NAPCON 2025 – Best Original Research Abstracts

Airway and Allergy Disorders: Severe asthma and phenotypic profiles: A prevalence study from a tertiary care centre

Zuhaib Younus , Fahim Manzoor

GMC, Srinagar, Jammu and Kashmir, India E-mail: zuhaibringshawl@gmail.com

Introduction: Asthma is a heterogeneous chronic respiratory disease with diverse phenotypes and varying degrees of severity. Understanding the prevalence of severe asthma and its phenotypic distribution is essential for targeted management strategies.

Methods: A hospital-based observational study was conducted in the Department of Respiratory Medicine, Government Chest Disease Hospital, Srinagar, from July 2023 to December 2024. The study included previously diagnosed cases of bronchial asthma confirmed by clinical history, spirometry with bronchodilator reversibility (BDR), or, in cases with normal spirometry or inability to perform it, elevated fractional exhaled nitric oxide (FeNO >25 ppb) or increased small airway resistance on lung oscillometry. Data collected included demographic characteristics, BMI, symptom profile, comorbidities, inhaler technique, treatment adherence, asthma control (ACQ-5), and inflammatory phenotype classification.

Results: A total of 639 patients were included, predominantly female (69.9%), with a mean age of 37.4 ± 14.6 years. Severe asthma was identified in 31 patients (4.8%). The most prevalent phenotype was eosinophilic asthma (47.6%), followed by paucigranulocytic (43.5%), neutrophilic (6.2%), and mixed granulocytic asthma (2.7%). Among severe asthma cases, eosinophilic phenotype was most common (67.7%). A significant proportion of patients demonstrated incorrect inhaler technique (58.2%) and suboptimal treatment adherence (62%).

Conclusion: Severe asthma accounted for 4.8% of the study population, with eosinophilic asthma being the predominant phenotype both overall (47.6%) and among severe cases (67.7%). The cohort showed a female predominance (69.9%) and a relatively young mean age (37 years). Frequent comorbidities such as allergic rhinitis and chronic rhinosinusitis, along with incorrect inhaler technique (58.2%) and sub optimal treatment adherence (62%), were important contributors to poor asthma control. These findings highlight the need for early identification of phenotypes, recognition of comorbidities, and correction of modifiable factors to achieve better disease outcomes and improve quality of life.

Keywords: Asthma phenotypes, eosinophilic asthma, inhaler technique, severe asthma, tertiary care, treatment adherence

*This article was selected for NAPCON 2025 best research award presentation.

Ultrasonographic evaluation of the diaphragm as a predictor of inhalation device suitability in COPD

Maruthi , Haritha

Andhra Medical College, Visakhapatnam, Andhra Pradesh, India E-mail: maruthi.challa001@gmail.com

Introduction: Dry powder inhalers (DPIs) require adequate inspiratory effort to achieve effective drug deposition. Peak inspiratory flow (PIF) assessment is essential but not always available in outpatient settings. Diaphragmatic ultrasound (DU) offers a simple bedside measure of diaphragmatic excursion (DE), potentially predicting inhalation device suitability. Objectives: To establish the correlation between diaphragmatic excursion and PIF in COPD patients and to determine practical cutoff values for DPI prescription.

Methods: A cross-sectional study was conducted in GOLD-defined COPD patients attending a tertiary clinic. PIF was measured using the spirometry in the seated position, followed by DU in the supine 45° position using ultra sound curvilinear probe (1-8 hz). Statistical analysis employed Pearson correlation and linear regression.

Results: Forty five stable COPD patients (mean age 55 years, 59% males, mean BMI 19 kg/m 2 ) were enrolled. Mean CAT score was 16 and mMRC grade was 3. Diaphragmatic excursion correlated strongly with PIF (r = 0.78, R² = 0.61, p<0.01). A minimum PIF of 30 L/min, sufficient for basic DPI use, corresponded to a diaphragmatic excursion of approximately 2.8 cm. Patients achieving PIF >60 L/min, corresponding to DE = 4.5 cm, could be prescribed DPI with high confidence for optimal deposition.

Conclusion: Diaphragmatic ultrasound provides a reliable surrogate for inspiratory flow assessment in COPD patients. Simple cutoff values (2.8 cm for minimum DPI use = 4.5 cm for confident DPI prescription) can guide individualized inhaler selection when PIF measurement is unavailable.

Keywords: COPD, diaphragmatic ultrasound, dry powder inhaler, peak inspiratory flow, pulmonary rehabilitation

*This article was selected for NAPCON 2025 best research award presentation.

Etiology and clinical profile of chronic obstructive pulmonary disease in adult nonsmokers

Alida Chandraboss , Paulo Varghese Akkara

Government Medical College, Kozhikode, Kerala, India E-mail: alidachandraboss008@gmail.com

Introduction: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide, long regarded as a smoker’s disease. However, many patients are non-smokers. In India, biomass fuel, second-hand smoke, tuberculosis, and low socioeconomic status are important contributors. The etiology and clinical profile of COPD in non-smokers remain less explored. Objective: To study the etiology, clinical profile, and severity of COPD in non-smokers.

Methods: A cross-sectional study was conducted in 100 nonsmoker COPD patients at the Institute of Chest Diseases, Government Medical College, Kozhikode, over 18 months. Diagnosis was based on symptoms and confirmed by post-bronchodilator spirometry (FEV1/FVC <0.7). Demographics, exposures, exacerbations, radiography, and spirometric severity were assessed.

Results: Of 100 patients, 73 were females and 27 males, mean age 61.4 ± 9.2 years. Most (68%) belonged to the lower middle socioeconomic class. Biomass fuel exposure was the most common risk factor (64%), followed by second-hand smoke (31%), childhood asthma/allergy (26%), past tuberculosis (18%), occupational exposure (8%), and childhood respiratory infections (17%). Multiple risk factors occurred in 42%. Spirometry showed mild obstruction in 13%, moderate in 44%, severe in 34%, and very severe in 9%. GOLD grouping classified 46% as Group B, 32% as Group A, and 22% as Group E.

Conclusion: COPD in never-smokers was predominantly observed in women exposed to biomass fuel, with many having multiple risk factors. Most had moderate to severe obstruction and belonged to GOLD Group B, underscoring the need for targeted public health measures.

Keywords: Biomass fuel, chronic obstructive pulmonary disease, nonsmoker, risk factors

Comparing noninvasive ventilation failure with oral versus intravenous systemic steroids in the treatment of moderate to severe exacerbation of chronic obstructive pulmonary disease patients in the respiratory intensive care unit: Pilot study

Kamini Anusuya , Madhusmita Mohanty Mohapatra, Balamurugan

JIPMER, Puducherry, India E-mail: kaminimariyappan@gmail.com

Introduction: Though the guidelines recommended oral steroids in stable patients, intravenous steroids administration is often preferred clinically given in hypoxia, poor oral intake and compatibility with non-invasive ventilation during exacerbations. Despite widespread use, there is limited high-quality evidence comparing the effectiveness of oral versus intravenous corticosteroids specifically in respiratory ICU patients with moderate to severe AECOPD undergoing NIV. Objective: This study evaluates the efficacy and safety of IV steroids in patients with moderate to severe COPD exacerbations, and their outcome on NIV failure compared to oral steroids.

Methods: This pilot study enrolled the sample size of 66 patients based on expected RICU admission per year in JIPMER. Patients who met the criteria for moderate to severe acute exacerbation of COPD were recruited after obtaining informed consent. Participants were then randomized into two groups: Group A (control arm - oral) and group B (intervention arm - IV). All patients were managed with non-invasive ventilation (NIV) as part of standard care. The primary outcome assessed was NIV failure, defined as any of the following: the need for endotracheal intubation, reinstitution of NIV within 48 hours of initial discontinuation, or in-hospital mortality.

Results: In the interim analysis, 40 patients were analysed. Proportion of patients experiencing NIV failure was higher in control arm (oral steroids) but difference between the two groups did not reach statistical significance (p = 0.169). The odds ratio of 0.29 indicates that the intervention arm had a 71% lower incidence of NIV failure compared to the control arm.

Conclusion: Interim analysis suggests that intravenous steroids as an adjunct to NIV may modestly reduce NIV failure in moderate to severe AECOPD, though the difference was not statistically significant. Larger sample sizes and further studies are needed to confirm the efficacy and potential superiority of intravenous steroids in this setting.

Keywords: IV and oral steroids, moderate to severe COPD exacerbations, noninvasive ventilation failure

Physician perspectives on spacer device usage, prescription patterns, and clinical decision

Amitrajit Pal , Dattatray Pawar, Akhilesh Sharma

Alkem Laboratories Ltd., Mumbai, Maharashtra, India E-mail: amitrajit.pal@alkem.com

Introduction: Spacer devices, particularly when used with pressurized metered-dose inhalers (pMDIs), improve drug delivery and adherence in asthma and chronic obstructive pulmonary disease (COPD). Despite clinical guideline recommendations, their usage remains inconsistent across healthcare settings. This study aimed to assess physician perspectives on spacer usage, prescription patterns, and clinical decision-making factors in India.

Methods: This nationwide, multicenter, cross-sectional, questionnaire-based observational study was conducted among qualified medical practitioners including pulmonologists, pediatricians, and general physicians across India. A structured 12-item digital survey captured data on usage patterns, clinical considerations, barriers, and physician perceptions regarding spacer devices. Descriptive statistics was used for data analysis.

Results: In the analysis (N = 2,165), the most common respondents were chest physicians (48.9%), consulting physicians (23.7%), and pediatricians (14.5%). Spacers were frequently recommended by 42.5% of respondents, primarily for asthma maintenance (77.5%), followed by acute asthma (10.4%) and COPD (10.2%). Age of the patient (68.6%) and patient’s ability to use inhalers correctly (37.9%) were top prescribing factors. However, correct usage by patients was frequently observed by only 35.2% of physicians. Key barriers included lack of patient/caregiver education (74.3%), high device cost (12.5%), and poor technique/compliance (11.3%). Most respondents (70.6%) believed spacers to be more effective than nebulizers. Preferred spacer shape was cylindrical (69%). Physicians highlighted improved design (65.5%) and better educational materials (9.9%) as critical areas for improvement. Additionally, 89.6% expressed the need for enhanced patient/caregiver training resources. Although widely recognized for their efficacy, spacer devices face adoption challenges due to patient-related and system-level factors. This study underscores the importance of targeted education, user-friendly designs, and awareness to standardize spacer use.

Conclusion: Spacer usage in clinical practice remains suboptimal. Addressing practical barriers and reinforcing education among both physicians and patients may significantly improve respiratory care outcomes.

Keywords: Asthma management, inhaler adherence, physician perspectives, spacer devices

Understanding perceptions and place of triple therapy for management of asthma

Kanishka Singh , Sujeet Rajan, Anuroop Shankar

Metro Centre for Respiratory Diseases, Noida, Uttar Pradesh, India E-mail: dr.kanishka1990@gmail.com

Introduction: Despite being on medium-to-high doses of ICS-LABA, approximately 35-55% of asthma patients remain uncontrolled. The GINA 2024 report recommends addition of LAMA in asthma patients who do not achieve control with medium-to-high-dose of ICS+LABA. This survey was conducted to gather insights into the perceptions, preferences, prescribing patterns, and the role of triple therapy in asthma management across India.

Methods: This nation-wide self-reported digital survey was conducted among clinicians managing asthma between January-September 2024 using a 16-item questionnaire. Consent was obtained from the doctors before getting the survey responses. The responses were analyzed using descriptive statistics.

Results: A total of 116 clinicians from 24 states across India participated in the survey 77.6% were pulmonologists. 86.7% clinicians reported managing more than 30 asthma patients per month. 82.8% clinicians stated that >5% of these patients remained uncontrolled despite being on medium-to-high doses of ICS-LABA. According to 41.4% of the clinicians, >20% of their uncontrolled asthma patients were receiving triple therapy. Glycopyrronium was chosen as the most preferred LAMA for asthma management by 79.31% of the respondents due to its well-established safety and efficacy profile (71.55%). Majority (86.84%) of clinicians preferred single inhaler triple therapy (SITT) for managing patients with asthma, with glycopyrronium-formoterol-budesonide (70.69%) being the most preferred combination. The leading reasons for this preference were better efficacy (67.54%) and safety (51.75%). The respondents cited asthma-COPD overlap (23.76%), smoking history (14.85%) and recurrent asthma exacerbations (11.88%) as key profiles likely to benefit with early initiation of triple therapy.

Conclusions: Findings highlight that SITT is well-accepted for management of uncontrolled asthma with glycopyrronium-formoterol-budesonide being the preferred combination. Key patient profiles identified by clinicians for early initiation of triple therapy include asthma-COPD overlap, a history of smoking and recurrent exacerbations.

Keywords: Asthma management, early initiation, LAMA, single inhaler triple therapy

Real-world characteristics of asthma patients treated with fluticasone propionate + formoterol

Ronak Panwala , Kamlesh Patel

Lupin Ltd., Mumbai, Maharashtra, India E-mail: ronakpanwala@lupin.com

Introduction: There is limited real-world data on Indian asthma patients treated with inhaled Fluticasone Propionate/Formoterol (FP/FORM).

Methods: A retrospective study was conducted across 292 pulmonology centers in India. Asthma patients newly initiated with FP/FORM were identified by pulmonologists, and they were given an EDC platform to fill data. Descriptive analysis was performed. Ethics committee approval was obtained.

Results: Data from 4733 asthma patients were analyzed. Of these, 57% were male and 43% female. Age distribution: 2% patients aged 12–17 years, 35% aged 18–40 years, 40% aged 41–60 years and 22% aged >60 years. Asthma duration: 11% had asthma for <1 month, 38% had duration of 1–12 months, 30% had 1–5 years, 19% had >5 years. FP/FORM 250/6mcg (MDI/DPI) was prescribed to 86% patients, followed by FP/FORM 500/12mcg DPI (7%) and FP/FORM 100/6 DPI or 125/6 mcg MDI (6%). The lower strength (100/6 or 125/6) was more commonly prescribed in adolescents (12–17 years), with 125/6 mcg MDI preferred over 100/6 DPI. Overall, 55% received DPI and 45% MDI. Common comorbidities included allergic rhinitis (49%), COPD (24%), hypertension (12%), and obstructive sleep apnea (8%). The study highlights a high asthma burden across age groups and genders. Nearly 50% of patients had asthma duration <1 year and other 50% of patients had asthma duration of >1 years, indicating FP/FORM usage in both- newly diagnosed and previously treated patients. The high prevalence of allergic rhinitis and COPD comorbidities suggests the need for integrated management strategies.

Conclusion: ~75% of FP/FORM prescriptions were for patients aged 18–60 years, indicating high asthma prevalence in productive age group. FP/FORM 250/6 mcg was the most prescribed strength. Allergic rhinitis and COPD were common comorbidities. FP/FORM preferred for recently diagnosed as well previously diagnosed (and possibly treated with other therapies) patients with Asthma in India.

Pre-TOPD: Expanding the spectrum of post-tuberculosis obstructive airway disease

Awnish Shubham , Mehul Thakkar, Alpa Dalal

Jupiter Lifeline Hospital, Thane, Maharashtra, India E-mail: awnish.dayal@gmail.com

Introduction: Pulmonary tuberculosis (TB) often leaves structural and functional sequelae, collectively termed post-TB lung disease (PTLD). A major component is post-tuberculosis obstructive airway disease (TOPD), conventionally defined by fixed airflow obstruction (FEV1/FVC<0.7). However, this definition may be inadequate in TB survivors, as parenchymal fibrosis may reduce FVC, artificially elevating FEV1/FVC and masking airway disease. Some patients may represent an early disease stage where spirometric obstruction has not yet developed. We aimed to describe this subgroup, operationally defined as Pre-TOPD.

Methods: Seventy symptomatic post-pulmonary tuberculosis patients underwent spirometry, chest X-ray, biomarkers and functional assessment. Patients with normal spirometry were subjected to a body plethysmography. Patients with previous diagnosis of asthma or with exposure to cigarette/biomass smoke were excluded. Tuberculosis-associated obstructive pulmonary disease (TOPD) was defined as symptomatic patients with FEV1/FVC<0.7(n = 40) and Pre-TOPD as symptomatic patients with FEV1/FVC = 0.7 with RV/TLC>35% (n = 30).

Results: Pre-TOPD patients were younger (37years vs. 51years,p<0.001) with a shorter interval since TB treatment (7years vs. 15years,p = 0.006). They demonstrated better lung function (FEV1 1.54L vs. 1.19L, p = 0.005 FEV1/FVC 84.5% vs. 60.3%, p<0.0001), longer 6MWD (445m vs. 393m, p=0.049), less desaturation (0.8% vs. 2.2%, p=0.014), and lower BODE index scores (2.0 vs. 3.2, p<0.016). Serum IgE was significantly higher in TOPD (281IU/ml vs. 129IU/ml, p=0.049), while eosinophils did not differ. Logistic regression identified age, lower FEV1, and higher IgE as independent predictors of TOPD.

Conclusion: Recognizing Pre-TOPD broadens the spectrum of post-TB airway disease. More data is currently needed to assess if treating these patients could prevent development of further spirometric obstruction.

Keywords: Post-tuberculosis lung disease, pretuberculosis-associated obstructive pulmonary disease, tuberculosis-associated obstructive pulmonary disease

Real world study of awareness of appropriate diagnosis and rational inhalation therapy in bronchial asthma

Patil Shital , Rajesh Patil, Gajanan Gondhali

Venkatesh Chest Hospital and Critical Care Center, Latur, Maharashtra, India E-mail: drsvpatil1980@gmail.com

Introduction: Bronchial asthma is easily treatable chronic lung disease having high morbidity and mortality in developing countries like India. This may be due to diversity in medical professionals (allopathy, homeopathy, ayurvedic specialists) and lack of awareness regarding disease and severity in patients and care takers.

Methods: Prospective, observations study, included 2900 patients of bronchial asthma patients with chronic respiratory symptoms and diagnosed with spirometry. All patients were assessed for the disease knowledge, methods of treatment offered by treating professional by applying Respiratory questionnaire to patient and treating physician. Difficult doctor (when primary treatment providers are not convinced or not ready to start inhalation treatment in spite of knowing benefits of it over other treatment options), difficult patient (when patients are not convinced or not ready to accept the disease and rational inhalation treatment in spite of spirometry abnormalities) and difficult treatment (when patients economic status is unable to take rational inhalation treatment in spite of prescription irrespective of knowing advantages) were categorised by applying questionnaire on the basis of the response.

Results: In present study, 16.89% study cases were aware about bronchial asthma disease, 44.10% are not having knowledge about disease and 39% cases are not accepting the diagnosis (p<0.0001). Inhalation treatment use documented in 37.51% cases, as levosalbutamol monotherapy in 10.27% cases, levosalbutamol plus beclometasone in 10.68% cases, and formoterol plus budesonide or salmeterol plus fluticasone only in 16.55% cases (p<0.0001). Oral medicines use documented in 62.48% cases, as theophylline in 13.24% cases, salbutamol in 28.13% cases, oral steroids in 33.77% cases (p<0.0001). Difficult doctor, difficult patient and difficult treatment were documented in 34.34%, 39% and 26.655 respectively.

Conclusion: Doctor-patient-drug trio discordance clubbed as “difficult doctor, difficult patient, and difficult treatment” is very crucial issue observed during diagnosis and management of Bronchial asthma in peripheral setting and tier 4 cities in India. We recommend more awareness and sensitization regarding risk factors disease symptoms and benefits of rational inhalation treatment should be done on large scale to decrease morbidity and mortality.

Keywords: Bronchial asthma, difficult treatment, inhalation, spirometry

Safety and effectiveness of fluticasone furoate/vilanterol DPI in asthma

Surajit Chatterjee , Bhavesh Vaghani, Gajendra Vikram Singh

Shanti Wellness Care, Kolkata, West Bengal, India E-mail: surajit.chat@gmail.com

Introduction: The FDC of Fluticasone Furoate and Vilanterol trifenatate (FF/VI) is an ultra-long-acting ICS/LABA indicated for asthma. This PMS evaluated the safety and effectiveness of FF/VI 100/25 or 200/25 via DPI in asthma.

Methods: We conducted a 12-week open label, multicentre, surveillance of 200 participants, (>12 years), prescribed FF/VI. Primary endpoint was incidence of adverse events (AEs). Secondary endpoints were change in ACQ-5 score and PEFR recorded at sites from baseline to week 4, 8 and 12.

Results: Of the 200 enrolled participants, 195 completed the surveillance (51% women mean age 37 years, duration of asthma 2 years). Five AEs were reported in five participants: cough and nasopharyngitis in FF/VI 100/25, and pruritus (related and led to discontinuation), headache, and myocardial infarction (MI) in FF/VI 200/25, of which MI was a serious event reported as unassessable by the Investigator. No clinically significant changes were observed in vitals, physical examination, or laboratory parameters. At week 12, ACQ-5 LS Mean (95%CI) decreased by -1.57(-1.79, -1.34) and -1.76 (-2.01, -1.51) from baseline (p<0.0001), exceeding MCID (0.5) and PEFR increased from baseline by 144.58 (122.66, 166.49) L/min and 141.27 (120.53, 162.01) L/min for FF/VI 100/25 and FF/VI 200/25, respectively (p<0.0001). Significant improvements in ACQ-5 and PEFR were observed as early as 4 weeks.

Conclusion: The FF/VI FDC demonstrated a favourable safety profile and was effective in significantly improving PEFR and asthma control over 12 weeks in Indian asthmatics.

Keywords: ACQ-5, asthma, PEFR

Proof on concept: Exhaled breath capnograph – A simple tool to detect obstructive airway disease

Sapna Madas , Monica Barne, Shitalkumar Zambad

Pulmocare Research and Education Foundation, Pune, Maharashtra, India E-mail: sapnamadas@purefoundation.in

Introduction: Capnography is a non-invasive method to measure the concentration of exhaled carbon dioxide (CO 2 ), providing insights into ventilation, perfusion, and metabolism. The end-tidal CO 2 (ETCO2) value and waveform (capnogram) are established in critical care but less explored as a community screening tool. A handheld device (Breath-AI) measuring ETCO2 and vital biomarkers from natural breathing offers potential for early detection of obstructive airway disease (OAD). This study aimed to evaluate exhaled breath capnography as a screening tool for OAD in a community-based setting.

Methods: A cross-sectional study was conducted through health screening camps under the pollution awareness and wellness assessment (PAWAN) initiative in urban slums and rural regions of Pune district, India. Participants completed a lung health questionnaire and underwent peak expiratory flow rate (PEFR) testing. Exhaled breath profiles were recorded using the Breath-AI V3 handheld device, held near the nose for 40–60 seconds to capture 5–10 natural breaths. Data on ETCO2 and breath biomarkers were collected and compared between participants with and without OAD.

Results: A total of 2,651 participants were enrolled (mean age 47 ± 15 years 30% male). Respiratory symptoms (cough, breathlessness, wheeze, or chest tightness) were reported by 40%, and reduced PEFR (<80% predicted) was observed in 12%. Self-reported history of OAD was 2.8%. ETCO2 values were significantly lower in participants with OAD compared to healthy individuals (37.2 ± 6.7 vs. 40.3 ± 6.1 mmHg p <0.001). The time to reach 85% of ETCO2 was longer in OAD (0.84 ± 0.34 vs. 0.69 ± 0.25 sec p <0.001).

Conclusion: This study demonstrates that exhaled breath capnography using a handheld device can differentiate between healthy individuals and those with OAD in community settings. Non-potentially invasive ETCO2 profiling has potential as a rapid, scalable screening tool for early detection of obstructive airway disease, especially in resource-limited populations. More studies are needed to validate these findings.

Keywords: Early detection, end-tidal carbon dioxide, exhaled breath capnography, noninvasive screening, obstructive airway disease

Role of serum olfactomedin 4 as a biomarker in bronchial asthma

Ankit Sharma , Mahesh P. A., Shamnaz Shahul

JSS Medical College and Hospital, Mysuru, Karnataka, India E-mail: ankit.gtx1234@gmail.com

Introduction: Asthma is a heterogeneous airway inflammatory disease with variable severity and control status. While eosinophilic biomarkers are well established, neutrophil-related markers are less explored. Olfactomedin 4 (OLFM4), a neutrophil-derived glycoprotein involved in immune regulation, has been linked with neutrophilic inflammation and severe, corticosteroid-resistant asthma. This study evaluated serum OLFM4 levels in asthma and their correlation with severity, asthma control, and quality of life.

Methods: A hospital-based comparative study was conducted at JSS Hospital, Mysuru, from June 2023 to December 2024. Eighty participants were enrolled: 60 asthmatics (20 each mild, moderate, severe) and 20 healthy controls. Diagnosis and severity classification followed GINA 2023 guidelines. Serum OLFM4 was measured using ELISA. Spirometry assessed lung function, and asthma control was evaluated using the Asthma Control Test (ACT). Correlations with inflammatory markers, spirometry, and quality of life were analyzed.

Results: Mean OLFM4 levels were significantly higher in asthmatics than controls (4309.23 ± 1533.97 vs. 1344.41 ± 256.38 pg/mL, p<0.001). Levels increased with severity: mild 2947.49, moderate 4371.45, severe 5608.75 pg/mL. OLFM4 negatively correlated with ACT scores (r = −0.820, p<0.001) and lung function parameters (FEV1 r = −0.564, FEV1/FVC r = –0.542). Positive correlations were seen with TLC, ANC, and AEC. ROC analysis showed excellent discriminatory power for asthma diagnosis (AUC 0.997) and for severe disease (AUC 0.890). Multivariate analysis identified OLFM4 as an independent predictor of severe asthma (OR 1.23, p=0.011).

Conclusion: Serum OLFM4 is a promising biomarker for asthma diagnosis, severity assessment, and control evaluation, with potential applications in risk stratification and personalized management.

Keywords: Asthma control, asthma, biomarker, neutrophilic inflammation, olfactomedin 4, severity

Comparative analysis of 5-repetition sit-to-stand test, Borg Dyspnoea Scale, and GOLD criteria in chronic obstructive pulmonary disease

Ambika Sharma , R. S. Mathur

Institute of Respiratory Disease, SMS Medical College, Jaipur, Rajasthan, India E-mail: ambikasharma65@gmail.com

Introduction: Chronic obstructive pulmonary disease (COPD) is a leading global health concern contributing to high morbidity and mortality. Simple functional tests such as the Five-Repetition Sit-to-Stand (5STS) may provide a practical means of assessing disease severity, particularly in resource-limited settings. This study aimed to evaluate the relationship between the 5STS, Borg Dyspnoea Scale, and GOLD spirometric classification in Indian patients with COPD.

Methods: A cross-sectional study was conducted among 71 stable COPD patients attending a tertiary care center in Mumbai. All participants underwent spirometry, 5STS, and dyspnoea assessment using the Modified Borg Scale. Patients were staged according to GOLD spirometric classification. Statistical analysis included Spearman’s correlation, ANOVA, and post hoc Tukey tests.

Results: The mean age of participants was 65.7 ± 8.3 years, with 80.3% being male. The average 5STS completion time was 14.98 ± 3.64 seconds. A strong positive correlation was observed between 5STS performance and Borg Dyspnoea scores (r = 0.857, p < 0.001). ANOVA demonstrated significant differences in 5STS times across GOLD categories (p < 0.001). Reliability testing showed good internal consistency of 5STS in reflecting symptom severity (Cronbach’s a = 0.829).

Conclusion: The 5STS demonstrates a strong association with established indices of COPD severity and represents a reliable, rapid, and cost-effective tool for functional assessment. It may serve as a useful surrogate marker of disease severity in clinical practice, especially in low-resource environments.

Digital interventions for integrated care of obstructive airway disease patients in India: DECODE survey

Rohan Gupta , Arjun Khanna, Richa Mittal

Department of Medical Affairs, Mumbai, Maharashtra, India E-mail: rohan.gupta@cipla.com

Introduction: Obstructive airway diseases (OADs) are a growing health concern in India. Digital interventions (DI) are being recognized for their role in enhancing OAD management. However, there is lack of knowledge on their usage and perception amongst clinicians in India. Objective: To understand adoption, usage and impact of DIs among clinicians managing OADs in India.

Methods: A nationwide, self-reported digital survey was conducted from January-September 2024. Data was analyzed using descriptive statistics.

Results: 112 clinicians (75.9% pulmonologists) participated. 54.2% reported seeing >50 OAD patients/month. Overall, 56% of clinicians used digital tools for OAD management. Clinicians with =20 years of experience showed higher usage (60%) of digital tools compared to those with >20 years of experience (37%). 97% found DI helpful for doctors, particularly for patient education (100%), obtaining periodic reports(66.4%) and reducing consultation time (61.7%). DI could positively impact medication adherence and quality of life in patients with OAD as per 86.5% and 73.9% clinicians, respectively. Clinicians cited that smart inhalers could help improve treatment outcomes (76.4%), record inhaler technique (75.5%), and support adherence and technique improvement (71.8%) Digital peak flow meters were preferred over manual ones as clinicians mentioned that they would help in maintaining and generation of records (94.4%). 29% of clinicians had either used or were aware of digital pulmonary rehabilitation (DPR), with higher uptake among those with <20 years of experience(34%) compared to senior clinicians with >20 years of experience (15%). Key advantages cited for DPR included better adherence(84.3%) and improved accessibility (78.7%), with 91% clinicians interested in recommending it to patients preferred features recommended for lung disease app included disease education (97.2%), breathing exercises (95.4%), medication reminders (92.7%) and Pulmonary rehabilitation (91.7%).

Conclusion: This survey highlights the potential of DI to enhance clinical care and improve outcomes in OAD management.

Asthma on the move: Functional correlation with spirometry, control, and quality of life

Ajay Gopal A , Bhagyashri Patil, Jyothi Hattiholi

Jawaharlal Nehru Medical College, Belagavi, Karnataka, India E-mail: ajaygopalnair2@gmail.com

Introduction: Asthma is a chronic inflammatory airway disease affecting nearly 300 million people globally. It is heterogeneous, ranging from mild disease with minimal impact on quality of life to difficult-to-control asthma with persistent symptoms and frequent exacerbations. Physical activity is an important determinant of morbidity and mortality in chronic diseases. In asthma, higher activity levels are linked with better lung function and outcomes. Aim of the study: To assess physical activity and exercise tolerance in asthma patients using the six-minute walk test (6MWT), and correlate results with spirometry, the asthma control test (ACT), and the asthma quality of life questionnaire (AQLQ).

Methods: The study included 100 patients attending the Respiratory Medicine OPD at KLE’S Dr. Prabhakar Kore Hospital, Belagavi. All underwent 6MWT, spirometry, ACT, and AQLQ assessments.

Results: The mean ACT score was 17.5 ± 4.4, showing many patients had partly controlled to uncontrolled asthma. The mean AQLQ score was 4.96, reflecting moderate quality-of-life impact. Mean FEV1 % predicted was 77.8 ± 10.3, consistent with mild to moderate obstruction. The 6MWT demonstrated reduced exercise tolerance, correlating with lower ACT scores, impaired AQLQ, and reduced FEV1 %.

Conclusion: Asthma patients demonstrated significant limitation in physical activity and exercise tolerance, strongly associated with asthma control, quality of life, and lung function. The 6MWT is a simple, reliable tool to assess functional limitation and complements spirometry and patient-reported outcomes in clinical practice.

Keywords: Asthma control test, asthma quality of life questionnaire, asthma, exercise tolerance

Clues to closing the gap: Atopic symptoms as predictors of undiagnosed asthma in the Global Asthma Network Phase I study

Nishtha Singh

Asthma Bhawan, Jaipur, Rajasthan, India E-mail: drnishthasingh@gmail.com

Introduction: Asthma and allergic diseases are frequently underdiagnosed worldwide. This study quantified the extent of undiagnosed asthma (wheeze), hay fever, and eczema among children and adolescents, and assessed whether four atopic symptoms could aid diagnosis.

Methods: The Global Asthma Network (GAN) Phase I used standardized questionnaires in 6–7-year-olds (n=109,089 19 countries) and 13–14-year-olds (n=168,827 26 countries). Prevalence of current wheeze, hay fever, and itchy rash, their doctor diagnosis, and undiagnosed proportions were calculated. Associations with four “clue” symptoms–exercise-induced wheeze, nocturnal cough, nose allergy, and itchy rash–were analyzed using odds ratios.

Results: More than half of children with current wheeze were undiagnosed (61.7% in 6–7 years 67.2% in 13–14 years). The gap was larger in lower-income countries. Similar patterns were seen for hay fever (67.5% and 81.5% undiagnosed) and eczema (58.2% and 74.7%). In younger children, exercise-induced wheeze (OR 7.7), nocturnal cough (OR 5.2), and nose allergy (OR 4.7) strongly predicted undiagnosed asthma these symptoms also predicted undiagnosed hay fever (ORs 2.8–6.7) and eczema (ORs 2.6–3.7). In adolescents, the same associations were observed (ORs 2.6–4.2). Awareness of these four symptoms could identify nearly three-quarters of undiagnosed cases across all three conditions.

Conclusions: GAN Phase I reveals a substantial global diagnostic gap in childhood asthma, hay fever, and eczema. A simple symptom-based approach using four atopic clues – wheeze after exercise, nocturnal cough, nose allergy, and itchy rash – can strengthen diagnosis, reduce under-recognition, and support earlier treatment, especially in resource-limited settings.

A cross-sectional study to assess the bacteriological profile and it’s antimicrobial resistance in chronic obstructive pulmonary disease

Dhanyalakshmi S , Suresh D

Government Stanley Medical College and Hospital, Chennai, Tamil Nadu, India E-mail: dhanyamanian@gmail.com

Introduction: Chronic respiratory diseases (CRDs) such as cystic fibrosis, severe asthma, chronic obstructive pulmonary disease and bronchiectasis, managed with long-term antibiotic therapies, lead to multidrug resistance. Chronic obstructive pulmonary disease (COPD) is one of the major cause of chronic morbidity and mortality worldwide. In the majority, infectious agents, particularly bacteria, cause exacerbation of COPD, this study aimed to determine the bacteriological profile and its antibiogram among patients with acute exacerbations of chronic obstructive pulmonary disease. Based on results patient can be benefited from receiving sensitive antibiotics. Objectives: To determine the bacteriological profile in sputum among hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease.

Methods: Study design: Cross sectional study, study population: Chronic obstructive pulmonary disease patients with acute exacerbation admitted in Government Stanley Medical College, Chennai and Government Hospital of Thoracic Medicine, Tambaram Sanatorium, Duration of study: 6 months (December 2024 to May 2025). Procedure: (1) Sputum for pyogenic culture will be sent (before starting Empirical antibiotics) in Chronic Obstructive Pulmonary Disease patients with acute exacerbation. (2) Organism grown in culture will be assessed for its antibiogram pattern. (3) Reports will be disseminated to treating physician and treated accordingly.

Results: Among 100 patients, 74 patients were found to be sputum culture positive. Klebsiella pneumoniae isolated were 51, pseudomonas aeruginosa were 19, streptococcus pneumoniae were 4. Each has certain sensitivity and resistance Pattern.

Conclusion: Early sputum examination and antimicrobial sensitivity testing helps in treating with appropriate antibiotics. This study also helps in identifying emerging drug resistance pattern.

