation; however, presentation as an empyema, as in our case, has not been reported previously. Case description: We present a very rare case of a young, previously healthy female patient who presented with a right-sided pleural collection, who was initially suspected to have empyema due to characteristic findings on ultrasonography and pleural fluid appearance. Her pleural fluid cytology revealed atypical cells and was later diagnosed with an underlying anterior mediastinal mass confirmed to be DLBCL. Conclusion: Empyema may be the first harbinger of malignancy, especially in young immunocompetent patients. Timely diagnosis may be challenging but it improves the prognosis of such patients. Clinical significance: In a TB-endemic country like India, a patient with empyema poses a diagnostic dilemma. Cytology/biopsy and immunohistochemistry aid in diagnosis in such cases. Imaging also plays a key role in tumor staging, therapeutic planning, and follow-up of patients.

Leprosy and tuberculosis (TB) share geographic endemicity. The degree of cross-immunity of one against the other makes coinfection an uncommon clinical encounter. Here, we report a 35-year-old male patient who presented with a history of fever and cough for a month. He had ulnar claw deformity and multiple hypopigmented lesions since childhood. Chest radiograph showed left middle zone airway opacification and HR-CT revealed left lingular consolidation. Cartridge-based Nucleic Acid Amplification Test (CBNAAT) confirmed Mycobacterium tuberculosis and ulnar nerve biopsy confirmed borderline leprosy. The patient had no predisposing factors for TB other than the underlying leprosy. The dual infection was approached with WHO-recommended antitubercular treatment along with dapsone, clofazimine, and prednisolone for leprosy. Prednisolone was gradually tapered and discontinued, while the other medications were maintained. The patient's overall health showed improvement on follow-up. The possibility of concomitant leprosy and TB must be considered by the clinicians to obtain an accurate clinical diagnosis, advise a comprehensive management plan, and avoid treatment-related complications.

Tracheobronchial foreign body (FB) aspiration to date has been described in terms of types of FB, their myriad of presentations, diagnostic evaluation, tools, and techniques for their management in various case reports and systematic reviews. However, FB extraction in some cases may be difficult due to the nature of FB, the clinical state of the patient, the unavailability of adequate tools, and the surrounding tissue response to FB. We would like to bring out the terminology of complex FB to describe the above-mentioned scenarios. In the following paper, we have enumerated one such case of complex FB based on its nature and its subsequent management.

Neurofibromatosis type 1 (NF1) is a rare genetic disorder characterized by multiple benign tumors of the nerves and skin, known as neurofibromas. Mediastinal involvement in NF1, particularly with anatomical extension to both posterior and middle mediastinum along with extension into lung parenchyma, is an uncommon occurrence. Here, we present the case of a 20-year-old male with a known history of NF1 who was incidentally found to have a mediastinal mass during a pre-surgical fitness evaluation. Histopathological analysis confirmed the mass to be a neurofibroma. This case highlights the importance of considering neurofibromas in the differential diagnoses of mediastinal masses in patients with NF1, even when they are asymptomatic. The potential risk for malignant transformation into a malignant peripheral nerve sheath tumor (MPNST) warranted surgical intervention and hence the patient was referred to a thoracic surgeon.