1
|
Dhar R, Talwar D, Christopher DJ, Dumra H, Koul PA, Chhajed PN, Roychowdhury S, Arjun P, Guleria R. Experts' Opinion on diagnosis and management of Severe Asthma, an Indian/Low and middle-income countries (LMIC) Perspective. J Asthma 2024:1-16. [PMID: 38767570 DOI: 10.1080/02770903.2024.2349614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 04/25/2024] [Indexed: 05/22/2024]
Abstract
Objective In this document, 9 Indian experts have evaluated the factors specific to LMICs when it came to Severe Asthma (SA) diagnosis, evaluation, biologic selection, non-biologic treatment options and follow-up.Data Sources A search was performed using 50 keywords., focusing on the Indian/LMICs perspective, in PubMed, Cochrane Library, and Google Scholar. The key areas of the search were focused on diagnosis, phenoendotyping, non-biological therapies, selecting a biologic, assessment of treatment response and management of exacerbation.Study Selections The initial search revealed 1826 articles, from these case reports, observational studies, cohort studies, non-English language papers etc were excluded and we short-listed 20 articles for each area. 5 relevant papers were selected by the experts for review.Results In LMICs SA patients may be referred to the specialist for evaluation a little late for Phenoendotyping of SA. While biologic therapy is now a standard of care, pulmonologists in LMICs may not have access to all the investigations to phenoendotype SA patients like Fractional exhaled nitric oxide (FeNO), Skin prick test (SPT) etc., but phenotyping of SA patients can also be done with simple blood investigations, eosinophil count and serum immunoglobulin E (IgE). Choosing a biologic in the overlapping phenotype of SA and ACO patients is also a challenge in the LMICs.Conclusion Given the limitations of LMIC, it is important to select the right patient and explain the potential benefits of biological therapy. Non-biologic add-on therapies can be attempted in a resource-limited setting where biological therapy is not available/feasible for patients.
Collapse
Affiliation(s)
| | | | | | - Harjit Dumra
- Sparsh, Chest Disease Centre, Navrangpura, Ahmedabad, India
| | - Parvaiz A Koul
- Department of Pulmonary Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Prashant N Chhajed
- Institute of Pulmonology, Medical Research and Development; Department of Lung Care and Sleep Center, Fortis Hiranandani Hospital, Vashi; Department of Respiratory Medicine, Dr. Balabhai Nanavati Hospital and Lilavati Hospital, Mumbai, Maharashtra, India
| | | | - Padmanabhan Arjun
- Department of Respiratory Medicine, Kerala Institute of Medical Sciences, Thiruvananthapuram, Kerala, India
| | - Randeep Guleria
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| |
Collapse
|
2
|
Christopher DJ, Gupta R, Thangakunam B, Daniel J, Jindal SK, Kant S, Chhajed PN, Gupta KB, Dhooria S, Chaudhri S, Chaudhry D, Patel D, Mehta R, Chawla RK, Srinivasan A, Kumar A, Bal SK, James P, Roger JS, Nair AA, Katiyar SK, Agarwal R, Dhar R, Aggarwal AN, Samaria JK, Behera D, Madan K, Singh RB, Luhadia SK, Sarangdhar N, Souza GD, Nene A, Paul A, Varghese V, Rajagopal TV, Arun M, Nair S, Roy DA, Williams BE, Christopher SA, Subodh DV, Sinha N, Isaac B, Oliver AA, Priya N, Deva J, Chandy ST, Kurien RB. Pleural effusion guidelines from ICS and NCCP Section 1: Basic principles, laboratory tests and pleural procedures. Lung India 2024; 41:230-248. [PMID: 38704658 DOI: 10.4103/lungindia.lungindia_33_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/19/2024] [Indexed: 05/06/2024] Open
Abstract
Pleural effusion is a common problem in our country, and most of these patients need invasive tests as they can't be evaluated by blood tests alone. The simplest of them is diagnostic pleural aspiration, and diagnostic techniques such as medical thoracoscopy are being performed more frequently than ever before. However, most physicians in India treat pleural effusion empirically, leading to delays in diagnosis, misdiagnosis and complications from wrong treatments. This situation must change, and the adoption of evidence-based protocols is urgently needed. Furthermore, the spectrum of pleural disease in India is different from that in the West, and yet Western guidelines and algorithms are used by Indian physicians. Therefore, India-specific consensus guidelines are needed. To fulfil this need, the Indian Chest Society and the National College of Chest Physicians; the premier societies for pulmonary physicians came together to create this National guideline. This document aims to provide evidence based recommendations on basic principles, initial assessment, diagnostic modalities and management of pleural effusions.
Collapse
Affiliation(s)
| | - Richa Gupta
- Department of Respiratory Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Jefferson Daniel
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Surya Kant
- Department of Respiratory Medicine, King George's Medical University, Lucknow, UP, India
| | - Prashant N Chhajed
- Centre for Chest and Respiratory Diseases, Nanavati Max Super Specialty Hospital, Mumbai, Maharashtra, India
| | - K B Gupta
- Department of Respiratory Medicine, Eras Medical College, Lucknow, Uttar Pradesh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sudhir Chaudhri
- Department of Respiratory Medicine, Rama Medical College, Kanpur, Uttar Pradesh, India
| | - Dhruva Chaudhry
- Department of Pulmonary and Critical Care Medicine, University of Health Sciences Rohtak, Haryana, India
| | - Dharmesh Patel
- City Clinic and Bhailal Amin General Hospital, Vadodara, Gujarat, India
| | - Ravindra Mehta
- VAAYU Chest and Sleep Services and VAAYU Pulmonary Wellness and Rehabilitation Center, Bengaluru, Karnataka, India
| | - Rakesh K Chawla
- Department of Respiratory Medicine Critical Care and Sleep Disorders, Jaipur Golden Hospital and Saroj Super Specialty Hospital, Delhi, India
| | - Arjun Srinivasan
- Centre for Advanced Pulmonary Interventions, Royal Care Hospital, Coimbatore, Tamil Nadu, India
| | - Arvind Kumar
- Institute of Chest Surgery, Chest Onco Surgery and Lung Transplantation and Medanta Robotic Institute, Medanta-the Medicity, Gurugram, Haranya, India
| | - Shakti K Bal
- Department of Pulmonary Medicine, AIIMS Bhubaneswar, Odisha, India
| | - Prince James
- Interventional Pulmonology and Respiratory Medicine, Naruvi Hospital, Vellore, Tamil Nadu, India
| | - Jebin S Roger
- Department of Respiratory Medicine, Apollo Hospital, Chennai, Tamil Nadu, India
| | | | - S K Katiyar
- Department of Tuberculosis and Respiratory Diseases, G.S.V.M. Medical College, Kanpur, Uttar Pradesh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Raja Dhar
- Department of Pulmonology, C K Birla Hospitals, Kolkata, West Bengal, India
| | - Ashutosh N Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - J K Samaria
- Department of Chest Diseases, IMS, B.H.U., Varanasi, Uttar Pradesh, India
| | - Digambar Behera
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Karan Madan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, India
| | - Raj B Singh
- Department of Respiratory Medicine, Apollo Hospital, Chennai, Tamil Nadu, India
| | - S K Luhadia
- Department of Respiratory Medicine, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India
| | | | - George D' Souza
- Department of Pulmonary Medicine, St. John's Medical College, Bangalore, Karnataka, India
| | - Amita Nene
- Department of Respiratory Medicine, Bombay Hospital India, Mumbai, Maharashtra, India
| | - Akhil Paul
- Department of Pulmonary Medicine, MOSC Medical Mission Hospital, Thrissur, Kerala, India
| | - Vimi Varghese
- Department of Heart and Lung Transplant, Yashoda Hospitals, Hyderabad, Telangana, India
| | - T V Rajagopal
- SKS Hospital and Post Graduate Medical Institute, Salem, Tamil Nadu, India
| | - M Arun
- Department of Respiratory Medicine, Meenakshi Hospital, Thanjavur, Tamil Nadu, India
| | - Shraddha Nair
- Department of Respiratory Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Dhivya A Roy
- Kanyakumari Medical Mission, CSI Mission Hospital, Neyyoor, Tamil Nadu, India
| | - Benjamin E Williams
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Shona A Christopher
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Dhanawade V Subodh
- Division of Critical Care Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Nishant Sinha
- Department of Pulmonary Medicine, Continental Hospitals, Financial District, Hyderabad, Telangana, India
| | - Barney Isaac
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ashwin A Oliver
- Department of Respiratory Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - N Priya
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Sujith T Chandy
- Department of Respiratory Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Richu Bob Kurien
- Department of Respiratory Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| |
Collapse
|
3
|
Kleinsorge L, Pasha Z, Boesing M, Abu Hussein N, Bridevaux PO, Chhajed PN, Geiser T, Joos Zellweger L, Kohler M, Maier S, Miedinger D, Tamm M, Thurnheer R, Von Garnier C, Leuppi JD. Clinical characteristics governing treatment adjustment in COPD patients: results from the Swiss COPD cohort study. Swiss Med Wkly 2023; 153:40114. [PMID: 37955986 DOI: 10.57187/smw.2023.40114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a widespread chronic disease characterised by irreversible airway obstruction [1]. Features of clinical practice and healthcare systems for COPD patients can vary widely, even within similar healthcare structures. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy is considered the most reliable guidance for the management of COPD and aims to provide treating physicians with appropriate insight into the disease. COPD treatment adaptation typically mirrors the suggestions within the GOLD guidelines, depending on how the patient has been categorised. However, the present study posits that the reasons for adjusting COPD-related treatment are hugely varied. OBJECTIVES The objective of this study was to assess the clinical symptoms that govern both pharmacological and non-pharmacological treatment changes in COPD patients. Using this insight, the study offers suggestions for optimising COPD management through the implementation of GOLD guidelines. METHODS In this observational cohort study, 24 general practitioners screened 260 COPD patients for eligibility from 2015-2019. General practitioners were asked to collect general information from patients using a standardised questionnaire to document symptoms. During a follow-up visit, the patient's symptoms and changes in therapy were assessed and entered into a central electronic database. Sixty-five patients were removed from the analysis due to exclusion criteria, and 195 patients with at least one additional visit within one year of the baseline visit were included in the analysis. A change in therapy was defined as a change in either medication or non-medical treatment, such as pulmonary rehabilitation. Multivariable mixed models were used to identify associations between given symptoms and a step up in therapy, a step down, or a step up and a step down at the same time. RESULTS For the 195 patients included in analyses, a treatment adjustment was made during 28% of visits. In 49% of these adjustments, the change in therapy was a step up, in 33% a step down and in 18% a step up (an increase) of certain treatment factors and a step down (a reduction) of other prescribed treatments at the same time. In the multivariable analysis, we found that the severity of disease was linked to the probability of therapy adjustment: patients in GOLD Group C were more likely to experience an increase in therapy compared to patients in GOLD Group A (odds ratio [OR] 3.43 [95% confidence interval {CI}: 1.02-11.55; p = 0.135]). In addition, compared to patients with mild obstruction, patients with severe (OR 4.24 [95% CI: 1.88-9.56]) to very severe (OR 5.48 [95% CI: 1.31-22.96]) obstruction were more likely to experience a therapy increase (p <0.0001). Patients with comorbidities were less likely to experience a treatment increase than those without (OR 0.42 [95% CI: 0.24-0.73; p = 0.002]). A therapy decrease was associated with both a unit increase in COPD Assessment Test (CAT) score (OR 1.07 [95% CI: 1.01-1.14; p = 0.014]) and having experienced an exacerbation (OR 2.66 [95% CI: 1.01-6.97; p = 0.047]). The combination of steps up as well as steps down in therapy was predicted by exacerbation (OR 8.93 [95% CI: 1.16-68.28; p = 0.035]) and very severe obstruction (OR 589 [95% CI: 2.72 - >999; p = 0.109]). CONCLUSIONS This cohort study provides insight into the management of patients with COPD in a primary care setting. COPD Group C and airflow limitation GOLD 3-4 were both associated with an increase in COPD treatment. In patients with comorbidities, there were often no treatment changes. Exacerbations did not make therapy increases more probable. The presence of neither cough/sputum nor high CAT scores was associated with a step up in treatment.
Collapse
Affiliation(s)
- Lea Kleinsorge
- University Center of Internal Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
- Medical Faculty, University of Basel, Basel, Switzerland
- Departement of Pneumology, Claraspital, Basel, Switzerland
| | - Zahra Pasha
- University Center of Internal Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
- Medical Faculty, University of Basel, Basel, Switzerland
| | - Maria Boesing
- University Center of Internal Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
- Medical Faculty, University of Basel, Basel, Switzerland
| | - Nebal Abu Hussein
- University Center of Internal Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
- Departement of Pneumology, University Hospital and Inselspital Bern, Bern, Switzerland
| | - Pierre O Bridevaux
- Clinic of Pneumology, Hospital of Valais and University of Geneva, Sion and Geneva, Switzerland
| | - Prashant N Chhajed
- University Center of Internal Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
- Medical Faculty, University of Basel, Basel, Switzerland
| | - Thomas Geiser
- Departement of Pneumology, University Hospital and Inselspital Bern, Bern, Switzerland
| | | | - Malcolm Kohler
- Departement of Pneumology, University Hospital Zürich, Zürich, Switzerland
| | - Sabrina Maier
- University Center of Internal Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
| | - David Miedinger
- University Center of Internal Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
- Medical Faculty, University of Basel, Basel, Switzerland
| | - Michael Tamm
- Medical Faculty, University of Basel, Basel, Switzerland
- Departement of Pneumology, University Hospital Basel, Basel, Switzerland
| | - Robert Thurnheer
- Clinic of Medicine and Departement of Pneumology, Cantonal Hospital Münsterlingen, Münsterlingen, Switzerland
| | | | - Joerg D Leuppi
- University Center of Internal Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
- Medical Faculty, University of Basel, Basel, Switzerland
| |
Collapse
|
4
|
Abu Hussein NS, Giezendanner S, Urwyler P, Bridevaux PO, Chhajed PN, Geiser T, Joos Zellweger L, Kohler M, Miedinger D, Pasha Z, Thurnheer R, von Garnier C, Leuppi JD. Risk Factors for Recurrent Exacerbations in the General-Practitioner-Based Swiss Chronic Obstructive Pulmonary Disease (COPD) Cohort. J Clin Med 2023; 12:6695. [PMID: 37892832 PMCID: PMC10606981 DOI: 10.3390/jcm12206695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) often suffer from acute exacerbations. Our objective was to describe recurrent exacerbations in a GP-based Swiss COPD cohort and develop a statistical model for predicting exacerbation. METHODS COPD cohort demographic and medical data were recorded for 24 months, by means of a questionnaire-based COPD cohort. The data were split into training (75%) and validation (25%) datasets. A negative binomial regression model was developed using the training dataset to predict the exacerbation rate within 1 year. An exacerbation prediction model was developed, and its overall performance was validated. A nomogram was created to facilitate the clinical use of the model. RESULTS Of the 229 COPD patients analyzed, 77% of the patients did not experience exacerbation during the follow-up. The best subset in the training dataset revealed that lower forced expiratory volume, high scores on the MRC dyspnea scale, exacerbation history, and being on a combination therapy of LABA + ICS (long-acting beta-agonists + Inhaled Corticosteroids) or LAMA + LABA (Long-acting muscarinic receptor antagonists + long-acting beta-agonists) at baseline were associated with a higher rate of exacerbation. When validated, the area-under-curve (AUC) value was 0.75 for one or more exacerbations. The calibration was accurate (0.34 predicted exacerbations vs 0.28 observed exacerbations). CONCLUSION Nomograms built from these models can assist clinicians in the decision-making process of COPD care.
