Background: Many patients suffer from various manifestations even after four weeks of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) positivity and they are labelled as “Long COVID”. Guidelines on pharmacological management of these patients are lacking till date. Methods: The present study is a retrospective analysis of “Long COVID” patients presenting to one of the units of Viswanathan Chest Hospital of our Institute between June 2020 and December 2020. All the records of these patients were analysed. Inclusion criteria was no pre-existing pulmonary disease and availability of follow-up visits. Systemic steroids had been given to patients with (a) resting hypoxia or (b) exertional desaturation along with radiological abnormalities, categorised as long COVID-interstitial lung disease (LC-ILD). The patients with breathlessness and wheeze or rhonchi on auscultation were categorised as long COVID-obstructive airway disease (LC-OAD). Inhaled corticosteroid and bronchodilators were given to them. Results: Out of the 3363 patients provided consultation in the OPD, 50 patients were categorised as of long-COVID. Only 10 patients fulfilled the inclusion criteria and were included in the present study. Two patients had hypoxia at rest and three patients with significant desaturation on six-minute walk test (6MWT). On chest radiography, six patients had bilateral lower zone reticulations/nonhomogeneous opacities. High resolution computed tomography confirmed ground-glass opacities (GGOs) in five of them. There were seven patients of LCILD, 2 of LC-OAD and 1 of “long COVID cough”. LC-ILD patients responded to oral steroid therapy and showed clinical, radiological as well as functional improvement. In these patients both resting hypoxia and exertional desaturation disappeared. Also improvement in 6MWT distance was observed in these patients. Long COVID-OAD patients responded well to inhaled corticosteroids and bronchodilators with symptomatic and functional improvement. Conclusions: Patients of LC-ILD responded well to systemic steroids and LC- OAD to inhaled corticosteroids and bronchodilators. Despite the small number of patients, the present study provides a road-map for the management of “long COVID” pulmonary sequalae till large scale studies are being done.

Objective: Bronchiectasis is a suppurative lung disease characterised by wide and distorted bronchi, with profuse expectoration, resulting in impaired qualityof- life. The present study evaluated the clinico-radiological and functional characteristics of patients with bronchiectasis. Methods: A hospital-based, prospective, cross-sectional study was conducted for one year. Chest radiograph followed by high resolution computed tomography was done in patients with features suggestive of bronchiectasis. All patients were assessed with spirometry, sputum gram-stain and pyogenic culture-sensitivity. Severity was assessed using FACED score. Results: Eighty patients (38 males) were included in the study with a mean age of 47.0±13.7 years. Average lung involvement was ≥2 lobes and cystic bronchiectasis was the most common abnormality. Shortness of breath (91%) and cough with expectoration (87%) were the most frequent complaints. The most common functional impairment was obstructive (58.7%), with a mean percent predicted forced expiratory volume in first second (FEV1) of 55.8±15.1. The patients with Pseudomonas spp growth in sputum culture had more severe disease in the form of more number of lobes involvement and cystic destruction (P<0.001). Conclusions: Bronchiectasis is a progressive disease with significant morbidity and mortality. While radiology plays an important role in the diagnosis, microbiology is an important aspect in the management of the diseases as well as in preventing exacerbations/disease progression.

Objective: Chronic obstructive pulmonary disease (COPD) is a common chronic lung disease posing a huge challenge to the public health system of India. The present study was designed to assess the physical, psycho-social and economic burden of COPD depending on severity of airflow limitation. Methods: A cross-sectional, hospital-based study was done among 200 patients diagnosed with COPD attending a tertiary care hospital in Kolkata, West Bengal. COPD Assessment Test (CAT) questionnaire and modified British Medical Research Council Questionnaire were used to assess the physical burden of COPD on daily life and severity of the breathlessness. Psycho-social and economic burden were assessed with a structured, validated questionnaire. Results: Nearly half (46%) had severe or very severe airflow limitation as per predicted forced expiratory volume in the first second (FEV1). Severity of dyspnoea and CAT score increased linearly with the severity of the airflow limitation. In last 30 days, proportion of patients needing support in self-care and chores were 28% and 51%, respectively. Median (± interquartile range [IQR]) direct and indirect cost of managing COPD were Indian rupee (INR) 319.5 (± 55.0) and 49.5 (± 600.0), respectively. A considerable proportion (87%) of patients took recourse to different cost-cutting measures. Physical, psycho-social and economic burden had significant association with severity of airflow limitation. Conclusion: In our study, COPD had a staggering physical, psycho-social and economic burden on patients and their families.

