LABAs and Asthma: From the SMART Study to the SMART Approach
[Year:2010] [Month:October-December] [Volume:52] [Number:4] [Pages:3] [Pages No:191 - 193]
DOI: 10.5005/ijcdas-52-4-191 | Open Access | How to cite |
[Year:2010] [Month:October-December] [Volume:52] [Number:4] [Pages:2] [Pages No:195 - 196]
DOI: 10.5005/ijcdas-52-4-195 | Open Access | How to cite |
Outpatient Pulmonary Rehabilitation in Severe Chronic Obstructive Pulmonary Disease
[Year:2010] [Month:October-December] [Volume:52] [Number:4] [Pages:5] [Pages No:197 - 201]
Keywords: Chronic obstructive pulmonary disease, Pulmonary rehabilitation, Health-related quality of life
DOI: 10.5005/ijcdas-52-4-197 | Open Access | How to cite |
Abstract
Objectives. An outpatient programme for rehabilitation of patients with severe ventilatory impairment due to chronic obstructive pulmonary disease (COPD) was conducted. Its main purpose was to assess the feasibility of the programme for COPD patients. Methods. Initial assessment included a shuttle walking test, administration of the chronic respiratory disease questionnaire (CRDQ), assessment of the hospital anxiety and depression scale (HAD) and sickness impact profile (SIP). The patients were entered into a 6-week outpatient programme between January 2007 to July 2007 during which they attended twice weekly for a 2½ hour session. Assessment was repeated on completion of the study at three months and later at six months. Results. The study included 44 (28 males) patients with COPD with a mean age 66 years. All patients had severe ventilatory impairment as defined by a forced expiratory volume in one second (FEV1) of less than 40% of predicted. The shuttle walking distance improved significantly and was maintained at the improved level for six months. The improvement in all four dimensions of the CRDQ was statistically significant (p<0.05) and reached clinical significance for fatigue and for mastery. On entry, a notable level of depression was found in 32% of patients, and anxiety in 40 percent. There was a significant reduction in both of these that was maintained at six months (p<0.05). There was no improvement in the SIP at three months, but significant improvement was found at six months (p<0.05). Conclusions. This study shows that a successful outpatient programme can be conducted in patients with severe ventilatory impairment, and that benefits in physical ability and in health-related quality of life (HRQOL) can be achieved. The improvements were maintained at six months.
[Year:2010] [Month:October-December] [Volume:52] [Number:4] [Pages:4] [Pages No:203 - 206]
Keywords: COPD, Acute exacerbation, Admission, Risk factors
DOI: 10.5005/ijcdas-52-4-203 | Open Access | How to cite |
Abstract
Background. Acute exacerbations of chronic obstructive pulmonary disease (AE-COPD) impair quality of life (QOL), accelerate the decline in lung function and often require hospitalisation, and thus, leading to increased healthcare burden. By identifying factors that may be associated with AE-COPD and managing them rationally, not only the hospital admissions could be avoided but progression of the disease may also be slowed. Objective. The aim of the present study was to determine the factors associated with hospital admissions among adults with AE-COPD. Methods. Seventy-three patients admitted with AE-COPD were administered a structured questionnaire during their hospital stay. Data on body mass index (BMI), smoking, symptoms, co-morbidities course of the disease, spirometry management and outcomes during the hospitalisation were obtained. Factors associated with hospital admissions were analysed. Results. The hospitalisation due to AE-COPD was significantly associated with the reduced forced expiratory volume in one second (FEV1), and peak expiratory flow rates, increasing sputum purulence, number of hospitalisations during previous year for COPD and presence of co-morbidities. Conclusions. The study shows that both disease and healthcare-related factors are predictors for hospitalisation. Identification of risk factors and appropriate management may reduce hospitalisation due to AE-COPD.