Collapse
Affiliation(s)
- Nebal S. Abu Hussein
- University Institute of Internal Medicine, Cantonal Hospital Baselland, 4031 Liestal, Switzerland; (N.S.A.H.); (S.G.); (P.N.C.); (D.M.); (Z.P.)
- Medical Faculty, University of Basel, 4001 Basel, Switzerland
- Department of Pulmonary Medicine, Inselspital, Bern University Hospital, 3012 Bern, Switzerland;
- Department for BioMedical Research, University of Bern, 3012 Bern, Switzerland
- Pulmonary, Critical Care & Sleep Medicine, Yale School of Medicine, New Haven, CT 06510, USA
| | - Stephanie Giezendanner
- University Institute of Internal Medicine, Cantonal Hospital Baselland, 4031 Liestal, Switzerland; (N.S.A.H.); (S.G.); (P.N.C.); (D.M.); (Z.P.)
- Medical Faculty, University of Basel, 4001 Basel, Switzerland
| | | | | | - Prashant N. Chhajed
- University Institute of Internal Medicine, Cantonal Hospital Baselland, 4031 Liestal, Switzerland; (N.S.A.H.); (S.G.); (P.N.C.); (D.M.); (Z.P.)
- Medical Faculty, University of Basel, 4001 Basel, Switzerland
| | - Thomas Geiser
- Department of Pulmonary Medicine, Inselspital, Bern University Hospital, 3012 Bern, Switzerland;
- Department for BioMedical Research, University of Bern, 3012 Bern, Switzerland
| | | | | | - David Miedinger
- University Institute of Internal Medicine, Cantonal Hospital Baselland, 4031 Liestal, Switzerland; (N.S.A.H.); (S.G.); (P.N.C.); (D.M.); (Z.P.)
- Medical Faculty, University of Basel, 4001 Basel, Switzerland
| | - Zahra Pasha
- University Institute of Internal Medicine, Cantonal Hospital Baselland, 4031 Liestal, Switzerland; (N.S.A.H.); (S.G.); (P.N.C.); (D.M.); (Z.P.)
- Medical Faculty, University of Basel, 4001 Basel, Switzerland
| | | | - Christophe von Garnier
- Division of Pulmonology, Department of Medicine, CHUV, University Hospital Lausanne, University of Lausanne, 1011 Lausanne, Switzerland;
| | - Joerg D. Leuppi
- University Institute of Internal Medicine, Cantonal Hospital Baselland, 4031 Liestal, Switzerland; (N.S.A.H.); (S.G.); (P.N.C.); (D.M.); (Z.P.)
- Medical Faculty, University of Basel, 4001 Basel, Switzerland
| |
Collapse
|
5
|
Mandovra NP, Vaidya PJ, Shah RS, Nighojkar AS, Chavhan VB, Lohiya A, Leuppi JD, Leuppi-Taegtmeyer A, Chhajed PN. Factors Affecting Best-Tolerated Dose of Pirfenidone in Patients with Fibrosing Interstitial Lung Disease. J Clin Med 2023; 12:6513. [PMID: 37892651 PMCID: PMC10606989 DOI: 10.3390/jcm12206513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/13/2023] [Accepted: 09/15/2023] [Indexed: 10/29/2023] Open
Abstract
The aim of the study was to examine the best-tolerated dose of pirfenidone, the adverse effects profile, and potential factors other than drug dose influencing the tolerability of pirfenidone in patients with fibrosing interstitial lung diseases (ILDs). We performed an observational retrospective study of 113 patients with IPF and other fibrosing ILDs treated with pirfenidone. Baseline liver function tests (LFTs) and dose escalation of pirfenidone were recorded for all patients. The best-tolerated dose was continued if the patient did not tolerate full dose (2400 mg) despite repeated dose escalation attempts. Potential risk factors such as age, height, weight, body mass index (BMI), body surface area (BSA), gender, smoking, and presence of comorbidities were analyzed between 3 groups of best-tolerated pirfenidone doses: 2400 mg/day vs. <2400 mg/day, 2400 mg/day vs. 1800 mg/day, and 2400 mg/day vs. 1200 mg/day. A total of 24 patients tolerated 2400 mg/day, and 89 patients tolerated <2400 mg/day (43 tolerated 1800 mg/day, 45 tolerated 1200 mg/day and 1 tolerated 600 mg/day). Patients who tolerated 2400 mg/day were taller and had a larger BSA as compared to those tolerating <2400 mg/day. Overall, males tolerated the drug better. Presence of comorbidities or smoking did not affect the tolerance of pirfenidone, except for the presence of cerebrovascular diseases. Various adverse effects did not have any significantly different frequencies between the compared groups. Moreover, 71.7% of patients experienced at least one side effect. 1200 mg/day was the best-tolerated dose in the majority of the patients. Male patients with a larger BSA and greater height showed better tolerability of pirfenidone overall.
Collapse
Affiliation(s)
- Neha P. Mandovra
- Institute of Pulmonology Medical Research and Development, Mumbai 400054, India; (N.P.M.); (P.J.V.); (R.S.S.); (A.S.N.); (V.B.C.)
- Department of Respiratory Medicine, Fortis Hiranandani Hospital, Navi Mumbai 400614, India
| | - Preyas J. Vaidya
- Institute of Pulmonology Medical Research and Development, Mumbai 400054, India; (N.P.M.); (P.J.V.); (R.S.S.); (A.S.N.); (V.B.C.)
- Department of Respiratory Medicine, Fortis Hiranandani Hospital, Navi Mumbai 400614, India
| | - Ria S. Shah
- Institute of Pulmonology Medical Research and Development, Mumbai 400054, India; (N.P.M.); (P.J.V.); (R.S.S.); (A.S.N.); (V.B.C.)
- Department of Respiratory Medicine, Fortis Hiranandani Hospital, Navi Mumbai 400614, India
| | - Aishwarya S. Nighojkar
- Institute of Pulmonology Medical Research and Development, Mumbai 400054, India; (N.P.M.); (P.J.V.); (R.S.S.); (A.S.N.); (V.B.C.)
| | - Vinod B. Chavhan
- Institute of Pulmonology Medical Research and Development, Mumbai 400054, India; (N.P.M.); (P.J.V.); (R.S.S.); (A.S.N.); (V.B.C.)
| | - Ayush Lohiya
- Kalyan Singh Super Speciality Cancer Institute, Lucknow 226002, India;
| | - Joerg D. Leuppi
- University Centre of Internal Medicine, Kantonsspital Baselland, 4410 Liestal, Switzerland; (J.D.L.); (A.L.-T.)
- Medical Faculty, University of Basel, 4031 Basel, Switzerland
| | - Anne Leuppi-Taegtmeyer
- University Centre of Internal Medicine, Kantonsspital Baselland, 4410 Liestal, Switzerland; (J.D.L.); (A.L.-T.)
- Medical Faculty, University of Basel, 4031 Basel, Switzerland
- Department of Patient Safety, Medical Directorate, University Hospital Basel, 4031 Basel, Switzerland
| | - Prashant N. Chhajed
- Institute of Pulmonology Medical Research and Development, Mumbai 400054, India; (N.P.M.); (P.J.V.); (R.S.S.); (A.S.N.); (V.B.C.)
- Department of Respiratory Medicine, Fortis Hiranandani Hospital, Navi Mumbai 400614, India
- University Centre of Internal Medicine, Kantonsspital Baselland, 4410 Liestal, Switzerland; (J.D.L.); (A.L.-T.)
- Medical Faculty, University of Basel, 4031 Basel, Switzerland
| |
Collapse
|
6
|
Tschacher A, Cadus C, Schildge S, Diedrich JP, Chhajed PN, Leuppi-Taegtmeyer AB, Leuppi JD. Switching COPD patients from the disposable to the new reusable Respimat soft mist inhaler: a real-world study from Switzerland. Curr Med Res Opin 2021; 37:2019-2033. [PMID: 34433362 DOI: 10.1080/03007995.2021.1969354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aims of the survey were to assess first experiences of Swiss COPD patients switching from the disposable to the new reusable Respimat inhaler, and to evaluate physicians´ and patients´ views of the new training material. METHODS Patients with a confirmed diagnosis of COPD using a disposable Respimat inhaler for at least three months were included. Patients´ demographics, COPD stage, current treatment, and comorbidities relevant for the handling of the device were assessed. Further, patients were trained on the reusable Respimat by placebo inhaler, patient brochure, video cards/demo films and SMS reminder service. After at least one cartridge change, patients gave comprehensive feedback on their satisfaction with the reusable Respimat and physicians evaluated the need for re-training. RESULTS 235 patients participated in the survey. Of these, 37% suffered from comorbidities restricting the handling of the Respimat. 216 (92%) patients had a better overall satisfaction with the reusable than with the disposable Respimat. Dose counter (86%), monthly preparation (81%) and daily handling (77%) were also assessed as better by most of the patients. In 80% of cases, the user ability was stated as better than for the disposable Respimat. Less than 15% of the patients required further training. Placebo inhaler was the mostly preferred training material by both, physicians (in 86% of the patients) and patients (75%). In patients with comorbidities affecting inhaler handling, overall satisfaction was also better in 86% of the patients. CONCLUSION The majority of patients were satisfied with the new reusable Respimat device and proper handling could be attained using the provided training material, even in patients with restricting comorbidities.
Collapse
Affiliation(s)
- Anne Tschacher
- University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Cordula Cadus
- University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
| | | | | | - Prashant N Chhajed
- University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Anne B Leuppi-Taegtmeyer
- University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Clinical Pharmacology and Toxicology, University Hospital Basel, Basel, Switzerland
| | - Jörg Daniel Leuppi
- University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| |
Collapse
|
7
|
Hasan A, Mukherjee P, Chhowala S, Lopez M, Chhajed PN. Small Airways, Big Problem: Extrafine beclomethasone/formoterol in asthma and chronic obstructive pulmonary disease. Lung India 2021; 38:350-358. [PMID: 34259174 PMCID: PMC8272415 DOI: 10.4103/lungindia.lungindia_394_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Asthma and chronic obstructive pulmonary disease (COPD) are common chronic respiratory diseases characterized by an inflammatory process that extends from the central to peripheral airways. Conventional pressurized metered-dose inhalers and most dry-powder inhalers emit drug particles too large to target the small airways effectively. Advancements in drug formulation have given rise to a new generation of inhalers that can generate aerosols with extrafine drug particles that leads to more effective aerosol penetration into the lung periphery. An extrafine formulation of inhaled beclomethasone/formoterol (BDP-FF) with enhanced lung deposition is now available. This document reviews the various real-world and controlled studies that have evaluated the efficacy of extrafine BDP-FF in asthma and COPD.
Collapse
Affiliation(s)
- Ashfaq Hasan
- Professor, Department of Pulmonary Medicine, Deccan College of Medical Sciences, Hyderabad, Telangana, India
| | | | | | | | - Prashant N Chhajed
- Lung Care and Sleep Centre, Institute of Pulmonology, Medical Research and Development, Mumbai, Maharashtra, India
| |
Collapse
|
8
|
Marmy JL, Diedrich JP, Cadus C, Grendelmeier P, Tschacher A, Dieterle T, Chhajed PN, Leuppi JD. Adherence to GOLD Recommendations among Swiss Pulmonologists and General Practitioners. COPD 2020; 18:9-15. [PMID: 33342309 DOI: 10.1080/15412555.2020.1859469] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Significant variability in adherence to COPD management recommendations has been reported. We aimed to evaluate real-life COPD pharmacotherapy prescribing patterns and adherence to the 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) global strategy in Switzerland. A questionnaire-based survey was conducted among Swiss general practitioners (GPs) and pulmonologists (PULs) from May 1 to November 30, 2017. Participants were invited to complete a questionnaire on their next 5-10 consecutive patients already receiving a pharmacological treatment for COPD. They were requested to assess dyspnea using the modified Medical Research Council (mMRC) dyspnea scale and to determine whether a treatment adjustment was indicated. Fifty-three PULs and 39 GPs completed questionnaires on 511 COPD patients. Dyspnea with mMRC grade ≥2 was reported in 62.5% of the patients, and 31.9% had had at least two exacerbations (or at least one with hospital admission) in the last 12 months. The vast majority (87.1%) of GOLD A patients were overtreated. In the GOLD B group, 52.2% of prescriptions were concordant with GOLD 2017 recommendations, but 37% of patients were overtreated. Among GOLD C patients, 49.2% received GOLD-adherent treatment and 47.5% were overtreated. In the GOLD D category, 78.8% of the patients received a treatment consistent with recommendations but 15.2% were undertreated. After reassessment of patient status, treatment was modified in 50.3% of the patients. This study confirms that discordance of real-world prescription patterns with international guidance is frequent. Further educational efforts are required to improve adherence to COPD management recommendations.
