Objective: Tobacco consumption continues to rise in India with about 34.6% of adult population being tobacco users. This study was done to evaluate the epidemiological profile of the tobacco users presenting to a Tobacco Cessation Centre (TCC) in Delhi. Methods: This is a retrospective observational study of subjects seen over a period of 10 years (2001-2010) at TCC of Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India. Information from a structured questionnaire filled by all tobacco users was pooled and analysed. Results: Of a total of 4493 subjects seen in the TCC, 4370 (97.3%) were males. 2704 (60.2%) subjects were smokers and remaining were users of smokeless tobacco. The highest number of subjects attending the clinic was between the age of 31 to 40 years. The mean age of starting tobacco use was 21 years. 2518 subjects started tobacco use due to “peer group pressure”, while family history of tobacco use was observed in 2912 subjects. 3065 number of subjects attending the clinic were without any co-morbidity. Conclusions: Most of the subjects started tobacco use at a young age between 11 to 20 years. Peer pressure was the most common reason for initiation (56%). Most of the subjects (68.2%) had no co-morbidity. The present study observed that tobacco users probably want to quit smoking not only because of the consequences of co-morbidities but also because of the realisation of later harmful effects of continuing smoking.

Background: Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease with serious impact on quality of life (QoL). There are limited studies available supporting coexistence of sino-nasal involvement in COPD. Methods: A prospective study was conducted to evaluate sino-nasal status in patients with COPD (n=100) presenting to the Department of Respiratory Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur from July 2011 to October 2012. COPD was diagnosed based on the Global initiative on Obstructive Lung Disease (GOLD) guidelines. Sino-nasal status was assessed by detailed history, radiograph of the para-nasal sinuses (PNS), nasal endoscopy and mucociliary clearance time. Results: Sino-nasal symptoms were present in 74 patients with COPD; nasal discharge (75.7%) being the most common. Tobacco smokers with COPD had a higher occurrence of sino-nasal symptoms (76.8%). Radiograph of para-nasal sinuses showed that maxillary sinus was most commonly involved. Nasal endoscopy revealed discharge in 63.5% cases. Nasal mucociliary clearance time was delayed (>11 to >40 min) in 98% cases. Nasal mucociliary clearance time was significantly delayed (>20 min) in COPD patients who were tobacco smokers as compared to non-smokers (53.7% versus 16.7%) and also related with increasing severity of COPD. Conclusions: Our observations suggest that sino-nasal involvement and delayed mucociliary clearance are common in patients with COPD, especially in tobacco smokers. Assessment of upper airway involvement in all the patients with COPD can help better therapeutic intervention and improvement in QoL.

Objective: To determine the effect of levocetirizine, montelukast and the combination of both the drugs on symptoms of allergic rhinitis. Methods: Seventy-five patients with allergic rhinitis were randomly studied prospectively for a period of two weeks divided into three groups receiving either levocetrizine or montelukast or combination of both. The outcomes were measured by a visual analogue score for nasal and eye symptom during day-time and night-time. Results: All the three regimens were equally effective in improving the day-time symptoms, like sneezing and rhinorrhea. There was also no difference in the control of night-time and eye symptoms among the regimens. Conclusions: Montelukast, levocetirizine and their combination is equally effective in controlling symptoms, of allergic rhinitis. Thus, use of montelukast alone would be cost-effective and do avoid adverse effects of levocetirizine in combination therapy.

Pulmonary vasculitis is an uncommon disease. Patients present with unexplained haemoptysis, pulmonary infiltrates and constitutional symptoms. Pulmonary vasculitis often goes undiagnosed due to lack of awareness and the disease is often mis-diagnosed as tuberculosis in India. Delayed or missed diagnosis leads to disease progression to a catastrophic event like diffuse alveolar haemorrhage which carries a high mortality. The outcome of appropriately treated cases, on the contrary, is good with excellent long-term survival. The present narrative review attempts to provide an overview of pulmonary vasculitis as it is seen in India.

Exposure to cigarette smoke is by far the most common causative factor for chronic obstructive pulmonary disease. Occupational exposure to fumes, chemicals, dusts and environmental pollution is also an important cause of chronic productive cough. Emphysema developing as a consequence of an occupational exposure is extremely rare. We describe the rare occurrence of severe emphysema in a non-smoker male who had worked for nearly three decades in nickel electroplating industry.

Tuberculosis (TB) is a highly prevalent disease in developing countries where there is poor sanitation, over-crowding and malnutrition. It can affect various organ systems in our body including the central nervous system, respiratory, genito-urinary tract and bone, though respiratory involvement is by far the commonest. Though diagnostic modalities for TB are well defined, empirical therapy without a confirmed diagnosis continues to be used in specific clinical situations. We report two cases with suspected TB who served empirical treatment.

Chylothorax following coronary artery bypass graft (CABG) surgery is a very rare complication and its management is debatable. Opinions vary from early aggressive management to prolonged conservative treatment. We describe two cases of post-operative chylothorax following CABG and its management with intravenous octreotide.

A case of a patient with reported spinal tuberculosis (TB) that developed syringomyelia, a rare sequelae of the disease is presented in this report. He underwent syringo-pleural shunting for syringomyelia. After 15 years, the patient presented with recurrent pleural effusion. Diagnostic thoracentesis revealed fluid of transudative nature. Pleural fluid was positive for beta-2 transferrin. Pleural biopsy was negative for any malignancy or TB. Computed tomography scan focusing on the shunt showed that it was undisplaced. Video-assisted thoracoscopic exploration showed the distal tip of the shunt adherent to the lung parenchyma. The effusion resolved after the dislodgement of distal tip from lung parenchyma.

Airway-centered interstitial fibrosis (ACIF) is described as one of the interstitial lung diseases (ILDs) with rare histologic patterns. It is characterised by predominant airway involvement with centrilobular fibrosis, peribronchiolar metaplasia and bronchiolocentric inflammatory changes. We report the case of a female who presented with pneumothorax and central diabetes insipidus, diagnosed as ACIF on lung biopsy.