Evaluation of self-care manual in bronchial asthma

BACKGROUND

Asthma continues to be a substantial cause of morbidity. Various educational programmes have shown an increase in knowledge and self-management skills of asthmatic patients and also revealed a reduction of severe attacks, hospitalisations and days lost from work.

METHODS

A self-care manual on bronchial asthma was prepared. A total of 523 bronchial asthma patients were enrolled in the study. Out of these, 260 patients were included in the study group to whom self-care manual was provided and 263 were included in the control group to whom no specific instructions were given. After the initial interview (0 week), follow up of all the patients was carried out at two weeks, six months and at one year.

RESULTS

Out of the enrolled patients, 240 (92.31%) and 240 (91.25%), 212 (81.54%) and 210 (79.85%), and 204 (78.46%) and 194 (73.76%) patients completed the follow up at two weeks, six months and one year in the two groups, respectively. Various parameters analysed were knowledge of the patients, their symptomatology, various triggering factors which were inducing and/or precipitating symptoms, the self-care measures they adopted at the time of acute attacks and the indices of asthma morbidity during the last one year. The knowledge scores were significantly higher at all the three follow up visits (F = 633. 98, p < 0.001) as compared to the baseline in the study group patients. In both the groups, the symptom scores decreased at all the follow up visits (F = 71.78, p < 0.001 in the study group and F = 24.19, p < 0.001 in the control group). Multiple logistic regression analysis showed a significant improvement in knowledge and symptoms in the study group as compared to controls after adjusting for various confounding variables (p < 0.001). The number of patients whose symptoms were induced and/or precipitated by exposure to various triggering factors was significantly reduced in study group for all the triggers. There was a statistically significant decrease in the number of severe attacks, number of emergency visits and need of injections during last one year in both the groups, though the differences were more marked in the study group. However, there was a significant decrease in hospital admissions and absence from school/or job in the study group at one year as compared to the control group.

CONCLUSION

The self-care manual was effective in self-management of bronchial asthma.

A multicentric study on epidemiology of chronic obstructive pulmonary disease and its relationship with tobacco smoking and environmental tobacco smoke exposure

INTRODUCTION

Population prevalence of chronic obstructive pulmonary disease (COPD) and its relationship with tobacco smoking, environmental tobacco smoke (ETS) exposure and other variables were studied in adult subjects of 35 years and above at four different centres in India. Question-items for the diagnosis of COPD were included in the questionnaire used for the field study on asthma epidemiology.

METHODS

Field surveys were conducted in both the urban and the rural populations at Bangalore, Chandigarh, Delhi and Kanpur with the help of a structured and validated questionnaire for diagnosis of asthma and COPD. Separate sets of questions were used for the diagnoses of the two diseases. A two-stage stratified sample design was employed where a village or an urban locality formed the first stage unit and a household formed the second stage unit. A uniform methodology was used at all the four centres and the analyses were done at the central coordinating centre--Chandigarh. Chronic obstructive pulmonary disease, defined by chronic bronchitis (CB) criteria, was diagnosed from the presence of cough and expectoration on most of the days for at least three months in a year for two consecutive years or more.

RESULTS

Chronic obstructive pulmonary disease was diagnosed in 4.1% of 35295 subjects, with a male to female ratio of 1.56:1 and a smoker to nonsmoker ratio of 2.65: 1. Prevalence among bidi and cigarette smokers was 8.2% and 5.9%, respectively. Odds ratio (OR) for COPD was higher for men, elderly individuals, lower socio-economic status and urban (or mixed) residence. Environmental tobacco smoke exposure among nonsmokers had an OR of 1.4(95% CI 1.21-1.61). Combined exposure to both ETS and solid fuel combustion had higher OR than for ETS exposure alone.

CONCLUSIONS

Population prevalence of COPD is very high in India with some centre to centre differences. Smoking of both bidis and cigarettes, and ETS exposure among nonsmokers, were two important risk factors at all centres. It is important to employ uniform methodology for assessment of national burden and disease-surveillance programme.

Tobacco smoking in India: prevalence, quit-rates and respiratory morbidity

BACKGROUND

Population prevalence of tobacco smoking especially with reference to detailed habits such as the amount smoked, the smoking forms, quit-rates and relationship with demographic variables were studied at four different centres in India along with the study on epidemiology of asthma and chronic obstructive pulmonary disease.

METHODS

The study population included adults of over 15 years of age selected with two-stage stratified random sample design. A specifically designed questionnaire was used for the study.