Collapse
Affiliation(s)
- Joana Louise Marmy
- University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | | | - Cordula Cadus
- University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Peter Grendelmeier
- University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Anne Tschacher
- University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Thomas Dieterle
- University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Prashant N Chhajed
- University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Jörg Daniel Leuppi
- University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| |
Collapse
|
9
|
Mandovra NP, Lele TT, Vaidya PJ, Chavhan VB, Leuppi-Taegtmeyer AB, Leuppi JD, Chhajed PN. High Incidence of New-Onset Joint Pain in Patients on Fluoroquinolones as Antituberculous Treatment. Respiration 2020; 99:125-131. [PMID: 31935716 DOI: 10.1159/000505102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 11/28/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Joint pain is frequently observed in patients on antituberculous treatment, and pyrazinamide is known to be associated with joint pain in patients receiving antituberculous treatment. Fluoroquinolone-associated joint pain and tendon injury have been reported in long-term corticosteroid and transplant recipients, but data are lacking in patients with tuberculosis. OBJECTIVES The objective of this study was to examine the incidence of joint pain manifested during administration of antituberculous therapy and their association with fluoroquinolones. METHODS Patients diagnosed with tuberculosis attending the outpatient clinic over a period of 1 year were reviewed and divided into 3 groups: group A receiving pyrazinamide, group B receiving a fluoroquinolone, and group C receiving both pyrazinamide and a fluoroquinolone. Latency to onset of joint pain was noted in all 3 groups. Joint pain was initially managed with analgesics, and associated hyperuricemia was treated with allopurinol/febuxostat. Causative drugs were stopped in case of intolerable joint pain. RESULTS 260 patients (47% females, aged 38 ± 18 years; mean ± SD) were included [group A (n = 140), group B (n = 81), and group C (n = 39)]. Overall, 76/260 (29%) patients developed joint pain: group A - 24/140 patients (17%), group B - 32/81 patients (40%), and group C - 20/39 patients (51%). The median latency to the onset of joint pain was 83 days (interquartile range, IQR 40-167): 55 days (IQR 32-66) in group A, 138 days (IQR 74-278) in group B, and 88 days (IQR 34-183) in group C. Hyperuricemia was present in 12/24 (50%) patients in group A and 11/20 (55%) patients in group C. Pyrazinamide was stopped in 7/140 (5%) patients in group A, fluoroquinolones in 6/81 (7%) patients in group B, and both pyrazinamide and fluoroquinolones were stopped in 5/39 (13%) patients in group C because of intolerable joint pain. Major joints affected were knees and ankles. CONCLUSION There is a high incidence of joint pain in patients receiving antituberculous treatment, which is higher when fluoroquinolones or the pyrazinamide-fluoroquinolone combination are administered as compared to pyrazinamide alone.
Collapse
Affiliation(s)
- Neha P Mandovra
- Department of Respiratory Medicine, Fortis Hiranandani Hospital Vashi, Navi Mumbai, India.,Institute of Pulmonology, Medical Research and Development, Mumbai, India
| | - Tejashree T Lele
- Department of Respiratory Medicine, Fortis Hiranandani Hospital Vashi, Navi Mumbai, India.,Institute of Pulmonology, Medical Research and Development, Mumbai, India
| | - Preyas J Vaidya
- Department of Respiratory Medicine, Fortis Hiranandani Hospital Vashi, Navi Mumbai, India.,Institute of Pulmonology, Medical Research and Development, Mumbai, India
| | - Vinod B Chavhan
- Department of Respiratory Medicine, Fortis Hiranandani Hospital Vashi, Navi Mumbai, India.,Institute of Pulmonology, Medical Research and Development, Mumbai, India
| | - Anne B Leuppi-Taegtmeyer
- Department of Clinical Pharmacology and Toxicology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Joerg D Leuppi
- University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Prashant N Chhajed
- Department of Respiratory Medicine, Fortis Hiranandani Hospital Vashi, Navi Mumbai, India, .,Institute of Pulmonology, Medical Research and Development, Mumbai, India,
| |
Collapse
|
10
|
Madan K, Mittal S, Suri TM, Jain A, Mohan A, Hadda V, Tiwari P, Guleria R, Talwar D, Chaudhri S, Singh V, Swarnakar R, Bharti SJ, Garg R, Gupta N, Kumar V, Agarwal R, Aggarwal AN, Ayub II, Chhajed PN, Dhamija A, Dhar R, Dhooria S, Gonuguntla HK, Goyal R, Koul PA, Kumar R, Maturu N, Mehta RM, Parakh U, Pattabhiraman V, Raghupathi N, Sehgal IS, Srinivasan A, Venkatnarayan K. Bronchial thermoplasty for severe asthma: A position statement of the Indian chest society. Lung India 2020; 37:86-96. [PMID: 31898635 PMCID: PMC6961101 DOI: 10.4103/lungindia.lungindia_418_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
UNLABELLED Bronchial thermoplasty (BT) is an interventional bronchoscopic treatment for severe asthma. There is a need to define patient selection criteria to guide clinicians in offering the appropriate treatment options to patients with severe asthma. METHODOLOGY An expert group formed this statement under the aegis of the Indian Chest Society. We performed a systematic search of the MEDLINE and EMBASE databases to extract evidence on patient selection and the technical performance of BT. RESULTS The experts agreed that the appropriate selection of patients is crucial and proposed identification of the asthma phenotype, a screening algorithm, and inclusion/exclusion criteria for BT. In the presence of atypical clinical or chest radiograph features, there should be a low threshold for obtaining a thoracic computed tomography scan before BT. The patient should not have had an asthma exacerbation in the preceding two weeks from the day of the procedure. A 5-day course of glucocorticoid should be administered, beginning three days before the procedure day, and continued until the day following the procedure. General Anesthesia (total intravenous anesthesia with a neuromuscular blocker) provides ideal conditions for performing BT. A thin bronchoscope with a 2.0 mm working channel is preferable. An attempt should be made to deliver the maximum radiofrequency activations. Middle lobe treatment is not recommended. Following the procedure, overnight observation in the hospital, and a follow-up visit, a week following each treatment session, is desirable. CONCLUSION This position statement provides practical guidance regarding patient selection and the technical performance of BT for severe asthma.
Collapse
Affiliation(s)
- Karan Madan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
- Address for correspondence: Dr. Karan Madan, Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029, India. E-mail:
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Tejas M Suri
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Avinash Jain
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Hadda
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Pavan Tiwari
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Randeep Guleria
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Talwar
- Metro Centre for Respiratory Diseases, Noida, Uttar Pradesh, India
| | - Sudhir Chaudhri
- Department of Respiratory Medicine, GSVM Medical College, Kanpur, Uttar Pradesh, India
| | - Virendra Singh
- Department of Respiratory Medicine, Asthma Bhawan, Jaipur, Rajasthan, India
| | - Rajesh Swarnakar
- Department of Respiratory Medicine, Getwell Hospital and Research Institute, Nagpur, Maharashtra, India
| | - Sachidanand J Bharti
- Department of Onco-Anesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Garg
- Department of Onco-Anesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Nishkarsh Gupta
- Department of Onco-Anesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod Kumar
- Department of Onco-Anesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashutosh N Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Irfan I Ayub
- Department of Respiratory Medicine, Sri Ramachandra University and Hospital, Chennai, Tamil Nadu, India
| | - Prashant N Chhajed
- Lung Care and Sleep Centre, Institute of Pulmonology, Medical Research and Development, Mumbai, Maharashtra, India
| | - Amit Dhamija
- Department of Respiratory Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Raja Dhar
- Department of Respiratory Medicine, Fortis Hospital, Anandapur, Kolkata, West Bengal, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Hari K Gonuguntla
- Department of Pulmonary Medicine, Yashoda Hospitals, Hyderabad, Telangana, India
| | - Rajiv Goyal
- Department of Respiratory Medicine, Jaipur Golden Hospital and Rajiv Gandhi Cancer Institute, New Delhi, India
| | - Parvaiz A Koul
- Department of Internal and Pulmonary Medicine, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Raj Kumar
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, New Delhi, India
| | - Nagarjuna Maturu
- Department of Pulmonary Medicine, Yashoda Hospitals, Hyderabad, Telangana, India
| | - Ravindra M Mehta
- Department of Respiratory Medicine, Apollo Hospital, Bengaluru, Karnataka, India
| | - Ujjwal Parakh
- Department of Respiratory Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | | | | | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arjun Srinivasan
- Department of Respiratory Medicine, Royal Care Hospital, Coimbatore, Tamil Nadu, India
| | - Kavitha Venkatnarayan
- Department of Pulmonary Medicine, St. Johns Medical College, Bengaluru, Karnataka, India
| |
Collapse
|
11
|
Mandovra NP, Leuppi JD, Herth FJF, Chhajed PN. [Interventionen beim Asthma COPD]. Ther Umsch 2019; 76:328-336. [PMID: 31762420 DOI: 10.1024/0040-5930/a001097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Advanced emphysema and asthma constitute major health burden worldwide and are associated with significant morbidity and mortality. Pharmacological options are limited. Researches are being carried out aiming to modify the natural course of both the diseases. Lung volume reduction surgeries are performed in advanced emphysema but are associated with significant morbidity and prolonged hospital stay. Various minimally invasive bronchoscopic methods have been developed with the goal of achieving clinical benefits of volume reduction surgery but lower complications. Bronchial thermoplasty is a bronchoscopic method of delivering controlled heat in the airways to reduce airway smooth muscle mass, thereby reducing bronchoconstriction in patients with severe asthma who remain uncontrolled despite optimal medical therapy. Various randomised controlled trials have been performed to evaluate the safety and efficacy of various endoscopic treatments like valves, coils, use of sclerosants and targeted lung denervation for severe emphysema and bronchial thermoplasty in severe asthma. The current review summaries the clinical trial evidence available for lung volume reduction in emphysema and thermoplasty in asthma and provide guidance for optimal patient selection for various therapies available.
Collapse
Affiliation(s)
- Neha P Mandovra
- Institute of Pulmonology Medical Research and Development, Mumbai, India
| | - Jörg D Leuppi
- University Clinic of Medicine, Kantonsspital Baselland, Switzerland
| | - Felix J F Herth
- Thoraxklinik and Translational lung research Center (TLRCH), University of Heidelberg, Heidelberg, Germany
| | - Prashant N Chhajed
- Institute of Pulmonology Medical Research and Development, Mumbai, India.,University Clinic of Medicine, Kantonsspital Baselland, Switzerland
| |
Collapse
|
12
|
Chhajed PN, Vaidya PJ, Mandovra NP, Chavhan VB, Lele TT, Nair R, Leuppi JD, Saha A. EBUS-TBNA in the rapid microbiological diagnosis of drug-resistant mediastinal tuberculous lymphadenopathy. ERJ Open Res 2019; 5:00008-2019. [PMID: 31754620 PMCID: PMC6856492 DOI: 10.1183/23120541.00008-2019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 09/23/2019] [Indexed: 02/01/2023] Open
Abstract
This study aimed to examine the use of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the rapid diagnosis of mediastinal tuberculous lymphadenitis and drug-resistant mediastinal tuberculous lymphadenitis. A diagnosis of TB was confirmed by a positive Xpert MTB/RIF test or Mycobacterium tuberculosis culture. Rifampicin-resistant TB (RR-TB) or multidrug-resistant TB (MDR-TB) was diagnosed upon the detection of rifampicin resistance by Xpert MTB/RIF or resistance to rifampicin and isoniazid by phenotypic drug susceptibility testing (DST). Xpert MTB/RIF was positive in 43 of 56 patients (77%) and TB culture was positive in 31 of 56 patients (55%). Of these 56 patients, 25 (45%) were Xpert MTB/RIF positive and TB culture negative, 13 (23%) were Xpert MTB/RIF negative and TB culture positive, and 18 (32%) were Xpert MTB/RIF positive and TB culture positive. 11 patients (20%) had drug-resistant TB: seven with RR/MDR-TB, one with pre-extensively drug-resistant (XDR) TB, two with XDR-TB and one with isoniazid mono-resistance. An Xpert MTB/RIF assay carried out on EBUS-TBNA specimens provides rapid diagnosis of TB. Xpert MTB/RIF testing appears to have additional and more rapid sensitivity compared with culture alone. Culture-based DST provides an additional exclusive yield and the full resistance profile in addition to or instead of rifampicin resistance.
Collapse
Affiliation(s)
- Prashant N Chhajed
- Dept of Respiratory Medicine, Fortis Hiranandani Hospital, Navi Mumbai, India.,Institute of Pulmonology, Medical Research and Development, Mumbai, India
| | - Preyas J Vaidya
- Dept of Respiratory Medicine, Fortis Hiranandani Hospital, Navi Mumbai, India.,Institute of Pulmonology, Medical Research and Development, Mumbai, India
| | - Neha P Mandovra
- Dept of Respiratory Medicine, Fortis Hiranandani Hospital, Navi Mumbai, India.,Institute of Pulmonology, Medical Research and Development, Mumbai, India
| | - Vinod B Chavhan
- Dept of Respiratory Medicine, Fortis Hiranandani Hospital, Navi Mumbai, India.,Institute of Pulmonology, Medical Research and Development, Mumbai, India
| | - Tejashree T Lele
- Dept of Respiratory Medicine, Fortis Hiranandani Hospital, Navi Mumbai, India.,Institute of Pulmonology, Medical Research and Development, Mumbai, India
| | - Rekha Nair
- Dept of Microbiology, Fortis Hiranandani Hospital, Navi Mumbai, India
| | - Jörg D Leuppi
- University Clinic of Medicine, Kantonsspital Baselland, Liestal, Switzerland
| | - Avinandan Saha
- Dept of Respiratory Medicine, Fortis Hiranandani Hospital, Navi Mumbai, India
| |
Collapse
|
13
|
Urwyler P, Abu Hussein N, Bridevaux PO, Chhajed PN, Geiser T, Grendelmeier P, Joos Zellweger L, Kohler M, Maier S, Miedinger D, Tamm M, Thurnheer R, Dieterle T, Leuppi JD. Predictive factors for exacerbation and re-exacerbation in chronic obstructive pulmonary disease: an extension of the Cox model to analyze data from the Swiss COPD cohort. Multidiscip Respir Med 2019; 14:7. [PMID: 30774953 PMCID: PMC6364405 DOI: 10.1186/s40248-019-0168-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 11/27/2018] [Indexed: 11/24/2022] Open
Abstract
Background The Swiss COPD cohort was established in 2006 to collect data in a primary care setting. The objective of this study was to evaluate possible predictive factors for exacerbation and re-exacerbation. Methods In order to predict exacerbation until the next visit based on the knowledge of exacerbation since the last visit, a multistate model described by Therneau and Grambsch was performed. Results Data of 1,247 patients (60.4% males, 46.6% current smokers) were analyzed, 268 (21.5%) did not fulfill spirometric diagnostic criteria for COPD. Data of 748 patients (63% males, 44.1% current smokers) were available for model analysis. In order to predict exacerbation an extended Cox Model was performed. Mean FEV1/FVC-ratio was 53.1% (±11.5), with a majority of patients in COPD GOLD classes 2 or 3. Hospitalization for any reason (HR1.7; P = 0.04) and pronounced dyspnea (HR for mMRC grade four 3.0; P < 0.001) at most recent visit as well as prescription of short-acting bronchodilators (HR1.7; P < 0.001), inhaled (HR1.2; P = 0.005) or systemic corticosteroids (HR1.8; P = 0.015) were significantly associated with exacerbation when having had no exacerbation at most recent visit. Higher FEV1/FVC (HR0.9; P = 0.008) and higher FEV1 values (HR0.9; P = 0.001) were protective. When already having had an exacerbation at the most recent visit, pronounced dyspnea (HR for mMRC grade 4 1.9; P = 0.026) and cerebrovascular insult (HR2.1; P = 0.003) were significantly associated with re-exacerbation. Physical activity (HR0.6; P = 0.031) and treatment with long-acting anticholinergics (HR0.7; P = 0.044) seemed to play a significant protective role. In a best subset model for exacerbation, higher FEV1 significantly reduced and occurrence of sputum increased the probability of exacerbation. In the same model for re-exacerbation, coronary heart disease increased and hospitalization at most recent visit seemed to reduce the risk for re-exacerbation. Conclusion Our data confirmed well-established risk factors for exacerbations whilst analyzing their predictive association with exacerbation and re-exacerbation. This study confirmed the importance of spirometry in primary care, not only for diagnosis but also as a risk evaluation for possible future exacerbations. Trial registration Our study got approval by local ethical committee in 2006 (EK Nr. 170/06) and was registered retrospectively on ClinicalTrials.gov (NCT02065921, 19th of February 2014).
