Lung India最新文献

Background and objective: Eosinophils are an integral part of lung defence against microbes. It is also responsible for untoward hyper immune responses responsible for lung diseases including Chronic Obstructive Pulmonary Disease (COPD). To compare COPD patients with high and low Absolute Eosinophil Count (AEC) regarding their frequency of exacerbations, and response to treatment.

Materials and methods: Prospective observational study. Patients were divided into 2 groups above and below the mean AEC and followed up for 6 months, during when their frequencies of exacerbations were followed up. At the end of 6 months, symptomatology and lung function were reassessed.

Results: Those with high AEC had a shorter time to first exacerbation. These patients also needed significantly greater number of inpatient admissions during the study period. Fall in FEV1 was also significantly higher in this group. There was no significant difference in changes in BMI, CAT or MMRC scores, between these groups.

Conclusion: Patients with high AEC are at higher risk of exacerbations, as well as loss of lung function.

Background and objective: Lung cancer is one among the top five cancers in India, both in incidence and mortality and is thus, a significant public health challenge. The economic disparities among nations significantly contribute to differences observed in the management of lung cancer.

Methods: This study analysed the clinical spectrum of lung cancer from several hospitals using data from the National Cancer Registry Programme concerning demographic characteristics of patients, histological variants, and diagnostic and management practices between 2012 and 2019. For this descriptive study, data was drawn from 96 Hospital-Based Cancer Registries. Altogether, all cases classified under ICD-10, C34.90 were included in this study.

Results: The study findings revealed that most lung cancer cases occurred in males aged 50-74 years and females aged 45-69 years. Adenocarcinoma were the most common (39.7%) variety, almost twice higher than squamous cell carcinoma subtypes. The majority (50.7%) of the patients with lung cancer were detected with distant metastases. Low rates of surgery were observed among the patients who had localised/locoregional spread, while one third of the patients diagnosed at another facility reported to the treating hospital between 7 to 30 days after diagnosis.

Conclusion: This study highlights that delay in referral and subsequent treatment initiation are critical challenges in lung cancer care, including delayed diagnosis, limited treatment options, and a lack of streamlined referral processes. The study findings will be crucial for identifying the gaps in care and guiding strategies to improve early diagnosis and treatment of lung cancer.

Tuberculosis (TB) is a major global health challenge, particularly in polluted areas. The relationship between ambient particulate matter and TB risk remains unclear, making this systematic review and meta-analysis (SRMA) vital for assessing this link. This SRMA aimed to estimate the association between exposure to ambient particulate matter (PM10 and PM2.5) and the risk of pulmonary tuberculosis (PTB) infection. A literature search was conducted in PubMed, Web of Science, and Cochrane (English-language studies) on January 29, 2024. The review followed PRISMA Guidelines (2020) for comprehensive literature searches, data extraction, and quality assessment of included studies. A random-effects model was used for meta-analysis to estimate pooled effect sizes and assess heterogeneity. Study quality and publication bias were also evaluated. Of the 507 articles identified, 25 met the inclusion criteria. Long-term PM2.5 exposure was linked to a 26% increase in PTB risk (RR =1.26, 95% CI: 1.07-1.48), while short-term exposure raised the risk by 10% (RR =1.10, 95% CI: 0.98-1.25). Long-term PM10 exposure increased PTB risk by 7% (RR =1.07, 95% CI: 1.02-1.12), with short-term exposure showing a similar increase (RR =1.07, 95% CI: 0.95-1.17). Subgroup analysis revealed PTB risk increased by 15% in males and 29% in females for PM2.5, and by 10% in males and 7% in females for PM10. A 10 µg/m³ increase in Particulate matter is associated with a higher risk of pulmonary tuberculosis, highlighting the need for targeted public health measures to reduce particulate exposure, especially in high-risk urban and industrial areas.

Introduction: This study aimed to assess the risk factors and triggers predisposing to asthma in Indian children and adults.

Methods: The Global Asthma Network Phase I study was a multicentre, international, school, and questionnaire-based cross-sectional study conducted across the world with nine centers in India from 2017-18, the current study being analysis of the Indian data.

Results: There were 20084 children, 25887 adolescents, and 81296 adults from 9 sites across India. The adjusted odds ratio (AOR) and 95% confidence interval (CI) for atopic factors were as follows: parental history of asthma in adults (AOR 2.88, CI 2.21-3.75), hay fever in children (AOR 2.05, CI 1.62-2.58), and hay fever in adolescents (AOR 1.65, CI 1.40-1.94). Environmental triggers such as exposure to damp spots in the home (AOR1.28, CI 1.05-1.55), antibiotics consumption (AOR 1.80, CI 1.30-2.51), paracetamol taken during pregnancy (AOR 1.23, CI1.02-1.49), and laying on a woollen blanket in the first year of life (AOR 1.67, CI1.34-2.03) were the risk factors predisposing to current wheeze in the children. Risk factors for current wheeze in the adolescents included passage of trucks in front of the house (AOR 1.20, CI 1.04-1.39), and pet animal exposure (AOR 1.32, CI 1.14-1.53); and in the adults included damp spots in houses (AOR 1.61, CI 1.47-1.77), and the use of coal or kerosene or cow dung as a cooking fuel (AOR 1.48, CI 1.28-1.71). Personal factors such as the history of pneumonia in the children (AOR 1.71, CI 1.36-2.15); wheezing after exercise (AOR 1.45, CI 1.23-1.69), hospitalization in the past year (AOR 2.85, CI 2.61-3.59) and caesarean birth (AOR 1.28, CI 1.07-1.53) in the adolescents were associated with current wheeze. India-specific triggers included consumption of bananas (AOR 1.34, CI 1.10-1.63), curd (AOR 1.49, CI 1.23-1.82), packed crunchies (AOR 1.23, CI 1.03-1.48), ice-creams (AOR 1.31, CI1.12-1.53) in adolescents and use of mosquito repellents in adults (AOR 1.11, CI 1.01-1.22).