Retrospective Study of Interstitial Lung Disease in a Tertiary Care Centre in India
[Year:2010] [Month:October-December] [Volume:52] [Number:4] [Pages:5] [Pages No:207 - 211]
Keywords: Interstitial lung disease, Spectrum, Diagnosis
DOI: 10.5005/ijcdas-52-4-207 | Open Access | How to cite |
Abstract
Background. There has been a recent surge in the recognition of interstitial lung disease (ILD) in India. Methods. We conducted a retrospective study based on the available medical records of 274 patients with biopsy proven ILD seen during the period 1994-2001 at our tertiary care referral hospital. Results. Idiopathic pulmonary fibrosis (43%), sarcoidosis (22%), ILDs secondary to collagen vascular disease (19%) and extrinsic allergic alveolitis, among others, were the most common aetiological causes of ILD. The diagnostic yield from transbronchial lung biopsy (TBLB) was high (96%). Conclusions. Interstitial lung diseases (ILDs) appear to be under-reported from India. Lack of recognition and inadequate availability of diagnostic facilities, like high resolution computed tomography (HRCT) of the chest may be some of the reasons for this. The diagnostic yield from TBLB in our study was high at 96 percent. The TBLB may be used as the initial, cost-effective and safe tool for confirmation of aetiological diagnosis in most patients with diffuse parenchymal lung diseases.
[Year:2010] [Month:October-December] [Volume:52] [Number:4] [Pages:4] [Pages No:213 - 216]
Keywords: Spirometry, Diffusion, Diabetes, Microangiopathy
DOI: 10.5005/ijcdas-52-4-213 | Open Access | How to cite |
Abstract
Background. Diabetes is a systemic disease with-well known complications involving eyes, kidneys and nerves. The presence of an extensive pulmonary microvascular circulation and abundant connective tissue raises the possibility that lung may also be a target organ in diabetes. Methods. A total of 45 subjects were included in the study. All patients were evaluated for diabetic microangiopathies: nephropathy (by 24-hour protein excretion), retinopathy (by direct ophthalmoscopy) and neuropathy (by clinical examination). The patients were divided into following three groups: Group A: patients with type-2 diabetes mellitus (DM) with evidence of microangiopathy (n=15); Group B: patients with type-2 DM without any evidence of microangiopathy (n=15); Group C: non-diabetic subjects (n=15) as controls. Glycosylated haemoglobin (HbA1C) was measured as an indicator of glycemic control. Spirometry and single-breath diffusion capacity for carbon-monoxide (DLCO) were performed on all patients using Elite Series Body Plethysmograph machine. Results. A significant reduction of diffusion capacity corrected for alveolar volume (%DL/VA) was observed in group A (p<0.001), as compared to the other groups. There were no differences among the three groups for other pulmonary functions. There was a significant correlation between DL/VA percent predicted and albuminuria (r= -0.975, p<0.001), and DL/VA percent predicted and the retinopathy (r = -0.550, p< 0.05). Conclusion. This study shows a mild reduction in diffusing capacity in patients with type-2 DM with microangiopathy.