RESULTS

There were 11496 (15.6%) ever smokers in the study sample of 73605 subjects. Among 37682 males, 10756 (28.5%) were ever smokers and among 35923 females, 740 (2.1%) were ever smokers. Bidi was the commonest form of smoking, more so in the rural areas. The mean number of cigarettes/bidis smoked per day was 14 (+/- 11.5) and the mean age of starting smoking was 20.5 (+/- 20.0) years. Increasing age, low socio-economic status and rural residence were important factors associated with smoking. Vigorous anti-tobacco measures under the tobacco control programmes yielded only a quit-rate of 10 percent. Nearly 14% of ever smokers had some respiratory symptoms.

CONCLUSIONS

A substantial proportion of population in India has current or past smoking habit with higher prevalence among males than females. The quit-rates have been low in spite of the various anti-tobacco measures. There is a significant respiratory morbidity associated with smoking.

Prevalence and risk factors for bronchial asthma in Indian adults: a multicentre study

BACKGROUND

There is limited information on field epidemiology of bronchial asthma in Indian adults.

OBJECTIVES

To estimate prevalence of bronchial asthma in different regions of India and to define risk factors influencing disease prevalence.

METHODS

A field study was conducted at Chandigarh, Delhi, Kanpur and Bangalore through a two stage stratified (urban/ rural) sampling and uniform methodology using a previously validated questionnaire. Asthma was diagnosed if the respondent answered affirmatively both to (a) whistling sound from chest, or chest tightness, or breathlessness in morning, and (b) having suffered from asthma, or having an attack of asthma in the past 12 months, or using bronchodilators. Besides demographic data, information on smoking habits, domestic cooking fuel used, atopic symptoms, and family history suggestive of asthma was also collected. Univariate and multivariate logistic regression modelling was performed to calculate odds ratio of various potential risk factors.

RESULTS

Data from 73605 respondents (37682 men, 35923 women) were analysed. One or more respiratory symptoms were present in 4.3-10.5% subjects. Asthma was diagnosed in 2.28%, 1.69%, 2.05 and 3.47% respondents respectively at Chandigarh, Delhi, Kanpur and Bangalore, with overall prevalence of 2.38%. Female sex, advancing age, usual residence in urban area, lower socio-economic status, history suggestive of atopy, history of asthma in a first degree relative, and all forms of tobacco smoking were associated with significantly higher odds of having asthma.

CONCLUSION

Prevalence estimates of asthma in adults in this study, although lower than several previously reported figures, point to a high overall national burden of disease.

Household environmental tobacco smoke exposure, respiratory symptoms and asthma in non-smoker adults: a multicentric population study from India

BACKGROUND

Exposure to environmental tobacco smoke (ETS) is a risk factor for childhood asthma. Its association with asthma in adults is less clear.

METHODS

In a multicentric population study on asthma prevalence in adults, specific enquiries were made into childhood and adulthood exposure to household ETS, and its relationship with asthma diagnosis were analysed.

RESULTS

From a total of 73605 respondents, 62109 were studied after excluding current or past smokers. Overall observed prevalence of asthma was 2.0% (men 1.5%,women 2.5%, p < 0.001). Of all asthma patients, history of ETS exposure was available in 48.6 percent. Prevalence of asthma in the ETS exposed subjects was higher compared to non-exposed individuals (2.2% vs 1.9%, p < 0.05). Multiple logistic regression analysis showed a higher risk of having asthma in persons who were exposed to ETS compared to those not exposed (odds ratio [OR] 1.22, 95% CI 1.08-1.38) after adjusting for age, gender, usual residence, exposure to biomass fuels and atopy. Stratification of ETS exposure revealed that exposure during childhood and both during childhood and adulthood were significantly associated with asthma prevalence. Exposure only in adulthood was not a significant risk factor (OR 1.13, 95% CI 0.95-1.33). Persons reporting combined environmental tobacco smoke exposure from parents during childhood and spouse during adulthood had highest risk of having asthma (OR 1.69, 95% CI 1.38-2.07). Environmental tobacco smoke exposure was also significantly associated with prevalence of respiratory symptoms such as wheezing, cough and breathlessness.

CONCLUSIONS

Environmental tobacco smoke exposure during childhood is an important risk factor for asthma and respiratory symptoms in non-smoking adults.

Pulmonary mucormycosis: two of a kind

Mucormycosis is an uncommon infection caused by fungi of the class Zygomycetes, suborder Mucorales. It occurs predominantly in the immunodeficient host, the most common risk factor being diabetes mellitus. Pulmonary mucormycosis is a disease that is localized in the lungs or mediastinum. It usually presents in a fulminant manner, although a chronic presentation can also occur. We describe two cases of pulmonary mucormycosis in patients with diabetes mellitus, one with an acute and the other with a chronic presentation. A high level of clinical suspicion, combined surgical and medical therapy, and control of patient's underlying immunosuppression are the key to a successful outcome.