Collapse
Affiliation(s)
- Pascal Urwyler
- 1University Clinic of Medicine, Cantonal Hospital Baselland, University of Basel, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Nebal Abu Hussein
- 2University Hospital Basel, University of Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Pierre O Bridevaux
- 3Hospital of Valais, University of Geneva, Avenue du Grand-Champsec 80, 1950 Sion, Switzerland
| | - Prashant N Chhajed
- 1University Clinic of Medicine, Cantonal Hospital Baselland, University of Basel, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Thomas Geiser
- 4University Hospital Bern (Inselspital), University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Peter Grendelmeier
- 1University Clinic of Medicine, Cantonal Hospital Baselland, University of Basel, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Ladina Joos Zellweger
- 5St. Clara Hospital, University of Basel, Kleinriehenstrasse 30, 4002 Basel, Switzerland
| | - Malcolm Kohler
- 6University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Sabrina Maier
- 1University Clinic of Medicine, Cantonal Hospital Baselland, University of Basel, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - David Miedinger
- 1University Clinic of Medicine, Cantonal Hospital Baselland, University of Basel, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Michael Tamm
- 2University Hospital Basel, University of Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Robert Thurnheer
- Cantonal Hospital of Muensterlingen, Spitalcampus 1, 8596 Münsterlingen, Switzerland
| | - Thomas Dieterle
- 1University Clinic of Medicine, Cantonal Hospital Baselland, University of Basel, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Joerg D Leuppi
- 1University Clinic of Medicine, Cantonal Hospital Baselland, University of Basel, Rheinstrasse 26, 4410 Liestal, Switzerland
| |
Collapse
|
14
|
Urwyler P, Hussein NA, Bridevaux PO, Chhajed PN, Geiser T, Grendelmeier P, Zellweger LJ, Kohler M, Maier S, Miedinger D, Tamm M, Thurnheer R, Dieterle T, Leuppi JD. Predictive factors for exacerbation and reexacerbation in chronic obstructive pulmonary disease: an extension of the Cox model to analyze data from the Swiss COPD cohort. Multidiscip Respir Med 2019. [DOI: 10.4081/mrm.2019.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: The Swiss COPD cohort was established in 2006 to collect data in a primary care setting. The objective of this study was to evaluate possible predictive factors for exacerbation and re-exacerbation. Methods: In order to predict exacerbation until the next visit based on the knowledge of exacerbation since the last visit, a multistate model described by Therneau and Grambsch was performed. Results: Data of 1,247 patients (60.4% males, 46.6% current smokers) were analyzed, 268 (21.5%) did not fulfill spirometric diagnostic criteria for COPD. Data of 748 patients (63% males, 44.1% current smokers) were available for model analysis. In order to predict exacerbation an extended Cox Model was performed. Mean FEV1/FVC-ratio was 53.1% (±11.5), with a majority of patients in COPD GOLD classes 2 or 3. Hospitalization for any reason (HR1.7; P = 0.04) and pronounced dyspnea (HR for mMRC grade four 3.0; P < 0.001) at most recent visit as well as prescription of short-acting bronchodilators (HR1.7; P < 0.001), inhaled (HR1.2; P = 0.005) or systemic corticosteroids (HR1.8; P = 0.015) were significantly associated with exacerbation when having had no exacerbation at most recent visit. Higher FEV1/FVC (HR0.9; P = 0.008) and higher FEV1 values (HR0.9; P = 0.001) were protective. When already having had an exacerbation at the most recent visit, pronounced dyspnea (HR for mMRC grade 4 1.9; P = 0.026) and cerebrovascular insult (HR2.1; P = 0.003) were significantly associated with re-exacerbation. Physical activity (HR0.6; P = 0.031) and treatment with long-acting anticholinergics (HR0.7; P = 0.044) seemed to play a significant protective role. In a best subset model for exacerbation, higher FEV1 significantly reduced and occurrence of sputum increased the probability of exacerbation. In the same model for re-exacerbation, coronary heart disease increased and hospitalization at most recent visit seemed to reduce the risk for re-exacerbation. Conclusion: Our data confirmed well-established risk factors for exacerbations whilst analyzing their predictive association with exacerbation and re-exacerbation. This study confirmed the importance of spirometry in primary care, not only for diagnosis but also as a risk evaluation for possible future exacerbations. Trial registration: Our study got approval by local ethical committee in 2006 (EK Nr. 170/06) and was registered retrospectively on ClinicalTrials.gov (NCT02065921, 19th of February 2014).
Collapse
|
15
|
Dhooria S, Agarwal R, Sehgal IS, Aggarwal AN, Goyal R, Guleria R, Singhal P, Shah SP, Gupta KB, Koolwal S, Akkaraju J, Annapoorni S, Bal A, Bansal A, Behera D, Chhajed PN, Dhamija A, Dhar R, Garg M, Gopal B, Hibare KR, James P, Jindal A, Jindal SK, Khan A, Kishore N, Koul PA, Kumar A, Kumar R, Lall A, Madan K, Mandal A, Mehta RM, Mohan A, Nangia V, Nath A, Nayar S, Patel D, Pattabhiraman V, Raghupati N, Sarkar PK, Singh V, Sivaramakrishnan M, Srinivasan A, Swarnakar R, Talwar D, Thangakunam B. Bronchoscopic lung cryobiopsy: An Indian association for bronchology position statement. Lung India 2019; 36:48-59. [PMID: 30604705 PMCID: PMC6330795 DOI: 10.4103/lungindia.lungindia_75_18] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Bronchoscopic lung cryobiopsy (BLC) is a novel technique for obtaining lung tissue for the diagnosis of diffuse parenchymal lung diseases. The procedure is performed using several different variations of technique, resulting in an inconsistent diagnostic yield and a variable risk of complications. There is an unmet need for standardization of the technical aspects of BLC. METHODOLOGY This is a position statement framed by a group comprising experts from the fields of pulmonary medicine, thoracic surgery, pathology, and radiology under the aegis of the Indian Association for Bronchology. Sixteen questions on various technical aspects of BLC were framed. A literature search was conducted using PubMed and EMBASE databases. The expert group discussed the available evidence relevant to each question through e-mail and a face-to-face meeting, and arrived at a consensus. RESULTS The experts agreed that patients should be carefully selected for BLC after weighing the risks and benefits of the procedure. Where appropriate, consideration should be given to perform alternate procedures such as conventional transbronchial biopsy or subject the patient directly to a surgical lung biopsy. The procedure is best performed after placement of an artificial airway under sedation/general anesthesia. Fluoroscopic guidance and occlusion balloon should be utilized for positioning the cryoprobe to reduce the risk of pneumothorax and bleeding, respectively. At least four tissue specimens (with at least two of adequate size, i.e., ≥5 mm) should be obtained during the procedure from different lobes or different segments of a lobe. The histopathological findings of BLC should be interpreted by an experienced pulmonary pathologist. The final diagnosis should be made after a multidisciplinary discussion. Finally, there is a need for structured training for performing BLC. CONCLUSION This position statement is an attempt to provide practical recommendations for the performance of BLC in DPLDs.
Collapse
Affiliation(s)
- Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashutosh Nath Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajiv Goyal
- Department of Respiratory Medicine, Jaipur Golden Hospital and Rajiv Gandhi Cancer Institute, New Delhi, India
| | - Randeep Guleria
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Pratibha Singhal
- Department of Respiratory Medicine, Bombay Hospital and Fortis Hiranandani Hospital, Mumbai, India
| | - Shirish P Shah
- Department of Respiratory Medicine, Nanavati Super Speciality Hospital, Mumbai, India
| | - Krishna B Gupta
- Department of Respiratory Medicine, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Suresh Koolwal
- Department of Chest Diseases, SMS Medical College, Jaipur, Rajasthan, India
| | - Jayachandra Akkaraju
- Department of Respiratory Medicine, Century Hospital, Hyderabad, Telangana, India
| | - Shankar Annapoorni
- Department of Respiratory Medicine, Royal Care Hospital, Coimbatore, India
| | - Amanjit Bal
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Avdhesh Bansal
- Department of Respiratory Medicine, Indraprastha Apollo Hospital, New Delhi, India
| | - Digambar Behera
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Prashant N Chhajed
- India and Lung Care and Sleep Centre, Institute of Pulmonology, Medical Research and Development, Mumbai, India
| | - Amit Dhamija
- Department of Respiratory Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Raja Dhar
- Department of Respiratory Medicine, Fortis Hospital Anandapur, Kolkata, West Bengal, India
| | - Mandeep Garg
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bharat Gopal
- Department of Respiratory Medicine, Maharaja Agrasen Hospital, New Delhi, India
| | - Kedar R Hibare
- Department of Respiratory Medicine, Narayana Health City, Bengaluru, Karnataka, India
| | - Prince James
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Aditya Jindal
- Department of Respiratory Medicine, Jindal Chest Clinic, Chandigarh, India
| | - Surinder K Jindal
- Department of Respiratory Medicine, Jindal Chest Clinic, Chandigarh, India
| | - Ajmal Khan
- Department of Pulmonary Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Nevin Kishore
- Department of Respiratory Medicine, Max Hospital, New Delhi, India
| | - Parvaiz A Koul
- Department of Internal and Pulmonary Medicine, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Arvind Kumar
- Department of Respiratory Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Raj Kumar
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, New Delhi, India
| | - Ajay Lall
- Department of Respiratory Medicine, Max Hospital, New Delhi, India
| | - Karan Madan
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | | | - Ravindra M Mehta
- Department of Respiratory Medicine, Apollo Hospital, Bengaluru, Karnataka, India
| | - Anant Mohan
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Nangia
- Department of Respiratory Medicine, Fortis Hospital, New Delhi, India
| | - Alok Nath
- Department of Pulmonary Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sandeep Nayar
- Department of Respiratory Medicine, BLK Super Speciality Hospital, New Delhi, India
| | - Dharmesh Patel
- Department of Respiratory Medicine, City Clinic and Bhailal Amin General Hospital, Vadodara, Gujarat, India
| | | | | | - Pralay K Sarkar
- Department of Medicine, Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Virendra Singh
- Department of Respiratory Medicine, Asthma Bhawan, Jaipur, Rajasthan, India
| | | | - Arjun Srinivasan
- Department of Respiratory Medicine, Royal Care Hospital, Coimbatore, India
| | - Rajesh Swarnakar
- Department of Respiratory Medicine, Getwell Hospital and Research Institute, Nagpur, Maharashtra, India
| | - Deepak Talwar
- Metro Centre for Respiratory Diseases, Noida, Uttar Pradesh, India
| | | |
Collapse
|
16
|
Agrawal N, Lele T, Vaidya PJ, Chavhan V, Taegtmeyer A, Leuppi J, Chhajed PN. High incidence of new onset joint pain in patients receiving fluoroquinolones as part of anti-tuberculous treatment. Tuberculosis (Edinb) 2018. [DOI: 10.1183/13993003.congress-2018.pa2697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
17
|
Agrawal N, Vaidya PJ, Chhajed PN. Endobronchial ultrasound transbronchial needle aspiration (EBUS TBNA) in HIV affected individuals: Is the (E)BUS ready for unchartered territories? Lung India 2018; 35:371-372. [PMID: 30168453 PMCID: PMC6120313 DOI: 10.4103/lungindia.lungindia_312_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Neha Agrawal
- Institute of Pulmonology, Medical Research and Development, Mumbai, Maharashtra, India
| | - Preyas J Vaidya
- Institute of Pulmonology, Medical Research and Development, Mumbai, Maharashtra, India
| | - Prashant N Chhajed
- Institute of Pulmonology, Medical Research and Development, Mumbai, Maharashtra, India; Department of Internal Medicine, Kantonsspital Baselland, Liestal and University of Basel, Basel, Switzerland
| |
Collapse
|
18
|
Saha A, Vaidya PJ, Chavhan VB, Achlerkar A, Leuppi JD, Chhajed PN. Combined pirfenidone, azithromycin and prednisolone in post-H1N1 ARDS pulmonary fibrosis. Sarcoidosis Vasc Diffuse Lung Dis 2018; 35:85-90. [PMID: 32476885 PMCID: PMC7170064 DOI: 10.36141/svdld.v35i1.6393] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 08/08/2017] [Indexed: 11/02/2022]
Abstract
There are no specific data on the management of pulmonary fibrosis post-H1N1 ARDS. We present the cases of three patients who responded positively to treatment with pirfenidone, azithromycin and prednisolone. Three males, aged 40, 45 and 59 years, had H1N1 ARDS requiring mechanical ventilation for two weeks or longer. After weaning off ventilation, they had persistent symptoms and hypoxemia at rest despite receiving prednisolone and home oxygen for at least three weeks following discharge. Computed tomography (CT) of the chest showed fibrosis and traction bronchiectasis. At presentation, they could not perform spirometry. Investigations ruled out infection. Pirfenidone (600 mg daily escalated to maximum tolerable dose of 2.4 gm daily) and azithromycin (500 mg thrice weekly) were added off-label to prednisolone. In one patient pirfenidone was discontinued after three months due to an adverse reaction and azithromycin was continued for nine months. At one year follow-up, all patients had symptomatic improvement, better effort tolerance, regression of opacities and no progression of fibrosis on CT, and improvement in spirometry and six minute walk tests. Pirfenidone and azithromycin added to prednisolone may have led to clinical and radiological improvement. The current experience suggests that this treatment approach to pulmonary fibrosis post-H1N1 ARDS be studied further. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 85-90).
