Background: The prevalence of chronic obstructive pulmonary disease (COPD) is high in India. Various studies predict better survival in obese COPD patients in comparison to malnourished. The association between the body mass index (BMI) and progression of COPD is still ambiguous and less evaluated. Thus, we aim to determine the impact of different grades of BMI with pulmonary functions.
Methods: We studied 294 patients with COPD diagnosed on spirometry on out-patient basis from January 2015 to August 2019. As per BMI the patients were categorised into underweight, normal, overweight and obese. Association between BMI and lung volumes was studied.
Results: The number of cases and mean BMI as per BMI grades were: underweight (34 cases, BMI 16.5 Kg/m2), normal weight (76 cases, BMI 21.1 Kg/m2), overweight (27 cases, BMI 24.1 Kg/m2) and obesity (157 cases, BMI 28.2 Kg/m2). With increasing BMI, the value of forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and FEV1/FVC ratio were significantly increased. Also, majority of the cases in the obesity group were of low severity as per Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) classification.
Conclusion: Our observations suggest that as the BMI increases, lung volumes improve; thus, it may be used as a prognostic indicator for COPD.
How to cite this article:
Sabherwal PK. Immediate Effect of Proprioceptive Neuromuscular Facilitation on Chest Mobility, Pain and Range of Motion of Thorax in Patients of Intercostal Drainage: A Randomised Control Trial. Indian J Chest Dis Allied Sci 2021; 63 (3):131-135.
Objective: Intercostal muscle strain leading to pain, muscle spasm and related morbidities is common in pleural diseases following insertion of intercostal tube drain (ICD). Hence, suitable lengthening of soft tissue and muscles around the chest wall using various stretching techniques can help in improving the efficiency of respiratory muscles and chest movement.
Methods: Thirty patients who underwent ICD insertion were randomly allocated to control group (receiving chest mobility exercises only) and treatment group (receiving proprioceptive neuromuscular facilitation [PNF] stretches), in addition to chest mobility exercises. Pain assessed by visual analogue scale (VAS), thoracic spine range of motion (flexion and rotation) and chest expansion values at 2nd, 4th and 6th rib (R2, R4 and R6) were recorded before and after a single intervention session in both the groups.
Results: There was statistically significant improvement in VAS, thoracic ranges and chest expansion at all R2, R4 and R6 levels (P<0.05) in the treatment group.
Conclusions: Proprioceptive neuromuscular facilitation was more effective in reducing pain, increasing chest mobility and range of thoracic motion in patients with ICD insertion.
Md Monimul Islam,
Md Ali Hossain,
Kazi Saifuddin Bennoor,
How to cite this article:
Islam MM, Hossain MA, Bennoor KS, Ali T. Role of Fractional Exhaled Nitric Oxide in Distinguishing Asthma-COPD Overlap Among Patients with COPD: A Cross-Sectional Study. Indian J Chest Dis Allied Sci 2021; 63 (3):137-142.
Objective: Asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) and COPD share much of their clinical presentations, ensuring difficulties in their differentiation. As both the entities are characterised by airway inflammation, fractional exhaled nitric oxide (FeNO), as an inflammatory biomarker to distinguish between them, can be used for this purpose. The present study was done to assess the role of this local biomarker in distinguishing ACO among patients with COPD.
Methods: We enrolled 63 male stable patients of COPD from March 2019 to February 2020 from two tertiary care hospitals of Dhaka, Bangladesh. Among them, 51 patients were finally selected according to inclusion and exclusion criteria and divided into two study groups, ACO (n=26) and COPD-alone (n=25), according to GINA-GOLD Joint guidelines [Global Initiative for Asthma and the Global Initiative for Chronic Obstructive Lung Disease] on syndromic approach. The levels of FeNO were measured by NOBreath FeNO Monitor® (Bedfont, England).
Results: We observed that FeNO was significantly higher (P<0.01) in patients with ACO than COPD-alone. In addition, no statistically significant difference of FeNO was observed in patients with different stages of the disease severity in ACO and COPD-alone. Moreover, the correlation between FeNO levels and disease severity in both the groups was statistically insignificant. Area under the receiver operating characteristic curve of this biomarker was found as 0.724 and the optimal cut-off value was 29.5 parts per billion (ppb) to get the best diagnostic accuracy. At an optimal cut-off value, sensitivity, specificity were found to be 72.0% abd 84.6%, respectively. The positive predictive value and negative predictive value were 81.8%, 75.7%; whereas positive likelihood ratio, negative likelihood ratio and accuracy of FeNO were observed to be, 4.7%, 0.3%, 78.4%, respectively.
