Lung India最新文献

Tobacco is the leading preventable cause of death in the world, and India is the second largest consumer of tobacco. Smoking is associated with a myriad of respiratory diseases, including chronic obstructive pulmonary disease, asthma, pneumonia, and lung cancer. Smoking cessation is the only modality which has shown to reduce lung function decline. Despite established benefits of smoking cessation, its services in India are limited due to time constraints, lack of awareness, and unavailability of resources. Respiratory physicians play an important role in the journey of a patient willing to quit smoking through guidance, motivation, and support. More dedication, in the form of time and effort, is required from physicians' side to this end. This narrative review was performed to get a better understanding of smoking practices and cessation services in India to identify lacunae and help guide future interventions.

Background: Conventional bronchoscopic approaches have a lower diagnostic yield (DY) compared to transthoracic biopsy for sampling peripheral pulmonary lesions (PPLs). Cone-beam computed tomography (CBCT)-guided bronchoscopy overcomes the limitations of conventional bronchoscopy techniques. This study evaluates DY, predictors of success, and safety of CBCT-guided bronchoscopy for PPL biopsy.

Materials and methods: This single-center retrospective study included all consecutive patients who underwent CBCT-guided biopsy for PPLs between November 2023 and November 2024. Clinico-radiologic and procedural details, tool-in-lesion (TIL) relationships, DY, factors predicting DY, and complications were assessed.

Results: Of the 183 patients who underwent bronchoscopic sampling of PPL during study period, 50 patients underwent CBCT-guided biopsy. The overall DY of CBCT biopsy was 88% (44/50). A type 1 TIL (tool within lesion) was obtained in 57% (28/49), type 2 TIL (tool touch lesion) in 35% (17/49), and a type 3 TIL (tool away from lesion) in four cases. The factors predicting DY were size of lesion and the tool-lesion relationship. DY increased with increasing size of PPL and decreased the farther the tool was from the center of the target. The DY was 100%, 82%, and 25% for lesions with type 1, type 2, and type 3 TIL, respectively ( P = 0.024). CBCT biopsy was safe with no procedural mortality, no pneumothorax, and moderate to severe bleed in seven cases.

Conclusion: CBCT-guided biopsy for peripheral pulmonary lesions is safe and has a DY of 88%. DY is higher for lesions ≥2 cm and when the tool is within the lesion (type 1 TIL) on CBCT spin.

Silicosis, a progressive and irreversible pneumoconiosis resulting from crystalline silica particle inhalation, represents a significant occupational health burden in India. This condition disproportionately affects workers in high-risk industries, such as mining, construction, and manufacturing. Silicosis not only increases susceptibility to tuberculosis (TB) infection but also adversely impacts TB outcomes. Despite the long-established association between silicosis and TB, a clear understanding of the burden within the Indian context has remained unexplored. A thorough search of electronic databases was conducted to identify relevant studies reporting on the prevalence of silicosis, TB, and silico-tuberculosis (concurrent silicosis and TB). Data extraction and meta-analyses were conducted to estimate pooled prevalence proportions, employing random or fixed-effects models based on heterogeneity assessments. The analysis included four studies, encompassing 953 participants in the silicosis group and 959 participants in the TB group. Meta-analytical results yielded a pooled silicosis prevalence of 39.87 per 100 observations (95% CI: 21.43-58.31). TB in silicotic individuals was 40.99 per 100 observations (95% CI: 5.18-76.80), while the proportion of silico-tuberculosis cases was 8.74 per 100 observations (95% CI: 5.01-12.47). Notably, substantial inter-study heterogeneity was observed. This review reveals the prevalence of silicosis, 39.87 per 100 observations, and TB among silicotic individuals was 40.99 per 100, with 8.74 per 100 affected by silico-tuberculosis. These findings underscore the urgent need for enhanced occupational health measures and further comprehensive research across diverse Indian populations.

Endoscopic injection of a cyanoacrylate-lipiodol mixture is widely regarded as the first-line treatment for gastrointestinal bleeding secondary to ruptured gastric varices. Although generally effective, this technique carries the risk of rare but potentially life-threatening complications, including pulmonary glue embolism and interstitial pneumonitis. We present the case of a 65-year-old woman with cirrhosis who presented with hematemesis and melena and underwent endoscopic cyanoacrylate-lipiodol injection for bleeding gastroesophageal varices. Within 24 hours, she developed a persistent fever and bilateral crackles. Chest X-ray, CT imaging, and bronchoscopy findings were consistent with glue-induced pneumonitis. Corticosteroid therapy resulted in rapid clinical and radiological improvement. This case highlights the importance of recognising pulmonary complications following cyanoacrylate injection for gastric varices and underscores the need for prompt diagnosis and appropriate management to mitigate morbidity.

Background and objective: Aminophylline may play a role in managing both stable and exacerbating COPD, but its use is controversial due to its narrow therapeutic window. We aimed to evaluate the role of aminophylline in acute exacerbations of COPD under monitored conditions in patients who remained acidotic and hypercapnic after 48 hours of maximal treatment.

Methods: We conducted a prospective, nonrandomized cohort study with 30 patients receiving aminophylline infusion in addition to standard care, matched to 20 historical controls. The primary outcome was the length of hospital stay, with secondary outcomes including improvements in oxygenation, PaCO2, and dyspnea severity.

Results: There was no significant difference in hospital stay (11.23 vs. 12.65 days, P = 0.234) or ICU stay between the two groups. However, aminophylline significantly improved dyspnea severity (P = 0.0081), P/F ratio (P = 0.0014), and PaCO2 levels (P = 0.00001). Both groups showed improvements in oxygenation, but only the aminophylline group demonstrated a significant reduction in CO2 levels.

Conclusion: Aminophylline did not affect the length of hospital or ICU stay but improved hypercapnia and dyspnea severity in patients with refractory COPD exacerbations. We believe it should be used in severe acidotic COPD exacerbations unresponsive to conventional therapies, with an aim to correct hypercapnia.