Keywords: Chronic obstructive pulmonary disease, sputum

An observational study to assess the correlations of fractional exhaled nitric oxide, blood eosinophils, serum IgE, and lung function parameters in patients with bronchial asthma

Smruthi Valsalan , Lokesh Gupta

Dr. S.N. Medical College, Jodhpur, Rajasthan, India E-mail: smruthivalsalan@ymail.com

Introduction: Asthma is a heterogeneous chronic airway disease where traditional diagnostic approaches may not adequately reflect underlying inflammation. Biomarkers including fractional exhaled nitric oxide (FeNO), blood eosinophils, and serum IgE have emerged as valuable tools for assessing type 2 inflammation and guiding treatment decisions. Objective: To assess the levels and correlations between FeNO, blood eosinophils, serum IgE, and lung function parameters in patients with bronchial asthma.

Methods: This cross-sectional observational study was conducted at Kamla Nehru Chest Hospital, Jodhpur, involving 100 adult asthma patients. FeNO levels were measured using NIOX device, spirometry was performed with bronchodilator reversibility testing, blood eosinophil counts and serum IgE levels were measured, and asthma control was assessed using the Asthma Control Test (ACT). Correlations were analyzed using Spearmans rank correlation coefficient.

Results: Mean age was 37.16 years with female predominance (59%). Strong positive correlations were found between FeNO and absolute eosinophil count (r=0.769, p<0.0001) and serum IgE (r=0.623, p<0.0001). FeNO showed strong negative correlations with ACT scores (r=-0.782, p<0.0001) and FEV1 (r=-0.812, p<0.0001). Patients with elevated biomarkers (FeNO =25 ppb, eosinophils =300 cells/mm³, IgE =200 IU/ml) demonstrated significantly poorer asthma control and reduced lung function. Higher biomarker levels were significantly associated with increased disease severity.

Conclusion: FeNO, blood eosinophils, and serum IgE serve as valuable, cost-effective biomarkers for assessing airway inflammation, disease severity, and asthma control, facilitating phenotype identification and optimization of corticosteroid therapy in bronchial asthma management.

Keywords: Biomarkers, blood eosinophils, bronchial asthma, fractional exhaled nitric oxide, lung function, serum IgE

Evaluation of low-dose fluticasone furoate/vilanterol in asthmatic patients uncontrolled on low-medium dose of budesonide/formoterol

Divya Bhojwani , Saiprasad Patil, Hanmant Barkate

Glenmark Pharmaceuticals, Mumbai, Maharashtra, India E-mail: divya.bhojwani@glenmarkpharma.com

Introduction: Proactive regular dosing (PRD) with an ICS-based regimen has shown benefits in asthma management, symptom control, lower mortality, fewer severe exacerbations and reduced hospitalizations. This sub-group analysis aimed at evaluating the effectiveness and safety of switching to low dose of fluticasone furoate/vilanterol (FF/VI 100/25 mcg) dry powder inhaler in uncontrolled asthma patients on low-medium dose of budesonide (200-800 mcg)/formoterol.

Methods: A multicentre, open-label, prospective study was carried out across six centers in India, following ethics committee approval. Patients uncontrolled on twice-daily ICS/LABA switched to once daily FF/VI 100/25 mcg were followed up for 12 weeks for effectiveness and safety assessment.

Results: Out of 177 patients enrolled, 64.40% (n=114) patients were on low/medium dose FOR/BUD, of which, 44.73% (n=51) were switched to low dose FF/VI (100/25 mcg). Following the switch, significant improvements in lung function were observed with a mean increase in FEV1 of 225.69 ml (p<0.001) and FVC of 224.31 ml (p< 0.001) from baseline to week 12. At baseline, patients had poorly uncontrolled asthma reflected in a mean ACQ-5 score of 2.55 ± 0.47. After 12 weeks of FF/VI therapy, the mean ACQ-5 score was reduced to 1.32 ± 0.68 (p<0.001). Notably, majority of these patients 80.39% (n=41) achieved a minimally clinically important difference (ACQ5 score decrease from baseline of at least 0.5) by week 12. Furthermore, by week 12, only a few 21.56% (n=11) of patients reported need of rescue medication. The combination was well-tolerated with adverse events reported in 15.68% (n=8) of patients. The most common AEs were mild cases of fever and cold which resolved without requiring drug discontinuation.

Conclusion: Low-dose FF/VI (100/25 mcg) improved lung function, reduced asthma symptoms and decreased need of rescue medication in persistent asthma uncontrolled on low–medium-dose budesonide/formoterol, offering an effective alternative to ICS/LABA escalation and supporting personalized treatment to enhance adherence and outcomes.

Keywords: ICS-LABA, persistent asthma, SMART, vilanterol

*PROMISE-OD study: (CTRI/2023/10/058653).

*This article was selected for NAPCON 2025 best research award presentation.

Effectiveness and safety of budesonide/glycopyrrolate/formoterol fumarate DPI/pMDI in frequent exacerbators

Divya Bhojwani , Saiprasad Patil, Hanmant Barkate

Glenmark Pharmaceuticals Ltd., Mumbai, Maharashtra, India E-mail: divya.bhojwani@glenmarkpharma.com

Introduction: Up to 30% of COPD patients experience more than two exacerbations/year, often requiring hospitalization. This sub-group analysis aimed at evaluating the effectiveness and safety of Budesonide/Glycopyrronium/Formoterol (BGF) DPI/pMDI in COPD patients with frequent exacerbations, uncontrolled on dual therapies.

Methods: A sub-group analysis of a prospective, open-label, multicentre study was conducted on COPD patients after ethics approval. Patients received either BGF DPI (400/25/12 mcg) or BGF pMDI (160/9/4.8 mcg) and were assessed clinically at baseline and weeks 4, 12 and 24. Effectiveness and safety was evaluated among patients categorised as frequent exacerbators.

Results: Of the 182 patients enrolled, 21.4% (n=39) were frequent exacerbators. The cohort included 29 males (74.35%) and 10 females (25.64%), with mean age of 55.02±10.11 years. At screening, 48.71% patients (n=19) were on LABA/ICS and 51.28% (n=20) were on LABA/LAMA. At baseline, mean trough FEV1 was 1203.46±394.42 ml (50.2±10.59%) and mean trough FVC was 1862.56±507.81 ml. Lung function improved significantly, with mean trough FEV1 rising to 1372.56±493.61 ml (?169.1, p<0.001) at week 04, 1538.46±541.45ml at week 12 (?335, p<0.001) and 1788.94±523.45 ml (?585.49 ml, p<0.001) by week 24. Mean mMRC score improved from a baseline of 3±0.68 to 2.05±0.55, 1.57±0.75 and 1.39±0.97 at weeks 4, 12 and 24. Notably, treatment with BGF contributed to reduction in exacerbations among patients prone to frequent episodes, with only 2.56% (n=1) experiencing exacerbation during the study period, which was mild in severity. BGF was well-tolerated, with adverse events reported in 10.25% of patients (n=4), including mild cough (n=2), urinary tract infection (n=1), and upper respiratory tract infection (n=1), all resolved completely.

Conclusions: BGF DPI/pMDI is an effective and well-tolerated treatment option for patients with history of frequent exacerbations.

Keywords: AIR-FORCE study, BGF, COPD, frequent exacerbations, triple therapy

Evaluating the impact of digitalized home-based pulmonary rehabilitation exercises on quality of life in COPD

Adithya Murali

Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India E-mail: adivarahan.vmj@gmail.com

Introduction: Chronic obstructive pulmonary disease (COPD) significantly impairs patients’ quality of life and functional capacity. Pulmonary rehabilitation (PR) is an essential component for managing COPD, but traditional hospital-based programs have limited accessibility. Digitalized home-based PR exercises offer a promising alternative to enhance adherence and outcomes.

Methods: This study evaluated the impact of a digital home-based pulmonary rehabilitation program on quality of life and functional capacity in COPD patients. A total of 75 diagnosed COPD patients were enrolled and randomly assigned to the digital PR group or conventional care. The digital program included guided exercise sessions via a mobile application, weekly virtual monitoring, and educational support over 12 weeks. Quality of life was assessed using the COPD Assessment Test (CAT), and functional capacity was measured via the 6-Minute Walk Test (6MWT) pre- and post-intervention.

Results: Patients undergoing digitalized home-based PR showed a statistically significant improvement in both quality of life and functional capacity compared to controls. CAT scores decreased by an average of 5.3 points, indicating better symptom management. The 6MWT distance increased by an average of 45 meters, reflecting enhanced exercise tolerance.

Conclusion: Digital home-based pulmonary rehabilitation exercises significantly improve quality of life and functional capacity among COPD patients. Incorporation of such digital interventions could expand PR accessibility and optimize patient management in chronic respiratory diseases.

Keywords: Chronic obstructive pulmonary disease, digital health, home-based exercise, pulmonary rehabilitation

From eyes to airways: Allergic conjunctivitis and its links to systemic allergy

Medha Jain

Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat, India E-mail: medha897@gmail.com

Introduction: Allergic conjunctivitis (AC) is a common ocular disorder in children, yet its systemic associations are often overlooked. Evidence suggests that AC may be part of a wider atopic profile rather than an isolated condition. This study evaluates the systemic allergic associations of AC, emphasizing its role as a marker for broader allergic disease and the need for a multidisciplinary management approach.

Methods: A retrospective analysis of 96 patients (aged 4–32 years) with AC was conducted at ophthalmic and multispecialty centers in Vadodara, India. Clinical symptoms, systemic allergic comorbidities, and SPT sensitization profiles were documented and analyzed.

Results: Of 96 patients, 60 were male and 36 female. Common ocular symptoms included redness (100%), itching (95%), and dry eye (93%). Nasal symptoms were present in 54%. SPT showed sensitization to pollens (66%), mites (41%), and fungi (4%). Systemic allergic conditions included allergic rhinitis (56%), skin allergy (8%), and bronchial asthma (4%). The data supports the hypothesis that allergic conjunctivitis is often not an isolated ocular condition but rather a local manifestation of a broader allergic diathesis. Recognizing and investigating associated systemic allergies in patients with AC can enable earlier interventions and improved patient outcomes. The findings call for increased awareness among ophthalmologists and general practitioners about the need to screen for comorbid allergic conditions.

Conclusion: Allergic conjunctivitis frequently coexists with systemic allergic disorders, most notably allergic rhinitis. AC may serve as a visible indicator of atopic predisposition. Routine screening for systemic allergies in AC patients is recommended to enable early diagnosis and integrated management.

Keywords: Allergic conjunctivitis, allergic rhinitis, atopy, skin prick test, systemic allergy

Is my infant at risk of asthma or allergy? Insights from the GAN India study

Virendra Singh , Sushil Kumar Kabra, Meenu Singh

Rajasthan Hospital, Jaipur, Rajasthan, India E-mail: drvirendrasingh93@gmail.com

Introduction: Parents attending respiratory outpatient often worry whether their coughing infant has a risk of asthma or allergy in later childhood. We explored role of infant wheeze and parental atopy as risk factors, by making subset analysis of our GAN India study.

Methods: The global asthma network (GAN) India study surveyed 20,084 schoolchildren aged 6–7 years across eight cities. Among them, 673 children with wheezing in the first year of life were compared with 19,411 without early wheeze. Association between parental and doctor-diagnosed atopy (asthma, allergic rhinitis [AR], eczema) and early childhood wheezing was analyzed using univariate and multivariate logistic regression to assess the risk reported as odds ratios (OR), adjusted odds ratios (aOR), and 95% confidence intervals (CI).

Results: Children with a history of early life wheeze had a substantially higher prevalence of asthma and allergies (9.96%) at 6–7 years compared with non-wheezers (0.8%). The study revealed that children with early life wheeze had a 12 fold risk of suffering from asthma (aOR 12.75, 95% CI 9.10–17.87, p<0.001). Similarly, they had significantly (p<0.001) higher risks for AR (aOR 4.79), eczema (aOR 2.22), and any atopy (aOR 4.16). Parental history of atopy further amplified the risk. Among first-year wheezers with a history of parental asthma, almost 30% (aOR 1.45) children developed asthma by age 6–7. Similarly, 34.4% (aOR 1.69) developed AR, 48.9% (aOR 3.17) eczema, and 30.7% any atopy when parents had the same type of atopy. Notably, 76% of infants with early wheeze remained symptom-free by school age. Limitation: Questionnaire based study may have recall bias.

Conclusion: Infant wheeze and parental atopy are powerful predictors of later asthma and allergy in Indian children, with early wheeze conferring a 4–12-fold higher risk, amplified by parental atopy. Yet, reassuringly, three-fourths of early wheezers remain symptom-free by school age. These findings provide Indian-specific evidence for both clinical decision-making and parental counseling.

*This article was selected for NAPCON 2025 best research award presentation.

Unmasking undiagnosed asthma: A sub-analysis of Global Asthma Network Phase I data from India

Nishtha Singh , Sushil Kumar Kabra, Shally Awasthi

Asthma Bhawan, Jaipur, Rajasthan, India E-mail: drnishthasingh@gmail.com

Introduction: The Global Asthma Network (GAN) Phase I revealed a striking diagnostic gap: only 18% of children and 25% of adolescents with wheeze were doctor diagnosed asthma, leaving the majority undiagnosed. This sub-analysis of GAN India data examined whether a cluster of atopic symptoms could serve as clinical markers to identify undiagnosed asthma.

Methods: A cross-sectional, questionnaire-based survey was conducted across nine Indian centers. Odds ratios were estimated for individual symptoms and clusters to assess their association with current wheeze. Sensitivity, specificity, predictive values, and likelihood ratios were calculated to evaluate their diagnostic performance.

Results: Four symptoms – nose allergy, exercise-induced wheeze, nocturnal dry cough, and itchy rash – emerged as strong predictors of current wheeze (odds ratios 2.5–13 in children, 2.38–6.05 in adolescents). Presence of any symptom correctly identified almost 80% of children and adolescents with wheeze. Exercise-induced wheeze showed high NPV (97.9%), nocturnal cough had very high PPV (99.9%) and NPV (98.8%), while the symptom cluster demonstrated high sensitivity (75%) and NPV (99.2%). Positive likelihood ratios ranged from 1.23 to 10.7, indicating a substantially higher risk of asthma. Limitation: As a questionnaire-based study, recall bias is possible.

Conclusion: A simple cluster of atopic symptoms offers a scalable and effective screening tool for frontline healthcare providers. Its use could bridge the diagnostic gap and significantly reduce the burden of undiagnosed childhood and adolescent asthma in India.

*This article was selected for NAPCON 2025 best research award presentation.

Clinical profile and functional recovery of airway dysfunction in nonsmoking adults following influenza-like illnesses

Siddarth Mathur

J. L. N. Medical College, Ajmer, Rajasthan, India E-mail: alfsidm@gmail.com

Introduction: Influenza-like illnesses (ILIs) are commonly considered self-limiting, yet an increasing body of evidence suggests that a significant subset of patients may experience persistent respiratory symptoms and reversible airway dysfunction. The trajectory of clinical and physiological recovery following ILI, particularly the role of inflammation and spirometric patterns, remains inadequately characterized. Objectives: To assess the evolution of symptoms, spirometry parameters, and inflammatory markers in patients following ILI over a 90-day period, and to evaluate the prevalence and reversibility of bronchial hyperresponsiveness (BHR), airflow limitation (AL), small airway obstruction (SAO), and eosinophilic inflammation.

Methods: Fifty adult patients presenting with recent ILI were prospectively followed with structured assessments at Day 0, 15, 30, 45, 60, 75, and 90. Data collection included symptom and sign evaluation, spirometry (FEV1, FVC, FEV1/FVC, FEF25–75), fractional exhaled nitric oxide (FeNO), total eosinophil count (TEC), and bronchodilator reversibility (BDR). Radar plots and line graphs were used for visual depiction of recovery patterns.

Results: At baseline, coryza (92%), cough (88%), and fever (72%) were most prevalent. BHR was present in 42%, AL in 48%, SAO in 48%, and eosinophilic inflammation in 60%. Over 90 days, symptoms and auscultatory signs resolved completely, with significant improvement in all spirometric and inflammatory parameters. FEV1 improved from 80.92?±?17.73% to 87.94?±?16.82% predicted (p?=?0.001) FEF25–75 showed a marked rise from 62.11?±?22.36% to 73.08?±?21.98% (p?=?0.001). FeNO and TEC declined by over 85% and 97% respectively (both p?<?0.001). Eosinophilic inflammation resolved entirely by Day 15. BDR positivity dropped from 10% to 0% by Day 90. AL and BHR showed partial but significant improvement, while SAO persisted in 36% at follow-up.

Conclusion: Post-ILI airway dysfunction is common and often features reversible inflammation and small airway obstruction. Most patients show complete clinical and physiological recovery by 90 days, with early resolution of inflammation and gradual improvement in lung function. Spirometry combined with FeNO and TEC offers valuable insight into recovery trajectories and may inform early risk stratification.

Keywords: Airflow limitation, bronchial hyperresponsiveness, bronchodilator reversibility, eosinophilic inflammation, FeNO, influenza-like illness, longitudinal recovery, post-viral airway dysfunction, small airway obstruction, spirometry

*This article was selected for NAPCON 2025 best research award presentation.

Distribution of aeroallergen sensitivities in nasobronchial allergy patients by skin prick test

Shubhanu Tayal , Devashish Yadav

SGT University, Gurugram, Haryana, India E-mail: shubhtayal28@gmail.com

Introduction: Nasobronchial allergies, including allergic rhinitis and asthma, are increasingly prevalent due to urbanization, environmental pollution, and rising aeroallergen exposure. These IgE-mediated hypersensitivity conditions significantly impair quality of life and healthcare systems. Identifying specific allergen sensitivities is crucial for effective management. Skin Prick Test (SPT) remains the gold standard for diagnosing type I hypersensitivity due to its sensitivity, specificity, and cost-effectiveness.

Methods: This cross-sectional study was conducted over 18 months in the Department of Pulmonary Medicine at SGT Medical College, Budhera, Gurugram. A total of 100 patients with clinical suspicion of nasobronchial allergy were enrolled based on inclusion and exclusion criteria. Detailed clinical evaluation, serum IgE estimation, and SPT with 78 standardized aeroallergens were performed. A wheal size =3 mm compared to the negative control was considered positive.

Results: The mean age of participants was 32.46 years, with a slight male predominance (52%). Elevated serum IgE levels were observed in all patients, with moderate (37%) to high (35%) levels most common. The most frequent sensitizers were house dust mites – Dermatophagoides pteronyssinus (51%) and Dermatophagoides farinae (43%)—followed by cockroach (40%), housefly (40%), mosquito (39%), and ant (37%). Pollen allergens such as Cynodon dactylon (29%) and Holoptelea integrifolia (25%), and food allergens including groundnut (19%) and almond (19%), were also significant. Fungal allergens were less prevalent.

Conclusion: SPT proved to be a valuable diagnostic tool for identifying allergen sensitivities. Recognition of dominant sensitizers can guide targeted avoidance measures, immunotherapy, and community awareness strategies, ultimately improving patient outcomes in allergic airway diseases.

Aeroallergen sensitization, and FeNO in children with asthma: A cohort study

Rashmi Ranjan Das , Shakti Kumar Bal

AIIMS, Bhubaneswar, Odisha, India E-mail: rrdas05@gmail.com

Introduction: Aeroallergen sensitization is a risk factor in the development of childhood asthma. We aimed to study the prevalence of aeroallergen sensitization in children with asthma, and to correlate the level of Fractional exhaled nitric oxide (FeNO) in atopics and non-atopics.

Methods: This prospective cohort study was conducted in a tertiary care teaching hospital over two-years, and included children of 6-18 years age. Laboratory tests (FeNO, skin prick test [SPT] and spirometry) were carried out as per the guidelines. GINA 2022 guideline was used for diagnosis and management of asthma. The study was approved by the Institute Ethics Committee, parental consent was obtained.

Results: A total of 240 children (mean age: 9.5 years male = 60.2%) were included of which 140 children (58.3%) were sensitized to at least one aeroallergen, suggesting atopy. The pattern of sensitizations was as follows: 37.6% were sensitized to >1 allergen, 36.2% to housefly antigen 31.4% to rice grain dust, 18.8% to cockroach, and 8.7% to house dust mite (HDM) antigens. Atopic children had significantly higher median FeNO during follow-up than non-atopic children (37.5 ppb vs 22 ppb, P<0.01). There was a positive correlation between age and the number of allergens that an individual was sensitized to (r= 0.21 P=0.002).

Conclusion: More than half of asthmatic children in our cohort had sensitization to one or more aeroallergens suggesting atopy sensitization was most commonly seen to housefly antigen and rice grain dust. Atopic children had significantly higher FeNO measurements during follow-up as compared to non-atopic children.

Keywords: Asthma, atopy, pediatric, skin prick test, spirometry

Real world evidence on safety and effectiveness of single inhaler triple-therapy (formoterol/glycopyrrolate/budesonide)

Ravi T. Mehta

Zydus Healthcare Limited, Mumbai, Maharashtra, India E-mail: drravi.mehta@yahoo.com

Introduction: Single inhaler triple therapy (SITT) combining Formoterol + Glycopyrrolate + Budesonide (FGB) is commonly utilised in India for manageSITTment of COPD. However, there is paucity of real-world and long-term data with this combination amongst Indian patients. This study was initiated with the objective of bridging this gap in evidence.

Methods: Real-world, prospective, multicentric, observational study involving patients diagnosed with COPD prescribed SITT (FGB DPI [25 mcg/12 mcg/400 mcg] or MDI [9 mcg/4.8 mcg/160 mcg]) at the physician’s discretion and followed for 24 weeks. Outcomes included effectiveness parameters including lung function by spirometry, changes in CAT, mMRC, and CCQ scores, along with adverse events monitoring.

Results: The study enrolled 705 patients across 38 centers throughout the country. There was significant improvement in FEV1 and FVC at week 4, sustained up to week 24. FEV1 improved from 1.24±0.58 litres at baseline to 1.45±0.80 litres at week 4 (mean change 0.21±0.58 P<0.001) and 1.63±0.91 litres at week 24 (mean change 0.39±0.78 P<0.001). FVC improved from 1.96±0.79 litres at baseline to 2.14±0.85 litres at week 4 (mean change 0.18±0.59 P<0.001) and 2.32±1.02 litres at week 24 (mean change 0.37±0.87 P <0.001). CAT score improved from 23.91±7.07 to 14.37±6.47 (P<0.001), Total CCQ reduced from 3.22±1.02 to 1.73±0.80 (P<0.001) along with reduction in mMRC dyspnea grades from 3-4 to 1-2 at week 24, indicating better symptom control, physical functioning, and reduced dyspnea. FGB was well-tolerated - adverse events were noted in 12 patients (1.7%) and included palpitations, dryness of mouth, and tremors.

Conclusion: SITT with FGB effectively reduces symptoms and improves lung function, and quality of life in Indian COPD patients with excellent tolerability.

Current attitudes and practices on triple therapy use in asthma by respiratory specialists

Suman S V , Ashok Jaiswal

Zydus Healthcare Limited, Mumbai, Maharashtra, India E-mail: suman.sv@zyduslife.com

Introduction: Despite updated GINA guidelines endorsing triple therapy (ICS+LABA+LAMA) for patients with uncontrolled asthma on medium/high-dose ICS+LABA, its real-world adoption remains suboptimal due to various practice habits. This study assessed the knowledge, attitude, and practice (KAP) of Indian pulmonologists regarding triple therapy use in asthma management.

Methods: A cross-sectional KAP survey was conducted among 3,136 pulmonologists across India. A 2-stage validated, self-administered questionnaire comprising knowledge-based multiple-choice items, Likert-scale attitude statements, and practice-related frequency questions (30 item) was circulated digitally.

Results: In the study majority of the participants were male (81.2%) and half of the participants had >10years of clinical experience (48.4%). Knowledge scores indicated substantial gaps, with only 39% correctly identifying the GINA definition of difficult-to-treat asthma and 57% aware of the correct indication for triple therapy. However, attitudes revealed a largely positive outlook toward triple therapy over 75% agreed that triple therapy offers superior risk- and cost-benefit compared to oral corticosteroids or biologics, endorsing its cost-effectiveness, steroid-sparing potential, reduction in lung function decline, and appropriateness before biologics. Positive attitudes were observed towards twice-daily triple therapy offering better 24hr symptom-control than once-daily (73%). Meanwhile, they agreed that triple therapy is underutilized in asthma and need greater emphasis in current guidelines. In practice, most pulmonologists reported a significant proportion of patients uncontrolled on ICS+LABA (55% reported 25-75% of their patients uncontrolled). >90% of respondents reported using triple therapy before escalating to biologics or systemic therapies.

Conclusion: Although Indian pulmonologists demonstrate strong attitudes and pragmatic clinical practices regarding triple therapy, critical knowledge gaps and access-related barriers remain. Targeted continuing medical education, improved inhaler availability, and broader dissemination of updated guidelines are essential to ensure optimal asthma control and evidence-based escalation of therapy.

Keywords: Asthma, GINA guidelines, ICS+LABA+LAMA, KAP Survey, triple therapy

Efficacy and safety of novel vilanterol/glycopyrronium/fluticasone furoate inhaler compared to indacaterol/glycopyrronium/fluticasone furoate in asthma

Suman S V

Zydus Healthcare Limited, Mumbai, Maharashtra, India E-mail: suman.sv@zyduslife.com

Introduction: Adding LAMA to ICS/LABA is recommended by GINA guidelines in patients with persistent asthma. This study evaluated the novel once-daily fixed-dose combination (FDC) of vilanterol 12.5 µg, glycopyrronium 25 µg, and fluticasone furoate 100 µg (VIL-GLY-FF) in metered-dose inhaler (pMDI) formulation for the management of asthma.

Methods: This was a Phase 3, multicentre, parallel group, open-label, non-inferiority 12-week study. Patients with asthma uncontrolled with medium or high-dose inhaled corticosteroid (ICS)/LABA were randomized (1:1) into either the test (VIL-GLY-FF pMDI 2 actuations once-daily) or reference (Indacaterol 150µg, GLY 50µg, and mometasone furoate 160µg [IND-GLY-MF one capsule once-daily]) group. The primary efficacy endpoint was the change in trough forced expiratory volume in 1sec (FEV1) at week 12 from baseline. Secondary outcomes included change in trough forced vital capacity (FVC), post-bronchodilator FEV1, FVC, and asthma control test score between the two groups.

Results: The study enrolled 256 patients demographic characteristics were similar across the groups. The primary endpoint, i.e., trough FEV1, improved significantly at week 12 from baseline in VIL-GLY-FF group by 287.15 (18) ml [mean (SE)] and 284.94 (18) ml in the reference group (p = 0.931) with a lower limit of 95% CI above the noninferiority margin. Mean (SD) change in trough FVC at week 12 from baseline was 280.95 (279.85) ml and 276.93 (252.60) ml for the test and reference groups (p=0.905), respectively. There was significant improvement in post-bronchodilator FEV1 and FVC with VIL-GLY-FF and the results were comparable with the reference group. ACT scores improved significantly (7.31 ± 1.94) from baseline by VIL-GLY-FF. No exacerbations were reported during the study. No serious adverse events were reported during the study.

Conclusion: VIL-GLY-FF pMDI was non-inferior to IND-GLY-MF in improving lung function, symptom burden and reducing exacerbations. The combination was well-tolerated in Indian patients with persistent asthma.

Keywords: Asthma, fluticasone furoate, glycopyrronium, triple therapy, vilanterol

Prevalence of aspergillus sensitization and allergic bronchopulmonary aspergillosis in patients with bronchial asthma

Vishal Shukla

King Georges Medical University, Lucknow, Uttar Pradesh, India E-mail: vishal595.vs43@gmail.com

Introduction: Asthma affects nearly 300 million people worldwide, with India contributing a significant share. A substantial subset of asthmatics develops sensitization to Aspergillus fumigatus, which may progress to Allergic Bronchopulmonary Aspergillosis (ABPA) – a condition associated with frequent exacerbations, bronchiectasis, and irreversible lung damage. Data on its prevalence in Indian asthmatics remain limited. Objectives: To determine the prevalence of Aspergillus sensitization and ABPA in patients with bronchial asthma and to evaluate their clinical, radiological, immunological, and spirometric correlations.

Methods: This prospective cross-sectional study was conducted in the Department of Respiratory Medicine, King George’s Medical University, Lucknow. One hundred consecutive adult asthmatic patients (diagnosed per GINA guidelines-2023) were enrolled. Aspergillus sensitization was assessed using skin-prick testing and specific IgE assays. Patients with elevated total IgE and radiological or immunological features were further evaluated for ABPA using ISHAM criteria. Demographic, clinical, spirometric, and CT chest findings were compared between sensitized and non-sensitized groups.

Results: Of 100 asthmatic patients, 38% were sensitized to Aspergillus and 12% fulfilled criteria for ABPA. Sensitized patients were younger (mean age 28.3 vs. 34.1 years, p=0.032) and predominantly urban. High-resolution CT revealed bronchiectasis in 34.2% of sensitized versus 8.1% of non-sensitized patients (p=0.001). Elevated serum IgE (>1000 IU/ml) was significantly associated with sensitization (31.6% vs. 8.1%, p=0.001). Spirometry showed greater impairment in sensitized asthmatics, particularly among smokers and those with dyspnoea. Uncontrolled symptoms were more frequent in sensitized patients (44.7% vs. 19.3%).

Conclusion: The study demonstrates a high prevalence of Aspergillus sensitization (38%) and ABPA (12%) among Indian asthmatics. Sensitized patients exhibited higher IgE levels, more frequent bronchiectasis, and poorer asthma control. Routine screening for fungal sensitization in asthma is recommended to enable early detection and management of ABPA, thereby preventing long-term pulmonary complications.

Keywords: Allergic bronchopulmonary aspergillosis, aspergillus sensitization, asthma, IgE, prevalence, spirometry

Impact of smoking status on the effectiveness of indacaterol/mometasone/glycopyrronium in uncontrolled asthma

Divya Bhojwani , Saiprasad Patil, Hanmant Barkate

Glenmark Pharmaceuticals Ltd., Mumbai, Maharashtra, India E-mail: divya.bhojwani@glenmarkpharma.com

Introduction: Asthma in smokers and ex-smokers is linked to fixed airflow limitation, faster lung function decline, and—among current smokers—reduced steroid responsiveness due to impaired glucocorticoid receptor activity. Triple therapy may help overcome these challenges. This study assessed the impact of smoking status on lung function and symptom control in uncontrolled asthma patients switched to Indacaterol/Mometasone/Glycopyrronium (150/160/50 µg) DPI.

Methods: This is a post hoc analysis of a 12-week, phase IV, prospective, multicentre study conducted across 5 centers in India, following EC approval. Adults with symptomatic asthma (ACQ-5 =1.5) and at least one exacerbation in the previous year, uncontrolled on dual therapy, were switched to IMG DPI and followed for 12 weeks.

Results: Among the 182 patients enrolled, 96 (52.74%) were never smokers, 61 (33.51%) were former smokers, and 25 (13.73%) were current smokers baseline mean trough FEV1 was 1308.2?±?475?mL (51.31?±?10.97% predicted), 1170.8?±?426.9?mL (53.17?±?12.94%), and 1236?±?321.3?mL (55.08?±?8.61%) in these groups, respectively, and after 12?weeks of IMG DPI therapy, significant improvements (p?<?0.001) were observed, with FEV1 increasing to 1806?±?483.2?mL (+497.82?mL), 1573.8?±?528.7?mL (+403?mL), and 1665.6?±?501.7?mL (+429?mL), respectively. Symptom control also improved significantly following treatment, with mean ACQ 5 scores decreasing from 3.01?±?0.53 to 1.53?±?0.49 in never smokers, from 3.34?±?0.45 to 1.96?±?0.61 in former smokers, and from 3.20?±?0.49 to 1.50?±?0.40 in current smokers the largest numerical gain was seen in never smokers. The combination was well tolerated, with AE reported in 13.74% of patients. The most common AEs were cough (3.85%), fever (2.75%) and headache (1.65%), all of which completely resolved.

Conclusion: Switching uncontrolled asthma patients to once-daily IMG DPI improved lung function and symptom control across all smoking subgroups. While gains were greatest in never-smokers, clinically meaningful benefits were also seen in former and current smokers, supporting IMG DPI as an effective triple therapy option regardless of smoking history.

Keywords: Asthma, indacaterol, mometasone, OASIS study, smoking

Real-world demographic insights on FF/UMEC/VI SITT usage in COPD patients across India: Initial analysis

Ronak Panwala , Kamlesh Patel

Lupin Ltd., Mumbai, Maharashtra, India E-mail: ronakpanwala@lupin.com

Introduction: SITT combining Fluticasone Furoate, Umeclidinium, and Vilanterol (FF/UMEC/VI 100/62.5/25 mcg DPI) is relatively newly introduced in India for COPD management and Real-world usage patterns remain unexplored in the Indian context.

Methods: A retrospective, multicenter study was conducted across 2000+ pulmonology centers in India. COPD patients prescribed with FF/UMEC/VI SITT were identified by pulmonologists and data were collected via an EDC platform. Ethics committee approval was obtained. Due to the retrospective nature of study and availability of only limited data, the study focused on age, gender, duration of COPD, and cardiovascular (CV) comorbidities.

Results: Data from 11,996 patients were analyzed. Of these, 66% were male, 34% female. Age distribution: 30% were aged 61–70 years, 25% aged 51–60 years, 25% aged =50 years, 20% aged >71 years. Duration of COPD: 21% had COPD diagnosis of =30 days, 36% had of 1–12 months, 42% had COPD >1 year since initiating FF/UMEC/VI SITT. CV comorbidity was present in 37% patients, with prevalence increasing with age: 54% in >80 years, 44% in 71–80 years, and progressively lower in younger groups, as expected.

Conclusion: FF/UMEC/VI SITT is prescribed to patients across wide age groups, in recently diagnosed as well as known COPD patients, and considerable patients have CV comorbidity. Future prospective studies should be planned for evaluating real world effectiveness and safety of this combination in India.

Keywords: COPD, fluticasone furoate, real-world, SITT, umeclidinium, vilanterol

Level of symptom control and pulmonary function among school children with asthma in Kuttanad, Kerala

Geethu Vinoppan

GMC, Kottayam, Kerala, India E-mail: geethuvinoppan0398@gmail.com

Introduction: Asthma is the leading chronic childhood respiratory disease. Kuttanad, Kerala’s “Rice Bowl,” lies below sea level with recurrent floods, humidity, saline intrusion, and pesticide use. These unique exposures may worsen asthma, yet control and lung function in this region remain under studied.

Methods: A cross-sectional observational study was conducted among 406 school children (aged 10–17 years) with asthma from five schools in Kuttanad. Data were collected using the Asthma Control Test (ACT) questionnaire and spirometry (FEV1, FVC, FEV1/FVC ratio). Environmental exposures, treatment adherence, and inhaler technique were also recorded. ACT scores = 19 were classified as suboptimal control. Descriptive statistics and chi-square tests were used for analysis.