Conclusion: The study identifies genetic, environmental, personal health, and dietary risk factors for asthma in India, underscoring the need for public health measures to improve air quality, promote dietary awareness, and reduce indoor hazards.

Introduction: Gene Xpert sensitivity is low in paucibacillary conditions like extrapulmonary tuberculosis (EPTB); to overcome that, Gene Xpert Ultra was introduced. This study aims to assess Gene Xpert Ultra's diagnostic accuracy in EPTB.

Methods: This prospective observational study was conducted at Apollo Hospital, Greams Road, Chennai, Tamil Nadu, India, from May 2022 to April 2023. A total of 200 patients, 39 (19.5%) abdominal, 61 (30.5%) musculoskeletal, one (0.5%) bone marrow, 50 (25%) lymph nodes, 11 (5.5%) CNS, two (1%) upper airway, one (0.5%) cardiovascular, and 35 (17.5%) pleural cases were enrolled. Samples were analyzed for Gene Xpert Ultra, MGIT culture, cytology, and histopathology wherever feasible with tuberculosis. Tissue sampling was performed rather than bodily fluid in all cases except in CNS and abscess, where CSF and pus were analyzed, respectively. Gene Xpert Ultra was then compared with MGIT culture and Composite reference standard (CRS).

Results: The pooled sensitivity and specificity of Gene Xpert Ultra were 96.18% and 18.84% against MGIT and 94.30% and 100% against CRS. The lowest sensitivity (90%) was in CSF, and the highest (100%) was in pleura against CRS.

Conclusion: Gene Xpert Ultra has high sensitivity and specificity in tissue samples in various system involvements. This study recommends employing Gene Xpert Ultra in EPTB and further encourages tissue sample testing.

Background: The advent of glycopyrronium responsiveness has opened the prospect of selective responsiveness-based prescription of bronchodilators-β2-agonists or anti-muscarinic agents (AMA) for COPD. Such a concept needs ratification through clinical trials.

Methods: Stable COPD patients [post-bronchodilator FEV1/FVC <0.7] underwent serial glycopyrronium responsiveness [≥100 ml FEV1-improvement] after salbutamol before universal prescription of LABA-LAMA ± ICS as per guideline recommendation. At real-world follow-up, we noted the adverse and serious adverse events (exacerbations and hospitalizations) and, whenever possible, repeated spirometry in the similar fashion. Based on the initial glycopyrronium responsiveness, we divided the patients into glycopyrronium-sensitive and non-sensitive groups and compared the impact of treatment between them using spirometric variables (FEV1, FVC, FEV1/FVC and FEF25-75). We compared the 'trough'-FEV1 and 'total'-FEV1 (difference from the initial pre-bronchodilator to final post-dual-bronchodilator values) along with the frequency of exacerbation and hospitalization in each group.

Results: The glycopyrronium-responsive and non-responsive groups (n = 30 for each) were similar demographically and on initial spirometry (pre-bronchodilator and post-salbutamol values). They received treatment for 162.4 ± 134.8 and 212 ± 118.1 days, respectively. The glycopyrronium-sensitive patients displayed significant improvement in both trough-FEV1 [0.17 ± 0.29 vs. 0.02 ± 0.2; (P = 0.0308)], total-FEV1 [0.32 ± 0.29 vs. 0.17 ± 0.21; (P = 0.0273) litres], in addition to trough FEF25-75 (P = 0.0204), total FEV1/FVC (0.0174) and total FEF25-75 (P = 0.0322). The exacerbations (P = 0.0056) were significantly lower in glycopyrronium-responsive patients.

Conclusion: The glycopyrronium-responsive COPD patients show a significantly better overall improvement including the significant change in trough and total FEV1 with significantly reduced exacerbations in the real-world observation. The revelation demands more research.

Background: Chronic obstructive pulmonary disease (COPD) is a significant global health concern, projected to be the fourth leading cause of death by 2030. This study explores the correlation between the COPD assessment test (CAT) score, history of exacerbations, and the BODE Index in stable COPD patients. While the BODE Index is a validated multidimensional grading system, its application in outpatient settings, especially in resource-constrained setting, can be challenging due to the need for spirometry.

Methods: We conducted a cross sectional, observational study. It was conducted over 18 months in Mumbai and recruited 50 stable COPD patients. The CAT score and history of exacerbations in the previous year were evaluated alongside the BODE Index and other demographic data.

Statistical: The correlation between quantitative variables was performed using Pearson and Spearman's correlation coefficient, with P < 0.05 considered statistically significant.

Results: In the study population, the mean rate of exacerbation observed was 1.52 (SD = 2.279)/person/year, and the mean CAT score was 9.88 ± 7.34 (range: 0-27). The median BODE Index was 3 with most of the patients 44% (n = 22) having a BODE score falling in the first quartile. Positive correlations r (Pearson's) =0.468 (P = 0.000614) and σ (Spearman's) =0.2797 (P = 0.0490) were observed between CAT score with BODE Index and exacerbation history and BODE Index, respectively, indicating a moderate positive correlation between CAT score and BODE Index and statistically significant, albeit weak, correlation with exacerbation history.

Conclusions: Our findings suggest that simple tools like CAT and exacerbation history can be used as surrogates for the BODE Index.