Collapse
Affiliation(s)
- Avinandan Saha
- Department of Respiratory Medicine, Fortis Hiranandani Hospital, Navi Mumbai, India
- Institute of Pulmonology Medical Research and Development, Mumbai, India
| | - Preyas J Vaidya
- Department of Respiratory Medicine, Fortis Hiranandani Hospital, Navi Mumbai, India
- Institute of Pulmonology Medical Research and Development, Mumbai, India
| | - Vinod B Chavhan
- Department of Respiratory Medicine, Fortis Hiranandani Hospital, Navi Mumbai, India
- Institute of Pulmonology Medical Research and Development, Mumbai, India
| | - Amolkumar Achlerkar
- Department of Respiratory Medicine, Fortis Hiranandani Hospital, Navi Mumbai, India
- Institute of Pulmonology Medical Research and Development, Mumbai, India
| | - Jörg D Leuppi
- Institute of Pulmonology Medical Research and Development, Mumbai, India
| | - Prashant N Chhajed
- Department of Respiratory Medicine, Fortis Hiranandani Hospital, Navi Mumbai, India
- Institute of Pulmonology Medical Research and Development, Mumbai, India
| |
Collapse
|
19
|
Carron T, Bridevaux PO, Lörvall K, Parmentier R, Moix JB, Beytrison V, Pernet R, Rey C, Roberfroid PY, Chhajed PN, Dieterle T, Joos Zellweger L, Kohler M, Maier S, Miedinger D, Thurnheer R, Urwyler P, Tschopp JM, Zuercher E, Leuppi JD, Burnand B, Peytremann-Bridevaux I. Feasibility, acceptability and effectiveness of integrated care for COPD patients: a mixed methods evaluation of a pilot community-based programme. Swiss Med Wkly 2017; 147:w14567. [PMID: 29231234 DOI: 10.4414/smw.2017.14567] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
QUESTION UNDER STUDY The aim of this study was to assess the feasibility, acceptability and effectiveness of a pilot COPD integrated care programme implemented in Valais, Switzerland. METHODS The programme was adapted from the self-management programme Living Well with COPD, and included the following elements: self-management patient-education group sessions, telephone and medical follow-ups, multidisciplinary teams, training of healthcare professionals, and evidence-based COPD care. A process and outcome evaluation of the pilot phase of the programme was conducted by means of qualitative and quantitative methods. Reach (coverage, participation rates), dosage (interventions carried out), fidelity (delivered as intended) and stakeholders' acceptance of the programme were evaluated through data monitoring and conduct of focus groups with patients and healthcare professionals. Effectiveness was assessed with pre-post analyses (before and after the intervention). The primary outcome measures were; (1) generic and disease-specific quality of life (36-Item Short Form Health Survey, Chronic Respiratory Questionnaire); and (2) hospitalisations (all-cause and for acute exacerbations) in the past 12 months. Secondary outcomes included self-efficacy, number of exacerbations and exercise capacity. Finally, controlled pre-post comparisons were also made with patients from the Swiss COPD Cohort for three common outcome measures (dyspnoea [mMRC score], number of exacerbations and smoking status). RESULTS During the first 2 years of the programme, eight series of group-based education sessions were delivered to 57 patients with COPD in three different locations of the canton of Valais. Coverage objectives were achieved and attendance rate at the education sessions was high (83.6%). Patients' and healthcare professionals' reported a high degree of satisfaction, except for multidisciplinarity and transfer of information. Exploration of the effectiveness of this pilot programme suggested positive pre-post results at 12 months, with improvements in terms of health-related quality of life, self-efficacy, exercise capacity, immunisation coverage and Patient Assessment of Chronic Illness Care score. No other outcome, including the number of hospital admissions, differed significantly after 12 months. We observed no differences from the control group. CONCLUSIONS The evaluation demonstrated the feasibility and acceptability of the programme and confirmed the relevance of mixed method process evaluation to adjust and improve programme implementation. The introduction of multidisciplinary teams in a context characterised by fragmentation of care was identified as the main challenge in the programme implementation and could not be achieved as expected. Despite this area for improvement, patients' feedback and early effectiveness results confirmed the benefits of COPD integrated care programmes emphasising self-management education.
Collapse
Affiliation(s)
- Tania Carron
- Institute of social and preventive medicine (IUMSP), Lausanne University Hospital, Switzerland
| | - Pierre-Olivier Bridevaux
- Division of Pneumology, Hospital of Valais, Sion, Switzerland / Division of Pneumology, University Hospitals of Geneva, Switzerland / Faculty of Medicine, University of Geneva, Switzerland
| | - Karin Lörvall
- Institute of social and preventive medicine (IUMSP), Lausanne University Hospital, Switzerland / Division of Pneumology, Hospital of Valais, Sion, Switzerland / Ligue pulmonaire Valaisanne - Promotion Santé Valais, Sion, Switzerland
| | - Rachel Parmentier
- Ligue pulmonaire Valaisanne - Promotion Santé Valais, Sion, Switzerland
| | - Jean-Bernard Moix
- Ligue pulmonaire Valaisanne - Promotion Santé Valais, Sion, Switzerland
| | | | | | | | | | - Prashant N Chhajed
- University Clinic of Medicine, Kantonsspital Baselland, Liestal, and Medical Faculty of Medicine, University of Basel, Switzerland
| | - Thomas Dieterle
- University Clinic of Medicine, Kantonsspital Baselland, Liestal, and Medical Faculty of Medicine, University of Basel, Switzerland
| | | | - Malcolm Kohler
- Division of Pneumology, University Hospital Zürich, Switzerland
| | - Sabrina Maier
- University Clinic of Medicine, Kantonsspital Baselland, Liestal, and Medical Faculty of Medicine, University of Basel, Switzerland
| | - David Miedinger
- University Clinic of Medicine, Kantonsspital Baselland, Liestal, and Medical Faculty of Medicine, University of Basel, Switzerland
| | - Robert Thurnheer
- Division of Pneumology, Kantonsspital Münsterlingen, Switzerland
| | - Pascal Urwyler
- University Clinic of Medicine, Kantonsspital Baselland, Liestal, and Medical Faculty of Medicine, University of Basel, Switzerland
| | - Jean-Marie Tschopp
- Centre Valaisan de Pneumologie, Department of Internal Medicine, Montana, Switzerland
| | - Emilie Zuercher
- Institute of social and preventive medicine (IUMSP), Lausanne University Hospital, Switzerland
| | - Jörg Daniel Leuppi
- University Clinic of Medicine, Kantonsspital Baselland, Liestal, and Medical Faculty of Medicine, University of Basel, Switzerland
| | - Bernard Burnand
- Institute of social and preventive medicine (IUMSP), Lausanne University Hospital, Switzerland
| | | |
Collapse
|
20
|
Saha A, Vaidya PJ, Chavhan VB, Pandey KV, Kate AH, Chhajed PN. Inconsistency in the reporting of antitubercular drug susceptibility tests in an endemic region. Lung India 2017; 34:427-429. [PMID: 28869226 PMCID: PMC5592753 DOI: 10.4103/0970-2113.213840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Individualized treatment for multidrug-resistant tuberculosis (MDR TB) is associated with improved outcomes. Therapy needs to be tailored to drug susceptibility testing (DST) results. We present our observations on the inconsistency in DST reporting in an endemic region with a high prevalence of MDR TB. Methods: We retrospectively analyzed 118 DST reports from 10 different laboratories. Observations: Of 118 patients, only 79 (67%) had DST reports with results to all first-line drugs, a fluoroquinolone (excluding ciprofloxacin), all aminoglycosides, and a polypeptide. Twenty-one (18%) isolates did not have DST reports for all first-line drugs; 4 (3%) did not have DST reports for any second-line drugs; 9 (8%) did not have DST reports for a fluoroquinolone; and 31 (26%) did not have DST reports for all second-line aminoglycosides and polypeptide. Conclusion: Inconsistencies were observed in several of the 118 DST reports. A case is made for sensitization toward standardization and completeness in TB DST reporting in India.
Collapse
Affiliation(s)
- Avinandan Saha
- Department of Respiratory Medicine, Fortis Hiranandani Hospital, Navi Mumbai; Institute of Pulmonology Medical Research and Development, Mumbai, Maharashtra, India
| | - Preyas J Vaidya
- Department of Respiratory Medicine, Fortis Hiranandani Hospital, Navi Mumbai; Institute of Pulmonology Medical Research and Development, Mumbai, Maharashtra, India
| | - Vinod B Chavhan
- Department of Respiratory Medicine, Fortis Hiranandani Hospital, Navi Mumbai; Institute of Pulmonology Medical Research and Development, Mumbai, Maharashtra, India
| | - Kamlesh V Pandey
- Department of Respiratory Medicine, Fortis Hiranandani Hospital, Navi Mumbai; Institute of Pulmonology Medical Research and Development, Mumbai, Maharashtra, India
| | - Arvind H Kate
- Institute of Pulmonology Medical Research and Development, Mumbai, Maharashtra, India
| | - Prashant N Chhajed
- Department of Respiratory Medicine, Fortis Hiranandani Hospital, Navi Mumbai; Institute of Pulmonology Medical Research and Development, Mumbai, Maharashtra, India
| |
Collapse
|
21
|
Saha A, Vaidya PJ, Chavhan VB, Pandey KV, Kate AH, Leuppi JD, Tamm M, Chhajed PN. Factors affecting outcomes of individualised treatment for drug resistant tuberculosis in an endemic region>. Tuberculosis (Edinb) 2017. [DOI: 10.1183/1393003.congress-2017.pa2728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
22
|
Vaidya PJ, Munavvar M, Leuppi JD, Mehta AC, Chhajed PN. Endobronchial ultrasound-guided transbronchial needle aspiration: Safe as it sounds. Respirology 2017. [DOI: 10.1111/resp.13094] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Preyas J. Vaidya
- Institute of Pulmonology, Medical Research and Development; Mumbai India
- Department of Pulmonary Medicine, Fortis Hospitals; Mumbai India
| | - Mohammed Munavvar
- Department of Pulmonary Medicine, Lancashire Teaching Hospitals; Preston UK
| | - Joerg D. Leuppi
- Department of Internal Medicine, Kantonsspital Baselland, Liestal; Basel Switzerland
| | - Atul C. Mehta
- Department of Pulmonary Medicine, Cleveland Clinic; Cleveland Ohio USA
| | - Prashant N. Chhajed
- Institute of Pulmonology, Medical Research and Development; Mumbai India
- Department of Pulmonary Medicine, Fortis Hospitals; Mumbai India
- Department of Internal Medicine, Kantonsspital Baselland, Liestal; Basel Switzerland
| |
Collapse
|
23
|
Vaidya PJ, Sandeepa HS, Singh T, Susheel Kumar SK, Bhargava R, Ramakrishnan G, Chhajed PN. Combined prednisolone and pirfenidone in bleomycin-induced lung disease. J Cancer Res Ther 2017; 12:1198-1202. [PMID: 28054535 DOI: 10.4103/0973-1482.197530] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Bleomycin is a cytostatic drug commonly employed in the treatment of Hodgkin's disease, seminomas, and choriocarcinoma. Bleomycin may induce a chronic pulmonary inflammation that may progress to fibrosis. So far, only corticosteroids have been used in the treatment of bleomycin-induced lung disease with variable results. Pirfenidone is an antifibrotic drug that has been approved for the treatment of idiopathic pulmonary fibrosis. We report two cases of bleomycin-induced lung disease treated successfully with pirfenidone and oral corticosteroids.
Collapse
Affiliation(s)
- Preyas J Vaidya
- Institute of Pulmonology, Medical Research and Development; Lung Care and Sleep Center, Fortis Hospitals, Mumbai, Maharashtra, India
| | - H S Sandeepa
- Institute of Pulmonology, Medical Research and Development, Mumbai, Maharashtra, India
| | - Tejinder Singh
- Department of Medical Oncology, Fortis Hospitals, Mumbai, Maharashtra, India
| | - S K Susheel Kumar
- Department of Radiology, Dr. Balabhai Nanavati Hospital, Mumbai, Maharashtra, India
| | - Rajat Bhargava
- Department of Radiology, Fortis Hospitals, Mumbai, Maharashtra, India
| | - Gopal Ramakrishnan
- Department of Medical Oncology, Dr. Balabhai Nanavati Hospital, Mumbai, Maharashtra, India
| | - Prashant N Chhajed
- Institute of Pulmonology, Medical Research and Development; Lung Care and Sleep Center, Fortis Hospitals; Department of Respiratory Medicine, Dr. Balabhai Nanavati Hospital, Mumbai, Maharashtra, India
| |
Collapse
|
24
|
Pandey K, Vaidya PJ, Kate AH, Chavhan VB, Jaybhaye P, Patole K, Deshpande RK, Chhajed PN. Bronchoscopic and surgical management of rare endobronchial tumors. J Cancer Res Ther 2017; 12:1093-7. [PMID: 27461707 DOI: 10.4103/0973-1482.186692] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Pure endobronchial neoplasms are a rare entity, and they may present with diverse pathological findings. Malignant diseases are more common than benign ones, and they mostly originate from the surface epithelium. Endobronchial tumors usually present with symptoms such as cough, hemoptysis, recurrent pneumonia, wheezing, and chest pain. Flexible bronchoscopy is necessary for diagnosis and evaluation of these endobronchial tumors. Advance bronchoscopy or definitive surgery is the modality of treatment for these tumors based on the presentation. We present a case series of patients suffering from different rare endobronchial tumors and their management along with the review of literature.