Results: Of the 406 children, 30.5% demonstrated suboptimal asthma control (ACT =19). Mean FEV1% predicted was 82 ± 12, FVC% was 85 ± 11, and mean FEV1/FVC ratio was 0.79 ± 0.06. Cause for suboptimal control was significantly associated with incorrect inhaler technique,poor drug compliance. High prevalence of asthma noted in children with close proximity to paddyfields.

Conclusion: Asthma control among school children in Kuttanad is suboptimal. School-based asthma education, improved access to spirometry, and interventions targeting rural environmental risks are urgently needed.

Keywords: Asthma, children, rural health, spirometry, symptom control

Unmasking the invisible enemy: Clinical, radiological and spirometric profile of patients with dust mite allergy

Kaushani Patel

GCS Medical College and Research Centre, Ahmedabad, Gujarat, India E-mail: kaushi.patel06@gmail.com

Introduction: Dust mite allergy, an IgE mediated Type I hypersensitivity reaction, is an allergic reaction to droppings of dust mites found in household dust. They are indoor aeroallergen which on inhalation trigger allergic symptoms. This activity reviews the evaluation and treatment of dust mite allergy.

Methods: With informed consent, observational cross-sectional study was conducted on 40 patients presenting to a private clinic in city of Ahmedabad, Gujarat having Positive skin prick test to dust mites in correlation with history. The patients were further evaluated with Serum total IgE, CXR-PA View, CT PNS (wherever feasible) and spirometry. The data of patients was collected and analysed. The patients were further counselled for immunotherapy.

Results: Of 40 patients, 24 (60%) were males and 16 (40%) were females. The mean age was 33 years. From history evaluation it was seen 28 (70%) patients had predominant indoor occupation. Most common presenting symptom was running nose (67.5%) followed by sneezing (57.5%) pointing towards predominant allergic rhinitis. The most common dust mite found positive was dermatophagoides pteronyssinus (72.5%). Most common chest X-ray finding was Normal (85%). Most common CT PNS finding was deviated nasal septum (42%). On spirometry, 11 (27.5%) patients had FEV1/FVC<0.7. Further evaluation and statistical correlation between variables to be presented at the conference.

Conclusion: Prevalence of atopic diseases like allergic rhinitis and asthma with house dust mite being allergen has been increasing and hence early diagnosis, evaluation and management can help in controlling and preventing progression of the diseases which in turn can improve quality of life. The collaboration and communication amongst interprofessional team should be emphasized.

Keywords: Allergy, dermatophagoides pteronyssinus, dust mites, rhinitis, spirometry

The prevalence of asthma phenotypes in India

Jefferson Daniel

Christian Medical College, Vellore, Tamil Nadu, India E-mail: jefferson.daniel@cmcvellore.ac.in

Introduction: India accounts for 13.09% of the global asthma burden and 42% of global asthma deaths. However, the distribution and prevalence of asthma phenotypes in Indian populations remains poorly characterized. This ongoing study aims to determine the prevalence and distribution of asthma phenotypes in rural and urban populations of Vellore, India.

Methods: An ongoing cross-sectional study is being conducted in Kaniyambadi Block, Vellore, using a three-step approach: (1) community screening using the European Community Respiratory Health Survey (ECRHS2) questionnaire (2) comprehensive phenotyping including spirometry, fractional exhaled nitric oxide (FeNO), forced oscillation technique, skin prick testing, and biomarker assessment and (3) one-year follow-up. Target recruitment is 922 participants (461 rural, 461 urban) for detailed phenotyping based on sample size calculations for detecting differences in eosinophilic asthma prevalence.

Results: Preliminary findings show urban asthma prevalence (8.36%) is significantly higher than rural prevalence (3.30%). Among the 254 rural participants analyzed, 48.8% had uncontrolled asthma, 57% experienced exacerbations in the past year, and only 37.8% used inhalers. High rates of occupational asthma (12.0%) and work-exacerbated asthma (24.1%) were observed, particularly in brick-making, painting, and stone quarrying industries. House dust mites (13.9%) and cockroach allergens (12.4%) were the most common sensitizing agents. Significant environmental exposures included biomass fuel use (wood: 70%, coal/coke: 25%) during childhood. Mental health comorbidity was substantial, with 65.8% of participants showing some degree of depression.

Conclusion: This interim analysis reveals substantial rural-urban disparities in asthma prevalence and highlights the significant burden of occupational and environmental asthma in rural India. Poor disease control and limited inhaler use indicate major gaps in asthma management. High rates of occupational exposures and biomass fuel use suggest important region-specific risk factors. Complete enrollment and follow-up data collection are ongoing, with final results expected to provide comprehensive insights into asthma phenotype distribution and stability over time in Indian populations.

Keywords: Asthma, eosinophilic, neutrophilic, steroid-dependent

A comparison of skin prick test and serum specific immunoglobulin E in bronchial asthma patients

Prateek Jain , Raj Kumar

Vallabhbhai Patel Chest Institute, Ghaziabad, Uttar Pradesh, India E-mail: drprateekjain23@gmail.com

Introduction: Sensitization can be demonstrated in vivo, by skin prick test (SPT) or in vitro, by serum specific IgE (sSIgE) assay. We aimed to compare accuracy of sSIgE by ELISA based Indian kit compared to SPT as gold standard for allergen sensitization in BA patients.

Methods: This cross-sectional observational study included 103 stable, newly diagnosed bronchial asthma patients at V.P. Chest Institute (2024–2025). Patients’ detailed history and demographics were recorded, followed by skin prick testing (SPT) and ELISA-based sSIgE testing done with Vitrotest ® Indian allergen kit against a panel of selected aeroallergens. Correlation between SPT and sSIgE was assessed using kappa agreement and correlation coefficients. Sensitivity and specificity of sSIgE were compared with SPT as gold standard.

Results: Indoor allergens like House dust mite(HDM), cockroach, mosquito, house fly, and moth showed higher positive SPT rates. sSIgE levels were moderate to very high for cockroach and house fly, Moderate kappa agreement was found for HDM, mosquito, house fly, and brassica. sSIgE for HDM, cockroach, and silk had high sensitivity and Negative predictive value(NPV) but lower specificity and positive predictive value (PPV). Strong positive correlations existed between SPT and sSIgE for several allergens, especially Alternaria and Aspergillus flavus.

Conclusion: Sensitivity of sSIgE was good for most allergen but specificity was low. sSIgE done by Indian kits showed good correlation with SPT in diagnosing sensitization. Hence sSIgE testing may be a good alternative to SPT if the latter can’t be carried out.

Keywords: Bronchial asthma, diagnostic accuracy, house dust mite, serum specific IgE, skin prick test

Bronchopulmonary Infections: Soluble triggering receptor expressed on myeloid cells-1 as a prognostic biomarker of mortality in ventilator-associated pneumonia: A prospective observational study

Bhargav Naik K B , Mahesh P A, Jayaraj B S

JSS Medical College and Hospital, Mysuru, Karnataka, India E-mail: bhargavnaikkb111@gmail.com

Introduction: Ventilator-associated pneumonia (VAP) remains a major cause of morbidity and mortality in intensive care units (ICUs). Soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), an inflammatory mediator released by neutrophils and monocytes, has emerged as a potential biomarker. However, its prognostic role in VAP is not well established.

Methods: This prospective observational study was conducted in a tertiary care ICU in southern India. Eighty adult VAP patients were enrolled (40 survivors, 40 non-survivors). Clinical data, APACHE II scores, inflammatory markers (CRP, procalcitonin, D-dimer, albumin), and oxygenation indices were recorded. Serum sTREM-1 was measured within 24 hours of VAP diagnosis using ELISA. Statistical analyses included ROC curves, Cox regression, and Kaplan-Meier survival analysis.

Results: Non-survivors had significantly higher sTREM-1 levels than survivors (17.3 ± 11.2 vs. 7.2 ± 7.2 pg/mL, p < 0.001). sTREM-1 positively correlated with CRP, D-dimer, and APACHE II scores, and negatively with PaO2/FiO2 and albumin. ROC analysis showed good prognostic accuracy for sTREM-1 (AUC 0.800), similar to APACHE II (AUC 0.825). Combining sTREM-1 with APACHE II improved prognostic value (AUC 0.945). Kaplan-Meier analysis showed reduced survival in patients with sTREM-1 >9.5 pg/mL (mean 20.8 vs. 51.2 days, p < 0.001).

Conclusion: sTREM-1 is a promising early prognostic biomarker in VAP. When combined with APACHE II, it enhances risk stratification and may guide ICU management.

Keywords: Prognostic biomarker, sTREM-1, ventilator-associated pneumonia

*This article was selected for NAPCON 2025 best research award presentation.

Descriptive study on risk factors for post tubercular chronic pulmonary aspergillosis

Sriharsha Voleti , Arghadip Samaddar, Payel Pramanik

SDS TRC and Rajiv Gandhi Institute of Chest Diseases, Bengaluru, Karnataka, India E-mail: harshavoleti3@gmail.com

Introduction: Chronic pulmonary aspergillosis (CPA) is a major long-term complication following pulmonary tuberculosis (TB) in high-burden countries. Early identification of at-risk patients is critical, yet often delayed due to nonspecific clinical features. This study was done to to describe the clinico-radiological profile and to assess the risk factors for CPA in post TB patients.

Methods: We conducted a descriptive cross-sectional study among post-TB patients evaluated for CPA. Diagnosis was supported by immunochromatographic test (ICT) and Calcofluor white stain microscopy. Patients were classified as CPA positive if either test was positive. Data on demographics, comorbidities, laboratory values, clinical and radiological findings were analyzed. Statistical comparisons between CPA-positive and CPA-negative groups were performed using chi-square and t-tests.

Results: Of 104 patients screened, 71 (68.2%) were CPA positive. The mean age was 51.6 years (median 50 range 27–82), with a male-to-female ratio of approximately 3:1. Hemoptysis was significantly associated with CPA positivity (Odds Ratio = 3.34, 95% CI: 1.19 - 9.38, p = 0.0221), making it a strong clinical indicator for CPA. Fungal ball (38 CPA-positive vs. 13 CPA-negative) and Pleural thickening (36 CPA-positive vs. 17 CPA-negative) were more frequently observed in CPA-positive patients, but these findings were not statistically significant (p > 0.05). Comorbidities were frequent: diabetes mellitus was significantly associated with CPA (p = 0.04), as was alcohol use (p = 0.02) and smoking (p = 0.07) was not statistically significant, though smoking showed a trend toward association. Laboratory analysis showed that CPA positives had a higher ESR (69.2 vs. 59.3 mm/hr, p = 0.03), while hemoglobin (p = 0.98) and serum albumin (p = 0.45) did not differ significantly between groups.

Conclusion: This study highlights the risk factors of post TB CPA and determines the commonest clinical symptoms and radiological findings associated with it. It also underscores the need for combining clinical, imaging and laboratory investigations in improving early recognition of the condition.

Keywords: Chronic pulmonary aspergillosis, post tuberculosis, risk factors

*This article was selected for NAPCON 2025 best research award presentation.

Clinicoradiological profile of people living with HIV infection having CD4 count below 100 with respiratory complaints

Viji Sundar C , Swapna, Anushree Chakraborthy

SDS TRC and Rajiv Gandhi Institute of Chest Diseases, Bengaluru, Karnataka, India E-mail: vijisundarc6@gmail.com

Introduction: Acquired immunodeficiency syndrome (AIDS) is a multi-system disorder affecting various organs of the body at various stages of the disease. Lower respiratory tract infections are the most frequent respiratory diseases among PLWH having CD4 counts less than 200. Aim: To study the clinico-radiological profile and etiology of PLWH having CD4 count below 100 with respiratory complaints.

Methods: This is a retrospective cross-sectional study conducted in the Department of pulmonary medicine SDS TRC and RGICD between the time period of JULY 2024 -JULY 2025 where PLWH having CD4 count less than 100 with respiratory symptoms were enrolled, medical records of these patients reviewed for demographic, clinical and radiological data. Descriptive statistics were applied, and results presented as mean with standard deviation and percentage.

Results: Out of 30 patients enrolled for the study, 19 were previously diagnosed RVD cases out of which 13 were on regular ART. Mean age of presentation was 41.2 years and males comprised 73.3%. Mean duration between the diagnosis of HIV and first respiratory symptom was 22 months. Cough (98%) was the most common presenting symptom. Infective etiology was identified in 80% cases in which the most common cause was Pneumonia in 40% [viral (41.6%), bacterial (33.3%), and fungal (25%)] cases followed by pulmonary Tuberculosis in 26.66% and Bronchiectasis in 13.3%. Non-infective etiology was present in the 20% cases like OSA OAD overlap syndrome in 50%, COPD in 33.33%, and Pneumothorax in16.66%. On radiology most common presentation was consolidation 80% followed by 40% Ground glass opacites and 11% had nodules.

Conclusion: The study found that infective etiology was the most common cause, with Mycobacterium tuberculosis being the primary causative agent, and consolidation as the most frequent radiological feature.

Keywords: Acquired immunodeficiency syndrome, COPD, OSA OAD, PLWH

Real-world multicenter retrospective study evaluating the effectiveness and safety of cefotaxime in hospitalized respiratory tract infection patients

Ajitkumar Gondane , Dattatray Pawar, Akhilesh Sharma

Alkem Laboratories, Mumbai, Maharashtra, India E-mail: ajitkumar.gondane@alkem.com

Introduction: Respiratory tract infections (RTIs) are a major cause of hospitalization, often requiring rapid antimicrobial intervention. Cefotaxime, a third-generation cephalosporin, is widely used for their treatment. This study evaluated its real-world effectiveness and safety in hospitalized RTI patients.

Methods: This multicenter, retrospective analysis reviewed medical records of hospitalized RTI patients treated with cefotaxime. Data included illness duration, treatment days, hospitalization, dosing, bacterial isolates, clinical outcomes, and adverse events. Assessments were made during therapy, at the end of therapy, and at post-treatment follow-up (where available). Patients with incomplete records were excluded. Descriptive statistics were applied.

Results: A total of 6,425 patients were analyzed. Mean illness duration was 7.1 ± 3.0 days cefotaxime was administered for 6.0 ± 0.8 days, with hospitalization averaging 6.6 ± 1.0 days. The mean daily dose was 1.98 g, and 86.64% received twice-daily dosing. Among 412 microbiologically assessed samples during therapy, S. pneumoniae (31.6%) and S. pyogenes (26.7%) were most common. Their prevalence declined to 31.4% and 26.8% at the end of therapy, and to 36.1% and 30.6%, respectively, at follow-up among 36 samples. Clinical cure was achieved in 78.97% at end of therapy and 95.53% at follow-up, with most others improving. No major adverse events were reported.

Conclusion: Cefotaxime remains an effective and well-tolerated option for hospitalized patients with RTIs, providing high cure rates, sustained pathogen reduction, and favorable safety outcomes.

Keywords: Clinical cure, real-world evidence, respiratory tract infection, retrospective, streptococcus pneumoniae, streptococcus pyogenes

Pulmonary mucormycosis: Clinical spectrum, diagnostic challenges and outcomes from a tertiary care

Kona Lakshmi Chermisha Naidu , Viswesvaran Balasubramanian, P. Navneeth Sagar Reddy

Yashoda Hospitals, Hyderabad, Telangana, India E-mail: lakshmichermisha2608@gmail.com

Introduction: Pulmonary mucormycosis is an uncommon but life-threatening invasive fungal infection, often misdiagnosed due to its nonspecific clinical and radiological features. The recent surge in cases, particularly among patients with diabetes and post-COVID-19 sequelae, underscores the need for better clinical characterization.

Methods: We retrospectively reviewed the records of 15 patients with histopathologically confirmed pulmonary mucormycosis at Yashoda Hospitals, Hyderabad from January 2024 to January 2025. Demographic details, comorbidities, presenting complaints, radiologic findings, diagnostic techniques, treatment, and clinical outcomes were systematically evaluated.

Results: The mean patient age was 48.7 years (range: 35–60), with a male predominance (85.7%). Diabetes mellitus (64%) was the leading comorbidity. The most common presenting symptoms were cough (50%), fever (36%), and hemoptysis (29%). Radiological findings were heterogeneous, including cavitary lesions, consolidations, and nodular opacities, frequently mimicking tuberculosis or malignancy. Diagnosis was established using bronchoscopic cryobiopsy, bronchoalveolar lavage (BAL), CT-guided biopsy, and histopathology. All patients received amphotericin B-based therapy, some required combined surgical management. At follow-up, 57% achieved recovery, 21% remained on treatment, and one patient (7%) succumbed to the disease.

Conclusion: Pulmonary mucormycosis predominantly affects middle-aged diabetic men and often masquerades as other pulmonary diseases. Our series highlights the importance of maintaining a high index of suspicion in at-risk populations and demonstrates the utility of minimally invasive diagnostic modalities such as cryobiopsy and bronchoalveolar lavage in establishing early diagnosis.

Serum heparin binding protein as a biomarker to determine severity of community acquired pneumonia

Mohit R V , Vivek, Jayaraj B S, Mahesh P A

JSS Medical College, Mysuru, Karnataka, India E-mail: rvmohit03@gmail.com

Introduction: Community-acquired pneumonia (CAP) is a serious worldwide health problem with substantial morbidity and mortality. Timely risk is essential to successful management. Predictive performance of conventional scores like CURB-65, PSI is still suboptimal. Heparin Binding Protein (HBP), a new neutrophil-derived biomarker, has emerged as a potential biomarker for disease severity and endothelial dysfunction in infectious diseases.

Methods: Hospital-based observational study was carried out for 18 months at JSS Hospital, Mysuru. Seventy-five participants were enrolled and stratified into three groups: mild-moderate CAP (n=25), severe CAP (n=25), and healthy controls (n=25). Clinical data and PSI scores, and levels of serum biomarkers (HBP, CRP, PCT, D Dimer and Albumin) were noted. Statistical analyses involved ANOVA, ROC curve analysis, and correlation tests to evaluate the prognostic accuracy of HBP and comparison with conventional biomarkers was done.

Results: HBP concentration was increased significantly in CAP cases as compared to controls. In comparison with conventional biomarkers, HBP proved to be more specific and predictive of CAP severity, ICU admission and need for ventilatory support. HBP concentration correlated well with PSI Score. The combination of HBP with hematological parameters like TLC, NLR and PLR allowed further enhancement of prognostic performance.

Conclusion: Serum HBP is a sensitive and early biomarker for the identification of severity of CAP and the prediction of clinical outcomes. Its incorporation into the diagnostic process may improve early intervention and personalized care, thus improve patient prognosis.

Keywords: Biomarkers, community-acquired pneumonia, disease severity, heparin binding protein, ICU admission

Pulmonary manifestations of scrub typhus

Lisa Mukherjee , Saswat Subhankar, Amrut Kumar Mohapatra

Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India E-mail: mukherjee.lisa.1997@gmail.com

Introduction: Scrub typhus is an infectious disease caused by Orientia tsutsugamushi (formerly classified under the genus Rickettsia) and is transmitted to humans by arthropod vectors from the Trombiculidae family. Pulmonary manifestations, both clinical and radiological, of the disease are varied. The incidence of chest radiographic abnormalities in these patients ranges from 59% to 72%. Common radiological findings reported include bilateral diffuse reticulo-nodular opacities, hilar lymph node enlargement, and interstitial pneumonia. Our study aimed to determine the various clinical and radiological manifestations in patients affected with the disease.

Methods: The study was done in the Department of Respiratory Medicine, KIMS. Retrospective study of patients diagnosed with scrub typhus (based on IgM IFA test) and admitted between June 2023 and May 2024 was done. Clinical presentation, laboratory values, radiographic abnormalities, and outcomes of treatment were recorded. Continuous variables were presented as mean ± standard deviation and categorical variables as percentages.

Results: The study included 100 patients who were scrub typhus IgM positive. The median age of the patients was 38 years. Among them, 38 (38%) patients had pulmonary manifestations. Fever was the most common complaint (100%) followed by cough (46.4%) and shortness of breath (14.3%). Abnormal chest imaging results were found in 37% of the 100 patients. Bilateral pleural effusion (67.5%) was the most frequent abnormality followed by ground-glass opacities (40.5%) and consolidation (24.3%).

Conclusion: Pulmonary involvement in scrub typhus is an important cause of morbidity and mortality. With its nonspecific presentation, increased clinical suspicion is important for the early diagnosis. The finding of raised CRP levels, pleural effusion, and ground-glass opacities should lead to consideration of scrub typhus in febrile patients with respiratory illness. Enhanced awareness and research are necessary to improve diagnostic and therapeutic approaches.

Keywords: Pleural effusion, radiology, scrub typhus

COPD with bronchiectasis versus COPD without bronchiectasis: A comparative analysis

Lakshmi Parameswaran

PGIMER and CH, Khordha, Odisha, India E-mail: lakshmiparameswaran96@gmail.com

Introduction: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality around the world. Understanding the presence of bronchiectasis in COPD is important for future intervention and disease prevention.

Methods: One hundred and sixty patients (151 men and 09 women) registered in the OPD of the Department of Respiratory Medicine, PGIMER and Capital Hospital, Bhubaneswar between January 2024 to June 2025 (6 months) were enrolled in this study. These patients were classified into two groups: Group I (COPD without bronchiectasis) and Group II (COPD with bronchiectasis). The parameters considered for both the groups were the history of hospitalizations and number of exacerbations in the previous year, quality of life, auscultatory findings and Blood investigations. Chest radiology were reviewed to evaluate the presence or absence of bronchiectasis. Spirometry results and sputum culture were also recorded.

Results: Of the 160 patients assessed 105 (65.62%) were diagnosed to have COPD alone and 55 (34.38%) had bronchiectasis along with COPD. Spirometry test showed that FEV1 /FVC ratio < 0.7 in all COPD patients with bronchiectasis. The mean FEV1 was 53.54% and 39.01% respectively, in patients with and without bronchiectasis.

Conclusion: COPD exacerbations in patents with comorbid bronchiectasis is associated with more bacteriological load, an increase in both local and systemic inflammation and worse exacerbation course.

Keywords: Bronchiectasis, chronic obstructive pulmonary disease, exacerbation, systemic inflammation

Role of expanded A-DROP score in predicting 14-day mortality in patients with community-acquired pneumonia

Reshma Prakash

ABVIMS and Dr. Ram Manohar Lohia Hospital, New Delhi, India E-mail: reshmaprakash52608@gmail.com

Introduction: Community-acquired pneumonia causes substantial mortality. While CURB-65, A-DROP, and PSI have limitations, the Expanded A-DROP integrates clinical and biochemical markers, showing promise for improving early mortality prediction and supporting need for its validation in Indian hospital settings.

Methods: This prospective observational study at a North Indian tertiary centre (March 2024–June 2025) enrolled 80 adults with CAP. Expanded A-DROP scores were calculated within 24 hours of admission. Patients were followed for ICU admission, in-hospital and 14-day post-discharge mortality. Statistical analyses included One-Way ANOVA, Chi-square, logistic regression, and ROC curve, with significance set at p<0.05.

Results: Among 80 patients, 22 (27.5%) died within 14 days. Mortality was 1/23 (4.3%) in Group I (0–2), 2/22 (9.1%) in Group II (3–4), and 19/35 (54.3%) in Group III (=5) (p<0.001). ICU admission occurred in 1/23 (4.3%), 8/22 (36.4%), and 25/35 (71.4%) respectively (p<0.001). Mean (SD) hospital stay increased with severity: 4.0 (0.9) days, 7.0 (1.1) days, and 9.0 (1.3) days (H=22.02, p<0.0001). Length of stay correlated positively with increasing score (Spearman coefficient: ?=0.53, p<0.000001). ROC analysis showed an AUC of 0.871 (95% CI: 0.783–0.958). A score =5 predicted mortality with 86.2% sensitivity and 72.4% specificity. Multivariate regression confirmed Expanded A-DROP as the only independent predictor (OR 3.07, p<0.001).

Conclusion: The Expanded A-DROP score is a simple, clinically relevant, and effective tool for early risk stratification in CAP.

Keywords: 14-day mortality, community-acquired pneumonia, expanded A-DROP, prognostic scoring, risk stratification

Clinico-radiological and microbiological profile of pleuro-pulmonary infections in patients with hematologic malignancies

Purnima Kadel , Prakas Kumar Mandal

Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India E-mail: drpurnima.kadel@gmail.com

Introduction: Infection is the leading cause of morbidity and mortality in leukemias and lymphomas, with pneumonia being the most frequent complication, especially in neutropenic patients. The objective is to look for clinico-radiological and microbiological profile of pleuro-pulmonary infections in patients with hematological malignancies.

Methods: This cross-sectional descriptive study included patients fulfilling inclusion and exclusion criteria. Data were analyzed using SPSS.

Results: Among 80 patients (55 male, 25 female), 14 (17.5%) had AML, 38 (47.5%) ALL, 22 (27.5%) lymphoma, and 6 (7.5%) multiple myeloma. Common presenting symptoms were cough (33%), fever (23%), and expectoration (15.3%). HRCT showed consolidation (36.7%) and GGO (15.6%) as the most frequent findings. ANC was =1500 in 46.3% 13.8% each had 1000–1499, 500–999, and 200–499 while 12.5% had <200. Blood cultures grew CONS (5%), E. coli (3.8%), Acinetobacter baumanii (2.5%), MRSA (2.5%), Pseudomonas (2.5%), Candida auris (2.5%) and C. tropicalis (1.3%). Sputum cultures revealed Klebsiella pneumoniae (12.5%), Acinetobacter (3.8%), E. coli (2.5%), S. aureus (1.3%), Enterobacter (1.3%), and M. tuberculosis (1.3%). Of 11 patients undergoing bronchoscopy, BAL culture was positive in 2 (18.2%), both Acinetobacter. No significant association was found between clinical features, radiology, organism isolated, and diagnostic groups. Significant associations were observed between neutropenia and diagnostic groups (p=0.003), and between neutropenia and organisms isolated from blood (p=0.000).

Conclusion: ALL was most often associated with severe neutropenia, while lymphoma and myeloma preserved counts, and AML showed mixed patterns. Acinetobacter was the most frequent pathogen, even among non-neutropenic patients. Other organisms occurred predominantly in patients with ANC <1000, highlighting the link between neutropenia and opportunistic infections.

Keywords: Acinetobacter, ALL, AML, ANC, HRCT, lymphoma, myeloma

*This article was selected for NAPCON 2025 best research award presentation.

Impact of multiplex PCR panel testing of lower respiratory secretions in shortening antibiotic duration and hospitalization in hospitalized pneumonia patients

Muhammed Anjoom

Rajagiri Hospital, Kochi, Kerala, India E-mail: anjoommuhammed786@gmail.com

Introduction: Multiplex PCR testing (mPCR) has emerged as a useful diagnostic tool in pneumonia. Indian evidences on the ability of mPCR testing to decrease antibiotic exposure and hospital stay are limited. Aim: To evaluate the microbial yield of the FAPP panel in hospitalised adult patients with pneumonia. To study impact of multiplex PCR pneumonia panel with respect to the turnaround time of test results, ability to deescalate antibiotics and length of hospital stay as compared to conventional culture results.

Methods: This is a single centre longitudinal prospective observational study. All hospitalised pneumonia patients in whom lower respiratory samples were subjected to both multiplex PCR panel and conventional bacterial culture were studied. Time taken for culture positivity as well as FAPP results was documented. Antibiotic de-escalation potential with FAPP results was compared with that of culture results. Overall days of antibiotic usage and length of hospital stay was compared with FAPP positive cases versus culture positives.

Results: 103 patients with pneumonia were studied. The FAPP detected at least one pathogen in 92/103 of tested specimens, yielding an overall positivity rate of 89.3%. 56 (54.3%) additional specimens were positive with FAPP when compared to culture. The mean duration of antibiotic therapy in FAPP positive cases was 4.89 ± 1.84 days versus 7.2 ± 3.83 days (p value 0.019). Similarly, the duration of hospital stay in FAPP positive cases versus negative cases were 5.136 ± 1.73 days versus 7.6 ± 3.36 days respectively (p value 0.007).

Conclusion: FAPP has better yield, faster turnaround time than conventional culture. This translates to reduced days of antibiotic exposure and shorter hospital stay.

*This article was selected for NAPCON 2025 best research award presentation.

Determinants and clinical outcomes of late-onset ventilator-associated pneumonia in a tertiary care center

Nensi Singh , Animesh Dubey, Sharad Singour

L. N. Medical College and J. K. Hospital, Bhopal, Madhya Pradesh, India E-mail: amazingkhushboo@gmail.com

Introduction: Late-onset ventilator-associated pneumonia (LVAP) is a significant healthcare-associated infection that contributes to substantial morbidity, mortality, and healthcare costs in intensive care units (ICUs). This study aimed to identify the determinants of LVAP, microbial profile, and clinical outcomes among mechanically ventilated patients in a tertiary care hospital.

Methods: A 1:1 matched case-control study was conducted over 12 months in the ICU of JK Hospital and LN Medical College, Bhopal. A total of 130 patients (65 cases with LVAP and 65 controls without LVAP) were included. Cases were defined as patients who developed pneumonia 96 hours or more after intubation. Controls were matched based on APACHE II score and duration of mechanical ventilation. Data on demographics, clinical history, risk factors, microbiological findings, and outcomes were collected and analyzed.

Results: The key risk factors for LVAP included re-intubation (16.4% vs. 3.6% p = 0.018), and bacteremia (27.1% vs. 5.0% p = 0.001). Patients with LVAP had a longer median duration of mechanical ventilation (p < 0.001) and ICU stay (p = 0.046). Mortality was significantly higher in LVAP cases (27.1% vs. 14.3% p = 0.022). The most common pathogens were Klebsiella spp. (41.5%), Enterobacter (32.3%) and Pseudomonas spp. (18.5%), with 59% of cases involving MDR organisms.

Conclusions: LVAP is associated with significant risk factors, predominantly MDR Gram-negative bacteria, and worse clinical outcomes. Effective preventive strategies, early diagnosis, and targeted antibiotic therapy are critical to improving patient outcomes and reducing the burden of LVAP in ICUs.

Keywords: Intensive care unit, mechanical ventilation, multidrug-resistant pathogens, ventilator-associated pneumonia

*This article was selected for NAPCON 2025 best research award presentation.

Mean platelet volume and red cell distribution width as markers in community acquired pneumonia

Pooja Meena

SMS Medical College, Jaipur, Rajasthan, India E-mail: meenapooja17398@gmail.com

Introduction: Community-acquired pneumonia (CAP) remains a significant cause of morbidity and mortality globally. Conventional scoring systems such as CURB-65 and PSI help assess severity but have limitations. This study evaluated the role of Delta Mean Platelet Volume (DELTA MPV) and Red Cell Distribution Width (RDW) as prognostic markers in CAP. Objectives: To assess the utility of DELTA MPV and RDW in predicting CAP severity and correlate these with established scoring systems.

Methods: A prospective observational analytical study was conducted on 120 consecutive CAP patients at the Institute of Respiratory Diseases, S.M.S. Medical College, Jaipur, over a 12 month period. Data on clinical parameters, laboratory values (DELTA MPV, RDW), CURB-65 and PSI scores were collected. Outcomes were compared between survivors and non-survivors.

Results: The mean age of non-survivors was significantly higher than that of survivors (60 vs. 48 years). DELTA MPV and RDW were significantly elevated in non-survivors. DELTA MPV showed stronger correlation with CURB-65 (r=0.40) and PSI (r=0.38) compared to RDW. Multivariate analysis revealed DELTA MPV as the most significant independent predictor of mortality (OR 3.29), followed by PSI and RDW. ROC analysis confirmed DELTA MPV >3.13 fL as a strong predictor of mortality (AUC 0.87).

Conclusion: DELTA MPV and RDW are cost-effective, readily available hematological parameters that enhance prognostic accuracy in CAP. Integration of DELTA MPV with clinical scores may improve early risk stratification.

Keywords: Community-acquired pneumonia, CURB-65, mean platelet volume, prognostic marker, PSI, red cell distribution width

*This article was selected for NAPCON 2025 best research award presentation.

Role of neutrophil to lymphocyte ratio as a prognostic marker in community acquired pneumonia

Sravani Udayagiri , K. VenkataRamana

Andhra Medical College, Visakhapatnam, Andhra Pradesh, India E-mail: udayagirisravani123@gmail.com

Introduction: Community-acquired pneumonia (CAP) is a significant infectious disease requiring hospitalization. Existing severity scores like CURB-65 and Pneumonia Severity Index (PSI) do not assess the host inflammatory response, which is crucial in prognosis.

Methods: A prospective observational study was conducted on 50 CAP patients at GHCCD, Visakhapatnam, over 4 months. Neutrophil to Lymphocyte Ratio (NLR) and CURB-65 scores were calculated on admission. Oxygen support, intubation needs, and mortality were documented.

Results: Patients with NLR >7 had longer hospital stays (15.92 ± 6.72 days) compared to NLR <7 (9.66 ± 5.52 days). Higher mortality correlated with NLR >7 and CURB-65 score =3. Area under curve (AUC) for predicting mortality was 0.897 for NLR, 0.92 for CURB-65, and 0.94 for their combination. Elevated NLR reflects systemic inflammation characterized by neutrophilia and lymphocytopenia due to infection. Combining NLR with CURB-65 enhances prediction accuracy for in-hospital mortality, outperforming either marker alone.

Conclusion: NLR is a simple, promising prognostic marker for CAP severity and mortality. Combined use of NLR and CURB-65 improves mortality prediction over individual scores. Larger multicentric studies are recommended.

Keywords: Community-acquired pneumonia, CURB-65, mortality prediction, neutrophil to lymphocyte ratio, prognostic marker

*This article was selected for NAPCON 2025 best research award presentation.

To estimate the prevalence of pulmonary hypertension and it’s correlation with severity of bronchiectasis

Nupur Khanna

Institute of Respiratory Disease, SMS Hospital, Jaipur, Rajasthan, India E-mail: nupurkhanna28@gmail.com

Introduction: Bronchiectasis is progressive structural lung disease characterized by permanent dilation of airway. This disease is increasing in Prevalence with considerable morbidity and low mortality. The FACED score is a very simple multilevel system for evaluating the initial severity and prognosis of patients with bronchiectasis by embracing the various clinical, functional, radiological and microbiological aspects characteristic of the disease. One of the frequent complications encountered with bronchiectasis is pulmonary hypertension (PH), which occurs due to hypoxic pulmonary vasoconstriction and destruction of pulmonary bed leading to increase in pulmonary artery pressure. Bronchiectasis subjects with PH has worst survival so early evaluation and therapy is crucial.

Methods: This descriptive cross-sectional study was conducted in department of respiratory medicine SMS medical college Jaipur from august 2024 to July 2025. The study included 60 patients attending institute of respiratory diseases Jaipur and each patient was subjected to Chest X-ray Computed Tomography, ECG, 2D Echocardiogram, PFT and Sputum examination. Statistical analysis was performed using Pearson Chi-square Test with a p-value <0.05 considered significant.

Results: Out of 60 patients included in the study 38 [63.33%] were females and 22 [36.67%] were males. History of tuberculosis was present in 75% of cases. On Echocardiography it was found that 32 subjects had PH with prevalence of 53.33%. Prevalence of PH was more in moderate and severe bronchiectasis with 73.91% and 66.67% respectively. Analysis showed there was a positive correlation (r=0.67) between severity of bronchiectasis and prevalence of pulmonary hypertension {p-value<0.05}.

