Indian Journal of Public Health Research & Development

Achchhar Singh ¹, Jai Kishan ², Sameer Singhal ³, Vishvdeep Saini ⁴, Abhishek Chauhan ⁴

Affiliations
1 Associate Professor, Department of Respiratory Medicine, MMIMSR, M.M. Deemed to be University, Mullana, Ambala, Haryana, IN
2 Professor and Head, Department of Respiratory Medicine, MMIMSR, M.M. Deemed to be University, Mullana, Ambala, Haryana, IN
3 Professor, Department of Respiratory Medicine, MMIMSR, M.M. Deemed to be University, Mullana, Ambala, Haryana, IN
4 Junior Resident, Department of Respiratory Medicine, MMIMSR, M.M. Deemed to be University, Mullana, Ambala, Haryana, IN

Abstract

The aim was to evaluate the inhalation technique among COPD patients using pressurized metered dose inhaler and determinants of incorrect inhalation technique. In this hospital based cross-sectional study, total 92 COPD patients were enrolled. Basic socio-demographic information was collected. The inhalation technique was visually observed and scored on checklist. Statistical Analysis Used: Chi-square test and Fisher exact test. Among the 92 patients observed, 69 (75.0%) were males. The mean age of the patients was 45.8 ± 1.4 years. Correct technique was observed in only 22 (23.9%) patients step at which maximum number of patients committed mistake was exhalation 65.2% followed by breath holding 45.7% and multiple actuations were seen in 44.5%. It was found that substantial errors were made in the inhalation technique hence proper training and follow-up of the patients is required to achieve the desired effects of the inhaled medications.

Keywords

COPD, pMDI, Inhalation technique.

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Vishvdeep Saini ¹, Sameer Singhal ², Sukhjinder Pal Singh ³, Achchhar Singh ⁴, Aditi Gupta ⁵

Affiliations
1 Junior Resident, Department of Respiratory Medicine, MMIMSR, M.M. Deemed to be University, Mullana, Ambala, Haryana, IN
2 Professor, Department of Respiratory Medicine, MMIMSR, M.M. Deemed to be University, Mullana, Ambala, Haryana, IN
3 Senior Resident, Department of Respiratory Medicine, MMMC & H, Kumarhatti, Solan, Himachal Pradesh, IN
4 Associate Professor, Department of Respiratory Medicine, MMIMSR, M.M. Deemed to be University, Mullana, Ambala, Haryana, IN
5 Assistant Professor, Department of Respiratory Medicine, MMIMSR, M.M. Deemed to be University, Mullana, Ambala, Haryana, IN

Abstract

Introduction: Spirometry helps us to differentiate between obstructive and restrictive disease, body plethysmography tells about lung volumes and DLCO about diffusion defect. Determining which tests to do depends on the clinical question to be answered i.e. whether test is being done to diagnose a disease or for evaluation for lung surgery or some other reason. Material and Method: 46 patients coming to department of respiratory medicine, who were diagnosed with obstructive lung disease by PFT as per GOLD guidelines were considered for the study. Chest X-ray and CT chest were also done. Then DLCO was performed in every patient. Single breath hold method was used in the study. The report of the DLCO was interpreted according to the American Thoracic Society/European Respiratory Society statement on PFT interpretation. Results: Male preponderance was seen in study cases with 65.2% males to 34.8% females. Mean age of the study group was 54.39 years with most cases (18) from 31-50 years of age group. Most common diagnosis was COPD emphysema (22) followed by chronic bronchitis (12), bronchial asthma (10) and bronchiectasis (2). Among obstructive lung diseases, B. asthma had the highest mean DLCO percentage predicted of 102.20 ± 14.36 followed by COPD-Bronchitis (76.33±5.57), COPD–Emphysema (37.80±13.41) and bronchiectasis (62±4.48). Conclusion: DLCO can be helpful beyond spirometry in classification of obstructive lung diseases. DLCO values in COPD Emphysema variant are decreased, COPD bronchitis variant remains normal or slightly reduced and asthma either normal or increased. So, DLCO can help in differentiation or sub categorization of obstructive disease more than spirometry.