Collapse
Affiliation(s)
- Kamlesh Pandey
- Institute of Pulmonology, Medical Research and Development; Lung Care and Sleep Centre, Fortis Hiranandani Hospital, Mumbai, Maharashtra, India
| | - Preyas J Vaidya
- Institute of Pulmonology, Medical Research and Development; Lung Care and Sleep Centre, Fortis Hiranandani Hospital, Mumbai, Maharashtra, India
| | - Arvind H Kate
- Institute of Pulmonology, Medical Research and Development; Lung Care and Sleep Centre, Fortis Hiranandani Hospital, Mumbai, Maharashtra, India
| | - Vinod B Chavhan
- Institute of Pulmonology, Medical Research and Development; Lung Care and Sleep Centre, Fortis Hiranandani Hospital, Mumbai, Maharashtra, India
| | - Pruthviraj Jaybhaye
- Department of Pathology, SRL Laboratories, Fortis Hiranandani Hospital, Mumbai, Maharashtra, India
| | - Kamlakar Patole
- Department of Pathology, SRL Laboratories, Mumbai, Maharashtra, India
| | | | - Prashant N Chhajed
- Institute of Pulmonology, Medical Research and Development; Lung Care and Sleep Centre, Fortis Hiranandani Hospital, Mumbai, Maharashtra, India
| |
Collapse
|
25
|
Vaidya PJ, Saha A, Kate AH, Pandey K, Chavhan VB, Leuppi JD, Chhajed PN. Diagnostic value of core biopsy histology and cytology sampling of mediastinal lymph nodes using 21-gauge EBUS-TBNA needle. J Cancer Res Ther 2017; 12:1172-1177. [PMID: 28054531 DOI: 10.4103/0973-1482.197535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the initial modality of choice in sampling mediastinal lymphadenopathy. It is possible to obtain both cytological and histological samples using both 21-gauge and 22-gauge EBUS-TBNA needles. The current study was undertaken to compare the diagnostic yield of cytology and histology samples obtained by the same EBUS-TBNA 21-gauge needle. PATIENTS AND METHODS One hundred sixty-six consecutive patients who underwent EBUS-TBNA with a 21-gauge EBUS-TBNA needle over a period of 3 years were included in this retrospective analysis. The diagnostic yields of EBUS-TBNA histology (EBUS-TBNA-H) and EBUS-TBNA cytology (EBUS-TBNA-C) specimens were compared using the McNemar test. RESULTS The overall sensitivity and specificity of EBUS-TBNA were 89% and 100%, respectively. The positive predictive value (PPV) and negative predictive value (NPV) of EBUS-TBNA were 100% and 53%, respectively. The overall sensitivity and specificity of EBUS-TBNA-H were 85% and 100%, respectively. The PPV and NPV of EBUS-TBNA-H were 100% and 43%, respectively. The overall sensitivity and specificity of EBUS-TBNA-C were 65% and 100%, respectively. The PPV and NPV of EBUS-TBNA-C were 100% and 14%, respectively. The diagnostic yield of EBUS-TBNA-H over EBUS-TBNA-C was statistically significant (P < 0.0001). CONCLUSION EBUS-TBNA-H with 21-gauge needle significantly improves the diagnostic yield of EBUS-TBNA. EBUS-TBNA-H improves the NPV of EBUS-TBNA. The combination of EBUS-TBNA-H and EBUS-TBNA-C improves the overall diagnostic yield of EBUS-TBNA.
Collapse
Affiliation(s)
- Preyas J Vaidya
- Institute of Pulmonology, Medical Research and Development, Mumbai; Lung Care and Sleep Centre, Fortis Hiranandani Hospital, Navi Mumbai, Maharashtra, India
| | - Avinandan Saha
- Institute of Pulmonology, Medical Research and Development, Mumbai, Maharashtra, India
| | - Arvind H Kate
- Institute of Pulmonology, Medical Research and Development, Mumbai; Lung Care and Sleep Centre, Fortis Hiranandani Hospital, Navi Mumbai, Maharashtra, India
| | - Kamlesh Pandey
- Institute of Pulmonology, Medical Research and Development, Mumbai; Lung Care and Sleep Centre, Fortis Hiranandani Hospital, Navi Mumbai, Maharashtra, India
| | - Vinod B Chavhan
- Institute of Pulmonology, Medical Research and Development, Mumbai; Lung Care and Sleep Centre, Fortis Hiranandani Hospital, Navi Mumbai, Maharashtra, India
| | - Joerg D Leuppi
- Institute of Pulmonology, Medical Research and Development, Mumbai, Maharashtra, India
| | - Prashant N Chhajed
- Institute of Pulmonology, Medical Research and Development, Mumbai; Lung Care and Sleep Centre, Fortis Hiranandani Hospital, Navi Mumbai, Maharashtra, India
| |
Collapse
|
26
|
Chhajed PN, Gehrer S, Pandey KV, Vaidya PJ, Leuppi JD, Tamm M, Strobel W. Utility of Transcutaneous Capnography for Optimization of Non-Invasive Ventilation Pressures. J Clin Diagn Res 2016; 10:OC06-OC09. [PMID: 27790484 DOI: 10.7860/jcdr/2016/19911.8514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 05/31/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Nocturnal Non-invasive Positive Pressure Ventilation (NPPV) is the treatment of choice in patients with chronic hypercapnic respiratory failure due to hypoventilation. Continuous oxygen saturation measured with a pulse oximeter provides a surrogate measure of arterial oxygen saturation but does not completely reflect ventilation. Currently, Partial Pressure of Arterial (PaCO2) measured by arterial blood analysis is used for estimating the adequacy of ventilatory support and serves as the gold standard. AIM To examine the safety, feasibility and utility of cutaneous capnography to re-titrate the non-invasive positive pressure ventilation settings in patients with chronic hypercapnic respiratory failure due to hypoventilation. MATERIALS AND METHODS Twelve patients with chronic hypercapnic respiratory failure prospectively underwent complete polysomnography and cutaneous capnography measurement on the ear lobe. Non-invasive ventilation pressures were adjusted with the aim of normalizing cutaneous carbon dioxide or at least reducing it by 10 to 15 mmHg. Sensor drift for cutaneous carbon dioxide of 0.7 mmHg per hour was integrated in the analysis. RESULTS Mean baseline cutaneous carbon dioxide was 45.4 ± 6.5 mmHg and drift corrected awake value was 45.1 ± 8.3 mmHg. The correlation of baseline cutaneous carbon dioxide and the corrected awake cutaneous carbon dioxide with arterial blood gas values were 0.91 and 0.85 respectively. Inspiratory positive airway pressures were changed in nine patients (75%) and expiratory positive airway pressures in eight patients (66%). Epworth sleepiness score before and after the study showed no change in five patients, improvement in six patients and deterioration in one patient. CONCLUSION Cutaneous capnography is feasible and permits the optimization of non-invasive ventilation pressure settings in patients with chronic hypercapnic respiratory failure due to hypoventilation. Continuous cutaneous capnography might serve as an important additional tool to complement diurnal arterial carbon dioxide tension values.
Collapse
Affiliation(s)
- Prashant N Chhajed
- Privat Dozent, Department of Pulmonary Medicine, University Hospital Basel , Switzerland
| | - Simone Gehrer
- Assistant Arzt, Department of Pulmonary Medicine, University Hospital Basel , Switzerland
| | - Kamlesh V Pandey
- Consultant Chest Physician, Insitute of Pulmonology, Medical Research and Development , India
| | - Preyas J Vaidya
- Consultant Chest Physician, Insitute of Pulmonology, Medical Research and Development , India
| | - Joerg D Leuppi
- Professor, Department of Pulmonary Medicine, University Hospital Basel , Switzerland
| | - Michael Tamm
- Professor and Head, Department of Pulmonary Medicine, University Hospital Basel , Switzerland
| | - Werner Strobel
- Oberarzt, Department of Pulmonary Medicine, University Hospital Basel , Switzerland
| |
Collapse
|
27
|
Vaidya PJ, Kate AH, Mehta D, Dhabar BN, Chhajed PN. ALK positivity on pleuroscopic pleural biopsy in lung adenocarcinoma. J Cancer Res Ther 2016; 12:1090-2. [PMID: 27461706 DOI: 10.4103/0973-1482.154053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Lung cancer is the leading cause of cancer deaths worldwide, and around 75% to 80% of lung cancers are detected in advanced stage. Multiple genetic mutations are identified and reported in adenocarcinoma of the lung. Various pulmonary samples can be tested for molecular mutations in lung cancer. However, feasibility of molecular profiling of pleuroscopic pleural biopsies in lung adenocarcinoma is not reported. We describe a case of advanced adenocarcinoma of lung with positive anaplastic lymphoma tyrosine kinase mutation on pleuroscopic pleural biopsy and improved with oral crizotinib. The current case highlights the feasibility of pleuroscopy.-guided pleural biopsies in molecular profiling of lung adenocarcinoma.
Collapse
Affiliation(s)
- Preyas J Vaidya
- Institute of Pulmonology, Medical Research and Development; Lung Care Team, Fortis Hospitals, Mumbai, Maharashtra, India
| | - Arvind H Kate
- Institute of Pulmonology, Medical Research and Development; Lung Care Team, Fortis Hospitals, Mumbai, Maharashtra, India
| | - Deval Mehta
- Institute of Pulmonology, Medical Research and Development; Lung Care Team, Fortis Hospitals, Mumbai, Maharashtra, India
| | - Boman N Dhabar
- Department of Oncology, Fortis Hospital, Mulund, Mumbai, Maharashtra, India
| | - Prashant N Chhajed
- Institute of Pulmonology, Medical Research and Development; Lung Care Team, Fortis Hospitals, Mumbai, Maharashtra, India
| |
Collapse
|
28
|
Vaidya PJ, Heroor A, Prasad S, Bhargava R, Arulvannan N, Mehta J, Dhabhar BN, Chhajed PN. Multimodality management of primary diaphragmatic synovial sarcoma: First report. J Cancer Res Ther 2016; 12:1098-101. [PMID: 27461708 DOI: 10.4103/0973-1482.179525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Synovial cell sarcoma is an extremely rare tumor of mesenchymal origin. It commonly affects the soft tissues of the extremities but could possibly origin from the head and neck, heart, lung, pleura, mediastinum, esophagus, abdominal wall and the mesentery, and retroperitoneum. Primary synovial sarcoma of pleura, mediastinum, and lung have been reported. Primary synovial sarcoma of the diaphragm has not been reported to the best of our knowledge. We report a case of primary synovial cell sarcoma of the diaphragm presenting as a recurrent pleural effusion and pain in the left hypochondrium managed with multimodality approach.
Collapse
Affiliation(s)
- Preyas J Vaidya
- Institute of Pulmonology, Medical Research and Development; Lung Care and Sleep Centre, Fortis Hospitals, Mumbai, Maharashtra, India
| | - Anil Heroor
- Department of Oncosurgery, Fortis Hospital Mulund, Mumbai, Maharashtra, India
| | - Sitaram Prasad
- Department of Plastic Surgery, Fortis Hospital Mulund, Mumbai, Maharashtra, India
| | - Rajat Bhargava
- Department of Radiology, Fortis Hospital Mulund, Mumbai, Maharashtra, India
| | - Nanadan Arulvannan
- Department of General Surgery and Laparoscopy, Fortis Hospital Mulund, Mumbai, Maharashtra, India
| | - Jay Mehta
- Department of Pathology, SRL Diagnostics, Mumbai, Maharashtra, India
| | - Boman N Dhabhar
- Department of Oncology, Fortis Hospital Mulund, Mumbai, Maharashtra, India
| | - Prashant N Chhajed
- Institute of Pulmonology, Medical Research and Development; Lung Care and Sleep Centre, Fortis Hospitals, Mumbai, Maharashtra, India
| |
Collapse
|
29
|
Vaidya P, Kate A, Mehta D, Chavan V, Chhajed PN. Blunt head and neck trauma: Interesting chest tomographic "effect". Lung India 2016; 33:237-9. [PMID: 27051122 PMCID: PMC4797453 DOI: 10.4103/0970-2113.177461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Preyas Vaidya
- Lung Care and Sleep Centre, Fortis Hiranandani Hospital, Navi Mumbai, Maharashtra, India; Institute of Pulmonology Medical Research and Development [IPMRD], Mumbai, Maharashtra, India
| | - Arvind Kate
- Lung Care and Sleep Centre, Fortis Hiranandani Hospital, Navi Mumbai, Maharashtra, India; Institute of Pulmonology Medical Research and Development [IPMRD], Mumbai, Maharashtra, India
| | - Deval Mehta
- Lung Care and Sleep Centre, Fortis Hiranandani Hospital, Navi Mumbai, Maharashtra, India; Institute of Pulmonology Medical Research and Development [IPMRD], Mumbai, Maharashtra, India
| | - Vikram Chavan
- Department of Radiology, SRL Diagnostics, Fortis Hiranandani Hospital, Navi Mumbai, Maharashtra, India
| | - Prashant N Chhajed
- Lung Care and Sleep Centre, Fortis Hiranandani Hospital, Navi Mumbai, Maharashtra, India; Institute of Pulmonology Medical Research and Development [IPMRD], Mumbai, Maharashtra, India
| |
Collapse
|
30
|
Abstract
Parasite infections are increasing worldwide due to increasing migration and traveling. Parasitic infections can affect lungs and present as a focal or diffuse lung diseases. High index of suspicion and detailed history are most important. We present a case of interstitial pneumonitis caused by parasite infestation, which was diagnosed on transbronchial lung biopsy.
Collapse
Affiliation(s)
- Parth Shah
- Institute of Pulmonology, Medical Research and Development, Mumbai, Maharashtra, India; Department of Lung Care and Sleep Centre, Fortis Hiranandani Hospital, Vashi, Maharashtra, India
| | - Arvind H Kate
- Institute of Pulmonology, Medical Research and Development, Mumbai, Maharashtra, India; Department of Lung Care and Sleep Centre, Fortis Hiranandani Hospital, Vashi, Maharashtra, India
| | - Nora Nester
- Institute of Pulmonology, Medical Research and Development, Mumbai, Maharashtra, India; Department of Lung Care and Sleep Centre, Fortis Hiranandani Hospital, Vashi, Maharashtra, India
| | - Kamlakar Patole
- Department of Pathology, SRL Diagnostics Institute, Mumbai, Maharashtra, India
| | - Joerg D Leuppi
- Institute of Pulmonology, Medical Research and Development, Mumbai, Maharashtra, India
| | - Prashant N Chhajed
- Institute of Pulmonology, Medical Research and Development, Mumbai, Maharashtra, India; Department of Lung Care and Sleep Centre, Fortis Hiranandani Hospital, Vashi, Maharashtra, India
| |
Collapse
|
31
|
Godse K, Rajagopalan M, Girdhar M, Kandhari S, Shah B, Chhajed PN, Tahiliani S, Shankar DSK, Somani V, Zawar V. Position statement for the use of omalizumab in the management of chronic spontaneous urticaria in Indian patients. Indian Dermatol Online J 2016; 7:6-11. [PMID: 26955580 PMCID: PMC4763587 DOI: 10.4103/2229-5178.174314] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Chronic spontaneous urticaria (CSU) affects 1% of the world population and also their quality of life, and 50% of these patients are refractory to H1-antihistamines. Omalizumab is a humanized monoclonal anti-IgE antibody that binds with free IgE antibodies and reduces the circulating levels of free IgE. This reduction in free IgE prevents mast-cell degranulation. The EAACI/GA2LEN/EDF/WAO guidelines recommend omalizumab as the third-line of therapy as an add-on to antihistamines. The recommended dose of omalizumab is 300 mg, 4 weekly in the management of CSU refractory to standard of care with H1-antihistamines in adults and adolescents ≥12 years of age. In some patients, a dose of 150 mg may be acceptable. Omalizumab has a good safety profile. However, due to the biologic nature of the drug, all patients administered omalizumab must be observed for 2 h after administration for anaphylactoid reactions. There have been no studies on the effect of impaired renal or hepatic function on the pharmacokinetics of omalizumab. While no particular dose adjustment is recommended, omalizumab should be administered with caution in these patients.