[Year:2010] [Month:October-December] [Volume:52] [Number:4] [Pages:8] [Pages No:217 - 224]
Keywords: Asthma, Rhinitis, Food allergy, Skin prick test, Enzyme linked immunosorbent assay, Double-blind, placebo-controlled food challenge
DOI: 10.5005/ijcdas-52-4-217 | Open Access | How to cite |
Abstract
Background and objective. Prevalence of immunoglobulin (Ig) E-mediated food allergy is primarily reported for certain pediatric populations and adults. The present study was aimed to investigate the relative prevalence of food allergy and allergens in older children and adults with asthma and allergic rhinitis. Methods. Patients (12-62 years) were screened using standard questionnaire and skin prick-test (SPT) with common foods and aeroallergens. Specific IgE level was determined by enzyme linked immunosorbent assay (ELISA) and allergy was established by blinded food challenges. Results. Of 1860 patients screened, 1097 (58.9%) gave history of food allergy. Of the history positive patients skin tested (n=470), 138 (29.3%) showed a marked positive reaction to food extracts. Rice elicited positive SPT reaction in maximum number of cases 29 (6.2%) followed by blackgram 28 (5.9%), lentil 26 (5.5%), citrus fruits 25 (5.3%), pea 18 (3.8%), maize 18 (3.8%) and banana 17 (3.6%). The SPT positive patients showed elevated specific IgE levels (range: 0.8-79 IU/mL) against respective food allergens than normal controls (0.73 IU/mL, mean±2SD). Food allergy was confirmed in 21/45 (46.6%) of the patients by blinded controlled food challenges. The prevalence of food allergy was estimated to be 4.5% (2.6%-6.34%) at 95% confidence interval (95% CI) in test population (n=470). Sensitisation to food was significantly associated with asthma (p=0.0065) while aeroallergens were strongly related to rhinitis (p<0.01). Conclusions. Food allergy is estimated to be 4.5% in adolescents and adults with asthma, rhinitis or both. Rice, citrus fruits, blackgram and banana are identified as major allergens for inducing allergic symptoms.
[Year:2010] [Month:October-December] [Volume:52] [Number:4] [Pages:14] [Pages No:225 - 238]
Keywords: Chronic obstructive pulmonary disease, Corornary artery disease, Atherosclerosis, Heart failure, Brain natriuretric peptide, Beta blockers, Review
DOI: 10.5005/ijcdas-52-4-225 | Open Access | How to cite |
Abstract
Mortality in chronic obstructive pulmonary disease (COPD) is more often due to cardiac rather than respiratory causes. The coexistence of heart failure (HF) and COPD is frequent but remains under-diagnosed. Both conditions share several similarities including the age of the population affected, a common risk factor in smoking and symptoms of exertional dyspnoea. There is also a strong possibility of COPD promoting atherosclerotic vascular disease through systemic inflammation. Both the conditions are punctuated by episodes of acute exacerbations of symptoms from time to time where differentiation between these two can be especially challenging. Although coexistence of the two is common, more often, only one of the two is diagnosed resulting in under-treatment and unsatisfactory response. Awareness of co-occurrence is essential among both pulmonologists and cardiologists and a high index of suspicion should be maintained. The coexistence of the COPD and HF also poses several challenges in management. Active search for the second disease using clinical examination supplemented with specialised investigations including plasma natriuretic peptides, lung function testing and echocardiography should be carried out followed by appropriate management. Issues such as adverse effects of drugs on cardiac or pulmonary function need to be sorted out by studies in coexistent COPD-HF patients. Caution is advised with use of â2-agonists in COPD when HF is also present, more so in acute exacerbations. On current evidence, the beneficial effects of selective â1-blockers should not be denied in stable patients who have coexistent COPD-HF. The prognosis of coexistent COPD and HF is poorer than that in either disease alone. A favourable response in the patient with coexistent COPD and HF depends on proper evaluation of the severity of each of the two and appropriate management with judicious use of medication.
Hydatid Ruptured into the Bronchus
[Year:2010] [Month:October-December] [Volume:52] [Number:4] [Pages:2] [Pages No:239 - 240]
DOI: 10.5005/ijcdas-52-4-239 | Open Access | How to cite |
Primary Carcinoid of Posterior Mediastinum: Truth or Myth!