Keywords

DLCO, Obstructive diseases, Lung function test, COPD, Emphysema, Bronchial Asthma.

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Vishvdeep Saini ¹, Jai Kishan ², Sameer Singhal ³, Sukhjinder Pal Singh ⁴, Achchhar Singh ⁵

Affiliations
1 Junior Resident, Department of Respiratory Medicine, MMIMSR, M.M. Deemed to be University, Mullana, Ambala, Haryana, IN
2 Professor and Head, Department of Respiratory Medicine, MMIMSR, M.M. Deemed to be University, Mullana, Ambala, Haryana, IN
3 Professor, Department of Respiratory Medicine, MMIMSR, M.M. Deemed to be University, Mullana, Ambala, Haryana, IN
4 Senior Resident, Department of Respiratory Medicine, MMMC & H, Kumarhatti, Solan, Himachal Pradesh, IN
5 Associate Professor, Department of Respiratory Medicine, MMIMSR, M.M. Deemed to be University, Mullana, Ambala, Haryana, IN

Abstract

Introduction: CBNAAT is a very useful rapid diagnostic test for the early diagnosis of DS and DR TB. Report of sample can be available in just 2 hours. But the results of these tests are not available for many days to weeks which results in delay in diagnosis and treatment initiation. Material and Method: This study was conducted for a period of 4 months from mid-April to mid-august 2018 in MMIMSR, Mullana. A total of 535 samples were sent for CBNAAT to TB Hospital, Ambala and the time taken from sending of samples to the receiving of report was analysed and time lag was calculated. Results: Out of 535 samples, 429 samples were negative, 104 were positive for MTB and 2 samples resulted as invalid/error. Out of 104 positive samples, 95 were rifampicin sensitive and 9 were rifampicin resistant MTB. The average time lag in reporting of CBNAAT samples was 11.1 days with shortest time being 2 days and longest being 33 days. Conclusion: CBNAAT is a very useful modality in TB diagnosis and should be made available to all eligible patients especially so in high DR-TB prevalence areas. But delay in reporting undermines the purpose of the test i.e. rapid diagnosis and treatment. There is an urgent need to establish more centres with CBNAAT facility throughout India so that there is no delay in reporting and early treatment can be started.

Keywords

RNTCP, CBNAAT, Tuberculosis, NIKSHAY, TB prevalence.

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Achchhar Singh ¹, Jai Kishan ², Sameer Singhal ³, Vishvdeep Saini ⁴, Abhishek Chauhan ⁴

Affiliations
1 Associate Professor, Department of Respiratory Medicine, MMIMSR, M.M. Deemed to be University, Mullana, Ambala, Haryana, IN
2 Professor and Head, Department of Respiratory Medicine, MMIMSR, M.M. Deemed to be University, Mullana, Ambala, Haryana, IN
3 Professor, Department of Respiratory Medicine, MMIMSR, M.M. Deemed to be University, Mullana, Ambala, Haryana, IN
4 Junior Resident, Department of Respiratory Medicine, MMIMSR, M.M. Deemed to be University, Mullana, Ambala, Haryana, IN

Abstract

Aim: study the prevalence of various risk factors and co-morbidities in patients with acute exacerbation of chronic obstructive pulmonary disease. Material and Method: 73 patients admitted with AE-COPD data on body mass index (BMI), smoking, symptoms, co-morbidities course of the disease, spirometry management were obtained. Results: Eighty-eight percent of the admitted patients had current or past smoking habit of ‘Bidi’ and 9% were cigarette smokers. of admitted patients, 46% had at least one co-morbid condition. Mean FEV1 was 42.5%. Conclusion: Study concluded that the hospitalized patient with AE-COPD suggests spirometric impairments because majority of the patients had current or past smoking habits. Diabetes and cardiovascular diseases were found to be the major co-morbidities.

Keywords

AE-COD, Co-morbidities, FEV1.

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