Collapse
Affiliation(s)
- Kiran Godse
- Department of Dermatology, Dr. D. Y. Patil Medical College and Hospital, Mumbai, Maharashtra, India
| | | | - Mukesh Girdhar
- Department of Dermatology, Max Super Speciality Hospital, New Delhi, India
| | | | - Bela Shah
- Department of Dermatology, B. J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Prashant N. Chhajed
- Department of Research, Institute of Pulmonology, Medical Research and Development, Mumbai, Maharashtra, India
| | | | - D. S. Krupa Shankar
- Dr. Krupa Shankar Skin Diagnosis Center, Mallige Medical Centre Pvt. Ltd., Bengaluru, Karnataka, India
| | - Vijay Somani
- Somani Skin Care Centre, Hyderabad, Telangana, India
| | - Vijay Zawar
- Skin Diseases Center, Nashik, Maharashtra, India
| |
Collapse
|
32
|
Affiliation(s)
- Preyas J Vaidya
- Institute of Pulmonology, Medical Research and Development, Mumbai, Maharashtra, India ; Lung Care and Sleep Centre, Fortis Hospitals, Mumbai, Maharashtra, India
| | - Joerg D Leuppi
- Institute of Pulmonology, Medical Research and Development, Mumbai, Maharashtra, India ; Department of Medicine, Kantonsspital Liestal, University of Basel, Basel, Switzerland. E-mail:
| | - Prashant N Chhajed
- Institute of Pulmonology, Medical Research and Development, Mumbai, Maharashtra, India ; Lung Care and Sleep Centre, Fortis Hospitals, Mumbai, Maharashtra, India
| |
Collapse
|
33
|
Vaidya PJ, Kate AH, Yasufuku K, Chhajed PN. Endobronchial ultrasound-guided transbronchial needle aspiration in lung cancer diagnosis and staging. Expert Rev Respir Med 2014; 9:45-53. [PMID: 25496515 DOI: 10.1586/17476348.2015.992784] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Lung cancer is one of the most prevalent types of cancer in the world. A complete diagnosis of lung cancer involves tissue acquisition for pathological subtype, molecular diagnosis and accurate staging of the disease to guide appropriate therapy. Real-time endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is minimally invasive and relatively safe procedure, which can be done on an outpatient basis under moderate sedation. EBUS-TBNA has been shown to be a safe modality to obtain tissue for diagnosis, staging and molecular profiling in lung cancer. EBUS-TBNA stands out in comparison with other modalities for tissue acquisition in lung cancer. EBUS-TBNA performed with the patient under moderate sedation yields sufficient tissue for sequential molecular analysis in most patients. In this review, we describe the role of EBUS-TBNA in various aspects of diagnosis and staging of lung cancer in the present era along with its future aspects.
Collapse
Affiliation(s)
- Preyas J Vaidya
- Institute of Pulmonology, Medical Research and Development, Mumbai, India
| | | | | | | |
Collapse
|
34
|
Kate AH, Sandeepa HS, Khare S, Lokeshwar N, Shetty S, Tulasigeri C, Chhajed PN. Laryngeal Lymphoma: Before and After Chemotherapy. J Assoc Physicians India 2014; 62:45-46. [PMID: 26281481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
|
35
|
Abu Hussein N, Ter Riet G, Schoenenberger L, Bridevaux PO, Chhajed PN, Fitting JW, Geiser T, Jochmann A, Joos Zellweger L, Kohler M, Maier S, Miedinger D, Schafroth Török S, Scherr A, Siebeling L, Thurnheer R, Tamm M, Puhan MA, Leuppi JD. The ADO index as a predictor of two-year mortality in general practice-based chronic obstructive pulmonary disease cohorts. Respiration 2014; 88:208-14. [PMID: 25115178 DOI: 10.1159/000363770] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 05/19/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Existing prediction models for mortality in chronic obstructive pulmonary disease (COPD) patients have not yet been validated in primary care, which is where the majority of patients receive care. OBJECTIVES Our aim was to validate the ADO (age, dyspnoea, airflow obstruction) index as a predictor of 2-year mortality in 2 general practice-based COPD cohorts. METHODS Six hundred and forty-six patients with COPD with GOLD (Global Initiative for Chronic Obstructive Lung Disease) stages I-IV were enrolled by their general practitioners and followed for 2 years. The ADO regression equation was used to predict a 2-year risk of all-cause mortality in each patient and this risk was compared with the observed 2-year mortality. Discrimination and calibration were assessed as well as the strength of association between the 15-point ADO score and the observed 2-year all-cause mortality. RESULTS Fifty-two (8.1%) patients died during the 2-year follow-up period. Discrimination with the ADO index was excellent with an area under the curve of 0.78 [95% confidence interval (CI) 0.71-0.84]. Overall, the predicted and observed risks matched well and visual inspection revealed no important differences between them across 10 risk classes (p = 0.68). The odds ratio for death per point increase according to the ADO index was 1.50 (95% CI 1.31-1.71). CONCLUSIONS The ADO index showed excellent prediction properties in an out-of-population validation carried out in COPD patients from primary care settings.
Collapse
Affiliation(s)
- Nebal Abu Hussein
- University Clinic of Internal Medicine, Kantonsspital Baselland, Basel, Switzerland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Schafroth Török S, Mueller T, Miedinger D, Jochmann A, Zellweger LJ, Sauter S, Goll A, Chhajed PN, Taegtmeyer AB, Knöpfli B, Leuppi JD. An open-label study examining the effect of pharmacological treatment on mannitol- and exercise-induced airway hyperresponsiveness in asthmatic children and adolescents with exercise-induced bronchoconstriction. BMC Pediatr 2014; 14:196. [PMID: 25084607 PMCID: PMC4136947 DOI: 10.1186/1471-2431-14-196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 07/09/2014] [Indexed: 11/10/2022] Open
Abstract
Background Mannitol- and exercise bronchial provocation tests are both used to diagnose exercise-induced bronchoconstriction. The study aim was to compare the short-term treatment response to budesonide and montelukast on airway hyperresponsiveness to mannitol challenge test and to exercise challenge test in children and adolescents with exercise-induced bronchoconstriction. Methods Patients were recruited from a paediatric asthma rehabilitation clinic located in the Swiss Alps. Individuals with exercise-induced bronchoconstriction and a positive result in the exercise challenge test underwent mannitol challenge test on day 0. All subjects then received a treatment with 400 μg budesonide and bronchodilators as needed for 7 days, after which exercise- and mannitol-challenge tests were repeated (day 7). Montelukast was then added to the previous treatment and both tests were repeated again after 7 days (day 14). Results Of 26 children and adolescents with exercise-induced bronchoconstriction, 14 had a positive exercise challenge test at baseline and were included in the intervention study. Seven of 14 (50%) also had a positive mannitol challenge test. There was a strong correlation between airway responsiveness to exercise and to mannitol at baseline (r = 0.560, p = 0.037). Treatment with budesonide and montelukast decreased airway hyperresponsiveness to exercise challenge test and to a lesser degree to mannitol challenge test. The fall in forced expiratory volume in one second during exercise challenge test was 21.7% on day 0 compared to 6.7% on day 14 (p = 0.001) and the mannitol challenge test dose response ratio was 0.036%/mg on day 0 compared to 0.013%/mg on day 14 (p = 0.067). Conclusion Short-term treatment with an inhaled corticosteroid and an additional leukotriene receptor antagonist in children and adolescents with exercise-induced bronchoconstriction decreases airway hyperresponsiveness to exercise and to mannitol.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Jörg D Leuppi
- Internal Medicine, Kantonal Hospital Baselland and University of Basel, Basel, Switzerland.
| |
Collapse
|
37
|
Subramanian S, Sandeepa HS, Chaudhari P, Kate AH, Kumar S, Shah P, Chhajed PN. Mediastinal lymphadenopathy in malignancy: metastatic or granulomatous? J Assoc Physicians India 2014; 62:630-632. [PMID: 25672043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Mediastinal lymphadenopathy in patients with malignancy may not be always metastatic disease. We present three patients with proven thoracic or extra thoracic malignancies with mediastinal lymphadenopathy which were subsequently proven as granulomatous lymphadenitis by endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA). The objective of the current report is to emphasise that granulomatous lymphadenitis should be considered as an important differential diagnosis in such patients especially in tuberculosis endemic countries like India.
Collapse
Affiliation(s)
- Santhakumar Subramanian
- Lung Care and Sleep Centre, Fortis Hiranandani Hospital, Vashi, Navi M. Umbai and Institute of Pulmonology Medical Research and Development, Mumbai, India
| | | | | | | | | | | | | |
Collapse
|
38
|
Kate AH, Shah PS, Shukla NB, Chhajed PN, Shetty SN. Neoadjuvant bronchoscopic intervention: bridge to lung parenchyma sparing surgery. J Cancer Res Ther 2014; 9:760-1. [PMID: 24518744 DOI: 10.4103/0973-1482.126497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | | | | | - Prashant N Chhajed
- Department of Lung Care and Sleep Centre, Fortis Hiranandani Hospital,Vashi, Navi Mumbai, Maharashtra, India
| | | |
Collapse
|
39
|
Sandeepa HS, Kate AH, Chaudhari P, Chavan V, Patole K, Lokeshwar N, Chhajed PN. Primary pleural synovial sarcoma: A rare cause of hemorrhagic pleural effusion in a young adult. J Cancer Res Ther 2013; 9:517-9. [PMID: 24125997 DOI: 10.4103/0973-1482.119367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
This is a case report of a young adult presenting with hemorrhagic pleural effusion. Chest CT scan showed loculated pleural effusion with pleural nodule. Whole body PET scan showed thickening of pleura with multiple enhancing pleural nodules with different metabolic activity. Pleural nodule was biopsied which on histopathology showed pleural synovial sarcoma.
Collapse
|
40
|
Scherr A, Schafroth Török S, Jochmann A, Miedinger D, Maier S, Taegtmeyer AB, Chhajed PN, Tamm M, Leuppi JD. Response to add-on inhaled corticosteroids in COPD based on airway hyperresponsiveness to mannitol. Chest 2013; 142:919-926. [PMID: 22459771 DOI: 10.1378/chest.11-2535] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The use of inhaled corticosteroids in mild to moderate COPD is controversial. The aim of this study was to determine whether airway hyperresponsiveness to mannitol might identify patients who are likely to respond to add-on inhaled corticosteroids. METHODS Ninety subjects with mild to moderate COPD were recruited and 68 subsequently randomized in a double-blind manner to receive inhaled budesonide (1,600 μg/d, n = 31) or placebo (n = 37) for 3 months. Thirty-eight subjects had airway hyperresponsiveness to mannitol (17 received budesonide, 21 placebo). All subjects received tiotropium throughout the study, including 4 weeks before randomization. Spirometry, quality of life (St. George Respiratory Questionnaire), degree of dyspnea, airway responsiveness to mannitol, and exhaled nitric oxide were assessed at week 0 (recruitment), week 4 (baseline prior to randomization), and week 16 (posttreatment). RESULTS Compared with placebo, budesonide was associated with improved quality of life in subjects showing airway hyperresponsiveness to mannitol (difference of changes in quality of life score between randomization and study completion, −9.1; 95% CI, −15.8 to −2.3; P < .01). Treatment with inhaled budesonide also led to a reduction in airway responsiveness to mannitol compared with placebo (difference in log10 response-dose ratio, −0.3; 95% CI, −0.6 to −0.04; P < .01). However, postrandomization changes in FEV1 % predicted, quality of life, and exhaled nitric oxide showed no difference between budesonide and placebo. CONCLUSIONS In subjects with mild to moderate COPD and airway hyperresponsiveness to mannitol, quality of life and airway responsiveness improved after treatment with inhaled corticosteroids added to long-acting bronchodilator therapy.
Collapse
Affiliation(s)
- Andreas Scherr
- Clinic of Respiratory Medicine, University Hospital Basel, Basel, Switzerland; Clinic of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | | | - Anja Jochmann
- Clinic of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - David Miedinger
- Clinic of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Sabrina Maier
- Clinic of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Anne B Taegtmeyer
- Clinic of Clinical Pharmacology and Toxicology, University Hospital Basel, Basel, Switzerland
| | - Prashant N Chhajed
- Clinic of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Michael Tamm
- Clinic of Respiratory Medicine, University Hospital Basel, Basel, Switzerland
| | - Joerg D Leuppi
- Clinic of Internal Medicine, University Hospital Basel, Basel, Switzerland.
| |
Collapse
|
41
|
Kononowa N, Michel S, Miedinger D, Pichler CE, Chhajed PN, Helbling A, Leuppi JD. Effects of add-on montelukast on airway hyperresponsiveness in patients with well-controlled asthma - a pilot study. J Drug Assess 2013; 2:49-57. [PMID: 27536437 PMCID: PMC4937661 DOI: 10.3109/21556660.2013.791300] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2013] [Indexed: 11/13/2022] Open
Abstract
Objective Control of airway inflammation is the cornerstone of asthma management. The aim of the present pilot study was to assess the effects of a leukotriene receptor antagonist (LTRA) added to a basic treatment of inhaled corticosteroids (ICS) and long-acting beta-agonist (LABA) on airway hyperresponsiveness, inflammation, and quality of life in well-controlled patients with asthma. Research design and methods Seventeen patients (age 18–65, 11 women) with well-controlled asthma presenting airway hyperresponsiveness to mannitol and methacholine challenge were given add-on montelukast on a stable ICS + LABA for 4 weeks. Quality of life and selected parameters of airway inflammation were measured at baseline and at study end. (ClinicalTrials.gov (NCT01725360)). Results Adding montelukast to ICS + LABA resulted in an increase in mean FEV1 (+4.5%, p = 0.057), cumulated higher dose of mannitol (+32.5%, p = 0.023) and methacholine (+17.2%, 0.237) in the provocation test, lower airway reactivity with mannitol and methacholine (response dose ratio (RDR) –50.0%, p = 0.024 and –44.3%, p = 0.006, respectively), and improved airway sensitivity to mannitol and methacholine (+12.1%, p = 0.590 and +48.0%, p = 0.129 for PD15 and PD20 FEV1, respectively). Changes in inflammation parameters (blood eosinophil count, serum eosinophil cationic protein, and exhaled nitric oxide) were consistent with these findings. Asthma-related quality of life improved significantly in all domains and overall (from 5.3 at baseline to 6.1 at the final visit, p < 0.001). The main limitation was the absence of a control group. Conclusion The consistency of the changes in airway hyperresponsiveness and inflammation as well as in quality of life observed with an add-on therapy with montelukast in well-controlled asthma patients during 4 weeks suggests that residual inflammation may represent an area for further improvement of asthma control to be explored in adequately powered randomized controlled trials.