Background: Obstructive sleep apnoea (OSA) is considered positional (POSA) when sleep disordered breathing (SDB) events occur predominantly in supine position. Scarce data from Indian sub-continent regarding POSA are available. Methods: Records of patients who underwent two nights of nocturnal polysomnography (PSG) from January 2018 to June 2019 in the Department of Pulmonary Medicine, Government Medical College and Hospital, Chandigarh were evaluated. Patients were diagnosed as POSA if apnoea-hypopnoea index (AHI) was ≥5/h and supine AHI was at least two times higher than non-supine AHI (NSAHI). Results: Of the 130 patients studied, 100 were diagnosed as OSA; of these 68 PSG studies were analysed. Fourteen of the 68 (20.6%) had POSA. Both groups were similar in age, gender, body mass index (BMI) and quality of sleep. Mean AHI (P=0.001), NSAHI (P<0.001), right AHI (P=0.002), oxygen desaturation index (ODI) (P=0.007), number of subjects with oxygen saturation measured by pulse oximetry (SpO2) <90% (P=0.032) and <80% (P=0.031) and percentage of total sleep time (TST) with SpO2 <90% (P=0.031) was significantly lesser in POSA than non-POSA patients. Mean minimum SpO2 was significantly higher in POSA than non-POSA (P=0.025). Post continuous positive airway pressure (CPAP) trial, though average CPAP pressures differed significantly (P=0.001), resultant AHI and other PSG parameters in the two groups were not statistically different, suggesting adequate response to treatment. Conclusions: Identification of POSA is a key step for further studies aimed at deciphering wide array of issues which can be associated with this entity.

Background: Asthma and obstructive sleep apnoea (OSA) are the commonest pulmonary diseases worldwide and contribute to significant morbidity and mortality. Methods: Fifty patients aged 18 years and above with moderate to severe asthma, presented to our out-patient clinic during 2016-2017, were screened for OSA using a self-reported STOP BANG Questionnaire. Of these, 30 were found to be at risk of OSA (STOP BANG score > 2) and were included in the study. These 30 patients underwent diagnostic polysomnography (PSG), inflammatory markers interleukin (IL)-4, IL-5, IL-6, IL-13, high sensitivity c-reactive protein, fractional exhaled nitric oxide (FeNO) testing. Their quality-of-life and asthma control was evaluated with St. George Respiratory Questionnaire score and Asthma Control Test, respectively. Results: After PSG, OSA, apnoea-hypopnoea index (AHI) > 5/h was found in 15/30 (50%) cases with moderate and severe asthma (N=15 each). In moderate asthma 6/15 (40%) and in severe asthma 9/15(60%) were diagnosed to have OSA. Asthma patients with OSA fared poorly in asthma control test questionnaire and St. George's Respiratory Questionnaire (P=0.01) in comparison to those without OSA. Conclusions: Our study indicates high prevalence of OSA among patients of moderate to severe asthma which negatively affects quality of sleep and asthma control that further leads to poor quality-of-life in these patients. Thus, highlighting the need of maintaining high index of suspicion in identifying OSA among patients of moderate to severe asthma.

We report the case of a 35-year-old, non-smoker female who presented with arthralgia, dyspnoea, chest pain, fever and cough. Chest radiograph (postero-anterior view) showed ill-defined opacities in bilateral lower lung zones. High resolution computed tomography (HRCT) of chest revealed bilateral lower lobe consolidation with air bronchogram and interstitial septal thickening with ground-glass opacity. Diagnosis of polymyositis was confirmed by high titre of Jo-1 antibody and serum creatine kinase (CK) (1216 U/L). Video-assisted thoracoscopic lung biopsy showed evidence of non-specific interstitial pneumonia.

Microscopic polyangiitis (MPA) is anti-neutrophil cytoplasmic antibodies (ANCA)-related vasculitis affecting mainly small vessels of lung and kidney. MPA has a varied presentation with a wide variety of multi-systemic symptoms. If this syndrome is not recognised early; it can lead to a lethal outcome. It may mimic tuberculosis (TB) that may lead to problems in the early diagnosis in resource-limited countries, like India, where TB is endemic. We report a case of a female patient who reported to us with massive haemoptysis due to unilateral thick-walled cavitation in the upper lobe, mimicking TB but eventually turned out to be a case of MPA.