Conclusion: Presence of pulmonary hypertension in bronchiectasis patients is associated with poor prognosis and its prevalence increases with severity of bronchiectasis therefore to improve the overall survival and QOL it should be diagnosed and managed appropriately.

Keywords: Bronchiectasis, FACED score, mMRC grading, pulmonary hypertension

Bronchoscopy driven diagnosis of invasive pulmonary aspergillosis: Our experience at a tertiary care

Komal Shah , Bhavik Shah

Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik, Maharashtra, India E-mail: komaljasani@yahoo.com

Introduction: Invasive Pulmonary Aspergillosis (IPA) is a severe and potentially fatal respiratory infection predominantly caused by Aspergillus fumigatus and other species like flavus, niger, and terreus. It primarily affects individuals with compromised immune defences, such as those undergoing chemotherapy, hematopoietic stem cell or solid organ transplantation, or receiving long-term corticosteroid therapy.

Methods: Study Design and Setting This prospective observational study was conducted in the Department of Respiratory Medicine at a tertiary care centre between March 2024 and February 2025. Study population a total of 22 patients diagnosed as Invasive Pulmonary Aspergillosis (IPA) were included based on predefined criteria. Treatment and Follow-up All confirmed cases of IPA were treated with systemic antifungal azoles specifically posaconazole or voriconazol typically for a duration of 6–8 weeks.

Results: A total of 22 patients diagnosed with Invasive Pulmonary Aspergillosis (IPA) were included in the study. The most common predisposing factors were immunocompromised status and sepsis. Notably, two patients (9%) had no identify able immunosuppressive condition, suggesting that IPA can occasionally occur in apparently immunocompetent individuals. The clinical presentation was predominantly subacute, with fever, cough, and breathlessness reported by the majority of patients. In addition, 45% of patients exhibited constitutional symptoms such as weight loss and decreased appetite. Radiological imaging revealed consolidations with ground-glass opacities (GGOs) in 86% of cases, while only 27% demonstrated the classical cavitary lesions typically associated with IPA. The diagnosis of IPA was established using various modalities. The bronchoalveolar lavage (BAL) galactomannan assay was positive in 17 patients (77.3%), making it the most frequently employed diagnostic tool.

Conclusion: Bronchoscopy, with the aid of BAL and targeted biopsy, remains an indispensable tool in the early diagnosis of Invasive Pulmonary Aspergillosis, particularly in patients with non-specific clinical and radiologic features. This study reinforces the diagnostic utility of BAL galactomannan, along with culture and histopathological analysis, in establishing IPA in a diverse patient population.

DPLD and Pulmonary Circulation Including Pulmonary Rehabilitation: Cardiovascular complications in patients with interstitial lung disease and their correlation with 6-minute walk test and spirometry

Gyanendra Kumar Nanda

SCB Medical College, Cuttack, Odisha, India E-mail: gyanendrananda96@gmail.com

Introduction: The term “interstitial lung diseases” (ILD) refers to an array of disorders that diffusely disrupt the lung parenchyma.. Advanced fibrosis may cause prolonged hypoxemia, leading to pulmonary hypertension and right heart dysfunction. Early identification and comprehensive evaluation of cardiovascular involvement in ILD are essential for optimizing patient management and improving clinical outcomes. Aims: To study cardiovascular manifestation in patients with ILDs.

Methods: This study is a prospective observational study that included patients with Interstitial Lung Disease (ILD) among 50 patients aged more than 18 years. Extensive history, thorough clinical examination, routine blood investigations, chest x-ray PA-view, ECG was done followed by HRCT Thorax. Then the patients were subjected to spirometry and 6-minutes walk test followed by 2D-Echocardiography.

Results: Among 50 patients majority were females (70%). CTD were found to be the most common cause of ILD (58%) followed by HP and IPF. On examination of the Cardiovascular Systems loud P2 was heard in 13 (26%) patients, all of them are having pulmonary hypertension. The reticular pattern was the most common radiographic feature, observed in 43 (86%) cases. Cardiomegaly was seen in 14%, indicating possible cardiac involvement. 6 patients (12%) had other findings such as pleural effusion, hyperinflation, and dilated pulmonary trunk. A total of 22 patients (44%) had cardiac manifestations. The most common finding was Pulmonary Hypertension / Tricuspid Regurgitation found in 15 patients (30%) followed by Mitral Regurgitation found in 8 patients (16%) and Pericardial Effusion in 4 patients (8%). The mean PASP in ILD patients without PH was 21.97 mmHg (± 4.46), whereas the mean PASP in ILD patients with PH was 54.8 mmHg (± 10.72). All patients with severe PH walked less than 250 meters. Patients with moderate PH had significantly lower 6MWD compared to those with mild PH or no PH.

Conclusion: Clinicians should suspect cardiac complication, when patients symptoms are disproportionate to the severity of ILD and when exercise limitation is disproportionate to lung volume abnormality along with prominent arterial oxygen desaturation occurs during exercise. In our study 2D Echo assessment of all cases suggest high prevalence of pulmonary hypertension. Moreover, functional and physiological tests such as 6MWT and Spirometry have been extensively utilized in ILD.

Keywords: 6-min walk test, cardiovascular complication, interstitial lung disease

*This article was selected for NAPCON 2025 best research award presentation.

Clinico-radiological evaluation of interstitial lung disease and correlation with bronchoalveolar lavage cytology

Sarada Prasad Bal

SCB Medical College, Cuttack, Odisha, India E-mail: sardareloaded@gmail.com

Introduction: Interstitial Lung Disease (ILD) is a group of disorders characterized by different degrees of lung parenchymal fibrosis and inflammation sharing some similarities in the clinical, radiological, physiological, and pathological features. Work-up for connective tissue diseases (CTDs) is an important component of evaluation of a patient with ILD. Overall, ILD has been documented in up to 15% of patients with CTD. Aims and Objectives: We aimed to study the clinico-radiological presentation of CTD-ILDs and correlate the bronchoalveolar lavage (BAL) cytology with the HRCT patterns.

Methods: This prospective observational study was conducted among 22 patients>18 years with CTD-ILD admitted to the Chest Ward. Extensive history, thorough clinical examinations, routine blood investigations and autoantibody testing, chest radiography, HRCT chest and spirometry were done for all the patients. Bronchoscopy and bronchoalveolar lavage were performed in all the patients, and the obtained BAL fluids were sent for analysis.

Results: There were 22 patients with CTD-ILD, and Rheumatoid Arthritis was the most common CTD. The most common pulmonary symptom was shortness of breath (95.4%) andjoint pain was the most common extra-pulmonary symptom (31.8%). Bibasilar fine crepitations were found in all the patients. Usual Interstitial Pneumonia (UIP) was the most common HRCT pattern. Bronchoalveolar lavage (BAL) cytology was inflammatory in all the patients. Additionally, there were five patients with BAL C/S showing bacterial growth and one patient’s BAL CBNAAT was positive.

Conclusion: BAL alone is not diagnostic in CTD-ILD. However, it is useful in ruling out infections especially tuberculosis (TB) as the patients are usually on immunosuppressive therapy. Also, ruling out infection is of utmost importance because infections are one of the most common reasons for flare of disease in CTDs.

Keywords: Bronchoalveolar lavage cytology, clinico-radiological corelation, CTD-ILD

Effectiveness of three months pulmonary rehabilitation in patients with chronic respiratory diseases

S. Shyam

Shri. B. M. Patil Medical College, Hospital and Research Centre, Vijayapura, Karnataka, India E-mail: shyams9743@gmail.com

Introduction: Chronic respiratory disorders causes impaired spirometry, reduced exercise capacity and health-related quality of life. Improvements in exercise tolerance, dyspnea and health-related quality of life often occur after pulmonary rehabilitation is combined to regular treatment.

Methods: It is a prospective interventional study done over a period of 15 months on 25 patients with chronic respiratory diseases visiting the Department of Respiratory Medicine, Shri B. M. Patil Medical College, Hospital and Research Centre, Vijayapura. Baseline evaluation of patients were done on the basis of degree of dyspnea, spirometry, questionnaires and exercise tests. Pulmonary rehabilitation was taught to the patients. Patients were re-evaluated after 3 months.

Results: Study showed significant reduction in MMRC score and Borg Dyspnea scale after three months of pulmonary rehabilitation compared to the patient’s baseline degree of dyspnea (p=0.0000001). 6MWT and SPO2 levels also showed improvement suggesting an improved exercise tolerance (p=0.0005, p=0.005 respectively). The Chronic Respiratory Disease Questionnaire (CRQ) score improved markedly from a mean of 87.54 to 98.92 after pulmonary rehabilitation, suggesting improved HRQoL. FEV1/FVC, FVC, and FEV1 values showed improvements but these improvements did not show statistical significance (p = 0.199, 0.072, and 0.151, respectively). Peak expiratory flow rate (PEFR) increased from 231.54 ± 61.35 L/min from baseline to 258.46 ± 64.53 L/min after study indicative of improved airway patency and expiratory muscle performance.

Conclusion: Pulmonary rehabilitation resulted in statistically significant improvements in dyspnea, health related quality of life and exercise capacity. Changes in pulmonary function parameters (FEV1, FVC, and FEV1/FVC ratio) showed positive trends during the study but did not reach statistical significance.

Keywords: Health related quality of life, rehabilitation, spirometry

Can pulmonary rehabilitation for COPD be delivered digitally beyond literacy barriers in India?

Shruti Dilip Sahasrabudhe , Sundeep Salvi, Sally Singh

Symbiosis Medical College for Women, Pune, Maharashtra, India E-mail: shrutids31@gmail.com

Introduction: Digital PR is considered a potential option to overcome the barriers of PR uptake like unavailability and logistic challenges for patients to travel to PR centers. However, in India with constraints of illiteracy and electronic device unavailability, the feasibility to deliver digital PR remains unexplored. We developed and assessed the feasibility of delivering a web-based app (iRECHARGE) for delivering digital PR for people with COPD.

Methods: This is a single-arm feasibility study with Yoga-integrated PR delivered via iRECHARGE for 12 weeks conducted at Symbiosis Medical College for Women, Pune from August 2022 to August 2023. Inclusion criteria were age = 18 years, spirometry confirmed diagnosis of COPD (FEV1/FVC ratio of = 0.7 post bronchodilator), Medical Research Council (MRC) dyspnoea score = 2, access to electronic devices, and ability to comprehend verbal and/or written information. iRECHARGE contains disease education and video guides for exercises with provisions for entering participant exercise logs.

Results: Among 112 COPD patients screened, 16 (14%) with no access to electronic devices were screen-failed. We recruited 40 (37 males average age of 64.7 years) participants in the study, 8 (20%) of which were illiterate, whereas 19 (48%) and 13 (32%) completed schooling and higher education respectively. Of the 40, 16 (40%) participants took help from family members to access iRECHARGE and 11 of these 16, used the devices of family members. In all, 36 (90%) participants completed the program. Of the 8 illiterate participants, 6 (75%) completed the program.

Conclusion: With high completion among illiterate participants, it is feasible to deliver iRECHARGE among COPD patients in Indian settings warranting further research on applicability and generalizability.

Keywords: COPD, digital health, pulmonary rehabilitation

Early pulmonary rehabilitation enhances weaning and recovery in outpatient tracheostomized mechanically ventilated patients

Sameer Bansal , Yogita Hatmode, Sagar T V

Apollo and Vaayu Chest and Sleep Speciality, Bengaluru, Karnataka, India E-mail: sameer@vaayuchest.com

Introduction: Patients requiring prolonged mechanical ventilation (MV) via tracheostomy are a high morbidity vulnerable group with deconditioning, and respiratory dysfunction, Pulmonary rehabilitation (PR) offers support with a structured multidisciplinary plan to improve weaning, muscle strength, and functional recovery.

Methods: This prospective observational study of 20 tracheostomized MV patients receiving individualized, multidisciplinary pulmonary rehabilitation (respiratory training, mobilization, secretion management). Recorded baseline demographics, ventilator settings, comorbidities, and comprehensive PR assessment. Outcomes: SBT success, decannulation, mobilization, complications. Statistics: t-tests, Pearson correlations, Fisher’s exact test, and logistic regression to assess effects of PR timing and session frequency on outcomes.

Results: 20 mechanically ventilated patients were included,with mean age was 65.5 years (range 33–86), with 11 males. Respiratory failure due to primary pulmonary causes accounted for 14 cases 6 had neurological disorders. PR began after a median of 11.5 days post-tracheostomy. Five patients were on controlled ventilation (mean peak inspiratory pressure (PIP) 28 cm H2O) others on pressure support (mean pressure support 19.5 cm H2O). Median PR sessions were 41. Rapid shallow breathing index (RSBI) dropped by an average of 28 tidal volume rose by 40–70 ml. SBT succeeded in 18 (90%), decannulation was achieved in 55%, mobilization in 75% and ambulation in 55%. Average time to 1st successful SBT was 18 days, while average time to decannulation was 63 days. Early PR correlated significantly with SBT success [t = -2.68, p = 0.015 OR = 0.80, p = 0.01] and PR session count with decannulation [t = -2.33, p = 0.03 OR = 1.63, p = 0.04]. VAP occurred in 30%, hospitalization in 25% two patients died.

Conclusions: This study on early PR in mechanically ventilated patients shows significant benefits in terms of various physiological (RR, tidal volume, RSBI), ventilation (SBT, decannulation) and functional (mobilization, complication) parameters.

Impact of interstitial lung disease on mental health and quality of life at a tertiary care centre

Johns John

Rajiv Gandhi Super Speciality Hospital, Delhi, India E-mail: johnsj101@gmail.com

Introduction: Interstitial lung diseases (ILDs) are characterized by a progressive fibrotic phenotype that extends beyond pulmonary morbidity to impair mental well-being and health-related quality of life (HRQoL). This study sought to characterize the burden of anxiety, depression, and HRQoL in an ILD cohort in North India.

Methods: We conducted a prospective descriptive study of 145 patients with multidisciplinary team-confirmed ILD at a tertiary care hospital in New Delhi. Clinico-radiological data were collected, and patients were administered the Hospital Anxiety and Depression Scale (HADS) and the King’s Brief Interstitial Lung Disease (KB-ILD) health status questionnaire.

Results: Psychological morbidity was prevalent, with 30.1% (n=44) and 26.5% (n=39) of patients meeting the threshold for abnormal anxiety (HADS-A = 11) and depression (HADS-D =11) scores, respectively. The mean KB-ILD score was 3.3, indicating substantial impairment in overall HRQoL, with the breathlessness and activities domain most severely affected. Worsening pulmonary function tests correlated with poorer scores on both the HADS and KB-ILD instruments. Disease-specific analysis revealed that patients with Idiopathic Pulmonary Fibrosis (IPF) and Combined Pulmonary Fibrosis and Emphysema (CPFE) reported the greatest HRQoL impairment and psychological distress. In contrast, patients with sarcoidosis, while still impaired, demonstrated comparatively better psychological scores, a finding potentially influenced by a younger demographic and a more variable disease course. Patients with Chronic Hypersensitivity Pneumonitis and NSIP exhibited moderate-to-severe impairment. This study confirms a high prevalence of anxiety, depression, and reduced HRQoL among ILD patients in North India.

Conclusion: The findings highlight the necessity of incorporating structured psychological assessment and multidisciplinary supportive interventions into the comprehensive management of ILD to address the entirety of the patients experience.

Keywords: Anxiety, depression, Interstitial lung disease, mental health, quality of life

Pulmonary sarcoidosis: A study on clinicoradiological profile and follow up

Geethu Vinoppan , Sajitha M, John Sonia Kallarackal

GMC, Kottayam, Kerala, India E-mail: geethuvinoppan0398@gmail.com

Introduction: Sarcoidosis is a multisystem granulomatous disease of unknown cause, most often affecting the lungs. Pulmonary involvement determines most clinical outcomes, while extrapulmonary features can complicate diagnosis and management. Aim: To analyze the clinical, radiological, and pathological profile of pulmonary sarcoidosis and to assess the trends in symptomatic ,radiological and biochemical resolution.

Methods: Ambispective observational study conducted among patients, clinicoradiologically suggestive of sarcoidosis with histopathological confirmation. Data collected on symptom profile, HRCT findings, extrapulmonary involvement, mode of diagnosis and other investigations. Patients were initiated on treatment and were followed up at 3 and 6 months.

Results: 59 patients with pulmonary sarcoidosis included with a mean age of 50 years and 75% were females. Most common stage (scadding) was stage 2. The commonest diagnostic modality was EBUS. Corticosteroids were first line of treatment. DMARDS initiated in 8%. There is significant clinicoradiological improvement in 85 % cases at 3 and 6 months. Relapse was noted in 9% cases, ACE was elevated in relapse cases. Patients with stage iv disease on presentation had poor prognosis.

Conclusion: Clinical symptoms, radiological staging aids in diagnosis and ACE serves as a tool in predicting relapse after remission. Our study underscores the importance of maintaining longitudinal registries for sarcoidosis.

Keywords: ACE, histopathology, sarcoidosis

Development and validation of hypersensitivity pneumonitis South Asian questionnaire for exposure

Sheetu Singh , Vijay Hadda, Mansi Gupta

Rajasthan Hospital, Jaipur, Rajasthan, India E-mail: drsheetusingh1@gmail.com

Introduction: A significant gap exists in the availability of a validated tool that can both qualitatively and quantitatively assess environmental exposures in patients with interstitial lung disease (ILD). This study was undertaken to develop and validate a comprehensive instrument designed to systematically capture such exposures in ILD patients.

Methods: A systematic literature review was conducted to identify environmental exposures reported in more than five documented cases of Hypersensitivity Pneumonitis (HP). These exposures were further assessed using a two-round Delphi survey with 39 pulmonologists from India, Sri Lanka, Pakistan, and Nepal. The questionnaire was initially developed prospectively at a single center and subsequently validated across five centers in India and Sri Lanka. Validation of the HP South Asian Questionnaire for Exposure (HP-SAQE) was performed against the gold-standard multidisciplinary discussion (MDD) diagnosis, enabling differentiation between HP and non-HP ILD.

Results: The systematic review screened 5,170 records, of which 407 studies were included, identifying 24 relevant exposures. A 50-item Delphi survey was conducted, and expert consensus (>70%) was achieved on 17 qualitative and 4 quantitative items (6 questions) by 39 pulmonologists. The resulting HP-SAQE score ranged from 0 to 14. Following pilot testing, the questionnaire was translated into Hindi, Tamil, and Sinhala. In the derivation cohort (n=40), HP patients demonstrated significantly higher scores compared with non-HP patients (mean 10.2 ± 1.6 vs. 6.7 ± 4.2 p=0.001). These results were validated in an independent cohort (n=163), where HP patients again had higher scores (mean 9.4 ± 2.2 vs. 4.13 ± 4.28 p<0.001). Receiver operating characteristic (ROC) curve analysis confirmed good diagnostic performance, with an area under the curve (AUC) of 0.791 in the derivation cohort and 0.858 in the validation cohort.

Conclusion: The HP-SAQE represents the first combined qualitative and quantitative exposure assessment tool for ILD patients and demonstrates robust diagnostic performance.

*This article was selected for NAPCON 2025 best research award presentation.

Beyond imaging: Correlating artificial intelligence-based lung texture analysis and computed tomography

Pravitha S , P. Venugopal, Sajitha M

Government Medical College, Kottayam, Kerala, India E-mail: pravithas124@gmail.com

Introduction: High-resolution computed tomography (HRCT) visual scoring is the standard for assessing interstitial lung disease (ILD) extent but suffers from inter-observer variability. Artificial Intelligence (AI)-based lung texture analysis (LTA) enables quantitative, objective assessment, yet comparative studies with visual scores and functional parameters—Forced Vital Capacity (FVC), Six-Minute Walk Test (6MWT), and Modified Medical Research Council (mMRC) score – are scarce. This study evaluates correlations of AI-based LTA with visual scoring and functional impairment, exploring its role in ILD severity assessment.

Methods: This cross-sectional study included 70 ILD patients enrolled consecutively. All underwent chest HRCT, assessed using CT visual score and AI-based LTA software quantifying reticulation, honeycombing, ground-glass opacities, and hyperlucency. Functional evaluation comprised FVC, 6MWT distance, baseline and post-exercise oxygen saturation, and dyspnoea grading (mMRC scale). Correlations between imaging and functional parameters were analysed using Pearson’s correlation scatterplots with regression lines illustrated the key associations.

Results: AI-based LTA parameters strongly correlated with CT visual scores, notably fibrosis (r=0.667, p<0.001) and ground-glass opacities (r=0.741, p<0.001). Higher LTA fibrosis scores exhibited significant negative correlation with FVC, 6MWT distance, and oxygen saturation. AI-based LTA correlates well with visual CT scores and functional measures, indicating reliability for ILD severity assessment. It offers an objective, reproducible approach complementing imaging and physiological evaluation.

Conclusion: AI-based LTA provides a reproducible, objective measure with reduced inter-observer variability, which complements functional and physiological assessments. It may have potential for disease monitoring and prognostication.

Keywords: Artificial intelligence, interstitial lung disease, lung texture analysis

*This article was selected for NAPCON 2025 best research award presentation.

Development and validation of a novel screening tool for early detection of interstitial lung diseases

Supriya Phadnis , Deepak Muthreja, Meena Lopez

Pulmocare Research and Education Foundation, Pune, Maharashtra, India E-mail: supriya.mahabaleshwarkar@gmail.com

Introduction: Early detection of interstitial lung diseases (ILD) is crucial for timely management and improved outcomes. We aimed to develop and validate a simple ILD screening tool that can facilitate earlier referral and intervention.

Methods: This study was conducted in two parts across 23 centres in India. In Part I (development phase), 80 potential variables for ILD screening were identified through literature review, which were reduced to 21 variables, 10 questions through expert consensus by face validation (n=5) and content validation (n=15). The tool was administered to 619 confirmed ILD cases and 565 non-ILD controls (n=1184). Using a logistic regression and weighted scoring, we derived 18 significant variables, which were converted into an 8-question screening tool (score range: 0-15) with optimal cut-off values for sensitivity and specificity. In Part II (validation phase), the tool was prospectively tested in an independent cohort of 156 adults with respiratory symptoms recruited from 14 respiratory clinics, where all participants underwent HRCT as the diagnostic gold standard.

Results: The descriptive statistical analysis revealed that velcro crackles, finger clubbing, and connective tissue disease were the key predictors. In the development phase, a cut-off score of = 5 defined a screen-positive result, with the tool demonstrating 83% sensitivity, 79% specificity and 81% overall accuracy. In the validation cohort, the tool showed 69.2% sensitivity, 77.9% specificity, and 75% overall accuracy.

Conclusion: This is the first developed and validated screening tool for ILD. It offers a simple, evidence-based approach to facilitate early diagnosis of ILD, potentially improving patient outcomes.

Keywords: Interstitial lung diseases, screening tool, validation

*This article was selected for NAPCON 2025 best research award presentation.

The association between air pollution exposure and mortality in patients with interstitial lung disease

Chhaya Goyal , Virendra Singh, Madhur Joshi

Mahavir Jaipuriya Rajasthan Hospital, Jaipur, Rajasthan, India E-mail: chayagoyal02@gmail.com

Introduction: Interstitial lung disease (ILD) is a heterogeneous group of diseases with a variable course often determined by external factors like air pollution. The current study aims to analyse the effect of air pollution, measured by PM2.5, PM10, NO2, SO2, and O3 levels, on mortality in patients with ILD.

Methods: Consecutive patients with ILD presenting at a tertiary care centre in Jaipur were recruited. Standard diagnostic and follow-up investigations were conducted. Patients were followed up after 1 year for their status. The annual mean of pollution parameters for patients’ place of residence was obtained via the Central Pollution Control Board.

Results: Two hundred and nine patients with ILD were recruited between 2022 and 2024, comprising 77 males (36.8 %) and 132 females (63.1%), with a mean age of 58.5 11.7. The ILD subtypes included connective tissue disease-associated ILD (71, 34%), hypersensitivity pneumonitis (68, 32.5 %), idiopathic pulmonary fibrosis (25, 11.2%), sarcoidosis (20, 9.6 %), and others (25, 11.2 %). The mean of annual air pollutant level (µ/m3) for patient’s place of residence for 2 consecutive years (2023, 2024) was: PM2.5 (53.4 10.3, 108.3 27.8, p<0.0001), PM10 (127.1 25.6, 195.5 40.6, p<0.0001), NO2 (28.8 6.6, 32.2 7.0, p<0.0001), SO2 (9.7 3.4, 9.7 3.8, p>0.5), O3 (45.6 12.1, 41.3 17.0, p<0.0031). There were statistically higher numbers of deaths in 2024 (11, 36.7%) than in 2023 (3, 10%) (Chi-square, p value = 0.036). The follow-up data analysis of ILD patients revealed a statistically significant increase in mortality in the high pollution year as compared to the low pollution year. Limiting exposure to poor air quality is a modifiable risk factor that can decrease mortality in ILD patients.

Conclusion: Hence, we conclude that increasing levels of air pollution negatively affect survival in patients with ILD. However, the findings should be interpreted cautiously due to the small cohort of patients and single-centre design.

How effective is tele-rehab in ILD patients? A real-world study from a tertiary care centre in Mumbai

Khushboo Chahwala , Rhea Gandhi, Manisha Ailasinghani

P. D. Hinduja Hospital, Mumbai, Maharashtra, India E-mail: khushboochahwala66@gmail.com

Introduction: Interstitial lung diseases (ILD) are chronic progressive disorders characterized by dyspnoea, diminished exercise tolerance and poor quality of life. Pulmonary rehabilitation (PR) has consistently shown to improve symptoms, functional capacity, health-related quality of life yet in-person programs are often inaccessible to the majority of patients. Tele-rehabilitation has emerged as a practical alternative, with evidence suggesting comparable outcomes to in-person PR. However, real-world data from Indian settings are limited. Objective: To evaluate the effectiveness of an 8-week tele-rehabilitation program, for ILD patients at a tertiary care centre in Mumbai.

Methods: This observational study enrolled ILD patients in an 8-week structured tele-rehabilitation program conducted by Cipla in collaboration with a tertiary care centre in Mumbai. Pre- and post-intervention assessments included one-minute sit-to-stand test (1MSTS)/ six-minute walk test (6MWT), EQ-5D-3L for health-related quality of life, pulmonary function tests (PFTs), oxygen support level and rating of perceived exertion (RPE). Outcomes were evaluated by changes in functional performance, symptom burden, oxygen use and patient reported experiences.

Results: Among 60 patients, significant improvements were observed across multiple domains. 1-Minute Sit-to-Stand test, increased by a mean of three repetitions, with 91.6% of participants demonstrating measurable gains, indicative of enhanced lower-limb strength and endurance. EQ-5D-3L, improved by an average of 2.3 points, with 87% of patients reporting benefits across domains including mobility, usual activities, pain/discomfort. RPE decreased by a mean of one point, with 89% of patients experiencing reduced subjective effort during activity. Overall, 89.2% of participants demonstrated improvement in at least one of the outcome measures, underscoring the effectiveness in enhancing physical performance and patient-reported health status.

Conclusion: The 8-week tele-rehabilitation program helped 90% percent participants experience tangible gains, underscoring the viability of integrating structured tele-rehab into ILD care in India. Almost all patients, when questioned, approved the concept of tele-rehab citing convenience and easy accessibility.

Keywords: Functional outcomes, interstitial lung disease, pulmonary rehabilitation, quality of life, tele-rehabilitation

*This article was selected for NAPCON 2025 best research award presentation.

A study on association between gender, age, physiology index and radiological patterns in interstitial lung disease

Chirag K C

Adichunchanagiri Institute of Medical Sciences, Mandya, Karnataka, India E-mail: chiragkc23@gmail.com

Introduction: Interstitial lung diseases (ILDs) are heterogeneous disorders with parenchymal inflammation and fibrosis. The GAP (Gender, Age, Physiology) index predicts mortality and disease severity in patients with ILD but its radiological correlation is less studied. This study aims to study the association between GAP index with radiological patterns of interstitial lung disease.

Methods: This observational study was conducted in Rajiv Gandhi Institute of Chest Diseases, Bengaluru from February 2024 to November 2024. The inclusion criteria included patients aged = 18 years diagnosed with ILD based on the ATS/ERS criteria. GAP scores of 70 ILD patients were calculated and correlated with their HRCT features such as honeycombing, traction bronchiectasis, interstitial reticulation and ground-glass opacities. Statistical analysis performed using SPSS p<0.05 was significant.

Results: The study population had mean age of 55.26 years 36 males, 44 females. Dyspnea (100%) and cough (85.7%) were the most common symptoms. Over 32 (45.7%) patients had GAP Stage 1(score = 3) followed by 29 (41.4%) patients with GAP Stage 2 and 9 (12.9%) patients with GAP Stage 3. NSIP (30%) and Probable UIP (30%) were the most common types of ILD. Higher GAP stages showed increased UIP pattern prevalence (Stage 3: 55.6% vs Stage 1: 9.3%, p<0.001). The HRCT findings like honeycombing (p=0.001) and traction bronchiectasis (p=0.016) were significantly more frequent in advanced GAP stages whereas other findings like interstitial reticulation and ground-glass opacities had no significant correlation.

Conclusion: This study identified a significant association between distinct HRCT patterns and GAP index stages in ILD, highlighting GAP index as a useful surrogate for both prognosis and radiological disease heterogeneity. It may aid in risk stratification in resource limited settings and reduce frequency of CT scans in ILD patients.

Keywords: GAP Index, interstitial lung disease, radiological patterns

*This article was selected for NAPCON 2025 best research award presentation.

Clinical use and relevance of the core outcome set for physiotherapy trials in adults with bronchiectasis

Saumil Bendre (Pt) , Harriet Shannon

Dr. Bendres Clinic, Mumbai, Maharashtra, India E-mail: saumilbendre@gmail.com

Introduction: Bronchiectasis in India is more severe with peculiar characteristics compared to other countries. In 2024, a new physiotherapy-specific International Core Outcome Set for adults with bronchiectasis (COS-PHyBE) was developed in United Kingdom. Despite international consensus, there was no representation from India and minimal involvement from the global South during its development. This study aimed to explore the current use of outcome measures for individuals with bronchiectasis by physiotherapists in Mumbai and their perceptions of the new COS-PHyBE. This marks an initial step towards ensuring global relevance of the international core outcome set.

Methods: Semi-structured interviews, using an interview topic guide were conducted with cardiorespiratory physiotherapists from Mumbai. Data were collected between April and June 2024. Interviews were transcribed and analysed using content analysis, which included identifying themes, categories and codes from the interview transcripts.

Results: Twelve physiotherapists participated in on-line interviews. The outcomes they reported were similar to those recommended by the COS-PHyBE. Inconsistencies in outcome utilisation were evident with measures of fatigue and treatment adherence rarely mentioned. All felt that the COS-PHyBE included essential aspects and necessary components for assessment that would be valuable for clinical practice. This study suggests that the COS-PHyBE is appropriate to the bronchiectasis population in Mumbai. It would encourage a consistent approach to assessments, allowing individuals to be monitored more holistically before and after interventions. Future research should focus on developing and validating standardized outcome measurement tools for physiotherapists treating bronchiectasis, multilingual tools and strategies to improve patient adherence. Long-term studies are needed to evaluate assessments and interventions, enhancing clinical practice and improving patient outcomes.

Conclusion: While physiotherapists in Mumbai generally align with the COS-PHyBE framework in treating bronchiectasis, there is significant variability in the outcome measurement tools used, affecting the consistency and comparability of patient evaluations.

Keywords: Bronchiectasis, outcome, physiotherapy

Management of progressive pulmonary fibrosis in the real-world setting – The PROFIBRO survey

Monali Mehta , Yuvarajan Sivagnaname, Vijay Kumar Chennamchetty

Cipla Ltd., Mumbai, Maharashtra, India E-mail: monalim@cipla.com

Introduction: There is no data on how PPF is diagnosed and treated in India.

Methods: This survey was conducted in 2 phases. In phase 1, the questionnaire was administered to clinicians attending CME programmes on respiratory diseases during the period January-December 2024 in phase 2, the survey was conducted digitally from January – August 2025. Results are expressed as percentages based on the number of responses obtained.

Results: 300 clinicians across 16 Indian states participated in the survey 93% were pulmonologists. 55% of clinicians reported that 10–30% of their F-ILD patients develop PPF, whereas 27% clinicians reported < 10% patients. 51% of clinician’s diagnosis PPF based on 2022 ATS/ERS/ALAT/JRS criteria, while 34% relied on clinical judgement, radiology and lung function. 38% of clinicians labeled F-ILD as PPF when progression occurs over a 12-month period, while 26% and 23% of clinicians label F-ILD as PPF regardless of the duration of fibrosis progression and progression over 6 months, respectively. F-HP (88%) and RA-ILD (79%) were the most reported ILDs underlying PPF diagnosis. In >50% of non-IPF ILD patients, prednisone (50%), mycophenolate (49%) and mycophenolate with low dose prednisone (49%) was preferred before establishment of progression. Once progression is established, antifibrotics (70% nintedanib, 40% pirfenidone) were the most frequently reported additional treatments of choice for >50% of non-IPF ILD patients. In addition, 32–35% of clinicians reported increasing the dose of prednisone and / mycophenolate in this setting. 41% of clinicians reported considering antifibrotic combination in those who progressed on antifibrotic monotherapy.

Conclusion: PPF management have evolved over the years. Steroid and steroid sparing agents are the preferred therapies before establishment of progression. Nintedanib was the preferred in established PPF, dual antifibrotics was preferred in those who progressed on monotherapy.

Keywords: Antifibrotics, ILDs, progressive, pulmonary fibrosis, steroid sparing

Impact of pulmonary rehabilitation on psychological manifestation in patients with chronic respiratory diseases

Shivam Srivastava , Surya Kant

King Georges Medical University, Lucknow, Uttar Pradesh, India E-mail: dr.shivam.pt@gmail.com

Introduction: Chronic respiratory diseases (CRDs) are often accompanied by psychological manifestations such as depression, anxiety, and stress. This study evaluated the effect of pulmonary rehabilitation (PR) on these psychological symptoms using the Depression Anxiety Stress Scale (DASS-21).

Methods: We conducted a single-centred observational analytical study involving patients aged = 15 years with CRDs who had persistent dyspnea or fatigue after an acute illness. Participants underwent an 8-week PR program. DASS-21 scores (0–21 higher scores = more severe symptoms) were recorded pre- and post-intervention.

Results: Post-rehabilitation, 81.2% (43 patients) showed improved anxiety. Only 11.3% (6 patients) reported mild anxiety and 7.5% (4 patients) moderate, with no severe cases. Depression remained stable, with no new cases. Males demonstrated significant reductions: stress (4.55?2.53, p<0.001), anxiety (2.12?1.12, p<0.001), and depression (1.57?0.44, p<0.001). Females also improved: stress (4.2?1.87, p=0.002), anxiety (2.0?0.98, p<0.001), and depression (1.73?0.34, p=0.009). Overall, stress decreased significantly pre-test, 92.5% were normal and 7.5% mild, while post-test, all 53 patients (100%) had normal stress (p=0.041). Improvements were most pronounced in the 45–75 years group. Younger participants (15–30 years) showed minimal changes. Anxiety emerged as the most common psychological symptom at baseline, followed by stress.