Collapse
Affiliation(s)
- Nina Kononowa
- Clinic of Internal Medicine, University Hospital BaselSwitzerland
| | - Sandra Michel
- Clinic of Allergology, University Hospital Basel, Switzerland; University Clinic of Rheumatology, Clinical Immunology and Allergology, University Hospital BernSwitzerland
| | - David Miedinger
- Medical Faculty, University of Basel and Clinic of Internal Medicine, Canton Hospital Baselland, LiestalSwitzerland
| | - Christiane E Pichler
- University Clinic of Rheumatology, Clinical Immunology and Allergology, University Hospital BernSwitzerland
| | - Prashant N Chhajed
- Medical Faculty, University of Basel and Clinic of Internal Medicine, Canton Hospital Baselland, LiestalSwitzerland
| | - Arthur Helbling
- University Clinic of Rheumatology, Clinical Immunology and Allergology, University Hospital BernSwitzerland
| | - Jörg D Leuppi
- Medical Faculty, University of Basel and Clinic of Internal Medicine, Canton Hospital Baselland, LiestalSwitzerland
| |
Collapse
|
42
|
Mehta AJ, Kate AH, Gupta N, Chhajed PN. Interrupted inferior vena cava syndrome. J Assoc Physicians India 2012; 60:48-50. [PMID: 23405525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We report a case of interrupted inferior vena cava (IVC) as a rare developmental defect. Inferior vena cava interruption is usually accompanied with azygos and hemiazygos continuation, and is asymptomatic. Consequently, venous blood from the caudal part of the body reaches the heart via the azygous vein and superior vena cava. A 50 year old female who came for routine health check-up was found to have pulmonary hypertension on two dimensional echocardiography. On further investigations she also had restriction on pulmonary function test. When computed tomography pulmonary angiography was done, showed dilated azygous vein without pulmonary embolism. Computed tomography of the abdomen demonstrated interrupted inferior vena cava. Such patients are at increased risk of deep vein thrombosis and pulmonary embolism.
Collapse
Affiliation(s)
- Ankur J Mehta
- Institute of Pulmonology, Medical Research and Development, Mumbai
| | | | | | | |
Collapse
|
43
|
Jochmann A, Scherr A, Jochmann DC, Miedinger D, Török SS, Chhajed PN, Tamm M, Leuppi JD. Impact of adherence to the GOLD guidelines on symptom prevalence, lung function decline and exacerbation rate in the Swiss COPD cohort. Swiss Med Wkly 2012; 142:w13567. [PMID: 22481636 DOI: 10.4414/smw.2012.13567] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
PRINCIPLES The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines aim to optimise chronic obstructive pulmonary disease (COPD) diagnosis and treatment. However, little is known about the extent to which general practitioners' (GP) adherence to GOLD guidelines improves patient outcomes. METHODS In this questionnaire-based study, COPD patients were screened and enrolled; exacerbation history was recorded, and demographic, spirometric and management data were collected for 12 months. Spirometry was performed at least every 6 months according to American Thoracic Society guidelines. Based on these data, patients were grouped into GOLD COPD severity classifications. Data were expressed as the difference between baseline and month 12. RESULTS Among 139 GPs, 454 patients were analysed regarding baseline and 12 month data. There was no significant change in distribution of GOLD COPD severity grades, lung function or guideline adherence. Chronic cough and sputum production were significantly reduced (p <0.001; p <0.020), as was exacerbation rate (p = 0.041). Factors associated with exacerbations were male sex, asthma and cerebrovascular insult as a co-morbidity. Exacerbation rate was significantly reduced in patients treated with combination therapy (long-acting β2-agonist (LABA)+ inhaled corticosteroids (ICS); p = 0.0178) and long-acting anticholinergics (LAAC; p = 0.0011). Patients treated per guidelines had no advantage in lung function, estimation of symptom prevalence or, most importantly, exacerbation rate. CONCLUSIONS While there was no improvement in adherence to GOLD guidelines, disease severity was not affected detrimentally, suggesting that guideline adherence does not seem to impact symptom prevalence, exacerbation rate or lung function decline after one year of follow up.
Collapse
Affiliation(s)
- Anja Jochmann
- Clinic of Internal Medicine, University Hospital of Basel, Switzerland
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Chhajed PN, Chaudhari P, Tulasigeri C, Kate A, Kesarwani R, Miedinger D, Leuppi J, Baty F. Infraclavicular sensor site: a new promising site for transcutaneous capnography. Scand J Clin Lab Invest 2012; 72:340-2. [PMID: 22443124 DOI: 10.3109/00365513.2012.671490] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Transcutaneous measurement of carbon dioxide is routinely done at the earlobe site. In patients receiving non invasive ventilation or in the intensive care setting with necklines, an alternate measurement site would be useful. We started to use the infraclavicular site for transcutaneous measurements of carbon dioxide using a new digital sensor. AIM Comparison of transcutaneous carbon dioxide with arterial carbon dioxide at the infraclavicular site. METHODS We retrospectively compared transcutaneous carbon dioxide at the infraclavicular site with arterial carbon dioxide in 50 samples. The Sentec Digital Monitoring System (Sentec AG, Therwil, Switzerland) was used. The V-Sign digital sensor was placed on the infraclavicular site at the medial two third and one third point from the sternoclavicular joint and acromioclavicular joint. RESULTS When comparing P(c)CO(2) with P(a)CO(2) values, the Bland-Altman analysis revealed a bias of 0.02 kPa (95% CI: [- 0.1; 0.14]) with a precision of 0.42 kPa. Linear regression analysis describes the relationship between the two methods. The slope of the linear model was 0.85 ± 0.04 and the intercept was 0.77 ± 0.21 (RSE = 0.37, R(2) = 0.91). CONCLUSION The measurement of transcutaneous carbon dioxide at the infraclavicular site is feasible with a digital sensor and has a good correlation with the carbon dioxide values obtained from the arterial blood gas. The findings of the current study form the basis for further clinical studies for its regular application in clinical use.
Collapse
Affiliation(s)
- Prashant N Chhajed
- Department of Pulmonology, Fortis Hiranandani Hospital, Vashi, Navi Mumbai, India.
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Miedinger D, Jochmann A, Schoenenberger L, Chhajed PN, Leuppi JD. Resting and post bronchial challenge testing carbon dioxide partial pressure in individuals with and without asthma. PLoS One 2012; 7:e32464. [PMID: 22412876 PMCID: PMC3296724 DOI: 10.1371/journal.pone.0032464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 01/31/2012] [Indexed: 11/18/2022] Open
Abstract
Objective There is conflicting evidence about resting carbon dioxide levels in asthmatic individuals. We wanted to determine if transcutaneously measured carbon dioxide levels prior and during bronchial provocation testing differ according to asthma status reflecting dysfunctional breathing. Methods We investigated active firefighters and policemen by means of a validated questionnaire on respiratory symptoms, spirometry, bronchial challenge testing with methacholine (MCT) and measurement of transcutaneous blood carbon dioxide partial pressure (PtcCO2) at rest prior performing spirometry, one minute and five minutes after termination of MCT. A respiratory physician blinded to the PtcCO2 results assigned a diagnosis of asthma after reviewing the available study data and the files of the workers medical screening program. Results The study sample consisted of 128 male and 10 female individuals. Fifteen individuals (11%) had physician-diagnosed asthma. There was no clinically important difference in median PtcCO2 at rest, one and five minutes after recovery from MCT in asthmatics compared to non-asthmatics (35.6 vs 35.7 mmHg, p = 0.466; 34.7 vs 33.4 mmHg, p = 0.245 and 37.4 vs 36.4 mmHg, p = 0.732). The median drop in PtcCO2 during MCT and the increase after MCT was lower in asthmatics compared to non-asthmatics (0.1 vs 3.2 mmHg, p = 0.014 and 1.9 vs 2.9 mmHg, p = 0.025). Conclusions PtcCO2 levels at rest prior and during recovery after MCT do not differ in individuals with or without physician diagnosed asthma. The fall and subsequent increase in PtcCO2 levels are higher in non-asthmatics than in asthmatics and seems to be related with increased number of respiratory maneuvers during MCT.
Collapse
|
46
|
Miedinger D, Neukomm E, Chhajed PN, Schnyder A, Naef M, Ackermann M, Leuppi JD. The use of the Asthma Control Test in general practice and its correlation with asthma control according to the GINA guidelines. Curr Med Res Opin 2011; 27:2301-8. [PMID: 21988667 DOI: 10.1185/03007995.2011.630722] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The GINA guidelines have redefined the primary goal of asthma treatment as achieving optimum control. OBJECTIVES To document the level of asthma control in Switzerland, the correlations between the international guidelines by GINA and the ACT's rating of asthma control, current treatment in adolescent and adult Swiss asthma patients and factors associated with asthma control. METHODS General practitioners and specialists (pulmonologists, allergologists and paediatricians) were invited to participate in the cross-sectional survey. Asthma control was assessed in 1093 asthma patients using both the ACT and the GINA classification for asthma control. RESULTS According to the GINA guidelines controlled asthma was found in 290 (27%) patients, when measured with the ACT 124 (11.5%) patients showed sufficient asthma control. Of the test results 65% were in accordance with each other, whereas in 85% of the non-matching results the ACT underestimated control according to GINA classification. An ACT cut-off score of ≤17 best identified uncontrolled asthma according to GINA guidelines. A total of 956 (87.7%) patients received controller medication and 849 (77.9%) patients received reliever medication. The following parameters were consistently identified to be significantly associated with insufficient asthma control in both GINA and ACT measurements: presence of exacerbation, use of reliever medication, switch of therapy and smoking. STUDY LIMITATION For this study only the ACT version for adults was used. CONCLUSION Asthma control remains insufficient in the majority of patients, despite prescription of regular controller medication. This survey confirms the validated ACT to be useful and important in everyday practice as an objective measure for asthma control according to GINA guidelines in order to monitor control and adjust treatment.
Collapse
Affiliation(s)
- David Miedinger
- University Hospital Basel, Internal Medicine, Basel, Switzerland.
| | | | | | | | | | | | | |
Collapse
|
47
|
Chhajed PN, Kate A, Chaudhari P, Tulasigiri C, Shetty S, Kesarwani R, Jhawar N. Massive hemoptysis during pregnancy. J Assoc Physicians India 2011; 59:660-662. [PMID: 22479749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We report a case of pulmonary carcinoid presenting as massive hemoptysis in a pregnant patient. In our patient, diagnosis of carcinoid tumor was suspected after ruling out other probable and possible causes of hemoptysis. It was confirmed provisionally on flexible fiber optic bronchoscopy and later confirmed on histopathology. Our patient had two consecutive emergency surgeries, emergency cesarean section on one day followed by emergency pneumonectomy on next day. The lives of both, the mother and baby could be saved. At three month follow up, the mother did not have any symptoms.
Collapse
|
48
|
Strobel W, Schlageter M, Andersson M, Miedinger D, Chhajed PN, Tamm M, Leuppi JD. Topical nasal steroid treatment does not improve CPAP compliance in unselected patients with OSAS. Respir Med 2011; 105:310-5. [DOI: 10.1016/j.rmed.2010.10.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2010] [Revised: 09/28/2010] [Accepted: 10/04/2010] [Indexed: 11/28/2022]
|
49
|
Tamm M, Chhajed PN, Stolz D. Bronchoscopic lung volume reduction--current opinion. Swiss Med Wkly 2010; 140:w13140. [PMID: 21170762 DOI: 10.4414/smw.2010.13140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Bronchoscopic lung volume reduction is a new technology designed to reduce hyperinflation in severe COPD by implantation of endobronchial devices, such as biodegradable material, endobronchial valves or bronchopulmonary stents, via flexible bronchoscopy. This article discusses newest developments and results in bronchoscopic lung volume reduction.
Collapse
Affiliation(s)
- Michael Tamm
- Clinic of Pneumology and Respiratory Cell Research, University Hospital Basel, Switzerland.
| | | | | |
Collapse
|
50
|
Azzola A, von Garnier C, Chhajed PN, Schirp U, Tamm M. Fatal cerebral air embolism following uneventful flexible bronchoscopy. Respiration 2010; 80:569-72. [PMID: 21079412 DOI: 10.1159/000321849] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2009] [Accepted: 08/04/2010] [Indexed: 12/19/2022] Open
Abstract
Flexible bronchoscopy is a widely used and safe procedure with a reported maximal mortality rate of 0.04% and a major-complications rate of 0.5%. There are, however, only few case descriptions for postinterventional cerebral air embolism and the frequency of this supposedly rare complication is unknown. The current study presents 2 patients with non-small cell lung cancer who suffered fatal cerebral air embolism following diagnostic bronchoscopy with transbronchial needle aspiration and transbronchial biopsy, resulting in a frequency of <0.02% for this severe complication in our institution. In addition to early supportive measures, 1 patient received hyperbaric oxygen therapy as further treatment. Prompt recognition of this complication is mandatory in order to implement appropriate supportive measures. High-flow oxygen should be administered and hyperbaric oxygen therapy may be considered, if available. If possible, positive pressure ventilation should be avoided.
Collapse
Affiliation(s)
- Andrea Azzola
- Clinic of Pulmonary Medicine, University Hospital Basel, Basel, Switzerland
| | | | | | | | | |
Collapse
|