Opioid sparing during endotracheal intubation using McCoy laryngoscope in neurosurgical patients: the comparison of haemodynamic changes with Macintosh blade in a randomized trial

BACKGROUND

There is conflicting data in literature to show that the McCoy laryngoscope is less stressful and opioids can actually be avoided during laryngoscopy and intubation with the use of this laryngoscope.

AIM

A comparison of hemodynamic changes with McCoy vs Macintosh laryngoscope..

SETTINGS AND DESIGN

180 ASA I and II neurosurgical patients undergoing elective surgery for space occupying lesions were recruited. The study was was prospective, randomized and blinded in the setting of neurosurgical perioperative services.

METHODS AND MATERIALS

The patients were divided into four groups (Gr.1 McCoy and fentanyl; Gr. 2 McCoy and no fentanyl; Gr. 3 Macintosh and fentanyl; Gr. 4 Macintosh and no fentanyl). In Gr. 2 and 4 equivalent volume of saline was given in place of fentanyl as placebo. Heart rate, systolic and diastolic blood pressure were measured after laryngoscopy, after intubation and subsequently every minute for the next five minutes. The incidence of cough due to fentanyl treatment was observed.

STATISTICAL ANALYSIS

Haemodynamic changes were compared between and within groups using oneway ANOVA and repeated measures ANOVA. All analysis included 95% CI at 5% significance. The Mann Whitney U test was used for comparing incidence of cough.

RESULTS

No difference was found between McCoy laryngoscopy when done with or without fentanyl pretreatment (HR p=0.848, sys BP p=0.229 and diastolic blood pressure p=0.981). Significant changes in haemodynamic parameters were seen between Macintosh and McCoy laryngoscopy without fentanyl pretreatment (p<0.001) whereas changes were blunted with fentanyl pretreatment in Macintosh laryngoscopy (p<0.05).

CONCLUSIONS

McCoy laryngoscope blade is less stressful and fentanyl pretreatment is not necessary to attenuate haemodynamic responses with its use in ASA I and II patients.

Noninvasive estimation of clinically asymptomatic pulmonary hypertension in idiopathic pulmonary fibrosis

OBJECTIVES

To determine the prevalence of pulmonary hypertension in patients with idiopathic pulmonary fibrosis (IPF) by noninvasive methods.

PATIENTS AND METHODS

Twenty seven patients with IPF attending the Chest Clinic over a period of one-and-a-half-years underwent echocardiography for evidence of pulmonary hypertension, which was defined as pulmonary artery systolic pressure > or = 40 mmHg by Doppler echocardiography, or pulmonary acceleration time < or = 100 milliseconds or two-dimensional echocardiographic findings of right ventricular hypertrophy or overload.

RESULTS

Two patients with clinical evidence of pulmonary hypertension were excluded from analysis. Their mean age (n = 25) was 53.8 years. The mean duration of symptoms before presentation was 2.1 years. Pulmonary hypertension was diagnosed by echocardiography in nine of the 25 patients (36%). There was a statistically significant difference between the duration of illness, arterial oxygen tension (PaO2) levels and forced vital capacity in patients with pulmonary hypertension than in those without pulmonary hypertension. Logistic regression analysis showed a significant association between the duration of illness, decreasing forced vital capacity and hypoxemia with the development of pulmonary hypertension.

CONCLUSIONS

Echocardiography detects pulmonary hypertension in clinically asymptomatic individuals, and should be used routinely for the diagnosis of pulmonary hypertension in patients with IPF.

Successful management of ARDS with bronchopleural fistula secondary to miliary tuberculosis using a conventional ventilator

Most institutions in India and other developing countries do not have facilities for high frequency ventilation in adults. We report the successful management of a case of ARDS with bronchopleural fistula secondary to miliary tuberculosis using a conventional ventilator and early empiric anti-tubercular therapy.

Root canal configuration of deciduous mandibular first molars--an in vitro study

Root canal morphology of deciduous mandibular first molar was studied using roentgenographic and decalcification and clearing methods. Two groups of 15 teeth were formed. In the roentgenographic group, roots of the teeth were separated from the crown at the level of CEJ. Cut roots of the teeth were radiographed from both mesiodistal and buccolingual directions using separate IOPA films. In the decalcification and clearing group, teeth were decalcified and made transparent. Dye was injected later. The roots of the teeth were examined under 10 times for number, curvature, types and additional features of root canals. Deciduous mandibular first molar showed variability in root canal morphology. Four to five root canals were recorded. Majority of the teeth had 1-1 type of root canal anatomy, but 1-2 type anatomy was also reported. Straight, curved and S-shaped canal curvatures were recorded. Horizontal anastomosis, lateral canals and buccolingually broad root canals were also recorded.