Conclusion: Pulmonary rehabilitation plays a crucial role in improving mental health outcomes in CRDs patients. While depression remained unchanged, anxiety and stress improved markedly across genders and age groups. These findings highlight the importance of PR as a comprehensive approach to managing both physical and psychological health in CRDs. Further long-term studies are recommended.

Keywords: Chronic respiratory disease, DASS21, pulmonary rehabilitation

Prevalence and predictors of pulmonary hypertension in diffuse parenchymal lung disease

Obhiraj Nandi

Sawai Man Singh Medical College, Jaipur, Rajasthan, India E-mail: obhiraj.nandi@gmail.com

Introduction: Diffuse Parenchymal Lung Disease (DPLD) is a heterogeneous lung disease characterized by inflammation and/or fibrosis in the lungs. One of the frequent complications encountered with some DPLDs is Pulmonary Hypertension (PH), which occurs due to remodelling of pulmonary vasculature. Association of PH with DPLD has poorer prognosis, so determination of early predictors of PH is crucial for reducing morbidity.

Methods: An observational cross-sectional study was conducted in 86 patients attending Department of Respiratory Medicine from August 2024 to July 2025. Each patient was subjected to Chest X Ray, Computed Tomography (CT), Electrocardiogram (ECG), 2D Echocardiogram, Pulmonary Function Test (PFT) and 6 Minute Walk Test (6MWT). Statistical analysis were performed using t-test, Pearson coefficients and Receiver Operating Characteristic (ROC) Curve Analysis, with a p value<0.05 considered as significant.

Results: The most commonly encountered DPLDs are Connective Tissue Disease associated DPLD (40.7%), Idiopathic Pulmonary Fibrosis (30.2%) and Fibrotic Hypersensitivity Pneumonitis (16.3%). Most common patterns observed in HRCT is Usual Interstitial Pneumonia Pattern (46.5%). Prevalence of PH is 54.6%, with the maximum percentage occurring in Hypersensitivity Pneumonitis (64%). Predictors with statistical significance are 6 Minute Walk Distance (AUC = 0.884), Post 6MWT Desaturation (AUC = 0.849), mMRC grade (AUC = 0.831) and Baseline SpO2 (AUC = 0.83). A predictive model was prepared using logistic regression of these variables which at the cut off of 5 out of maximum 8 points, had an AUC, specificity and sensitivity of 0.918, 86.1% and 91.3% respectively to detect PH in DPLD, which was internally validated.

Conclusion: Early identification of risk factors like reduced 6 Minute Walk Distance, increased Post 6MWT Desaturation and higher mMRC grading in DPLD patients can aid in prompt diagnosis of PH, thus reducing both morbidity and mortality. Our prediction tool is an easy bedside test that incorporates these parameters and has good accuracy in detecting PH.

Keywords: 6-minute walk test, diffuse parenchymal lung disease, mMRC grading, pulmonary hypertension

CTD-ILD in central India: NSIP predominance and frequent misdiagnosis as tuberculosis

Tanushree Kothari

L. N. Medical College and J. K. Hospital, Bhopal, Madhya Pradesh, India E-mail: drtanuk38@gmail.com

Introduction: Connective tissue disease–associated interstitial lung disease (CTD-ILD) contributes substantially to diffuse parenchymal lung disease in India (~14% in national registry data). In TB-endemic regions, CTD-ILD is often misdiagnosed as pulmonary tuberculosis on clinicoradiological grounds, leading to inappropriate anti-tubercular therapy (ATT) and diagnostic delay.

Methods: We retrospectively analyzed 17 consecutive CTD-ILD patients (2023–2025) from a tertiary center in Central India. Demographics, connective tissue disease subtype, HRCT pattern, antibody profile, spirometry, and treatment details were collected using a structured proforma. Prior ATT exposure was also documented.

Results: Demographics: Mean age 52.7 years 94% female. CTD Subtypes: Sjögren’s (4), SLE (3), myositis (3), systemic sclerosis (2), MCTD/overlap (5). HRCT Pattern: NSIP 11 (65%), UIP 5 (29%), unclassified 1 (6%). Autoantibodies: All patients ANA positive disease-specific ENAs included Ro52/SSA (Sjögren’s), Jo-1 (myositis), Scl-70 (systemic sclerosis). Misdiagnosis: 9/17 patients (53%) had received empirical ATT before ILD diagnosis, with delays of 6–24 months. Pulmonary Function: Spirometry feasible in 7 patients (41%). Median FVC 75% predicted (IQR 70–85%) mean FEV1/FVC ratio 66% (SD 16.8), consistent with restriction. Treatment: Mycophenolate (53%) and nintedanib (41%) were the most frequent therapies. Cyclophosphamide and rituximab were administered in monthly standard protocols for patients with clinically active disease.

Conclusion: CTD-ILD in Central India shows predominant NSIP with a subset of UIP patterns, but over half of patients were initially misdiagnosed as tuberculosis and exposed to unnecessary ATT. Incorporating HRCT and antibody profiling into early evaluation can prevent misdiagnosis, shorten delays, and enable timely initiation of immunosuppressive or antifibrotic therapy.

Beyond medication: Role of pulmonary rehabilitation in improving functional outcomes in chronic obstructive pulmonary disease and chronic respiratory diseases

Sivaram Chandrasivam Rajendren , Anbumaaran, Prasanth

Saveetha Medical College, Chennai, Tamil Nadu, India E-mail: sivaramchandrasivamrajendren@gmail.com

Introduction: Chronic respiratory diseases (CRDs), including Chronic Obstructive Pulmonary Disease (COPD), are leading causes of disability worldwide, often resulting in reduced lung function, exercise intolerance, and poor quality of life This study evaluated the impact of a structured PR program on clinical outcomes, functional capacity, and quality of life in patients with COPD and other CRDs.

Methods: A prospective cohort study was conducted at Saveetha Medical College among 80 patients with stable CRDs. Participants underwent an eight-week structured PR program incorporating breathing exercises, aerobic training, limb strengthening, and patient education. Pre- and post-intervention assessments included pulmonary function tests (FEV1, FVC, FEV1/FVC), the Six-Minute Walk Test (6MWT), Modified Medical Research Council (MMRC) dyspnoea scale, St. George’s Respiratory Questionnaire (SGRQ), and additional symptom scales. Data were analyzed using paired t-tests, with p < 0.05 considered significant.

Results: PR led to statistically and clinically significant improvements across multiple parameters. Mean FEV1 increased from 41.3% to 50.6% (p < 0.001), while FEV1/FVC rose from 77.5% to 83.3% (p = 0.01). Functional capacity improved markedly, with mean 6MWT distance increasing from 181.9 m to 250.9 m (p < 0.001). Dyspnoea severity decreased significantly (MMRC: 2.94 ? 1.71, p < 0.001). Quality of life also improved, with mean SGRQ scores decreasing from 31.8 to 22.7 (p < 0.001). Improvements in Borg Dyspnoea and COPD Assessment Test (CAT) scores further supported symptom relief and better daily functioning.

Conclusion: A structured pulmonary rehabilitation program significantly enhances lung function, exercise tolerance, and health-related quality of life in patients with COPD and CRDs. Even short-term interventions yield meaningful benefits, reinforcing PR as a cost-effective, scalable, and patient-centered cornerstone in chronic respiratory disease management.

Keywords: Chronic obstructive pulmonary disease, chronic respiratory diseases, FEV1, pulmonary rehabilitation, quality of life

Challenges and opportunities in delivering pulmonary rehabilitation in low-resource settings

Dhiraj Agarwal , Vishal More, Hilary Pinnock

KEM Hospital Research Centre, Pune, Maharashtra, India E-mail: dhiraj.agarwal@kemhrcvadu.org

Introduction: Pulmonary rehabilitation (PR) is an evidence-based intervention that improves exercise capacity, quality of life, and symptom management in people with chronic respiratory diseases (CRDs). Most PR trials have been conducted in high-income countries, with limited evidence from low- and middle-income countries (LMICs). As part of the PuRe trial, we conducted a pilot study at VRHP, KEMHRC Pune to evaluate the feasibility of delivering PR in both centre- and home-based formats. This abstract reports key challenges and opportunities identified.

Methods: We enrolled 24 symptomatic CRD participants into the pilot phase and delivered PR through centre-based and home-based sessions. Feasibility, patient experience, and operational challenges were documented through team discussions and monitoring logs.

Results: The pilot highlighted several practical insights. During consenting and baseline assessments, participants brought forward challenges such as differentiating CRD types, variability in mMRC scoring, and literacy barriers, pointing towards the need for more adaptable and inclusive assessment tools. Centre-based PR revealed that work schedules, lengthy baseline visits, and caregiver dependence affected attendance, highlighting the importance of flexible scheduling and logistical support. Patients expressed interest in medicines and reimbursement support, emphasizing the need to strengthen counselling and communicate the added value of PR. Home-based PR underscored the role of digital infrastructure, as connectivity and monitoring challenges pointed towards the need for user-friendly technology and training for remote supervision. Social factors such as exercising in front of relatives, household environments, and space availability emphasized tailoring PR approaches to individual comfort and context. Variability in compliance and motivation highlighted the importance of continuous engagement and personalised follow-up.

Conclusion: Delivering PR in Pune was feasible, and the pilot phase provided valuable lessons for implementation. Strengthened patient counselling, caregiver engagement, simplified assessments, digital support, and context-specific adaptations are critical to enhance PR delivery and scalability in LMICs.

Breathing new life: Pulmonary rehabilitation as a transformative therapy in COPD and chronic respiratory diseases

Sivaram.C.R , Prasanth, Anbumaaran

Saveetha Medical College, Chennai, Tamil Nadu, India E-mail: sivaramchandrasivamrajendren@gmail.com

Introduction: Chronic respiratory diseases (CRDs), including Chronic Obstructive Pulmonary Disease (COPD), are leading causes of disability worldwide, often resulting in reduced lung function, exercise intolerance, and poor quality of life. This study evaluated the impact of a structured PR program on clinical outcomes, functional capacity, and quality of life in patients with COPD and other CRDs.

Methods: A prospective cohort study was conducted at Saveetha Medical College among 80 patients with stable CRDs. Participants underwent an eight-week structured PR program incorporating breathing exercises, aerobic training, limb strengthening, and patient education. Pre- and post-intervention assessments included pulmonary function tests (FEV1, FVC, FEV1/FVC), the Six-Minute Walk Test (6MWT), Modified Medical Research Council (MMRC) dyspnoea scale, St. George’s Respiratory Questionnaire (SGRQ), and additional symptom scales. Data were analyzed using paired t-tests, with p < 0.05 considered significant.

Results: PR led to statistically and clinically significant improvements across multiple parameters. Mean FEV1 increased from 41.3% to 50.6% (p < 0.001), while FEV1/FVC rose from 77.5% to 83.3% (p = 0.01). Functional capacity improved markedly, with mean 6MWT distance increasing from 181.9 m to 250.9 m (p < 0.001). Dyspnoea severity decreased significantly (MMRC: 2.94 ? 1.71, p < 0.001). Quality of life also improved, with mean SGRQ scores decreasing from 31.8 to 22.7 (p < 0.001). Improvements in Borg Dyspnoea and COPD Assessment Test (CAT) scores further supported symptom relief and better daily functioning.

Conclusion: A structured pulmonary rehabilitation program significantly enhances lung function, exercise tolerance, and health-related quality of life in patients with COPD and CRDs. Even short-term interventions yield meaningful benefits, reinforcing PR as a cost-effective, scalable, and patient-centered cornerstone in chronic respiratory disease management.

Keywords: Chronic obstructive pulmonary disease, chronic respiratory diseases, FEV1, pulmonary rehabilitation, quality of life

Association of type II HLA alleles with sarcoidosis disease susceptibility and chronicity in an Indian setting

Mandeep Kaur Sadhra

Postgraduate Institute of Medical Education Research, Chandigarh, India E-mail: mandeepsadhra.94@gmail.com

Introduction: Human leucocyte antigen (HLA) alleles of the major histocompatibility complex type II have been found to be associated with disease susceptibility and severity in sarcoidosis. There is little data on this subject in the Indian population. We aimed to investigate the association between HLA-DRB1 and DQB1 alleles and sarcoidosis susceptibility and disease course in Indian subjects.

Methods: This was a prospective, case-control study of healthy controls (no personal or family history of sarcoidosis or any chronic respiratory illness) and patients with sarcoidosis (cases). Cases were further categorized into chronic or resolving disease (defined based on the presence or absence, respectively, of symptoms and/or radiological abnormalities at two years of disease onset). We studied the presence of the HLA-DRB1 and DQB1 allele types using the site-specific polymerase chain reaction (PCR-SSP) method. We calculated the odds ratio (OR) with 95% confidence intervals (CI) for disease occurrence and chronicity for each of the studied allele types.

Results: We included 90 subjects (mean age, 40.5 years 46.7% women): 58 cases (23 resolving disease, 35 chronic disease) and 32 healthy controls. None of the studied alleles were associated with disease susceptibility, although HLA-DRB1*11 came close to statistical significance (p=0.08). DRB1*11 (OR, 7.06 95% CI, 1.77-28.13 p= 0.003) and DRB1*14 (OR, 5.00 95% CI, 1.25-19.99 p=0.02) alleles were associated with chronic disease, while DRB1*13 (OR, 5.69 95% CI, 1.32-24.54 p=0.02) was associated with resolving disease.

Conclusion: We found DRB1*11 and DRB1*14 significantly associated with chronic sarcoidosis. Larger studies are needed to confirm our findings.

Keywords: Antigen presentation, chronic sarcoidosis, genetics, human leucocyte antigen, PCR-SSP, severe sarcoidosis

Clinico-radiologic patterns of interstitial lung disease at a tertiary care centre in Mumbai, India

Sanjitha Muneeswaran

P. D. Hinduja Hospital, Mumbai, Maharashtra, India E-mail: sanjithamunish98@gmail.com

Introduction: Interstitial lung diseases (ILDs) represent a heterogeneous group of diffuse parenchymal lung disorders with varied etiologies. Understanding local patterns is essential for guiding diagnosis and management. This study aimed to analyze radiologic patterns of ILD on high-resolution CT (HRCT) and their clinical correlates at a tertiary care hospital in Mumbai, India.

Methods: A retrospective analysis was conducted at P. D. Hinduja National Hospital, Mumbai. Consecutive HRCT thorax scans performed between January 2023 and December 2024 were reviewed. Radiologic patterns and probable etiologies were classified according to the 2018 Fleischner Society guidelines. Clinical history proformas were analyzed for demographic details, risk factors, and exposures to establish clinico-radiologic correlation. Follow-up scans were excluded to avoid duplication.

Results: Among 3158 CT thorax scans, 437 (13.8%) were reported as ILD. Of these, 292 (66%) were female. Hypersensitivity pneumonitis (HP) was the most common diagnosis (47.6%), followed by idiopathic interstitial pneumonias (IIP, 26.7%) and autoimmune-related ILDs (15.6%). HP and autoimmune ILD were more frequent in women (81% and 73%, respectively). Among HP cases, 54 (77.1%) reported pigeon exposure as a significant environmental factor. Idiopathic pulmonary fibrosis (IPF) was strongly associated with smoking, reported in 31% of cases.

Conclusion: ILDs in India demonstrate unique patterns, with HP emerging as the leading subtype and pigeon exposure as a major risk factor. Recognition of these regional trends can guide targeted preventive and diagnostic strategies.

Keywords: High-resolution CT, hypersensitivity pneumonitis, idiopathic pulmonary fibrosis, interstitial lung disease, pigeon exposure

Interventional Pulmonology: Diagnostic utility of thoracoscopy in recurrent exudative pleural effusion: A single-arm intervention

Ishika Banerjee , Tapan Kalani, Swadip Mishra

Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India E-mail: ishikabanerjee1999@gmail.com

Introduction: Recurrent pleural effusion has always posed a challenge for definitive etiological diagnosis because it relies on nonspecific investigative methods like pleural fluid analysis. The non-specific method of diagnosis mainly depends upon pleural fluid biochemical and cytological tests. The low specificity of these tests leads to improper treatment, especially in peripheral health centres. Our study aimed to determine the role and efficacy of medical thoracoscopy for definitive diagnosis in patients having recurrent exudative pleural effusion.

Methods: The study was carried out on patients with recurrent exudative pleural effusion as per Lights criteria, admitted in the Dept of Respiratory Medicine of Kalinga Institute of Medical Sciences over a period of two years (2023-2025). All cases were subjected to medical thoracoscopy in the designated procedural suite of this hospital after doing the required investigations. Pleural biopsy samples were obtained in each patient and sent to the histopathology lab to obtain tissue diagnosis. Statistical analysis was performed using SPSS v 19.0.

Results: The mean age of cases was 58 years with a male-female ratio of 1.25:1. Hypertension was the most common comorbidity found among the cases (16 cases, 26.2%). The most common radiology finding was gross pleural effusion (54 cases, 88.5%), followed by mass lesion (16 cases, 26.2%). Pleural tissue biopsy revealed malignancy in 41 patients (67.2%), out of which adenocarcinoma was the most common subtype (30 patients, 49.2%), followed by squamous cell carcinoma (eight patients, 13.1%).

Conclusion: This study favored medical thoracoscopy as an ideal and effective tool to achieve a definitive diagnosis in recurrent exudative pleural effusion with very minimal and self-limited complications. Its role and efficacy are undisputed in all cases of recurrent exudative pleural effusion in order to achieve a highly promising diagnosis, so that an early treatment plan can be initiated accordingly.

Keywords: Exudate, malignancy, pleural effusion, thoracoscopy

Effect of structured training on ability of pulmonology residents to perform rapid on-site evaluations

Gyan Prakash Gupta , Noopur Gupta, Dipti Bisaria

Fortis Hospital, Noida, Uttar Pradesh, India E-mail: gyan801@gmail.com

Introduction: On-site cytopathologists are a scarce resource for rapid cytologic evaluation (ROSE) of endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA). Hence, pulmonologists are performing ROSE (PROSE) themselves. However, training requirement to achieve proficiency in performing PROSE remains as yet undefined.

Methods: In this single-centre study, three pulmonology residents, underwent structured training by pathologists to perform PROSE. After three and six months of training, anonymised representative ROSE slides of EBUS-TBNA from 60 consecutive patients were independently read by the residents. Thereafter, PROSE readings were unblinded and compared to corresponding ROSE. Anupama Nayak’s criteria were used for diagnostic categorization (nondiagnostic, negative for disease, granulomatous inflammation, suspicious for malignancy or malignant) and adequacy assessment (combing latter four categories versus nondiagnostic i.e. inadequate). Agreement between PROSE and ROSE were assessed.

Results: While evaluating adequacy, after three months of training, residents 1, 2 and 3 demonstrated slight to moderate agreement between PROSE and ROSE (Cohen’s kappa values 0.66, 0.17 and 0.42 respectively) that further improved (0.91, 0.82 and 0.50 respectively) after an additional three months of training. After three months of training, residents 1, 2 and 3 demonstrated 50, 46.67 and 51.67% diagnostic agreement respectively between PROSE and ROSE (kappa values of 0.30, 0.23, and 0.315) that improved to 76.67, 76.67 and 68.33% (kappa values of 0.68, 0.68, and 0.57) after an additional three months of training.

Conclusion: After a structured six-month training period, pulmonology residents could perform PROSE on EBUS-TBNA smears, define adequacy and have good diagnostic agreement with ROSE.

*This article was selected for NAPCON 2025 best research award presentation.

An innovative hemostasis technique in semi-rigid pleuroscopy: Coupling the externally applied touch using conventional biopsy forceps

Gopika , Ravindra Mehta

Apollo Hospital, Bengaluru, Karnataka, India E-mail: gopurkrishnan@gmail.com

Introduction: Bleeding during medical thoracoscopy, though uncommon (reported incidence ~0.4%), can pose a challenge – especially in patients with coagulopathies or those on anticoagulants. This case series presents a novel, rapid, and effective technique using conventional biopsy forceps in combination with touch electrocautery to achieve hemostasis during pleural biopsy and adhesiolysis.

Methods: Over two years, 20 patients (16 male, 4 female) underwent flexible thoracoscopy using the Olympus LTF 160. Electrocautery was delivered via a monopolar pencil (40–50 watts for 3–5 seconds) applied to the metal biopsy forceps (Olympus FB-420K) positioned at the bleeding site. This approach eliminated the need to withdraw the forceps to introduce a separate cautery tool, thus minimizing procedural delay and preserving visual field clarity.

Results: This technique was employed in 14 cases for hemostasis post-biopsy, 4 for adhesiolysis, and 2 for adhesion biopsies. Immediate hemostasis was achieved in all cases, including effective dissection of dense adhesions. Notably, there were no complications, equipment damage, or adverse outcomes for patients or operators. Current methods for pleural bleeding control—such as adrenaline-soaked gauze, internal diathermy, or argon plasma coagulation—typically require tool exchange, which prolongs the procedure and can hinder visibility. This technique addresses those limitations by integrating electrocautery with the existing biopsy tool.

Conclusion: In conclusion, the “touch cautery–conventional forceps” method represents an innovative and efficient advancement in pleural procedures. It ensures rapid, safe bleeding control and facilitates biopsy from firm or vascular adhesions without interrupting the procedural flow. Its real-time visual feedback and minimal instrument exchange make it a valuable tool for pleuroscopists.

Keywords: APC, bleeding, pleura biopsy, pleuroscopy, touch cautery

*This article was selected for NAPCON 2025 best research award presentation.

Evaluation of exudative lymphocytic pleural effusion with low adenosine deaminase value

Aakash Saha

Institute of Post-Graduate Medical Education and Research, Kolkata, West Bengal, India E-mail: aakashsaha100@gmail.com

Introduction: Adenosine deaminase (ADA) is an important biomarker of pleural effusion, especially in tuberculosis-prevalent country like India. Low ADA exudative lymphocytic effusion is always a clinical dilemma to pulmonologists. Medical thoracoscopy may be the need of the hour in such cases due to its ability for providing large biopsy samples by direct visualization of pleura.

Methods: This is a cross-sectional study among 81 adults, having exudative lymphocytic pleural effusion with ADA less than 40 U/L, inconclusive malignant cytology, normal bronchoscopy finding, negative tuberculosis work-up, admitted to our department. Patients underwent pleural biopsy using semi-rigid thoracoscope under local anesthesia and conscious sedation subsequently evaluated for histopathology with immunohistochemistry, and tuberculosis work-up.

Results: Mean age 58.5 years 59 males (73%). Thoracoscopy yielded definitive diagnosis in 70 patients (diagnostic yield: 86.4%) – malignancy in 51 patients (63%), tuberculosis (by histology/CBNAAT/culture) in 18 (22.2%) and pleural endometriosis in 1. Distribution of malignant cases: lung adenocarcinoma (35), poorly differentiated carcinoma (7), malignant mesothelioma (2), small cell carcinoma (1), others (breast – 3, cervix – 1, ovary – 1, endometrium – 1). Overall sensitivity and specificity of thoracoscopy for malignancy – 83.33% and 95.24% respectively. Mean ADA of tuberculosis cases was 24.09 U/L. Median post-procedure hospitalization stay was 5 days with no procedure-related mortality. 6 patients developed significant lung trapping with bronchopleural fistula. Comparing malignant effusion cases with tuberculous effusion, the difference in mean pleural fluid ADA, median pleural fluid LDH, mean CR (Cancer Ratio), mean CR+ values were found to be statistically significant (p < 0.05).

Conclusion: Medical thoracoscopy is a minimally-invasive ambulatory procedure with acceptable yield and favorable safety profile.

Keywords: Adenosine deaminase, biopsy, malignancy, semi-rigid, thoracoscopy

*This article was selected for NAPCON 2025 best research award presentation.

Mini-BAL versus bronchoscopic BAL in the diagnosis of ventilator-associated pneumonia

Pujari Aishwarya Varshini , A. N. V. Koteswara Rao, Venkateswara Reddy Tummuru

S. V. S. Medical College and Hospital, Mahbubnagar, Telangana, India E-mail: aishwaryavarshini96@gmail.com

Introduction: Ventilator-associated pneumonia (VAP) is the second most common nosocomial infection in critically ill patients, affecting ~27% and contributing to mortality rates of 33–71%. Bronchoscopic bronchoalveolar lavage (BAL) is a standard diagnostic method but requires specialised equipment. Mini-BAL is a simpler, cost-effective alternative. This study compared the diagnostic yield of mini-BAL and bronchoscopic BAL in ICU patients.

Methods: A prospective study was conducted on 60 mechanically ventilated patients (18–60 years) meeting VAP criteria: new chest radiograph consolidation, fever, leukocytosis, and purulent secretions. Patients were randomised to mini-BAL (n=30) or bronchoscopic BAL (n=30). Exclusion criteria included pre-existing consolidation, immunocompromised status, HIV, malignancy, and age outside the set range. Mini-BAL used a Foley catheter and mucus trap bronchoscopic BAL employed a flexible bronchoscope. Samples underwent microbial culture.

Results: Of 60 patients (38 male, 22 female equal gender distribution between groups), pathogen isolation occurred in 80% of mini-BAL and 86.6% of bronchoscopic BAL specimens. In mini-BAL, MRSA (41.6%) was most frequent, followed by Pseudomonas aeruginosa (25%) and Klebsiella pneumoniae (16.6%). Bronchoscopic BAL yielded MRSA (30.7%), Klebsiella pneumoniae (23%) and Pseudomonas aeruginosa (19.2%). Diagnostic yields were comparable.

Conclusion: Mini-BAL is a reliable, practical alternative to bronchoscopic BAL for VAP diagnosis without compromising accuracy.

Keywords: Bronchoscopic bronchoalveolar lavage, diagnostic yield, Intensive care unit infections, mini-bronchoalveolar lavage, ventilator-associated pneumonia

*This article was selected for NAPCON 2025 best research award presentation.

A study of montgomery T tube’s outcomes in benign tracheal stenosis based on protocolized care

Akula Priyanka 1,2 , Chakravarthi Lokhnath 1,2 , Ravindra Mehta 1,2

1 Apollo Hospitals, Bengaluru, Karnataka, India, 2 Vaayu Chest and Sleep Clinic, Bengaluru, Karnataka, India E-mail: 9849129955april@gmail.com

Introduction: Montgomery T-tubes (MTT) offer a dual function of airway stenting and phonation preservation in selected patients with benign tracheal stenosis [BTS]. Few studies have reported detailed outcomes in MTT patients. We describe a series of long-term outcomes with a standardized protocol in MTT patients for BTS.

Methods: Retrospective review of 25 patients with BTS managed with a MTT. Patient characteristics, indications, procedure details, complications and outcomes were reviewed. A standardized protocol was followed for assessment and follow-up for MTT patients including airway evaluation, post-placement care, periodic surveillance, removal assessment, and surgical intervention.

Results: 25 patients over 18 years with MTT placed were included in the study. All patients had BTS with tracheostomy. Further details: 16 had primary tracheostomy done, 6 had failed silicone stents followed by tracheostomy, and 3 patients had surgical resection and anastomosis, followed by MTT placement post-procedure. The mean interval between tracheostomy and MTT insertion was 40 days. The average MTT duration was 234 (range 30 to 1080 days). Major complications (obstructive to merit major intervention) were noted in 9 (36%) patients - proximal granulation (n=7) and major tube block necessitating tube removal (n=2). These 2 patients were from remote areas, the MTT was removed and tracheostomy was re-inserted. Granulation was managed bronchoscopically with hot/cold therapy debulking and repositioning of the tube. Minor complications 12 (48%) included mucous plugging, managed with enhanced humidification/nebulization/suctioning protocols, rarely requiring bronchoscopy. No observed complications 4(16%). Outcomes: Of 25 patients over 18 years, 4 (16%) had uneventful MTT removal without surgery, 3 (12%) had surgery with MTT removal, 14 (56%) have a long-term MTT, and 4(16%) have a long-term tracheostomy.

Conclusion: This is one of the recent comprehensive series from the Indian subcontinent on long-term MTT outcomes in BTS. MTT’s are usually the last resort of BTS and have issues in management and removal. The overall success of MTT removal in these patients is low in the absence of surgical management, and complications of granulation and blockage are common with long-term MTT’s. A structured protocol helps to streamline care.

Keywords: Benign tracheal stenosis, Montgomery T-tubes, tracheostomy

*This article was selected for NAPCON 2025 best research award presentation.

Clinical comparative evaluation of bronchoalveolar lavage, mini-BAL, and endotracheal aspirate in critically Ill patients

Easwaran Nampoothiri

Saveetha Medical College, Chennai, Tamil Nadu, India E-mail: easwarandxb@gmail.com

Introduction: Lower respiratory tract infections (LRTIs) in critically ill patients require accurate diagnosis for effective antimicrobial therapy. Bronchoalveolar lavage (BAL) is considered the diagnostic gold standard but is invasive. Mini-BAL offers a less invasive alternative, while endotracheal aspirate (ETA) is simple but has questionable accuracy. This study compared the diagnostic yield and safety of these three sampling methods.

Methods: A prospective study was conducted among 70 mechanically ventilated patients with suspected LRTIs in an ICU setting. BAL was obtained via fiberoptic bronchoscopy, Mini-BAL using a blind catheter technique, and ETA by suction. All samples were cultured for bacterial and fungal pathogens. Diagnostic accuracy was assessed using BAL as reference, and ROC curves, sensitivity, specificity, and correlation analysis were performed.

Results: BAL showed the highest diagnostic accuracy (sensitivity 100%, specificity 88.9%, AUC 0.981). Mini-BAL achieved comparable results (sensitivity 93.9%, specificity 61.9%, AUC 0.843) with strong correlation to BAL (r=0.865 bacteriology, r=0.937 mycology). ETA had poor diagnostic performance (AUC 0.520), reflecting high contamination risk. Complications were more frequent with BAL (hypoxemia, minor bleeding), minimal with Mini-BAL, and negligible with ETA.

Conclusion: Mini-BAL is a safe and reliable alternative to BAL for diagnosing LRTIs in critically ill patients, balancing diagnostic accuracy with procedural safety. ETA should be restricted to preliminary evaluation.

Keywords: Bronchoalveolar lavage, diagnostic accuracy, endotracheal aspirate, ICU, mini-BAL, respiratory infection

Identifying the burden and incidence of noctornal hypoxemia in patients without clinically significant OSA/ mild OSA patients – A retrospective polysomnography cohort

Swetha

Sri Ramachandra Medical College and Hospital, Chennai, Tamil Nadu, India E-mail: swetanaveen99@gmail.com

Introduction: Obstructive sleep apnoea, is a common disease with increasing global prevalence. According to the 2019 meta-analysis1, approx. 936 million adults between 30 and 69 years have mild to severe OSA (AHI = 5 event/hour) and about 425 million having moderate to severe OSA ( AHI = 15). Nocturnal hypoxemia (NH) is defined as, when a patient spends = 30% of total sleep time ( TST) with SpO2 of less 90% or nadir Spo2 = 88% for = 5 minutes during sleep3. T90 is defined as % of total sleep time with oxygen saturation <90% and depending on it, it is further divided into mild NH – T90 is 5-10% of the sleep time, moderate NH – T90 is 10-25%, and severe NH – T90 is more than 25% sleep time. We evaluated the prevalence, clinical predictors, and cardiac associations of NH among patients with AHI <5 and in patients of mild OSA.

Methods: Retrospective analysis of 50 consecutive diagnostic PSGs from [Jan to July 2025]. Demographics, comorbidities, PSG metrics, oxygenation, and cardiac parameters were compared. 50 patients with normal or mild OSA, patients are divided into 4 groups – Group A – no NH no OSA, Group B – NH without OSA, Group C – mild OSA without NH , Group D – mild OSA with NH.

Results: A total of 50 patients, were analysed and PSG was done and out of which, 36 patients (72%) had MILD OSA and 14 patients (28%) had no OSA. Patients were further subdivided into – those with significant NH and no NH and it was found to have equal number of patients having NH and without NH.

Conclusions: NH without OSA is often a missed entity. Clinicians should consider evaluation for hypoventilation or chronic lung disease when significant nocturnal desaturation occurs despite a low AHI.

Microbiological spectrum and antimicrobial resistance patterns in critically ill patients

Easwaran Nampoothiri

Saveetha Medical College, Chennai, Tamil Nadu, India E-mail: easwarandxb@gmail.com

Introduction: Lower respiratory tract infections (LRTIs) in critically ill patients require accurate diagnosis for effective antimicrobial therapy. Bronchoalveolar lavage (BAL) is considered the diagnostic gold standard but is invasive. Mini-BAL offers a less invasive alternative, while endotracheal aspirate (ETA) is simple but has questionable accuracy. This study compared the diagnostic yield and safety of these three sampling methods.

Methods: A prospective study was conducted among 70 mechanically ventilated patients with suspected LRTIs in an ICU setting. BAL was obtained via fiberoptic bronchoscopy, Mini-BAL using a blind catheter technique, and ETA by suction. All samples were cultured for bacterial and fungal pathogens. Diagnostic accuracy was assessed using BAL as reference, and ROC curves, sensitivity, specificity, and correlation analysis were performed.

Results: BAL showed the highest diagnostic accuracy (sensitivity 100%, specificity 88.9%, AUC 0.981). Mini-BAL achieved comparable results (sensitivity 93.9%, specificity 61.9%, AUC 0.843) with strong correlation to BAL (r=0.865 bacteriology, r=0.937 mycology). ETA had poor diagnostic performance (AUC 0.520), reflecting high contamination risk. Complications were more frequent with BAL (hypoxemia, minor bleeding), minimal with Mini-BAL, and negligible with ETA.

Conclusion: Mini-BAL is a safe and reliable alternative to BAL for diagnosing LRTIs in critically ill patients, balancing diagnostic accuracy with procedural safety. ETA should be restricted to preliminary evaluation.

Keywords: Bronchoalveolar lavage, diagnostic accuracy, endotracheal aspirate, ICU, mini-BAL, respiratory infection

Diagnostic yield of endobronchial ultrasound-guided transbronchial needle aspiration in mediastinal lymphadenopathy: A prospective study

Nalla Manusha , Raghottam Reddy

Yashoda Hospital, Hyderabad, Telangana, India E-mail: manushaganapathri@gmail.com

Introduction: Mediastinal lymphadenopathy (MLA) presents a diagnostic challenge with a wide spectrum of etiologies including malignancy, tuberculosis, and sarcoidosis. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has emerged as a minimally invasive, safe, and effective technique for evaluating MLA. Objective:To assess the diagnostic yield, safety profile, and spectrum of diagnoses obtained through EBUS-TBNA in patients with mediastinal lymphadenopathy at our tertiary care center.

Methods: This was a prospective observational study conducted from May 2025 to September 2025 at Yashoda hospitas,somajiguda, telangana, involving patients presenting with mediastinal and/or hilar lymphadenopathy detected on CT or PET-CT. All patients underwent EBUS-TBNA under general anaesthesia using a convex probe bronchoscope. Lymph nodes were sampled systematically based on standard protocols. Specimens were sent for cytology, cell block analysis, and relevant microbiological studies (e.g., AFB smear, GeneXpert, culture). Diagnostic yield was defined as the proportion of patients in whom a definitive diagnosis was established based on EBUS-TBNA findings.

