Cystic fibrosis--an Indian perspective on recent advances in diagnosis and management

Global pediatric pulmonology: what is coming to the West--out of India?

With the increasing globalisation, immigration and travel there are increasing opportunities for the exotic diseases to be seen in different settings. This paper highlights pulmonary diseases seen in the Indian subcontinent. It discusses briefly the clinical features and management of Tropical Pulmonary Eosinophilia, Hydatid disease of the lungs, Malarial lung pathology. In addition, the low cost medical innovations evolved to use the newer medical technologies, in an affordable fashion, in a developing countries context have been detailed.

Cystic fibrosis in North Indian children

Cystic fibrosis is the most common life threatening, inherited disease of the Caucasians. Ever since the gene for this disease was delineated in 1989, there are about 900 mutations discovered so far. This disease is being reported with increasing frequency from North India now. We present our experience with the diagnosis and management of cystic fibrosis in children seen at Post-Graduate Institute of Medical Education and Research, Chandigarh.

Recurrent lower respiratory tract infections in children

Recurrent lower respiratory tract infections in children are caused by a deficiency in the host defense or an underlying pulmonary disorder which may result from structural or functional alterations. Aspiration syndromes, congenital defects, airway clearance disorders and immune deficiency are the main categories. Careful evaluation with good history and examination provide important leads to limit the radiological and laboratory work up to the most relevant investigations. Some of the structural abnormalities are amenable to cure; however, secondary events need careful management of the underlying lung disorder to give the best quality of life to these children.

Diagnosis of cystic fibrosis: Indian perspective

Cystic fibrosis (CF) is one of the common life limiting inherited diseases in Caucasian population. Recent reports suggest that the diagnosis of cystic fibrosis in Indian children is missed or delayed due to low index of suspicion. The diagnosis of cystic fibrosis is suspected by the typical clinical features and should be confirmed by doing sweat chloride estimation. If sweat test is not available, ancillary tests including blood electrolyte and acid base balance, airway microbiology, tests to identify pancreatic insufficiency and semen analysis for obstructive azoospermia in post pubertal boys should be carried out. Positive results of these tests make the suspicion very strong. A strongly suspected case should be treated as cystic fibrosis, but for giving a diagnosis of CF, sweat test should be done from the nearest centre where it is available. In the presence of typical clinical features with borderline sweat chloride values sweat test should be repeated 2-3 times and the child should be investigated for alternative diagnosis. In the absence of alternative diagnosis with consistently high or borderline sweat chloride values an attempt should be made to get tests for mutations.