Low dose of snake antivenom is as effective as high dose in patients with severe neurotoxic snake envenoming

The objective of this study was to evaluate the effects of two different dosage protocols on the outcome of patients with severe neurotoxic snake envenoming, using a retrospective analysis of patients admitted with a diagnosis of severe neurotoxic snake bite over a 4 year period. In the study, 55 snake bite victims requiring ventilatory support for severe neurotoxic envenoming received either 150 ml of polyvalent snake antivenom (SAV) (low dose SAV group, n = 28) or 100 ml of SAV at presentation followed by 100 ml every 6 hours until recovery of neurological manifestations (high dose group, n = 27). The median dose of SAV in the high dose group was 600 ml (range 300 to 1600). The duration of mechanical ventilation in the low dose group (median 47.5 hours; range 14 to 248) was similar to that in the high dose group (median 44 hours; range 6 to 400). The mean (SD) duration of intensive care unit stay was similar in the two groups. There were three deaths in the high dose group; two patients in the low dose group had neurological sequelae. All other patients improved, had no residual neurological deficit, and were discharged. We conclude that there is no difference between a protocol using lower doses of SAV and one with higher doses in the management of patients with severe neurotoxic snake envenoming.

A study of chorda tympani nerve injury and related symptoms following middle-ear surgery

This is a prospective study that looks into the prevalence of chorda tympani nerve (CTN) injury and related symptoms following varying degrees of trauma to the nerve during three common types of middle-ear operation: myringoplasty, tympanotomy and mastoidectomy. The number of patients with CTN-related symptoms varied widely between the three groups. Increased occurrence of the nerve related symptoms and a prolonged recovery time were observed in the tympanotomy group. Stretching of the nerve produced more symptomatic cases than cutting it in the myringoplasty and mastoidectomy groups. Recovery was complete in 92 percent of the symptomatic patients by 12 months. It is important to inform patients about the possibility of CTN injury during middle-ear operations, and it should also be emphasized that symptoms related to CTN injury can occur irrespective of the type of damage to the nerve.

Prevalence of tobacco use among school going youth in North Indian States

BACKGROUND

Tobacco use, which is the cause of several respiratory diseases, generally starts in the teens. Global Youth Tobacco Survey (GYTS) is an international initiative to investigate the tobacco use in school going youth of 13 to 15 years of age. This report describes the GYTS findings in the North Indian region.

METHODS

A two-stage cluster sample was used with selection of schools on probability proportional to enrollment size followed by systematic equal probability sampling with a random start of classes from each school. The 85-item questionnaire included 'core GYTS' and other additional questions. Data analysis was performed using EpiInfo 3.2 software and the results accounted for the complex sampling design and weighting factors in the data set.

RESULTS

The sample consisted of 9319 students out of the total eligible population of 30488 from 100 schools. The prevalence of ever-use of tobacco varied between 2.9 to 8.5% in boys and 1.5 to 9.8% in girls. The prevalence was highest in Chandigarh and lowest in Punjab. Between 16 to 46% of students were exposed to the habit of tobacco among parents or friends. There were 10 to 34% students who were passively exposed to environmental tobacco smoke.

CONCLUSION

Tobacco use is present in up to 10 percent of school going youth in the region. A majority of them had desired to quit. Tobacco control and cessation programmes therefore, remain important health issues.

Profile of repeat fiberoptic bronchoscopy

BACKGROUND

Fiberoptic bronchoscopy (FOB) is invaluable in the diagnosis of a variety of pulmonary diseases, but in many instances the procedure has to be repeated because of an inconclusive initial FOB or for reassessment.

METHODS

A retrospective analysis of all the fiberoptic bronchoscopic procedures done between September 2000 and February 2003 was performed and details of patients undergoing repeat FOB abstracted.

RESULTS

Of the 2,270 bronchoscopies performed on 2114 patients, 132 procedures were repeated, yielding an over all frequency of repeat FOB of 6.34 percent. Bronchoscopy was done twice in 112 patients, thrice in 16 patients and four times in four patients. The commonest diagnosis in patients undergoing repeat bronchoscopy was bronchogenic carcinoma, followed by non-resolving pneumonia or presence of pulmonary infiltrates in immunocompromised host. The major indications for repeating FOB included obtaining specimens for pathological examination, pre and postoperative evaluation of airways, localization of site of bleeding in patients with hemoptysis, and placement of catheters for intraluminal brachytherapy. Of the 88 cases undergoing repeat bronchoscopy for diagnostic purposes, 41 (46.6%) yielded positive results, either in form of positive histology or localisation of source of hemoptysis.

CONCLUSIONS

The frequency of repeat bronchoscopy was low. Commonest indication for a repeat procedure was to obtain repeat/additional diagnostic samples. A repeat procedure can yield positive results even when the initial FOB is nondiagnostic.