Results: A total of 19 patients (mean age: 51.6 ± 17.1 years M:F = 14:5) were included. The most commonly sampled lymph node stations were 4R, 7, and 4L. A definitive diagnosis was achieved in 68.4% of cases. The most common etiologies identified were tuberculosis 76.9%, malignancy 23.1%. In 31.6% of patients, EBUS-TBNA was non-diagnostic, requiring further invasive procedures. There were no major complications, with only minor adverse events in 10% of patients.

Conclusion: EBUS-TBNA is a highly effective and safe tool with excellent diagnostic yield for evaluating mediastinal lymphadenopathy. It should be considered the first-line diagnostic modality in appropriate clinical settings, especially in TB-endemic regions like India.

Keywords: Diagnostic yield, endobronchial ultrasound-guided transbronchial needle aspiration, lung cancer, mediastinal lymphadenopathy, tuberculosis

Effectiveness of chemical pleurodesis using doxycycline in malignant and nonmalignant pleural disorders

Eshtamsetty Jaswanthi , A. Ayyappa, G. R. K. Gupta, T. Venkateswara Rao

Maharajah’s Institute of Medical Sciences, Vizianagaram, Andhra Pradesh, India E-mail: ejaswanthi1998@gmail.com

Introduction: Chemical pleurodesis is widely used in managing refractory pleural effusions and recurrent pneumothorax. While talc remains the standard sclerosing agent, doxycycline is gaining attention as a safer and more cost-effective alternative, particularly in resource-limited settings. Objective: This study aimed to evaluate the effectiveness and clinical safety of chemical pleurodesis using a single dose of 500 mg doxycycline in malignant pleural effusion, non malignant pleural effusion, and recurrent pneumothorax.

Methods: A retrospective analysis was conducted on 40 patients who underwent chemical pleurodesis between 2024 and 2025 at a tertiary care center in South India. Patients included had malignant pleural effusion (n=26), recurrent pneumothorax (n=10), and non malignant effusion secondary to hepatic hydrothorax (n=4). After intercostal drainage and pleural anesthesia, 500 mg of doxycycline was instilled into the pleural space. Successful pleurodesis was defined as lung expansion with minimal or no effusion or pneumothorax at 2 weeks.

Results: The overall success rate of pleurodesis was 88.9%. All patients with malignant pleural effusion and recurrent pneumothorax achieved successful pleurodesis. However, pleurodesis failed in all cases of hepatic hydrothorax. The most common adverse events were chest pain (69.4%) and fever (13.9%), but no serious complications were observed.

Conclusion: Doxycycline pleurodesis is a safe, effective, and economical option, particularly for malignant pleural effusion and recurrent pneumothorax. However, its efficacy in hepatic hydrothorax remains limited.

Keywords: Chemical pleurodesis, doxycycline, pleural effusion, pneumothorax

*This article was selected for NAPCON 2025 best research award presentation.

A study of exudative pleural effusions – Relationship between thoracoscopic findings and type of lesions

Piyush Kumar

Institute of Respiratory Diseases, SMS Medical College, Jaipur, Rajasthan, India E-mail: piyush.pankaj1995@gmail.com

Introduction: In India common causes of pleural effusion are tuberculosis, Para pneumonic effusion, malignancy, congestive heart failure, renal failure, connective tissue disorders and pulmonary embolism. Medical Thoracoscopy allows pulmonologist to enter the pleural space, inspect it and identify different nature of lesions in different etiology present on it like nodular, sago- grain like granule, cauliflower like growths and ulcerative lesions or fibrous septations on pleura. Objectives: Visualize a generous portion of parietal and visceral pleura in exudative pleural effusion to see nature of lesions over pleura and take numerous biopsies from selected areas of pleural lesion and to establish relationship of thoracoscopic finding with histo- pathological diagnosis of pleural effusion and to study diagnostic yield of medical thoracoscopy for undiagnosed exudative pleural effusions for early diagnosis and treatment according nature of lesion.

Methods: We performed a cross sectional observational study conducted in fifty patients at Institute of Respiratory Diseases (IRD), SMS Medical College, Jaipur, during the year 2023 – 2024 with approval from Institutional Review Board. We performed medical thoracoscopy (rigid) on 50 patients with exudative pleural effusions.

Results: In our study, we studied and summarized many differentials like Age, sex, type of effusion(either unilateral or bilateral), color of fluid, mediastinal shifting, type and size of growth present over the pleura, amount of tissue biopsy taken etc. and then we concluded the results. The diagnostic yield of thoracoscopy was around 90%.

Conclusion: In the diagnostic work up of pleural effusion, thoracoscopy provides direct visualization with magnification and panoramic view of hemithorax with high resolution so that it allows us to classify nature of different types of lesions which are specific to cause of effusion and adequate biopsy to be taken for histo-pathologic examination. We conclude that thoracoscopy, when properly performed, can confirm an uncertain diagnosis in most patients with pleural effusion.

Keywords: Malignancy, medical pleuroscopy, medical thoracoscopy, pleural effusion, tuberculosis

To study diagnostic yield and adverse effects of bedside bronchoscopy in acute respiratory failure patients

Gaurav Mishra , Manu Chopra

Armed Forces Medical College, Pune, Maharashtra, India E-mail: gaurav95bbs@gmail.com

Introduction: Bronchoscopy is a valuable tool in managing critically ill patients, particularly in intensive care settings, due to its diagnostic and therapeutic potential with a low incidence of complications. However, in patients with severe hypoxemic respiratory failure, bronchoscopy especially bronchoalveolar lavage (BAL), poses risks such as hypoxemia. Despite these risks, timely diagnosis is crucial as undetermined causes of acute hypoxemia are associated with poor outcomes. This study investigates the diagnostic yield, clinical outcomes, and complication rates of bedside bronchoscopy in hypoxemic patients.

Methods: This Ambispective observational study was conducted from December 2023 till September 2025 at a tertiary respiratory care center. 102 patients aged >14 years with hypoxemic respiratory failure with moderate to severe hypoxemia (FiO2 requirement >40%) underwent bedside bronchoscopy.

Results: In a cohort of 102 patients with hypoxemic respiratory failure (mean age: 51.5 years) who underwent videobronchoscopy with bronchoalveolar lavage (BAL), an etiological diagnosis was achieved in 66 patients (65% of the total cases). The BAL findings led to a change in treatment in 51 patients (50% of total cases), of whom 25 patients (50%) had a favorable outcome. In contrast, among the 36 patients where no diagnosis was established, only 10 patients (28%) had a favorable outcome. Overall, 36 patients (35%) survived, while 66 patients (65%) succumbed to their illness, highlighting the potential impact of BAL in guiding treatment decisions and improving outcomes in respiratory failure patients. BAL was crucial in diagnosing conditions like PCP pneumonia, fungal pneumonia, strongyloides, DAH and PAP, which would have been easily missed. The procedure was well-tolerated, with no significant complications other than transient increases in oxygen requirements.

Conclusion: Bronchoalveolar lavage (BAL) in acute respiratory failure, though technically challenging, facilitates the identification of atypical diagnoses and can significantly improve patient outcomes.

Keywords: Bedside bronchoscopy, bronchoalveolar lavage, clinical outcomes, diagnostic yield, hypoxemic respiratory failure

Lung Function Tests: Diagnostic value of forced vital capacity/diffusing capacity of the lungs for carbon monoxide ratio in PH-ILD

Alimath Nafeena

Subbaiah Institute of Medical Sciences and Research Centre, Shimoga, Karnataka, India E-mail: nafeenam@gmail.com

Introduction: Interstitial lung disease (ILD) is a significant manifestation of connective tissue diseases (CTD). CTD associated Pulmonary Hypertension (CTD-PH) is the second most common cause of group 1 Pulmonary Arterial Hypertension after idiopathic PAH. Transthoracic Echocardiography is recommended as the primary non-invasive screening and evaluation method for PH using Right Ventricular Systolic Pressure (RVSP). Pulmonary function tests (PFTs) especially the FVC%/ DLCO% ratio reflects disproportionate gas-exchange impairment relative to volume restriction with studies suggesting that an elevated ratio >1.35 correlates with PH-ILD.

Methods: This was a prospective, cross sectional study conducted at Medical College Hospital from June 2024 to May 2025 including 35 patients. The objectives of the study were to evaluate the predictive value of FVC%/DLCO% ratio for PH in ILD and examine the correlation between FVC/DLCO and RVSP. Patients aged >18 years with CTD-ILD were included while those hemodynamically unstable or contraindications to PFT were excluded from the study. Eligible patients were subjected to spirometry for FVC, DLCO testing, and Transthoracic Echocardiography for RVSP measurement. Data was collected in excel sheet and analysed using SPSS 20 version with necessary required tests.

Results: Mean age was 47.8 ± 11.3 years and majority were females (n=28, 80%). Mixed CTD (37%) was predominant subtype followed by rheumatoid arthritis (25.7%). PH was detected in 12 patients (34.3%). The mean FVC%/DLCO% ratio was 1.11. Using a cut-off >1.11, sensitivity and specificity for PH were 62.5% and 31.6% respectively. With >1.35, sensitivity remained 62.5% but specificity decreased to 27.3%. Pearson’s correlation coefficient between FVC%/DLCO% ratio and PH was 1.03, showing negative correlation.

Conclusion: The FVC%/DLCO% ratio has a screening tool failed to predict PH in patients with CTD-ILD. Larger studies may be required to confirm its diagnostic utility as we had less patients with PH.

Keywords: Connective tissue disease, interstitial lung disease, pulmonary hypertension

Role of FEV1/DLCO ratio in predicting pulmonary artery hypertension in chronic obstructive pulmonary disease individuals

Rachuru Mohan Krishna , Sree Swathi, Manasa

Gandhi Medical College and Hospital, Hyderabad, Telangana, India E-mail: mohanrachuru143@gmail.com

Introduction: Pulmonary Artery hypertension (PAH) is a common complication of chronic obstructive pulmonary disease (COPD). Aim of the study is to know whether the ratio of forced vital capacity (FEV1) to diffusing lung capacity for carbon monoxide (Dlco) can identify PAH in patients with COPD.

Methods: Informed consent was taken from 80 random COPD patients who attended the department of Respiratory Medicine Gandhi Hospital. Spirometry, Dlco and 2d Echo was done to compare the ratio of (FEV1/ Dlco) is compared to the Pulmonary Artery Pressure in 2d echo.

Results: Study included 32 severe and very severe COPD patients. 23 patients of 32 are moderate and severe PAH in 2d Echo .normal value In our study the ratio of more than or equal to 0.85 l/mmol/min/kpa is associated with Pulmonary Artery Pressure more than 35 mmHg. Both fev1 and Dlco decrease in copd. In severe COPD cases, as airway narrowed to maximum, there is a platue in decrease of fev1 . But, the dlco continue to further decrease due to both parenchymal destruction and vascular remodeling due to hypoxia leading to further increase in the ratio of fev1/dlco. As the severity of the disease progress further decrease in Dlco increase the ratio of FEV1/Dlco.

Conclusion: In conclusion, the FEV1/DLCO ratio may be an additional non-invasive tool that can aid in predicting PAH and survival in patients with COPD. It may provide a simpler, more accurate, and more accessible tool for the prediction of severe PH in patients with COPD-PAH when elevated, this can prompt further invasive diagnostic work-up.

Keywords: Chronic obstructive pulmonary disease, Dlco, FEV1, FVC, pulmonary artery hypertension

*This article was selected for NAPCON 2025 best research award presentation.

The utility of impulse oscillometry in asthma and its comparison with spirometry in diagnosing asthma

Rahul Sharma , Huda Shamim

Chandan Hospital, Lucknow, Uttar Pradesh, India E-mail: dr.rahulsharma210@gmail.com

Introduction: Asthma is a chronic inflammatory disease marked by variable airflow limitation and significant involvement of small airways. While spirometry is the standard diagnostic tool, it may miss subtle changes in peripheral airway function. Impulse Oscillometry (IOS), a non-invasive technique requiring minimal patient effort, is emerging as a sensitive modality to assess small airway dysfunction (SAD), especially in populations where spirometry is difficult to perform.

Methods: This was a cross-sectional observational study conducted at Chandan Hospital, Lucknow, over a 12-month period (June 2023–June 2024), including 116 asthmatic patients aged 18–80 years. Clinical history, ACT scores, FeNO, spirometry, and IOS were assessed. IOS parameters included R5, R20, R5–R20, X5, AX, and Fres. Statistical analysis was conducted using SPSS v26.0 with p<0.05 considered significant.

Results: The mean age of patients was 42.05±16.06 years with a nearly equal gender distribution. Abnormal spirometry findings were noted in 62.07%, while abnormal IOS parameters were seen in 62.93%. Small airway involvement was detected by spirometry in only 13.79% but was better captured by IOS (R5–R20 mean: 0.18±0.15 AX: 1.89±1.89 Fres: 21.89±7.13). Mean FeNO was 27.28±29.86 ppb, with 33.6% showing moderate to high levels. A significant positive correlation was observed between IOS parameters (particularly R5–R20 and AX) and ACT scores. IOS could identify small airway dysfunction in patients with normal spirometry and poor asthma control.

Conclusion: IOS is a valuable adjunctive tool for asthma diagnosis and management, particularly in identifying small airway dysfunction that may be missed by spirometry. It demonstrates strong correlation with ACT and FeNO, suggesting a role in individualized asthma assessment and monitoring. Incorporation of IOS into routine practice may enhance diagnostic accuracy and therapeutic outcomes.

Keywords: Impulse oscillometry, lung function test, small airway dysfunction

*This article was selected for NAPCON 2025 best research award presentation.

The silent zone - Prevalence of small airway dysfunction in asthma

Midhun Raj K , Rahul Ramachandran

Government Medical College, Kozhikode, Kerala, India E-mail: midhunkovil@gmail.com

Introduction: Recently the clinical relevance of the small airways has gained greater recognition. Under normal circumstances they contribute only minimally to airway resistance - hence the “silent zone”. Despite inhaler therapy, a substantial proportion of asthmatics remain poorly controlled. Small Airway Dysfunction (SAD) appears to possess the characteristics of treatable trait, making it appealing for asthma control optimization. Objectives: To assess the prevalence of small airway dysfunction in asthma by spirometry and impulse oscillometry, and to assess their efficacy.

Methods: Observational study be conducted in our respiratory medicine OPD. Inclusion criteria: Asthma patients, who are on regular ICS-LABA inhaler therapy for the past 6 months, without any recent hospitalization. Asthma severity, Asthma Control Test score and blood eosinophil count were noted. Spirometry component FEF25–75% cutoff of <70% (less than 60% in some literature) or IOS component R5–R20 cutoff of > 0.07 kPas/L is chosen for the presence of SAD.

Results: 64% of our study subjects were female, with mean age of 44. Majority had well-controlled asthma, but most of them had the complaint of night time awakening. 70% of the study subjects had FEF25–75% less than cutoff value. In IOS, 80% had R5–R20 value more than 0.07 kPas/L. This correlated well with their asthma control test score. prevalence of small airway dysfunction can be around 70-80%.

Conclusion: There is a substantial prevalence of SAD in asthma. IOS can complement spirometry as part of asthma work-up.

Keywords: Airway and allergy disorder, asthma, impulse oscillometry, lung function test, small airway dysfunction

*This article was selected for NAPCON 2025 best research award presentation.

Correlation of fractional exhaled nitric oxide and blood eosinophil levels with disease severity in stable chronic obstructive pulmonary disease

Lokesh Kumar Gupta , Smruthi Valsalan

Kamala Nehru Chest Hospital, Jodhpur, Rajasthan, India E-mail: luckygupta5123@gmail.com

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of global morbidity and mortality, yet widespread under-diagnosis and misdiagnosis hinder effective treatment and public health impact. Identifying reliable biomarkers for disease severity and progression is crucial. This study investigated the correlation of Fractional Exhaled Nitric Oxide (FeNO) and blood eosinophil levels with various parameters of disease severity in stable COPD patients.

Methods: This observational study included 100 stable COPD patients with a mean age of 52.41 years (70% male, 87% rural residents). Data on demographics, smoking history, comorbidities (hypertension, diabetes, CAD), lung function (post-bronchodilator FEV1%), FeNO levels, and Absolute Eosinophil Count (AEC) were collected. Disease severity was assessed, and associations with biomarkers were statistically analyzed.

Results: Elevated FeNO levels and higher blood eosinophil counts were significantly associated with increased COPD disease severity (p<0.0001 for both), impaired lung function (lower post-bronchodilator FEV1, FVC, and FEV1/FVC p<0.0001), and a greater frequency of exacerbations requiring hospitalization (p<0.0001). Mild disease was predominantly characterized by lower biomarker levels, while severe disease consistently showed higher levels. A strong negative correlations were found between both FeNO and AEC with FEV1% (r=-0.656 and r=-0.745 respectively, both p<0.0001).

Conclusion: This study reinforces that elevated FeNO and blood eosinophil counts are strongly associated with increased disease severity, impaired lung function, and higher exacerbation rates in stable COPD patients. These biomarkers show promise as indicators of disease inflammation, and potential responsiveness to inhaled corticosteroids (ICS), warranting further extensive research to fully elucidate their role in COPD management.

Keywords: Absolute eosinophil count, fractional exhaled nitric oxide, chronic obstructive pulmonary disease

*This article was selected for NAPCON 2025 best research award presentation.

Impact of point-of-care spirometry on the diagnosis and management of obstructive airways diseases

Aishwarya Shashi Nair , Meena Lopez, Monica Barne

Chest Research and Training Private Limited, Pune, Maharashtra, India E-mail: aishwaryanairsp@gmail.com

Introduction: Asthma and COPD contribute significantly to morbidity and mortality in India, yet both remain underdiagnosed due to limited use of spirometry in routine practice. Point-of-care spirometry offers a simple, affordable, and objective tool that facilitates early detection and treatment decisions, ultimately improving patient care in obstructive airway diseases. This survey aimed to assess doctors’ perceptions regarding the role of point-of-care (POC) spirometry in enhancing the diagnosis and management of obstructive airway diseases in routine clinical practice.

Methods: The survey was conducted across India in collaboration with a partner engaged in the manufacturing and marketing of spirometers. Purposive sampling was used, enrolling clinicians currently using a POC- spirometer (Spirofy™) for at least 1 month.

Results: A total of 100 clinicians (71% pulmonologists, 14% pediatricians, 8% consulting physicians, and 5% general practitioners) participated. Reported benefits of point-of-care (POC) spirometry included timely diagnosis of asthma/COPD (94.2%), enhanced diagnostic confidence (92.3%), improved health outcomes (91.4%), support in disease management (93.3%), and reduced risk of losing patients (80.8%). The device was easy to operate (94.2%) and could be seamlessly integrated into practice (91.4%). Patient benefits included greater acceptability of the diagnosis (91.4%), better treatment compliance (87.5%), positive feedback (86.5%), and savings in time, cost, and effort (92.3%). Despite longer consultation times, 86.5% of clinicians felt that the availability of POC spirometry outweighed the challenges. Overall, 89.4% recommended Spirofy™ to peers, acknowledging its value in routine practice.

Conclusion: POC spirometry provides significant clinical and patient-centered benefits with minimal challenges, supporting its routine use in practice to aid timely diagnosis, enhance disease management, and improve outcomes in obstructive airway diseases (OAD).

Keywords: Diagnosis, obstructive airway diseases, point-of-care spirometry, disease management

*This article was selected for NAPCON 2025 best research award presentation.

Comparative analysis of pulmonary and renal parameters in COPD

Smitha Patil , T. Prasanna Kumar

M. S. Ramaiah Medical College, Bengaluru, Karnataka, India E-mail: smithapatil44@gmail.com

Introduction: COPD has its impact beyond the lungs, with systemic inflammation and cardiovascular burden that often remain under-recognised. With the increasing burden of chronic kidney disease (CKD), especially among COPD patients, further studies to establish the spectrum of cardiometabolic complications are the need of the hour in Indian scenarios where epidemiological data remain limited. Objective: To assess renal function across different stages of COPD and to evaluate the burden of comorbidities in COPD and age matched normal individuals.

Methods: This cross-sectional study included 178 individuals - 92 COPD patients (classified as per GOLD guidelines) and 86 age-matched controls. Demographics,spirometrydata (FEV1, FVC, FEV1/FVC, PEF, MMEF), and biochemical parameters (serum creatinine, albumin, BUN, uric acid, UACR, GFR) were recorded. Presence of hypertension, diabetes recorded. Statistical analysis included t-tests, Mann-Whitney U, and ?² tests, with p<0.05 considered significant.

Results: Mean age was similar between groups (COPD 67.75±7.5 vs. controls 67.0±9.26 p=0.61). Spirometry declined with severity (FEV1: controls 2.72±0.15 L vs. severe COPD 1.18±0.2 L p<0.001). FEV1/FVC fell from 0.80±0.03 to 0.46±0.04 (p<0.001). Renal function deteriorated: GFR reduced from 90.28±10.5 to 60.70±13.5 (p<0.001), albumin was lower (4.26±0.3 vs. 3.45±0.3 p=0.02). Hypertension rose (~32% controls vs. ~70% severe COPD p<0.001), and diabetes was more common (12.4% vs. 33% p=0.01).

Conclusion: COPD is associated with progressive pulmonary decline, renal dysfunction, and increasing cardiometabolic comorbidities compared to controls. These findings highlight the systemic nature of COPD and establish the need for integrating renal and cardiovascular evaluation into routine COPD care in India.

Keywords: Chronic obstructive pulmonary disease, comorbidities, renal function, spirometry, systemic disease

*This article was selected for NAPCON 2025 best research award presentation.

Unveiling subclinical airway dysfunction: Role of impulse oscillometry in asthmatics with normal lung function

Halma Salam V.A , Deepak Bansal, Shailesh Agrawal

MGM Medical College, Indore, Madhya Pradesh, India E-mail: halmasalam17@gmail.com

Introduction: Small airway dysfunction (SAD) is increasingly recognized as an early feature of airway disease but often remains undetected by spirometry, particularly in patients with normal lung function. Impulse Oscillometry (IOS), an effort-independent technique, offers greater sensitivity in identifying peripheral airway impairment. This study aims to assess and compare the prevalence of IOS-defined SAD in asthmatic patients with normal spirometry and in symptomatic smokers with normal spirometry.

Methods: This comparative cross-sectional observational study will be conducted at a tertiary care centre over six weeks. Ninety adult participants will be recruited, including 45 asthmatics clinically diagnosed based on symptoms and 45 smokers with COPD-like symptoms, all presenting with normal spirometry. Each subject will undergo spirometry (FEV1, FVC, FEV1/FVC) and IOS (R5, R20, R5–R20, X5, AX, Fres) both pre- and post-bronchodilator administration. Data will be analyzed using IBM SPSS version 27.0 and GraphPad Prism 7.0. Statistical significance will be defined at p < 0.05 possible.

Results: It is expected that IOS will identify a significantly higher prevalence of SAD in asthmatic patients compared with smokers, despite normal spirometric values. Among IOS parameters, R5–R20 and AX are anticipated to be more sensitive indicators of small airway impairment. Asthmatic patients may demonstrate greater bronchodilator reversibility, while smokers may show a lower degree of reversibility, reflecting early fixed airway obstruction. These findings, if confirmed, will emphasize the diagnostic utility of IOS in detecting subclinical small airway disease not captured by routine spirometry. The contrasting patterns between asthmatics and smokers may also provide insights into differing underlying pathophysiological mechanisms, with implications for early detection and tailored management.

Conclusion: (To be finalized after completion of data collection and statistical analysis).

Keywords: Asthma/diagnosis, chronic obstructive/diagnosis, oscillometry, pulmonary disease, respiratory function tests

Comparison of bronchodilator response measured by impulse oscillometry and spirometry in asthma

Santhiya

Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth (Deemed to be University), Puducherry, India E-mail: santhiyaramachandran@gmail.com

Introduction: Asthma is a prevalent chronic airway disease affecting millions globally, leading to significant health-related costs and morbidity. Spirometry is the conventional method for measuring large airway function, while Impulse Oscillometry System (IOS) offers a non- invasive alternative for assessing small airway resistance and reactance. This study aims to compare bronchodilator response (BDR) as measured by spirometry and IOS in asthmatic patients.

Methods: A cross-sectional study was conducted on 46 asthmatic patients who showed BDR response in spirometry with post FEV1 200 ml volume change and 12% reversibility. Both pre and post bronchodilator spirometry and IOS tests were performed. Spirometric parameters such as FEV1, FVC, FEV1/FVC and FEF25-75 were measured alongside IOS parameters like R5, X5, R20, R5-R20 and AX.

Results: Only 10 patients (21.7%) met the bronchodilator response criteria using ATS standards by impulse oscillometry. The decrease in the R5 values post bronchodilator by 40% and above, 30% and 20 % appeared in 10, 21 and 30 patients respectively. The increase in X5 values post bronchodilator by 50% and above, 40% and 30% appeared in 10, 15 and 23 patients respectively. The decrease in AX values post bronchodilator by 80% and above, 50 % and 30 % appeared in 10, 17 and 30 patients respectively.

Conclusion: By reducing the threshold cut-off values of R5, X5 and AX, the sensitivity of IOS improved significantly, enabling more participants to meet the BDR criteria. This suggests that revised thresholds tailored to the Indian population could enhance the diagnostic utility of IOS. The combined use of spirometry and IOS offers a more comprehensive assessment of airway function, particularly for patients with suspected small airway involvement.

Cut-off values for FOT to differentiate between healthy and obstructive airways diseases for an Indian population cohort

Deesha Ghorpade , A. K. Prakash, Harshvardhan Vhora

Chest Research and Training Pvt. Ltd., Pune, Maharashtra, India E-mail: deesha.ghorpade@yahoo.in

Introduction: Instead of predicted values, cut-off values are now being increasingly used to differentiate between healthy and OAD for interpreting FOT. We aimed to derive cut-off values using the Antlia Pro (iCALTECH, Bangalore, India) FOT, a multifrequency, pseudorandom prime numbers device.

Methods: Clinical, spirometry and FOT data of healthy (n= 111), Asthma (n= 89) and COPD (n=101) male and female subjects, =18years of age was collected from 8 centres across the country through the International Network of Lung Oscillometry Research (ARISE) using a convenient sampling method. All the data obtained was checked for quality.

Results: In the healthy population (N=111), mean age was 35.2±12.8 yrs, 58% were males, Ht: M-168.9±7.8, F-154.9±5.8, BMI: 24.9±4.03 and in the OAD population (N=190), mean age was 55.5±16.9 yrs, 49% were males, Ht: M-166.1±7.6, F-152.6±6.2, BMI: 24.9±5.69. Ht. was the only significant predictor (r=0.323 p<0.001). Cut-off values were generated for overall population as well as using two heights (<160 cm, >160 cm).

Conclusion: To the best of our knowledge, these are the first cut-off values developed for the adult population for FOT to differentiate between healthy and OAD (asthma and COPD). Using 2 categories of height (<160 and >160 cms) increased the cut-off accuracy.

Keywords: Asthma and lung oscillometer, COPD and lung oscillometer, cut-off values, lung oscillometer

Detection of small airway dysfunction in asymptomatic smokers with preserved spirometry using forced oscillation technique

Keerthana K , Vidya S

Stanley Medical College, Chennai, Tamil Nadu, India E-mail: keerthanambbs97@gmail.com

Introduction: Cigarette smoking is a well-established causative factor for Chronic Obstructive Pulmonary Disease (COPD). Smoking-induced bronchiolitis with progressive small airway dysfunction (SAD) is a major contributor to the development of COPD. Since the lungs have a wide functional reserve, significant changes in pulmonary function may occur before smokers develop respiratory symptoms. The Forced Oscillation Technique (FOT) measures the mechanical properties of the lungs during quiet tidal breathing by applying minimal pressures at the mouth. FOT provides parameters that complement traditional pulmonary function tests, such as spirometry, lung volumes, and diffusing capacity. The fall in resistance from 5 Hz to 20 Hz (R5–R20) is considered a sensitive measure of small airway resistance. Study design: Cross-sectional study Duration: 6 months.

Methods: Participants included: Smokers attending the smoking cessation clinic, Attendants accompanying opd patients, Visitors of inpatients Demographic details such as age, height, weight, smoking history, and duration of smoking were recorded. All subjects underwent: Spirometry: Forced Expiratory Volume in 1 second (FEV1), FEV1 % predicted, Forced Vital Capacity (FVC), FVC % predicted, FEV1/FVC ratio, and Forced Expiratory Flow (FEF25–75 %). FOT parameters: R5 (total resistance), R20 (central resistance), R5–R20 (peripheral resistance), AX and X5.

Results: Among 75 asymptomatic smokers with preserved spirometry, pack-years correlated significantly with impulse oscillometry (IOS) parameters. The IOS measure R5–R20 showed a significant inverse relationship with FEF25-75%. A significantly higher proportion of heavy smokers (=30 pack-years) demonstrated R5–R20 values exceeding 0.07 kPa·s·L?¹—an established threshold for small airway dysfunction—compared to mild smokers and never-smokers. In contrast, spirometry-based indices did not reveal similar differences.

Conclusion: Impulse oscillometry is capable of detecting early small airway dysfunction in asymptomatic heavy smokers with preserved spirometry. IOS can therefore serve as a valuable adjunct to conventional pulmonary function tests for identifying early COPD-related changes.

Keywords: Forced oscillation technique, small airways

Reliability of peak expiratory flow measurement in assessing bronchodilator response of airflow obstruction

C. R. Sivaram , Prasanth, Swetha

Saveetha Medical College, Chennai, Tamil Nadu, India E-mail: sivaramchandrasivamrajendren@gmail.com

Introduction: Asthma is a chronic airway disease marked by reversible obstruction. Forced Expiratory Volume in one second (FEV1) is the gold standard for bronchodilator response, but Peak Expiratory Flow Rate (PEFR) is simpler and inexpensive. This study aimed to assess the reliability of PEFR compared with FEV1 in asthmatic patients.

Methods: A cross-sectional study was conducted among 60 asthmatics at Saveetha Medical College. Baseline and post-bronchodilator pulmonary function tests were performed using spirometry and a peak flow meter. Salbutamol (200 mcg) was administered, and reversibility in PEFR and FEV1 was calculated. Correlation between both parameters was statistically analyzed.

Results: Mean PEFR increased from 295.3 L/min to 334.8 L/min, while mean FEV1 improved from 1.64 L to 1.84 L. PEFR reversibility averaged 200.2% and FEV1 15.0%, both highly significant (p < 0.05). Although PEFR demonstrated greater variability, it correlated with FEV1 changes, confirming its utility in detecting bronchodilator response.

Conclusion: PEFR can serve as a practical alternative to FEV1 in assessing bronchodilator response, though it should complement rather than replace spirometry in clinical decision-making.

Keywords: Asthma, bronchodilator response, FEV1, peak expiratory flow rate, spirometry

Lung Tumours: Clinicopathological spectrum and outcomes of lung cancer: Insights from a tertiary care centre in South India

Himanya Tatineni , Sridhar R, Meenakashi N

Chettinad Hospital and Research Institute, Chennai, Tamil Nadu, India E-mail: tatinenihimanya@gmail.com

Introduction: Lung cancer continues to be a smoldering enigma in the lungs – the leading cause of cancer-related deaths worldwide and a growing challenge in India. Regional variations in histology, diagnostic access, and treatment uptake can influence outcomes. With adenocarcinoma emerging as the dominant subtype and molecular therapy revolutionizing care, real-world data from South Indian tertiary centers are vital to map evolving trends.

Methods: A retrospective case series was conducted in the Department of Pulmonary Medicine from January 2023 to March 2025. Forty-five patients with histologically confirmed lung cancer and complete diagnostic records were included. Data on demographics, risk factors, clinical features, imaging, biopsy methods, histopathology, staging, molecular profiling (EGFR, ALK), treatment modalities, and outcomes were analyzed.

Results: Of 45 patients, 35 (77.8%) were male, mean age 62.3 ± 9.4 years 68.9% had a smoking history. Chronic cough (82.2%) was the leading symptom. Adenocarcinoma (48.9%) surpassed squamous cell carcinoma (28.9%) and small cell carcinoma (13.3%). Alarmingly, 64.4% presented at stage IV. Among 25 adenocarcinoma patients tested, 7 (28%) were EGFR-positive and 2 (8%) ALK-positive. Chemotherapy was given to 71.1%, targeted therapy to 9, and immunotherapy to 3 31.1% received only palliative care. One-year survival was 40%, with better outcomes in mutation-positive patients receiving targeted therapy.

Conclusion: When common symptoms meet uncommon pathology, vigilance makes all the difference. Our study reveals the urgent need for earlier detection, universal access to molecular diagnostics, and wider integration of personalized therapies to improve outcomes for lung cancer in South India.

Keywords: Adenocarcinoma, lung cancer, molecular profiling, South India, targeted therapy

PDL1 expression in non-small-cell lung cancer in a tertiary care centre in South India

Ilakiya P

Apollo Hospitals, Tamil Nadu, India E-mail: p.ilakiyasakthi@gmail.com

Introduction: Immune checkpoint inhibitors (ICIs) - PD-L1 inhibitors have made a revolution in the treatment of non-small cell lung cancer. A study of various proportions of PDL-1 expression in different diagnostic samples is useful to decide the diagnostic method and thereby increase the diagnostic yield of PDL-1 expression. The objective is to study the prevalence of PDL-1 expression in non-small cell lung cancer and assess the relationship between PD-L1 expression and different types of diagnostic samples.

Methods: Retrospective, Mono-centric, cross-sectional study.

Results: Of the 56 samples analyzed, PD-L1 expression was observed in 62%. The study population had a male-to-female ratio of 80:20 with a mean age of 62 years. No statistically significant association was found between PD-L1 expression and gender (p=0.79), smoking status (p=0.66), sample type (small biopsy vs. surgical resection, p=0.9), or tumor site (primary vs. metastatic lesion, p=0.63).

Conclusion: Small diagnostic biopsies are as reliable as surgical resections for determining PD-L1 status, supporting their continued use as the standard diagnostic method. Larger multicenter studies are needed to validate these findings which helps optimizing patient selection for immunotherapy.

Keywords: Nonsmall cell lung cancer, PDL-1

Low dose computed tomography for lung cancer screening: Results of two annual rounds

Oshin Bhatia , Ashu Seith Bhalla, Ayush Goel

All India Institute of Medical Sciences, New Delhi, India E-mail: bhatiaoshin@gmail.com

Introduction: Lung cancer screening using low dose computed tomography chest (LDCT) has shown to reduce mortality in high risk smokers. Annual LDCT chest is recommended as a screening modality for high risk smokers, albeit follow up scans showing lower positivity rates. The utility of annual follow up scans after the first negative scan is uncertain.

Methods: We conducted a prospective single-arm study. Persons aged 45-75 years with smoking index (SI) >400 underwent two annual rounds of LDCT chest. CT reporting and further nodule management was done as per LUNG-RADS recommendations. Proportion of patients with positive screen (Category 3 or 4 nodules) and lung cancer were calculated for first (T0) and annual follow up (T1) scans.