Conclusions: Fractional exhaled nitric oxide can play a substantial role in distinguishing ACO among the stable patients of COPD with good diagnostic accuracy. However, in our study no correlation of FeNO with the disease severity was obseved.
Lung cancer in India has changed over the years. The subject was reviewed earlier in 2004. Since then, it has become an important and second common cancer in Indian males. Although smoking continued to be an important factor for the causation of lung cancer in this country, particularly bidi smoking, new facts come into light. Biomass fuel is another important factor in the causation of lung cancer in non-smoking females. There is also a regional disparity in the prevalence of lung cancer in India. Aizawl district had the highest rank in incidence rates in both males (38.8 per 100,000) and females (37.9 per 100,000). There was a significant increase in the incidence rates of lung cancer in Kamrup (urban), Chennai, Delhi and Bangalore PBCRs (Population Based Cancer Registries) in both males and females. Five PBCRs showed a significant increase in incidence rates among males whereas it was seen in 11 PBCRs among females. In Asia, among males, Yueyanglou (95.5 per 100,000) in China had the highest incidence rate of lung cancer, whereas Aizawl district (37.9 per 100,000), had the highest age adjusted ratio in females. Over the years, there is also marked improvement in the availability of diagnostic facilities all over the country. There is also a significant transition of the cell type of lung cancer. While earlier reports showed squamous cell type as the commonest one, now adenocarcinoma has surpassed that as reported from most centers in the country including the National Cancer Registry maintained by the Indian Council of Medical Research. Advent of molecular biology is a new development since we reviewed the topic nearly 16 years back. This aspect has been discussed in detail in the second part of the review. However, lung cancer continues to present in a very advanced stage of the disease where definite therapy, like surgery could not be offered to most of them. In fact around 3% to 4% of cases could only be offered surgery in our country. There is a significant improvement in the management of advanced stage lung cancer with the availability of newer chemotherapeutic drugs and targeted therapy and immunotherapy (will be discussed in 2nd part) with better median survival and many centers in the country are now treating this disease more aggressively. Although smoking continues to be a major problem in India, more and more anti-tobacco laws are being persued aggressively by the Government. Lung cancer screening is not yet practised in our country because of various technical, and other logistic issues. COVID-19 pandemic has created difficulties in managing such patients.
Umesh Chandra Ojha,
Omkar K. Choudhari,
The work-place and household exposure to different pollutants involves airways as well as parenchyma of the lung. We evaluated four patients without comorbidities, working in plastic industries at least for 11 years. Pulmonary function testing of the patients revealed mixed airway disease. Computed tomography revealed bronchiectasis, centrilobular nodule, septal thickening and emphysema unrevealing the toxic potential of plastic fumes. The use of personal protective equipment with good work hygiene practises would certainly help in the prevention of these occupation-related morbidities.
Endobronchial non-Hodgkin's lymphoma (NHL) is rare and poses a diagnostic challenge if there is pre-existing lung disease, like idiopathic interstitial lung disease (ILD). We report refractory cough due to isolated endobronchial non-Hodgkin's low grade B-cell lymphoma in a 57-year-old female with ILD. Local diathermy fulguration of endobronchial NHL resulted in remission of cough and there was no recurrence or spread of endobronchial NHL at four years of follow up.
Chronic obstructive pulmonary disease (COPD) is a heterogeneous and multi-systemic disease with significantly increasing morbidity and mortality. COPD is now widely accepted to have multiple phenotypes. Tobacco smoking is very well recognised risk factor of COPD (25%–45% of patients with COPD have never smoked) and the burden of non-smoker COPD is increasing. This paper review in brief COPD in non-smokers, identification of various non-smoking risk factors that have contributed immensely in the causation of COPD and phenotypic variations which includes the existing and emerging phenotypes. It will also help us in proper diagnosis and pharmacological management of non-smoker COPD patients as their prevalence has been under-estimated.