[Year:2010] [Month:October-December] [Volume:52] [Number:4] [Pages:3] [Pages No:241 - 243]
Keywords: Carcinoid, Tumour, Mediastinum, Thymus
DOI: 10.5005/ijcdas-52-4-241 | Open Access | How to cite |
Abstract
Mediastinal masses present challenging problems in thoracic practice. Most of them remain asymptomatic for long and by the time the pressure symptoms develop, these are quite advanced. Carcinoids arising from the mediastinum are invariably related to thymus. Non-thymic origin of mediastinal carcinoids is rare, especially in the posterior mediastinum. Only two cases of posterior mediastinal carcinoids have been reported so far. These were assumed to be arising from ectopic thymus tissue. We report a case of a 45-year-old woman who presented with dyspnoea and dry cough due to giant carcinoid tumour of the mediastinum, the pedicle originating from the posterior mediastinum, not related to thymus. She underwent thoracotomy and resection that provided relief. The immunochemical studies revealed positive reaction to cytokeratin, chromogranins and synaptophysin, and negative reaction to S100, CD99 (MIC2) confirming the tumour being neuroendocrine in nature.
Mediastinal Hydatid Disease: An Unusual Presentation
[Year:2010] [Month:October-December] [Volume:52] [Number:4] [Pages:3] [Pages No:245 - 247]
Keywords: Mediastinal hydatid cyst, Echinococcosis, Mediastinal cyst
DOI: 10.5005/ijcdas-52-4-245 | Open Access | How to cite |
Abstract
Hydatid disease is a significant health problem in endemic areas. While occurrence of the cysts in the liver and lung is common, mediastinal localisation is extremely rare. We report the case of a 35-year-old male who presented with a painless swelling on the right side of the neck and features of superior vena caval obstruction. Chest radiography and computed tomography (CT) suggested a cyst in the right upper lobe, extending into the right supraclavicular region as well as another cyst in the left lung. Thoracotomy revealed that the right-sided cyst was actually mediastinal in location and had herniated through the thoracic inlet compressing the superior vena cava (SVC). Both cysts were removed in two separate operations and symptoms of SVC compression subsided after removal of the right-sided cyst. Histopathology was consistent with a hydatid disease.
Hantavirus Pulmonary Syndrome Coexistent with Dengue
[Year:2010] [Month:October-December] [Volume:52] [Number:4] [Pages:3] [Pages No:249 - 251]
Keywords: Co-infection, Dengue, Hantaviruses, Hantavirus pulmonary syndrome
DOI: 10.5005/ijcdas-52-4-249 | Open Access | How to cite |
Abstract
Dengue is an arthropod-borne disease caused by viruses of Flaviviridae family. It poses a major public health burden in tropical and sub-tropical regions. Clinical features of dengue vary from a mild flu-like disease and rash, to a potentially lethal haemorrhagic fever or shock syndrome. Hantavirus pulmonary syndrome is a rodent-born disease emerging in the American continent and is caused by viruses of the Bunyaviridae family. Potential reservoirs of these agents were described in Brazilian Central Plateau. Dengue infection is transmitted by mosquitoes, while hantaviruses are acquired by contact or inhalation of aerosolised excreta of infected rodents. Dengue and hantavirus infections have also been considered as emerging public health problems in some Indian areas; moreover, other infections mixed with dengue have been documented. The case of a Brazilian patient with hantavirus pulmonary syndrome and serologic evidence of dengue infection is described.
Role of T-Cells in Delayed Hypersensitivity Reactions in Patients of Allergic Diseases
[Year:2010] [Month:October-December] [Volume:52] [Number:4] [Pages:2] [Pages No:253 - 254]
DOI: 10.5005/ijcdas-52-4-253 | Open Access | How to cite |
[Year:2010] [Month:October-December] [Volume:52] [Number:4] [Pages:4] [Pages No:255 - 258]
DOI: 10.5005/ijcdas-52-4-255 | Open Access | How to cite |
Authors' Index-2010 [Vol. 52, Nos. 1-4]
[Year:2010] [Month:October-December] [Volume:52] [Number:4] [Pages:3] [Pages No:261 - 263]
DOI: 10.5005/ijcdas-52-4-261 | Open Access | How to cite |
[Year:2010] [Month:October-December] [Volume:52] [Number:4] [Pages:6] [Pages No:265 - 270]
DOI: 10.5005/ijcdas-52-4-265 | Open Access | How to cite |