Results: A total of 334 subjects (97.3% males, mean {SD} age, 61.7 {6.8} years, mean {SD} smoking index, 617 {164}) underwent first LDCT (T0). Thirty-seven subjects (11.1%) had an LDCT positive screen. Lung cancer was diagnosed in 7 subjects (2.1%, 95% CI: 0.8-4.3%). These included five subjects with stage I, one stage IIIA and one stage IVB disease as per TNM 9th ed. The presence of post-TB sequelae did not impact screen positivity rate (p = 0.96). A total of 103 subjects underwent first annual follow up LDCT (T1), out of which seven had positive screen (6.8%), but none of the subjects were diagnosed with lung cancer. One of the subject underwent wedge resection of nodule (PET avid) which turned out benign.

Conclusion: Screening for lung cancer using LDCT is feasible in TB-endemic countries like India. The proportion of subjects with positive screen and lung cancer detection rate are comparable to reported literature from developed countries. The potential utility of annual follow up scans after an initial negative scan needs to be confirmed in larger cohorts.

Keywords: LDCT chest, lung cancer screening, LUNG-RADS

*This article was selected for NAPCON 2025 best research award presentation

Invisible hazards, visible tumors: A case series on environmental and occupational determinants of lung cancer

Pavithra Muruganathan

Coimbatore Medical College Hospital, Coimbatore, Tamil Nadu, India E-mail: paviparasu@gmail.com

Introduction: Lung cancer is traditionally viewed as a disease of older adults with a strong link to tobacco exposure. However, growing evidence suggests that early-onset lung cancer (<50 years) may have substantial contributions from occupational and environmental exposures, particularly in low- and mid-income countries where regulatory oversight is limited. Objective to describe the environmental and occupational exposure profiles in adults under 50 years diagnosed with lung cancer and correlate these with histopathological subtypes and disease staging.

Methods: This retrospective case series evaluated 20 histopathologically confirmed lung cancer patients aged <50 years. Clinical data, smoking indices, occupation history, and duration of exposure were reviewed. Occupational sectors included metallurgy, agriculture, textiles, painting, and construction. Key exposures assessed included silica dust, volatile organic compounds (VOCs), biomass smoke, pesticides, and fine particulate matter.

Results: Among 20 cases, 16 were smokers and 4 were never-smokers. The most common histopathological subtype was adenocarcinoma (n=10), followed by squamous cell carcinoma (n=6), small cell carcinoma (n=3), and rare tumors such as PECOMA and adenoid cystic carcinoma (n=2). The average exposure duration was 17.5 years. Notably, 95% of cases presented at stage III or IV. Several never-smokers with prolonged VOC or fiber dust exposure developed adenocarcinoma, suggesting a strong environmental etiology.

Conclusion: This case series sheds light on a silent epidemic,lung cancer in young adults is no longer a smokers disease alone. Toxic occupational exposures, often invisible and unmonitored, act as cumulative carcinogens. Comprehensive occupational histories, targeted screening of high-risk workers, and implementation of workplace safety protocols are urgently needed. This case series supports the redefinition of risk stratification frameworks for lung cancer in younger populations.

The role of TTF-1 and p40 in improving diagnostic accuracy and subtyping of nonsmall cell lung cancer

Ashitosh Mane , Saswat Subhankar

KIMS, Bhubaneswar, Odisha, India E-mail: amane4500@gmail.com

Introduction: Early diagnosis in lung cancer is challenging due to the non-specific clinical features of the disease, leading to advanced-stage cancer in many cases. Accurate histological subtyping of lung cancer, particularly Non-Small Cell Lung Cancer (NSCLC), is crucial for guiding therapeutic decisions. Immunohistochemistry (IHC), particularly markers like TTF-1 and p40, plays a pivotal role in improving diagnostic accuracy, especially in small biopsy samples. This study aims to investigate the clinical, radiological, and histological features of lung cancer, focusing on the utility of immunohistochemistry (IHC) markers TTF-1 and p40 for subtyping NSCLC.

Methods: This diagnostic study was conducted at Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, from January 2024 to August 2024. The study involved 53 consecutive patients with suspected primary lung cancer based on radiological findings. Inclusion criteria were patients with radiologically suspected primary lung cancer, while those with secondary lung lesions, contraindications to biopsy, or non-malignant diagnoses were excluded. Diagnostic modalities included bronchoscopy, CT-guided fine-needle aspiration (FNA), and biopsy. The histopathological samples were subjected to IHC using TTF-1 and p40 to establish tumor subtypes.

Results: The study cohort had a male-to-female ratio of 4.3:1, with a predominance of patients aged 61-70 years. Most patients had mass lesions on radiology (86.8%). Clinical presentations were dominated by cough (71.7%) and breathlessness (66%). Histopathological examination revealed squamous cell carcinoma (SCC) in 22.6% and adenocarcinoma (ADC) in 16.9%. IHC confirmed adenocarcinoma in 45.2% of cases and SCC in 43.3%, with TTF-1 and p40 aiding in reclassification of poorly differentiated tumors.

Conclusion: The integration of IHC markers, particularly TTF-1 and p40, enhances the subtyping of NSCLC, especially in small biopsy samples, facilitating more accurate diagnosis and targeted therapy. This approach significantly reduces the number of NSCLC-NOS (Not Otherwise Specified) diagnoses, thereby enabling clinicians to make better-informed therapeutic decisions.

Keywords: Immunohistochemistry, nonsmall cell lung cancer, p40, TTF-1

*This article was selected for NAPCON 2025 best research award presentation

Proportion of malignant pleural effusions among patients with pleural effusion in malignancy presenting to a tertiary care centre in South India

Sarah Paul

GMC, Thrissur, Kerala, India E-mail: sarahpaul889@gmail.com

Introduction: Cancer is the one of the leading causes of death over the world and was responsible for an estimated 9.6 million deaths. Pleural effusion is a common complication in patients with cancer. Malignant pleural effusion is characterized by the presence of malignant or atypical cells in pleural fluid cytology. The most common causes of malignant effusion are lung cancer (37.5%), breast cancer (16.8%)and lymphoma (11.5%). Objective: Primary objective: To estimate the proportion of malignant pleural effusions among patients with pleural effusion in malignancy presenting to a tertiary care center in South India. Secondary objective: To assess the ability of LENT score in predicting survival of patients with malignant pleural effusion at 1, 3 and 6 months.

Methods: A prospective study was conducted at the Department of Pulmonary Medicine and Department of Radiotherapy, Govt Medical College Thrissur, Kerala. Malignant patients who presents with pleural effusion were evaluated for malignant pleural effusions by pleural fluid aspiration and thoracoscopy. LENT score was predicted for patients who were proven to have malignant pleural effusion. And they were followed up for a period of 1, 3 and 6months to assess the ability of LENT score to predict survival. Statistical analysis included descriptive statistics, chi square test. And Kaplan Meier survival curve was plotted.

Results: Among 102 patients with malignancy and pleural effusion, 56 (54.9%) had malignant pleural effusion. The 95 % CI is 45.2%- 64.6%. A stastically significant difference in 1 month survival was observed between moderate and highrisk LENT groups (Chi-square test-p=0.01) At 3 and 6 months, survival also differed significantly (Fishers exact test, p<0.001). Confirming the LENT scores prognostic utility.

Conclusion: Malignant pleural effusion is one of the most devastating conditions. LENT score can be used to predict the survival of patients with malignant pleural effusions. Palliative options like indwelling pleural catheters can be offered to patients with better survival to increase their quality of life.

Keywords: LENT score, malignant pleural effusion

*This article was selected for NAPCON 2025 best research award presentation.

Clinical outcomes of lung cancer patients receiving tyrosine kinase inhibitors

Akshay Kawedia , Karan Madan, Vijay Hadda

AIIMS, New Delhi, India E-mail: akshaykawedia22@gmail.com

Introduction: Tyrosine kinase inhibitors (TKIs) have transformed the management of non-small cell lung cancer (NSCLC) with actionable driver mutations. Real-world data from India remain limited, particularly regarding survival outcomes.

Methods: We ambispectively analysed [n=1,714 NSCLC] patients treated at our centre between [2012–2025] of which 315 patients were given TKI. Patients were stratified by first-line therapy (chemotherapy, TKI, Compassionate TKI immunotherapy, surgery). Survival outcomes were assessed using Kaplan–Meier analysis.

Results: Of 1,714 NSCLC patients, 248 received first-line TKIs. The median overall survival (OS) was 30.47 months (IQR 12.03–54.73) and progression-free survival (PFS) 12.33 months (IQR 6.50–22.17), both significantly superior to chemotherapy (OS 14.03 months,(IQR: 7.27–29.47) PFS 7.73 months, (IQR: 4.03–15.27). EGFR mutations were detected in 32.1% (34.7% tissue, 24.6% blood), ALK rearrangements in 14.8%, and ROS1 fusions in 13.7%. Among EGFR-mutant cases, exon 19 deletions predominated (71.4% tissue, 46.5% blood). Drug-specific survival outcomes showed: Gefitinib with OS 15.77 months (IQR 5.0–34.90) and PFS 8.33 months (IQR 3.10–15.40) Erlotinib with OS 22.77 months (IQR 10.10–40.30) and PFS 9.53 months (IQR 6.17–14.47) osimertinib OS 59.9 months (IQR 17.97–NR) and PFS 32.9 months (IQR 15.33–59.90). In ALK/ROS1-positive patients, crizotinib achieved OS 118.7 months (IQR 18.73–NR) and PFS 17.06 months (IQR 7,0–44.10). Compassionate-use TKIs had poor outcomes (OS 4.17, IQR 1.47–13.54) and PFS 3.03, (IQR 1.30–9.76)). For TKIs the objective response rate (ORR) was 72.61% and disease control rate (DCR) 80.89%, versus ORR 54.76% and DCR 70.62% with chemotherapy. Toxicities for prospective patients on TKI were reported in 59.2%, most commonly rash (30.8%), diarrhoea (25.6%), with serious ADRs in 5.1% and treatment discontinuation in 3.6%.

Conclusion: In this large Indian cohort, TKIs offered substantial survival and tolerability advantages over chemotherapy. Real-world evidence supports integrating molecular profiling and early TKI initiation into routine lung cancer care.

Keywords: Nonsmall cell lung cancer, survival outcomes, tyrosine kinase inhibitor

*This article was selected for NAPCON 2025 best research award presentation

Quantitative and qualitative analysis of microplastics in malignant and nonmalignant lung tissue

Madhavaram R

JIPMER, Puducherry, India E-mail: maddoc221b@gmail.com

Introduction: The growing body of literature documenting microplastic accumulation in human organs, such as the lungs, brings the issue of environmental pollution to a clinical focus. While a link between environmental pollutants and carcinogenesis is established, the specific role of microplastics in the pathogenesis of lung cancer remains largely uninvestigated. This study aims to quantify and characterise microplastic particles in paired malignant and adjacent non-malignant lung tissues.

Methods: In this cross-sectional descriptive pilot study, paired tissue samples were obtained from the patients undergoing lobectomy or pneumonectomy for lung carcinoma. Samples underwent chemical digestion using potassium hydroxide and sodium hypochlorite. Following digestion, we performed a quantitative analysis of the particles via light microscopy and subsequently determined their chemical makeup using µRaman spectroscopy.

Results: Of the 12 paired samples analysed, evidence of plastic contamination was found in nine. Microplastics were visually identified in six pairs among these, a total of 13 particles were found, with 9 in malignant tissue and 4 in adjacent non-malignant tissue. Raman spectroscopy of select particles revealed signals consistent with polypropylene. Notably, in the three additional sample pairs where no particles were visible under microscopy, subsequent particle size analysis confirmed the presence of nanoparticles. The remaining three paired samples were devoid of any detectable plastics.

Conclusion: The preliminary findings confirm the presence of both microplastics and nanoparticles within the human lung parenchyma. Finding polypropylene is unsurprising given its widespread production and environmental persistence. The inconsistent particle distribution we observed between malignant and non-malignant tissues indicates that a larger sample cohort is required to establish any statistical significance. Detecting nanoparticles in samples that were visually negative by microscopy suggests that conventional methods may underestimate the burden of plastic contamination in lung tissue. These foreign bodies could act as a chronic inflammatory stimulus, a known risk factor for carcinogenesis. While these findings do not establish a causal relationship, they do provide evidence of plastic contamination in the human lung and justify continued investigation into its role in the aetiology of lung cancer.

Keywords: Environmental pollutants, lung cancer, microplastics, pulmonary pathology, Raman spectroscopy

*This article was selected for NAPCON 2025 best research award presentation

Clinical outcomes and survival among lung cancer patients: A 2-year retrospective cohort study at LNMC and JK Hospital Bhopal

Nensi Singh , Gaurav Sahu, Darshi Rastogi

L. N. Medical College and J. K. Hospital, Bhopal, Madhya Pradesh, India E-mail: amazingkhushboo@gmail.com

Introduction: Lung cancer is a major public health concern in India, contributing significantly to cancer-related deaths. This study aimed to assess the clinical outcomes and survival among patients diagnosed with lung cancer at the Department of Pulmonary Medicine and Medical Oncology, LNMC and JK Hospital Bhopal.

Methods: A two-year retrospective cohort study was conducted, enrolling 58 patients diagnosed with lung cancer. Patients were followed for at least one-year post-diagnosis. Data on demographics, clinical characteristics, treatment modalities, and survival outcomes were collected from medical records. Patients lost to follow-up were excluded from the final analysis.

Results: Of the 58 enrolled patients, 47 (81%) completed at least one-year of follow-up. The cohort was predominantly male (n=42, 72%) and the mean age at diagnosis was 62 years (range: 45–78 years). The most common histological types were adenocarcinoma (n=21, 45%), squamous cell carcinoma (n=16, 35%), and small cell carcinoma (n=9,20%). The most frequent symptoms were persistent cough (n=40, 85%) and unintended weight loss (n=31, 65%). Tobacco use was reported in 39 patients (83%), and the mean time from symptom onset to diagnosis was 4.5 months (range: 1–12 months). At diagnosis, most patients were at advanced stages: Stage IV (n=24, 52%), Stage III (n=15,32%), Stage II (n=5, 10%), and Stage I (n=3, 6%). Rural patients (n=28, 60%) were more likely to present with advanced-stage disease than urban patients (n=19, 40%). The one-year survival rate was 34% (n=16), with better outcomes in earlier stages and those receiving multimodal treatment. The predominance of late-stage presentation reflects diagnostic delays, particularly in rural patients. High tobacco use and symptom-to-diagnosis lag emphasize the need for community awareness, early detection programs, and equitable access to oncology services.

Conclusion: This study provides insights into lung cancer outcomes in a tertiary care setting. The loss to follow-up highlights challenges in long-term patient tracking.

Keywords: Lung cancer, outcome, survival

Cracking the core: Clinicopathological correlation of central lung adenocarcinomas

Vandana H , Gayathri Devi H J, Madhusmita Jena, Safia Ahmed

East Point College of Medical Sciences and Research Centre, Bengaluru, Karnataka, India E-mail: drvandana1801@gmail.com

Introduction: Lung Adenocarcinoma is the most common histologic subtype of non-small cell lung cancer and is also the most commonly diagnosed subtype in nonsmokers. Commonly arising in the peripheral regions, a subset of these tumors may originate centrally involving the major airways and is less common. The aim of the study was to describe the clinical, radiological, histopathological characteristics of these Central tumors.

Methods: We report a case series of 5 patients diagnosed with Central adenocarcinoma at our tertiary care centre in the year 2025. This case series involves stepwise approach, the application of bronchoscopic and CT guided biopsy wherever appropriate and histopathological analysis guiding in the diagnosis of these tumors.

Results: The mean age of the patients was 61 years with male preponderance in the ratio of 3:2. The common clinical features were cough with expectoration and generalized weakness. History of significant weight loss (n=1), hemoptysis (n=1) and smoking (n=2) was present. All the patients were subjected to radiological investigations, Chest X ray and CT thorax. CT imaging revealed predominantly involvement of upper lobes, mediastinal and hilar lymph nodes, with spiculated margins of the mass lesion along with vascular encasement in some cases. Furthermore, they were evaluated with bronchoscopic biopsy (n=3) and CT guided biopsy (n=2) respectively, which were suggestive of non-small cell cancer favouring adenocarcinoma. Treatment strategies comprised of chemotherapy and palliative care.

Conclusion: Lung cancer is the the leading cause of mortality and morbidity worldwide. This case series documents a distinct central presentation of bronchogenic adenocarcinomas. Despite imaging features mimicking squamous cell carcinoma, all cases were confirmed as adenocarcinomas. Central presentation is usually discovered at an advanced stage, hence early detection and evaluation is crucial for accurate diagnosis, cancer staging and will aid in better patient outcomes.

Keywords: Bronchoscopic biopsy, central adenocarcinoma, chemotherapy, CT guided biopsy

Role of endobronchial needle aspiration in diagnosis of bronchogenic carcinoma at a tertiary care center

Anshita Chourasia

Sawai Man Singh Medical College, Jaipur, Rajasthan, India E-mail: dranshita22@gmail.com

Introduction: The only chance of successfully battling the disease is in detecting it at the earliest possible stage, particularly before the lesion has progressed to the stage of a visible and palpable tumour. Cancer researchers have long sought to develop approaches that would allow for early identification and treatment of lung cancer, reducing mortality. Although histology remains the gold standard, bronchial biopsies cannot be performed on all patients with cancer suspicion. Taking a bronchial biopsy becomes more difficult and requires expertise when the lesions are peripheral and there is a risk of bleeding. Cytologic procedures are less risky, less expensive, and produce faster results. Bronchoscopic cleaning, brushing, and fine needle aspirations not only supplement but are also similar to tissue biopsies in the diagnosis of lung cancer. As a result, the current study was designed to investigate the role of endobronchial fine needle aspiration and the combined yield of endobronchial needle aspiration, bronchial brush, and bronchial wash in bronchogenic cancer.

Methods: Current study was Hospital based prospective observational study conducted at the Institute of Respiratory Diseases, SMS Medical College, Jaipur, Rajasthan from 1 May 2024 to 30 April 2025. A total 120 cases suspected cases of Bronchogenic carcinoma aged above 18 years were included in the study. Data were analysed in SPSS v- 24 Chi square test was applied to compare the different methodology. Sensitivity, specificity, NPV and PPV was calculated. p value <0.05 was considered statistically significant.

Results: Out of the all 3 modalities EBNA followed by bronchial brush and least by bronchial wash were positive when compare with the biopsy findings to diagnose the bronchogenic carcinoma and out of all the 3 modalities sensitivity was maximum for combined all 3 followed by EBNA and least for bronchial wash.

Conclusion: Our study concluded that highest sensitivity to diagnose bronchogenic carcinoma was found for the all three EBNA, bronchial brush and bronchial wash together followed by the EBNA. It is the least invasive, cost-effective diagnostic technique which provides earlier and accurate diagnosis, thus facilitating the early diagnosis and treatment of a patient. It also has prognostic values.

*This article was selected for NAPCON 2025 best research award presentation.

Efficacy of total pleural fluid bilirubin and ratio to serum bilirubin levels, pleural fluid cholesterol, and total protein, as compared to lights criteria

Pavan Naik L

SMSMC, Jaipur, Rajasthan, India E-mail: drpavannaikl@gmail.com

Introduction: Pleural effusion is common and classified as transudates or exudates. Lights criteria misclassify 25% of transudates as exudates, necessitating better diagnostic parameters.

Methods: Fifty patients (>12 years) with pleural effusion were included, excluding those with jaundice, dyslipidemia, or hypoproteinemia. Exudates and transudates were classified using pleural fluid bilirubin, bilirubin/serum bilirubin ratio, cholesterol, and total protein, then compared with Lights criteria.

Results: Pleural fluid total protein showed the highest diagnostic accuracy (96.29% PPV, 95.23% NPV, 94% accuracy). Light’s criteria had 85.7% sensitivity, 90.9% specificity, and 88% accuracy. Pleural fluid bilirubin and cholesterol were less effective, while the pleural fluid bilirubin/serum bilirubin ratio and total protein were most reliable for differentiating exudative from transudative effusions.

Conclusion: Pleural fluid total protein is the most specific test, and the pleural fluid/serum bilirubin ratio is the most sensitive for classifying exudative and transudative pleural effusions. It also enhances diagnostic accuracy, providing valuable support in distinguishing between transudates and exudates effectively.

A comparative study on diagnostic yield of postprocedure collected sputum cytology with bronchoalveolar lavage and brush cytology by fibreoptic bronchoscopy in suspected cases of carcinoma lung

Mohit Soni

Government Medical College, Kota, Rajasthan, India E-mail: smohit292@gmail.com

Introduction: Lung cancer is the most commonly diagnosed cancer worldwide, accounting for 12.4% of cases. It is more frequent in men, ranking first among males and second among females for incidence and mortality.

Methods: This cross-sectional study was conducted at Government Medical College Hospital, Kota, Rajasthan. A total of 100 patients with suspected lung malignancy were included. Post-bronchoscopy sputum, bronchoalveolar lavage (BAL), and brush cytology samples were collected and compared with histopathological biopsy findings.

Results: Among 95 biopsy-confirmed lung cancer cases, squamous cell carcinoma was the most common type observed. All diagnostic procedures showed relatively low sensitivity. Post-bronchoscopy sputum cytology demonstrated the highest specificity (100%) and strong positive predictive value, confirming its reliability in ruling in disease when positive. Combining BAL and brush cytology improved sensitivity and overall diagnostic yield. Lung cancer in this cohort primarily affected older males, with squamous cell carcinoma most prevalent. Although sputum cytology alone had limited sensitivity, its excellent specificity enhances diagnostic accuracy. A multimodal approach, integrating sputum, BAL, and brush cytology, improves diagnostic yield while minimizing invasive procedures.

Conclusion: Comparative analysis highlights the value of integrating post-procedure sputum cytology, BAL, and brush cytology in lung cancer diagnosis. Such multimodal strategies support earlier detection and reduce dependence on invasive methods.

Keywords: Bronchoalveolar lavage, bronchoscopy, brush cytology, lung cancer, postbronchoscopy sputum

Miscellaneous: Breaking septa, building outcomes: Streptokinase timing matters

Sriram S , Yuvarajan S, Cherukumalli Navya

Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India E-mail: drsriramsuresh98@gmail.com

Introduction: Loculated pleural effusion is a challenging clinical condition due to fibrous septations that delay fluid drainage. Intrapleural fibrinolytic therapy with streptokinase may offer a non-surgical option for resolution. Objective: To assess the safety and efficacy of intrapleural streptokinase in patients with loculated pleural effusion who are not responding to conventional intercostal drainage.

Methods: A prospective case series was conducted over a period of 10 months, involving 17 patients admitted to the Department of Respiratory Medicine at Sri Manakula Vinayagar Medical College and Hospital. These patients had loculated pleural effusion and did not show improvement following intercostal drain (ICD) insertion. Patients received 250,000 IU of streptokinase in 50 mL normal saline via chest tube, up to 6 doses, based on clinical response. Pre- and post-treatment outcomes were monitored with imaging and drainage volumes.

Results: A total of 17 patients with loculated pleural effusion were included, with a mean age of 56.8 ± 13.5 years. Parapneumonic effusion was the most common etiology (47.1%), followed by tuberculous (35.3%) and malignant effusions (17.6%). The mean volume of pleural fluid drained increased significantly from 453 mL before streptokinase (SK) instillation to 2153 mL after instillation (mean difference: 1700 mL 95% CI: 1450–1950 mL P < 0.0001). Parapneumonic and tuberculous effusions showed significantly better radiological and sonological outcomes to streptokinase compared to malignant effusions (p = 0.0056). Radiological outcomes were significantly associated with the timing of SK instillation: patients with favorable outcomes received SK earlier (mean day:3.4) compared to those with partial (mean day: 5.5) or failed outcomes (mean day: 4), with P = 0.026. SK was well tolerated, with no complications in 82.4% of patients minor adverse events included transient fever (11.8%) and mild chest pain (5.9%).

Conclusion: Intrapleural streptokinase instillation is a safe and effective procedure in loculated pleural effusion, reducing the need for surgical intervention when used promptly.

Keywords: Intercostal drainage, intrapleural fibrinolytic therapy, loculated pleural effusion, streptokinase, treatment timing

Exhaled breath insights: Reference ranges of temperature, relative humidity and end tidal carbon dioxide (CO 2 ) in adult Indian population

Abhishek Sabale , Sapna Madas, Monica Barne

Pulmocare Research and Education Foundation, Pune, Maharashtra, India E-mail: stat@purefoundation.in

Introduction: Defining the range of exhaled breath temperature and relative humidity is important in the accuracy and efficiency of exhaled breath analysis. The observed decline in EB temperature, humidity, and end-tidal CO2 with age likely reflects age-related structural and functional changes in the lung, including reduced airway perfusion. However, data specific to the Indian population remain limited. Objective: We aimed to derive the ranges of exhaled breath temperature, humidity and end tidal CO2 obtained in adult, Indian cohort.

Methods: We conducted multiple health screening camps under the Pollution Awareness & Wellness Assessment Initiative-2 in urban slums and rural areas of Pune city during the Nov 2024-Feb 2025. A questionnaire was used to gather essential demographic and health data. Breath-AI V3 portable hand-held device, (Virtual Sense Global Technologies, Pune, India) was used to measure exhaled breath temperature, humidity and end tidal CO2.

Results: 2651 subjects participated (mean age 47 ± 14 years, 29.6% were males). The mean EB temp. was 31.4 ± 1.7? (range: 25.5–36.1?), mean EB humidity was 86.8 ± 6.4% (range: 59.3-96.2%) and mean end tidal CO2 level was 40.2 ± 6.1 mmHg (range: 14.1-66.8 mmHg). Age was negatively correlated with EB temperature (r=-0.128, p<0.001), humidity (r=-0.073, p=0.001) and end tidal CO2 (r=-0.115, p<0.001). Participants aged >60 years had significantly lower EB temperature than those aged 18–40 years (31.1 ± 1.9 vs 31.7 ± 1.6, p<0.001). EB humidity was lower in participants aged >60 years compared to those 18–40 years (85.4± 7.0 vs 86.7 ± 6.2, p<0.001) and 40–60 years participants (85.4± 7.0 vs 87.3 ± 6.3, p<0.001). End tidal CO2 was lower in aged > 60 years compared to those 18-40 years (38.3± 6.5 vs 40.4 ± 6.1, p<0.001) and 40-60 years participants (38.3± 6.5 vs 40.9 ± 5.8, p<0.001)

Conclusion: This study establishes reference ranges for exhaled breath temperature, humidity and end-tidal CO2 levels in Indian adult population. All three parameters decline significantly with increasing age, particularly in individuals over 60 years. Exhaled breath analysis may serve as a non-invasive marker of pulmonary ageing.

Keywords: Age, airway perfusion, end tidal CO 2 , exhaled breath temperature, humidity

*This article was selected for NAPCON 2025 best research award presentation.

Compliance to long term oxygen therapy in chronic respiratory diseases in patients attending a tertiary center

Sandra S

Government Medical College, Thrissur, Kerala, India E-mail: sandrasamson999@gmail.com

Introduction: Even with increased facilities of procuring LTOT in this post-covid era, patients have issues with noncompliance to LTOT, this non-compliance in turn can lead to exacerbations, hospitalizations, and mortality. Currently literature from our part of state regarding problems regarding compliance in patients with LTOT is sparse, hence, a study on proportion of compliant patients to LTOT and factors affecting compliance was being taken up. Objectives: To estimate the proportion of patients compliant to LTOT and factors associated with compliance.

Methods: A cross-sectional study was conducted among 110 patients prescribed LTOT. Data were collected using structured proforma from patients. Compliance was defined as oxygen use for =15 hours/day.

Results: Of 110 patients, 77 (70%) were compliant with LTOT. Demographics: Elderly and multi-morbid patients had higher compliance no gender association was observed. Clinical profile: ILD patients were more compliant compared to those with COPD or bronchiectasis. Higher literacy of patients improved understanding and compliance. Device-related: using concentrator and cylinder both gives better compliance than cylinder or concentrator alone. Economic factors: Electricity bill reduction schemes supported adherence, while high cylinder refill reduced it. Urban areas: Closer facility access and regular follow-up with reinforcement improved compliance. Patients with full time caretakers, those married with family have better compliance. All these factors were individually significant, after logistic regression analysis, only those with knowledge regarding schemes of LTOT, comorbidities, residence in urban areas and have full time care takers were compliant.

Conclusion: LTOT compliance was 70%. Higher adherence was seen in elderly, comorbid, literate, ILD patients, those with full time care takers, with usage of both cylinders and concentrators. Poor adherence was associated with economic burden with poor socioeconomic status, after logistic regression analysis only those with knowledge regarding schemes of LTOT, comorbidities, residence in urban areas and have full time care takers were compliant.

Postoperative pleuro-parenchymal complications following abdominal surgery

Naidu Phanitha Sri Yamuna , Praveena Sreerama

Government Hospital for Chest and Communicable Diseases, Visakhapatnam, Andhra Pradesh, India E-mail: phanithasri10@gmail.com

Introduction: Postoperative pulmonary complications frequently follow abdominal procedures and contribute substantially to patient morbidity and prolonged hospital stay.

Methods: A 6 - month prospective observational study was performed in a tertiary care centre enrolling adults undergoing elective or emergency abdominal surgeries. Postoperative assessment involved clinical evaluation, chest X-ray, sputum analysis, spirometry, chest ultrasound, arterial blood gas, and complete blood count. Smoking history, operative duration, comorbidities, and age were documented. Complications and risk factors were analyzed using appropriate statistical methods.

Results: Pleuroparenchymal complications developed in 27% of cases. Atelectasis was most common (74%), followed by pleural effusion and pneumonia (62.96% each), with frequent overlap. Respiratory failure occurred in 11.11%, predominantly in older patients, smokers, and those with pre-existing lung disease. Significant risk factors included pre-existing pulmonary disease (45.94%), smoking (43.90%), male sex (45.45%), operative duration >210 minutes (33.38%), and age >50 years (41.02%). Complications were linked to impaired respiratory muscle function, surfactant deficiency, and high intraoperative oxygen use. Overlap between atelectasis, effusion, and pneumonia necessitates targeted perioperative respiratory care, especially for high-risk individuals. Early identification and intervention could mitigate morbidity and reduce hospital stay.

Conclusion: Atelectasis and pleural effusion are the most frequent postoperative pleuroparenchymal complications after abdominal surgery. Prolonged operative time, high-risk surgical profile, and reduced preoperative pulmonary reserve warrant preventive strategies for improved outcomes.

Keywords: Abdominal surgery, atelectasis, pleuroparenchymal complications, pneumonia, postoperative care

Minimal pneumothorax: Comparison of chest posterioanterior expiratory view and opposite lateral decubitus view

Swathi K , A. N. V. Koteshwar Rao, V. Reddy Tummuru

SVS Medical College, Mahbubnagar, Telangana, India E-mail: swathirathod13695@gmail.com

Introduction: Pneumothorax is a potentially life-threatening condition. While chest X-ray posteroanterior (PA) view is commonly used for diagnosis, minimal pneumothorax often remains undetected, even on expiratory films, due to the collapsed lung border overlapping rib shadows. In such cases, opposite lateral decubitus view may provide greater diagnostic clarity. This study evaluates the comparative diagnostic yield of PA expiratory films and opposite lateral decubitus views in detecting minimal pneumothorax.

Methods: A prospective study was conducted in 50 patients aged 20–60 years with minimal secondary spontaneous pneumothorax. Patients with old or active tuberculosis were excluded. All patients underwent chest X-ray PA expiratory view, opposite lateral decubitus view, and CT chest when required. Diagnostic findings were compared across imaging modalities.

Results: Out of 50 patients, pneumothorax was detected on both PA and opposite lateral decubitus views in 30 cases. In 15 patients, the PA expiratory film failed to identify pneumothorax, but the opposite lateral decubitus view revealed characteristic signs including collapsed lung border and deep sulcus sign. In 5 patients, neither PA nor lateral decubitus views detected pneumothorax, which was confirmed by CT chest.

Conclusion: Opposite lateral decubitus view is superior to PA expiratory film in detecting minimal pneumothorax. It provides higher sensitivity, reduces the need for expensive investigations such as CT chest, and is especially useful during residency training where subtle findings may otherwise be overlooked.

Keywords: Chest X-ray, CT chest, deep sulcus sign, minimal pneumothorax, opposite lateral decubitus view, posteroanterior expiratory view, spontaneous pneumothorax

Diaphragm thickness and contractility in chronic obstructive pulmonary disease: Correlation with pulmonary function tests

Sruthi Atkuri , Ashwin K

MS Ramaiah Medical College, Bengaluru, Karnataka, India E-mail: sruthiatkuri@gmail.com

Introduction: Chronic obstructive pulmonary disease (COPD) is a major global health problem characterized by persistent airflow limitation and structural lung changes. Diaphragmatic dysfunction, resulting from hyperinflation and systemic muscle wasting, contributes to dyspnea and poor outcomes. Ultrasonography offers a simple, non-invasive method to evaluate diaphragm structure and function. This study assessed diaphragmatic thickness and contractility in COPD and correlated these findings with pulmonary function tests (PFTs).

Methods: A cross-sectional study was conducted between January and April 2025, including 30 spirometry-confirmed COPD patients. Right hemidiaphragm thickness was measured using high-frequency ultrasonography at end-expiration and end-inspiration. Diaphragm thickening fraction (DTF) was calculated as: DTF = (Thickness_inspiration – Thickness_expiration) / Thickness_expiration × 100. Disease severity was classified per GOLD 2025 criteria. Correlation with spirometric indices was analyzed using Pearson correlation, with significance at p<0.05.

Results: Mean expiratory and inspiratory diaphragm thicknesses were 1.52 ± 0.22 mm and 2.38 ± 0.33 mm, respectively. Average DTF was 33%. Diaphragmatic indices declined with disease severity: expiratory thickness and DTF were 1.62 mm and 36% in GOLD II, 1.50 mm and 32% in GOLD III, and 1.30 mm and 27% in GOLD IV. DTF showed a significant positive correlation with FEV1% predicted (r = 0.59, p<0.05). Ultrasonographic evaluation of the diaphragm reflects functional impairment in COPD and parallels spirometric severity grading. Decline in DTF across GOLD stages highlights its potential as a bedside biomarker for disease monitoring.

Conclusion: Diaphragm thickness and contractility decrease with COPD severity and correlate with PFTs. Ultrasonography is a valuable, non-invasive adjunct to spirometry in evaluating and monitoring COPD.

Keywords: Chronic obstructive pulmonary disease, contractility, diaphragm thickness, pulmonary function test, ultrasonography

*This article was selected for NAPCON 2025 best research award presentation.

Impact of Structured Training in Obstructive Airways Diseases on Knowledge Outcomes Among Allied Health Professionals in India

Aishwarya Nair , Vandana Das, Monica Barne

Chest Research and Training Pvt. Ltd., Pune, Maharashtra, India E-mail: aishwaryanairsp@gmail.com

Introduction: Time constraints are a major challenge for clinicians managing patients with Obstructive Airways Diseases (OADs) in India and other low- and middle-income countries (LMICs). Allied health professionals (AHPs) can play a key role in supporting clinicians with diagnosis and management, including spirometry, peak flow measurement, inhaler technique training, and patient counseling. However, structured OAD training programs for AHPs are lacking. To address this gap, we developed the Certificate Course on Obstructive Airways Diseases (CORD), a two-day (10-hour) online interactive program delivered in participant-friendly language, covering asthma, COPD, spirometry, peak flow monitoring, inhaler techniques, and patient counseling. This study aimed to evaluate the effect of CORD on the knowledge of AHPs regarding OADs.

Methods: 1087 allied health professionals (AHPs) trained over 24 CORD programmes between November 2020 and October 2024 were invited to participate in the study. Their knowledge levels were assessed using a simple online questionnaire, at three time points: before the training, within 24 hours after the training, and three months or more, after the programs completion. The responses to the multiple-choice questions were scored out of 20 points. Simple descriptive analysis was done using IBM SPSS Ver. 27.0.

Results: 527 participants completed the survey. Knowledge scores improved significantly from pre-test to immediate post-test (p < 0.001). On reassessment, participants who completed the training demonstrated sustained knowledge gains compared with baseline, with significant improvements observed even 3 months to 4 years after training (p < 0.001).

Conclusion: The two-day CORD program significantly improved and sustained AHPs’ knowledge of OADs. Scaling it across LMICs can strengthen primary respiratory care while reducing the routine workload of pulmonologists, enabling them to focus on complex case management and improved patient outcomes.

Keywords: Allied health professionals, asthma, chronic obstructive pulmonary disease

*This article was selected for NAPCON 2025 best research award presentation.

Comparison of pulmonary function, surfactant protein – B levels in COPD patients and age-matched controls

Saurav Suresh

Shri. B. M. Patil Medical College Hospital and Research Centre, Vijayapura, Karnataka, India E-mail: sauravsuresh@gmail.com

Introduction: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide, and its diagnosis is primarily based on pulmonary function testing. This study evaluated whether patients with a diagnosis of COPD exhibit altered plasma surfactant protein-B levels as compared with smokers and in individuals with substantial biomass exposure, and further examined its relationship with multiple spirometric parameters and DLCO as well as symptom burden assessments.

Methods: This is a case–control study conducted over 15 months in the Department of Respiratory Medicine, Shri B. M. Patil Medical College, Hospital and Research Centre, Vijayapura, and included 70 participants. Of these, 35 patients with established COPD were enrolled as cases, while 35 individuals who do not meet the GOLD 2025 COPD criteria but with recognized environmental risk factors for the same served as at-risk controls. Pulmonary function tests were done in all the participants and the results obtained were analyzed using NHANES III and Chhabra’s prediction equations following which, venous blood was analyzed for surfactant protein B concentrations using a quantitative sandwich ELISA.

Results: Mean age of cases was 66.3 ± 6.45 years compared with 64.3 ± 7.03 years in controls with comparable BMI. Symptom scores (MMRC and CAT) were significantly greater in cases. NHANES III equations yielded lower % predicted values and more negative Z-scores compared with Chhabra’s eg-, mean FEV1 % predicted in cases was 42.9% (NHANES III) versus 50.6% (Chhabra), and DLCO Z-scores were significantly reduced with NHANES III (–2.01 vs. –1.23 in controls, p = 0.018). Mean SP-B level in cases was 2.85 while in control group, exclusion of five patients later diagnosed with interstitial lung disease decreased the mean SP-B level from 2.17 to 1.9 ( p = 0.176). Serum SP-B levels showed a negative correlation with FVC Z-score (Chhabra) in cases (r = –0.334, p = 0.050), while in controls, SP-B correlated positively with, FEV1 Z-score (NHANES III, r = 0.378, p = 0.025), and FVC % predicted (NHANES III, r = 0.341, p = 0.045). Discussion: In COPD patients, disease severity estimates vary depending on the choice of reference equations. NHANES III equations consistently produced lower % predicted values and more negative Z-scores than Chhabra’s, hence overestimating results. Serum SP-B levels showed differential associations across groups: in COPD, higher SP-B tended to correlate with Disease severity, restrictive physiology and the Presence of interstitial lung disease among controls influenced mean SP-B levels.

Conclusion: Serum SP-B may serve as a sensitive biomarker of lung epithelial stress, complementing spirometry in COPD assessment.

Keywords: Chronic obstructive pulmonary disease, PFT, surfactant protein-B

Aetiology and clinical profile in the patients with pleural effusion

Shreya Shah

SBKS Medical Institute and Research Centre, Vadodara, Gujarat, India E-mail: shahshreyaankur@gmail.com

Introduction: Pleural effusion is a common clinical condition caused by diverse etiologies. In India, tubercular effusion is the most frequent cause of exudative effusion, followed by malignant and parapneumonic effusions. Differentiating between exudative and transudative effusions is essential for management, though diagnostic overlap often complicates evaluation. Objectives: To determine the type of effusion via lights criteria and analyse various causes of pleural effusion occurring in transudative and exudative effusion.

Methods: A hospital based study was conducted over 12 months in tertiary care center, pipariya, Vadodara. A total of 40 patients were enrolled. Detailed history, clinical examination, routine investigations, radiological investigations (chest x ray,usg thorax/CT scan) were done. After pleural tapping following investigations like Pleural fluid Ada, Ldh, routine microscopy, cytology,pleural fluid Afb and Cbnaat under NTEP was done. Data were statistically analysed to assess various etiologies of pleural effusion.

Results: Out of 54 patients, males (67.9%) were more affected than females (32.1%), with the majority aged 41-60 years. Breathlessness (85.1%), loss of appetite (64.8%), and chest pain (64.8%) were the most common presenting symptoms. According to Lights criteria, 84% were exudative and 15% transudative. Among exudates, tuberculosis (31.4%) was the leading cause, followed by paramalignant effusions (22.2%), malignancy (12.9%), and parapneumonic effusions (11.1%). Transudates were mainly due to cardiovascular disease (42.8%) and chronic kidney disease (25%).

Conclusion: Pleural effusion has varied etiologies with tuberculosis as the most common cause in this region. Accurate differentiation between exudative and transudative effusions requires a multiparametric diagnostic approach. Incorporating newer biomarkers and molecular tools alongside Lights criteria can enhance early and precise diagnosis, ensuring timely management.

Keywords: Adenosine deaminase, exudative effusion, lights criteria, pleural effusion, transudative effusion

Study on effectiveness and safety of intrapleural streptokinase fibrinolysis in patients with parapneumonic effusion

Hemaraj H D

Subbaiah Institute of Medical Sciences, Shivamogga, Karnataka, India E-mail: hemarajapd@gmail.com

Introduction: Para pneumonic effusion (PPE) is an exudative pleural effusion as a complication secondary to mainly pneumonia. PPE is associated with increased morbidity, mortality and prolonged hospital stays requiring aggressive treatment and interventions. Standard management includes antibiotics and pleural drainage via chest tube. Open Thoracotomy and VATS (Video Assisted Thoracoscopy Surgery) provide effective drainage in gross empyema or loculated effusions but are limited by risk, cost, and availability. Intrapleural fibrinolysis with streptokinase offer a safe, simple, and affordable alternative treatment option.

Methods: This was a cross sectional study conducted at a Medical College Hospital in Shivamogga from June 2024–May 2025 which included 14 patients with loculated PPE and Empyema. Objectives were to assess the efficacy and safety of intrapleural fibrinolysis with streptokinase. Informed written consent was taken from patients meeting inclusion criteria. Intrapleural Streptokinase 250,000 U in 100 mL saline was instilled through Intercostal tube over 10-15 min once daily over 3–5 days with routine standard of care. Patients were monitored for clinical, radiological and adverse outcomes. Data was collected and entered in excel sheet and analysed using SPSS v 20 with necessary required tests.

Results: In this study, mean age of the patients was 55 years and majority were males (n=9, 64.3%) with productive cough(92.9%) and fever(78.6%) being most common clinical presentations. 50% of patients were Diabetic.71.4 % patients had Loculated PPE and 28.6% had Empyema. Clinical and radiological improvement occurred in 71.4%patients, while 28.6% required surgery. Mean drainage improved from 191 mL to 416 mL post fibrinolysis, which was statistically significant and with no serious adverse events.

Conclusion: Intrapleural Streptokinase can facilitate pleural fluid drainage in PPE and is a safe, affordable management choice at resource limited settings reducing surgical referrals.

Keywords: Fibrinolysis, parapneumonic effusion, streptokinase

Clinicoradiological profile of patients requiring intercostal tube drainage (ICD) in a tertiary care

Abhishek Nagur , Swapna R, Yunus

SDS TRC and Rajiv Gandhi Institute of Chest Diseases, Bengaluru, Karnataka, India E-mail: abhisheknagur1@gmail.com

Introduction: ICD is a vital procedure in respiratory and critical care medicine which involves placing a tube into the intrapleural space through chest wall opening to evacuate air, fluid, blood, pus or chyle in conditions like pneumothorax, hemothorax, empyema, malignant pleural effusion there by restoring normal intrathoracic pressure and optimal lung function. Aim: To study the clinicoradiological profile of patients requiring ICD.

Methods: This is a retrospective cross-sectional study conducted in the Department of pulmonary medicine SDS TRC and RGICD between the study period of JULY 2024 -JULY 2025 where the Patients requiring ICD were enrolled and the medical records were reviewed for demographic, clinicoradiological and biochemical analysis of pleural fluid data. Descriptive statistics were applied, and results presented as mean with standard deviation and percentage.

Results: Out of 80 patients who required ICD, (83.75%) were males and (16.25%) females, with mean age 52.3 yrs. Most common indication was pyothorax (31. %) followed by hydropneumothorax (26.25%) pneumothorax (22.5%), pleural effusion (20%) [tubercular effusion (37.5%), Malignant pleural effusion (31.25%), hemothorax 3 (18.75%) pancreatic effusion (6.25%), and parapneumonic effusion (6.25%)]. Clinically majority presented with dyspnea (95%) followed by chest pain (86%) and cough (81.25%). Duration of ICD in situ on an average was 7 days for pneumothorax and 15 days for hydropneumothorax and empyema and overall average duration of hospital stay was 12 days ,in which hydropneumothorax was 17 days and malignant effusion was 5 days. Post ICD outcome, (88.75%) were discharged of which 7.04% required surgical intervention for persistent air leak and subcutaneous emphysema, (62.5%) (malignant effusion) were referred for further management and (5%) expired of which pyothorax was most common cause. Pyothorax and hydropneumothorax was the most common indication for ICD with male predominance in our study. MTB was the most common causative agent.

Conclusion: Early recognition of clinical features supported by radiological imaging is essential for timely intervention and improved outcomes

Keywords: Intercostal tube drainage, MTB, pyothorax

From numbers to prediction: Decoding the etiology of exudative pleural effusion

Pranjali Dutta , Amrita Karmakar

Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India E-mail: findpranjali@gmail.com

Introduction: Pleural effusion, a common clinical problem with diverse etiologies often poses diagnostic dilemma requiring invasive modalities. The study evaluates pleural fluid biochemical parameters [ pH, Lymphocyte Neutrophil Ratio (LNR), Serum LDH to Pleural fluid ADA Ratio (sLDH/pADA)] as early predictors of etiology of exudative pleural effusion.

Methods: A Descriptive Cross-sectional study was conducted in Department of Respiratory Medicine, NRS Medical College, with ethical approval and informed consent. 80 admitted patients having exudative pleural effusion, enrolled based on pre-defined criteria were categorized into Malignancy, Tubercular, Parapneumonic, Unknown etiologies biochemical parameters were compared across the groups. Data was entered in Microsoft Excel Datasheet, analyzed using GraphPad Prism v9.0. & SPSS v30.0.

Results: Of 80 patients (51 males and 29 females), Malignancy (61.25%) was the leading cause followed by Tubercular (16.25%) and Parapneumonic effusion (15%). Pleural fluid pH was significantly higher in Tubercular group (7.33 ± 0.06), while LNR was lowest in Parapneumonic effusion (1.33 ± 2.90). Patients with Malignant effusion showed higher serum LDH (791.71 ± 736.07), elevated sLDH/pADA (52.25 ± 49.61), lower ADA value [13.6 (2.8,1102)] [all with p value <0.05]. Multivariate Logistic Regression identified pleural fluid pH as the most consistent predictor across etiologies, particularly Malignant vs Non-malignant effusions sLDH/pADA distinguished Malignant from Tubercular effusions (p<0.05). Predictive accuracy was 95.9% for Malignancy, 92.3% for Tubercular & 83.3% for Parapneumonic Effusions, with overall prediction (88.8%). Receiver Operating Character (ROC) analysis of Log sLDH/pADA (cut-off 2.77) demonstrated good diagnostic accuracy [sensitivity (67.74%) specificity (95.92%) positive likelihood ratio (16.6)]. K means clustering identified 4 clusters representing pleural inflammatory phenotype.

Conclusion: Routine, affordable biomarkers provide early etiological clues in pleural effusion, thereby improving the diagnostic accuracy, clinical decision-making & expedite appropriate treatment.

Keywords: Lymphocyte to neutrophil ratio, pleural effusion, receiver operating character, serum LDH to pleural fluid ADA ratio

Utility of hematocrit and serum lactate dehydrogenase in the diagnosis of pleural effusion

Tanya Gupta

King George Medical College, Lucknow, Uttar Pradesh, India E-mail: gupta.tanya706@gmail.com

Introduction: Pleural effusion is a common clinical condition with diverse etiologies, requiring accurate differentiation for effective management. Conventional diagnostic methods include Light’s criteria, but newer, simple, and cost-effective parameters such as hematocrit and serum lactate dehydrogenase (LDH) may enhance diagnostic utility.

Methods: A prospective observational study was conducted on patients presenting with pleural effusion at a tertiary care center. Detailed clinical evaluation, radiological confirmation, and diagnostic thoracentesis were performed. Pleural fluid hematocrit and serum LDH levels were measured, and their diagnostic accuracy was compared with standard Light’s criteria in differentiating transudative and exudative effusions. Statistical analysis was applied to assess sensitivity, specificity, and correlation with clinical diagnosis.

Results: Serum LDH levels were significantly higher in exudative pleural effusions compared to transudates (p<0.01). Pleural fluid hematocrit values were useful in identifying hemorrhagic effusions, with a hematocrit >50% of peripheral blood hematocrit strongly suggestive of hemothorax. Combining serum LDH with hematocrit improved diagnostic yield, showing strong correlation with Light’s criteria. The sensitivity and specificity of LDH for detecting exudative effusions were comparable to established methods.

Conclusion: Serum LDH and pleural fluid hematocrit are simple and reliable parameters that can aid in the diagnosis and classification of pleural effusions, complementing conventional methods for improved clinical decision-making.

Keywords: Exudate, hematocrit, pleural effusion, serum lactate dehydrogenase, transudate

Understanding the educational needs, preferences and challenges of people with chronic respiratory diseases

Rohan Gupta , Vaishali Naik, Meena Lopez

Department of Medical Affairs, Cipla Limited, Mumbai, Maharashtra, India E-mail: rohan.gupta@cipla.com

Introduction: Chronic respiratory diseases (CRD) pose a major health burden in India, significantly affecting patients’ quality of life. It is important to understand educational needs and preferences of patients to improve self-care and adopt personalized treatment approaches.

Methods: A digital survey was conducted via Breathefree app and QR code enabled access to the structured questionnaire at OPD clinics across India among CRD patients/caregivers. Data was analyzed descriptively.

Results: 250 individuals (84% patients, 16% caregivers) who completed this survey were considered for this interim analysis. Mean patient age was 37.68±17.01 years, 59.6% were males. Asthma was the most common diagnosis (62.8%) followed by COPD (21.2%). 37.6% participants reported having “poor” or “fair” knowledge of their respiratory conditions. Although 69.6% of patients reported healthcare professionals (HCPs) as their main source of education, 50.4% of patients reported receiving less than 10 minutes of explanation about their health conditions from HCPs. 74% of participants reported having used a mobile application for managing respiratory conditions and 60% found them helpful most preferred app features included breathing exercises (60.8%) and doctor consultations assistance (42.4%). 48% of patients reported that their inhaler technique was not reviewed regularly, though 56.02% reported feeling ‘very confident’ that they were using their inhaler correctly. Only 43% patients had a clear action plan for symptom worsening and 43.60% reported feeling ‘very confident’ about preventive measures (vaccination and lifestyle changes). 51% participants believed education greatly influenced their ability to manage their condition. Preferred patient education components included disease understanding (51.6%), breathing exercises (41.2%), diagnostic tests (40.8%) and inhaler techniques (39.2%). Demonstrations with pictures/model/graphics was the most preferred format for patient education, followed by verbal explanation.

Conclusion: The survey demonstrates the need for patient education in an engaging visual/graphical format focused on disease awareness, diagnostic tests, breathing exercises, and inhaler use.

*This article was selected for NAPCON 2025 best research award presentation.

Effectiveness of intrapleural instillation of MESNA for adhesiolysis in multiloculated pleural effusion

S. K. Sumayya Naaz , A. N. V. Koteswara Rao, Venkateswara Reddy Tummuru

SVS Medical College and Hospital, Mahabubnagar, Telangana, India E-mail: sumayyanaaz3@gmail.com

Introduction: Multiloculated pleural effusions and empyema are difficult to drain due to fibrin membranes that create septations. Medical thoracoscopy is often required but may not be feasible in all settings. MESNA (2-mercaptoethane sulfonate Na), a disulfide bond–breaking agent with mucolytic and fibrinolytic properties, has shown potential for adhesiolysis. This study aimed to evaluate its intrapleural use in avoiding thoracoscopy.

Methods: A prospective study was conducted at SVS Medical College, Telangana, between August 2024 and February 2025. Fifteen patients aged 20–60 years with moderate multiloculated pleural effusions or empyema were included. MESNA (1800 mg diluted in 20 ml saline) was instilled intrapleurally under ultrasound guidance for three consecutive days. Patients were monitored with ultrasonography and chest radiographs. Successful adhesiolysis was followed by intercostal drainage until complete evacuation.

Results: Of 15 patients, 10 had multiloculated pleural effusions and 5 had multiloculated empyema. Successful adhesiolysis with MESNA was achieved in 9 of 10 patients with pleural effusion (90%) and 2 of 5 patients with empyema (40%). Remaining cases required thoracoscopy or surgical intervention. No significant adverse effects were noted, except for mild cough during instillation.

Conclusion: MESNA is a safe, effective, and affordable alternative for adhesiolysis in multiloculated pleural effusions and shows moderate benefit in empyema, potentially reducing the need for thoracoscopy.

Keywords: Adhesiolysis, MESNA, multiloculated empyema, multiloculated pleural effusion, thoracoscopy

Adults and adolescents above 15 years of age with cystic fibrosis in the Indian subcontinent: First characterization of phenotype–genotype profiles

Priyanka Medhi , Barney Isaac T J, Richa Gupta

Christian Medical College, Vellore, Tamil Nadu, India E-mail: emmanuel_priyanka@yahoo.com

Introduction: In India, Cystic Fibrosis (CF) remains under-recognized and is associated with substantial pulmonary morbidity. This single-centre study offers the first characterization of phenotype–genotype profiles and pulmonary outcomes in pwCF aged >15 years, with comparisons by pancreatic status.

Methods: After IRB approval, we retrospectively reviewed people with CF (pwCF)=15 years followed at our centre (2010–2025). Demographics and phenotype–genotype profiles were analysed, and patients were categorized by pancreatic sufficiency (PS/PI) for comparison using chi-square tests.

Results: Sixty-six patients were eligible [mean BMI 15 kg/m2 (SD 3.2)], 47% females. Mean current age is 20.6 years (SD 3.3), mean age of diagnosis was 11.7 years (SD 5.22) with median follow-up of 24 months (95% CI:10–40). Mutation data (available for 73%) unveiled 24.2% with =one F508del allele. Other common variants were c.3718-2477C>T (19%), c.1367T>C (5.4%) and c.1393-1G>A (4.2%). Overall mortality rate was 13.6% with 7 families reporting 16 CF-related-offspring deaths. Pancreatic status assessment (n=61) revealed 41% being PS (stool elastase>200 µg/g). At presentation, PS had higher BMI than PI (0.02) but significantly lower FEV1% predicted [56.5%pp (SD 21.9)] vs PI [72.6%pp (SD 14.4)](p=0.014). Age at death did not differ between PS and PI (p=0.77). Fifteen pwCF on donated CFTR modulators demonstrated marked FEV1 improvement.

Conclusion: Our data reveal delayed diagnosis, low BMI, significant pulmonary disease at presentation, and high mortality among pwCF. Contrary to developed nations, early pulmonary decline in both PS and PI pwCF exposes missed opportunities for timely care, especially in PS due to apparent “milder phenotype,” highlighting the vital role of clinical vigilance. Strengthened awareness, timely recognition, and robust lung care are cornerstones to bridge this gap, giving pwCF the chance to access novel therapeutics in optimal health and a brighter future.

Keywords: Cystic fibrosis, India, pancreatic insufficient, people with cystic fibrosis, pulmonary outcomes

Comparative study of bronchoscopic administration of adrenaline versus tranexamic acid in hemoptysis

Manoj Kumar Meena

Government Medical College, Kota, Rajasthan, India E-mail: mkm8058236060@gmail.com

Introduction: Hemoptysis, the expectoration of blood from the lower respiratory tract, is a life-threatening emergency requiring prompt intervention. While many cases are self-limiting, massive hemoptysis poses serious diagnostic and therapeutic challenges. Bronchoscopy aids both diagnosis and treatment. Hemostatic agents like tranexamic acid inhibit fibrinolysis, whereas adrenaline acts through local vasoconstriction.

Methods: A randomized, double-blinded study was conducted on 50 patients with hemoptysis from June 2022 to June 2023 in the Department of Respiratory Medicine. Patients were assigned into two groups: Group A received tranexamic acid (500 mg/20 mL saline) and Group B received adrenaline (1 mg/20 mL saline) instilled bronchoscopically. The procedure was repeated at 90-second intervals if needed. Data were analyzed using SPSS version 23.

Results: Among 50 patients (52% male, 48% female), baseline demographics showed no significant differences between groups. Cigarette smoking was present in 40% of the tranexamic acid group and 44% of the adrenaline group. The number of instillations required was significantly lower with tranexamic acid (p<0.05). Successful bleeding control was higher in the tranexamic acid group (48%) compared to adrenaline (28%). Hemoglobin changes and clotting patterns showed no significant differences. Discussion: Tranexamic acid demonstrated superior efficacy over adrenaline in controlling mild to moderate hemoptysis with fewer instillations required. This highlights the advantage of antifibrinolytic therapy over vasoconstrictor therapy in endobronchial management.

Conclusion: Bronchoscopic instillation of tranexamic acid is more effective than adrenaline in managing mild to moderate hemoptysis. Its use should be considered in clinical practice, with larger studies needed to confirm its role in mass lesions.

Keywords: Adrenaline, bronchoscopy, hemoptysis, hemostasis, tranexamic acid

Comparative efficacy and safety of pleurodesis using doxycycline versus povidone-iodine in patients with recurrent pleural effusion

Kajal Yadav

Government Medical College, Kota, Rajasthan, India E-mail: kajaljhook@gmail.com

Introduction: Recurrent pleural effusion (PE), commonly secondary to malignancy, significantly affects respiratory function and quality of life. Pleurodesis is a palliative procedure to prevent fluid reaccumulation. Doxycycline, a widely used sclerosing agent, has variable success and adverse effects. Povidone-iodine has emerged as a low-cost alternative with promising efficacy and safety.

Methods: A prospective observational study was conducted at a tertiary care center in Rajasthan over one year. A total of 110 patients were randomized to undergo pleurodesis with doxycycline (n=55) or povidone-iodine (n=55). Outcomes assessed included post-procedure recurrence, complications, and overall success within 90 days.

Results: The success rate was higher in the povidone-iodine group (75%) compared to doxycycline (52.7%). Recurrence at 90 days was lower with povidone-iodine (25%) than doxycycline (47.6%). Pain and fever occurred more frequently in the doxycycline group. No cases of empyema or pneumothorax were reported in either group. Discussion: Povidone-iodine demonstrated superior efficacy, lower recurrence, and better tolerability than doxycycline. Its cost-effectiveness and safety make it especially valuable in low-resource healthcare settings.

Conclusion: Povidone-iodine is a safe, effective, and well-tolerated alternative to doxycycline for pleurodesis in recurrent pleural effusion.

Keywords: Chemical pleurodesis, doxycycline, pleurodesis, povidone-iodine, recurrent pleural effusion

Real-world challenges of long-term oxygen therapy in India: Insights from a patient survey

Shikha Jindal Gupta , Pawan Gupta

Neo Super Speciality Hospital, Noida, Uttar Pradesh, India E-mail: drshikhajindal13@gmail.com

Introduction: Long-term oxygen therapy (LTOT) is a cornerstone in managing chronic hypoxemic respiratory diseases. In India, domiciliary oxygen use is rising, yet standardized monitoring, insurance coverage, and physician guidance remain limited.

Methods: A cross-sectional observational survey was conducted from June 2024 to August 2025. A structured online questionnaire was circulated via Google Forms to doctors and oxygen-providing vendors. Patients completed the form directly or with assistance from caregivers or physicians. Data collected included demographics, insurance coverage, oxygen use challenges, follow-up patterns, and details regarding prescribing physicians.

Results: A total of 106 patients participated. ~70% were male, 72% aged 41–80 years, and 65% resided in urban areas. Only ~15% had insurance coverage, with most self-funding therapy, highlighting financial burden. Diagnoses included COPD (41%), interstitial lung disease (19%), and post-tubercular obstructive airway disease (11.4%). Regarding oxygen use, 55% titrated flow at home using pulse oximetry, but ~45% were unaware of target oxygen saturations. ABG-based adjustment was performed in only 42% of patients. Follow-up adherence was reported by 82%, though many faced mobility or cost barriers. Awareness of oxygen safety measures was noted in 72%, and ~20% also required non-invasive ventilation.

Conclusion: This survey highlights significant real-world barriers to effective LTOT in India, including financial, logistical, and educational gaps, inconsistent follow-up, and underutilization of ABG-guided titration. Prescriptions often lack specialist oversight. Recommendations: National LTOT guidelines, structured patient education, physician training, insurance support for equipment (including portable devices), and home-visit programs by trained health workers are urgently needed.

Keywords: Chronic obstructive pulmonary disease, domiciliary oxygen, India, long-term oxygen therapy

*This article was selected for NAPCON 2025 best research award presentation.

Lung transplant recipient evaluation: Novel web-based software to reduce evaluation time in busy OPD

Shemsya Shajahan , Manu Chopra, Kislay Kishore

Armed Force Medical College, Pune, Maharashtra, India E-mail: shemsyashajahan@gmail.com

Introduction: Lung Transplantation has become a viable treatment option in patients with various advanced stage lung disease. Lung transplantation offers the potential to prolong and improve quality of life for patients.

Methods: Lung transplant evaluation in a busy OPD can be time consuming and may deter physicians from performing a detailed evaluation for LT referral and listing at an early stage. We hypothesized that assessing the same via a web-based software can provide accurate results in less time a step-based approach. We developed a web based ‘lung transplant eligibility calculator’ to assess patient systematically to look for eligibility of patients for referral/listing according to ISHLT criterion. Ethical clearance was taken from Institutional Ethical committee, AFMC, Pune (IEC No: IEC/2024/516) and the study was registered with CTRI (CTRI registration no- CTRI/2024/06/068913). Patients of COPD, ILD and Bronchiectasis with end- stage lung disease attending respiratory OPD at a tertiary care centre in Maharashtra were included.

Results: We have included 72 candidates till now of which 52% patients were found to be eligible for referral and 43% patients were eligible for listing according to ISHLT criterion.

Conclusion: Referral for lung transplantation is a complex, multifactorial process that significantly impacts patient outcomes. Early identification and prompt referral of eligible patients will streamline and accelerate the process for lung transplantation. A scientific study will give statistical data on average time period required in referring and listing patients eligible for lung transplantation.

Keywords: Bronchiectasis, chronic obstructive pulmonary disease, end stage lung disease, ILD, lung transplant eligibility calculator, lung transplantation, web-based software

*This article was selected for NAPCON 2025 best research award presentation.

Occupational and Environmental Disorders: Longitudinal effects of PM2.5 exposure on adolescent lungs: Role of CC16, oxidative stress, and life

M. V. Greeshma

JSS Hospital, Mandya, Karnataka, India E-mail: greeshmagreekz27@gmail.com

Introduction: Ambient fine particulate matter (PM2.5) and nitrogen dioxide (NO2) are major determinants of impaired lung development, yet longitudinal evidence from low- and middle-income countries is limited. The Adolescent Pollution Exposure and Lung Health (APEAL) study is the first large-scale Indian cohort to explore biological pathways and lifestyle modifiers of pollution-associated lung growth deficits.

Methods: Over 4,000 adolescents (11–14 years) from four Indian cities with diverse pollution profiles (annual PM2.5: 24.9–201.9 µg/m³) were prospectively assessed. Lung function (FEV1, FVC), circulating Club Cell Secretory Protein 16 (CC16), oxidative stress markers [lipid peroxidation (LPO), total antioxidant capacity], NO2 exposure, and lifestyle parameters (physical activity, dietary fiber intake) were measured. Mixed-effects regression, mediation, and moderation models were applied.

Results: More than half of participants demonstrated lung function <80% predicted. Each 10 µg/m³ increase in PM2.5 was associated with decrements in FEV1 (–0.07 dL) and FVC (–0.11 dL). Reduced circulating CC16 levels partially mediated these associations (12% for FEV1 7% for FVC), highlighting epithelial injury as a mechanistic pathway. Higher CC16 concentrations correlated with better lung function and conferred protection, especially in adolescents with high physical activity and dietary fiber intake. Importantly, the oxidative potential of PM2.5 varied across cities—Mumbai showed the highest oxidative activity despite lower mass concentrations, paralleling the greatest prevalence of impaired lung function. Elevated LPO and reduced antioxidant capacity amplified PM2.5-related lung function loss. Independent effects of NO2 were observed, with each 10 µg/m³ increment linked to –0.18 dL FEV1 and –0.31 dL FVC, not mediated by CC16 but significantly attenuated by lifestyle resilience factors.

Conclusion: Air pollution from PM. and NO was linked to reduced lung function in adolescents. Reduced CC16 correlated with PM. effects, suggesting epithelial injury, while higher CC16 and healthy lifestyles offered protection. Oxidative stress and pollutant toxicity varied by location, with Mumbai showing the highest impact. NO effects were independent and modified by lifestyle factors.

*This article was selected for NAPCON 2025 best research award presentation.

Correlation of symptoms and duration of exposure with estimated lung age in cement factory workers

Venkatprasad P

Karpaga Vinayaga Institute of Medical Sciences and Research Centre, Chengalpet, Tamil Nadu, India E-mail: puhalprasad03@gmail.com

Introduction: Occupational exposure to cement dust is a well-documented cause of chronic respiratory morbidity. Cement manufacturing releases fine particulate matter containing silica, calcium oxide, and other irritants that can goes up to small airway. Prolonged inhalation leads to accelerated decline in lung function, early onset of respiratory symptoms such as cough, wheeze, dyspnea, and sputum production. Estimated Lung Age (ELA), derived from spirometry measurements-offers an intuitive and patient-friendly metric to quantify lung function decline relative to chronological age. A higher ELA compared to actual age reflects premature pulmonary aging, associated with occupational hazards. In cement factory workers, symptoms and years of dust exposure may have a direct relationship with ELA, serving as an early marker of occupational lung disease. Although many studies are available in estimating lung function abnormalities among cement workers by using spirometry, ELA was not assessed in those studies, hence current study is undertaken.

Methods: Subjects satisfying the inclusion criteria included. Demographic data, years of exposure and symptoms recorded. ELA recorded using spirometry. correlation was done using SPSS software version.

Results: This study enrolled 84 subjects, of which 68 were asymptomatic and 54 had more than 5 years of exposure. ELA is elevated among 88.2% of asymptomatic and 98.14% of subjects with exposure more than 5 years.

Conclusion: ELA found to be abnormally elevated in subjects with longer duration of exposure and asymptomatic cement factory workers. Hence, regular screening for these high risk occupational group is recommended for early identification of lung function abnormalities.

Keywords: Cement factory, estimated lung age, spirometry

*This article was selected for NAPCON 2025 best research award presentation.

Association between smoke exposure and respiratory morbidity in rural primary school children

Ann Xavier Pulikkal , Chelangara Paul Davis

Amala Institute of Medical Sciences, Thrissur, Kerala, India E-mail: annxavieramala@gmail.com

Introduction: Prevalence of acute respiratory infections and asthma was found to be high in India. The WHO estimates that in 2020, 2.4 billion people, or one-third of the global population, were exposed to Household Air Pollution. Children are particularly more susceptible to these exposures and likely candidates for respiratory morbidities.

Methods: A questionnaire which included the socio demographic characteristics, details of respiratory symptoms, passive smoking, and indoor air pollution was given to guardians of students who were randomly selected from a rural primary school. Diagnosis of respiratory morbidity was made by examining the children with respiratory symptoms.

Results: Total children studied were 120, female-50.8 % (n =61) male-49.2% (n=59). Mean age 7.2+/-1.2. Respiratory morbidities was present in 44.16% (n =53). Bronchial asthma and Allergic Rhinitis were the commonest respiratory morbidities 62.3% (n= 33), followed by acute respiratory tract infection 26.4% (n= 14). Others included recurrent respiratory tract infection 5.7% (n=3) chronic respiratory tract infection 3.8% (n=2). There was one child with treated TB (1.9%) The children with exposure to Biomass Fuel was 63 52.5% (n =63) their respiratory morbidities 42.85% (n 27) (p=0.34). Tobacco smoke exposure in children was 14.16% (n =17) their respiratory morbidities was 58.82% (n=10)(p- 0.57). All Children had routine vaccinations and 53.3% (n =64) had influenza vaccination.

Conclusion: The Prevalence of respiratory morbidities in rural school children was high. The association between smoke exposure and respiratory morbidity was not significant.

Keywords: Primary school children, respiratory morbidity, smoke exposure

*This article was selected for NAPCON 2025 best research award presentation.

Assessment of diffusion capacity of lung for carbon monoxide (DLCO) in silica-exposed workers

Shafeena Basheer

Dr. S.N. Medical College, Jodhpur, Rajasthan, India E-mail: shermis141094@gmail.com

Introduction: Inhaled crystalline silica is associated with a spectrum of pulmonary diseases, posing a major public health issue with significant global morbidity and mortality. While management typically relies on a history of occupational silica dust exposure and chest X-ray findings, radiological changes often lag behind functional impairment. Early detection of lung function impairment is crucial, as there is no cure for the disease. DLCO is a pulmonary function test that measures the lungs ability to transfer gas from inspired air to the bloodstream. This study attempts to assess the utility of DLCO in identifying early lung impairment in silica-exposed workers.

Methods: Cross-sectional observational study involving 50 asymptomatic or mildly symptomatic workers with =5 years of silica exposure. We performed DLCO, spirometry, chest X-rays, and collected clinical/occupational history.

Results: The study population had a median age of 44 years, and 90% were male. Median duration of silica exposure was 15.5 years, and the majority were stone cutters. DLCO and spirometry detected abnormality in 72% and 52% of the study population, respectively. The severity of DLCO impairment was mild in most (52.8%) of them. Notably, among the 24 participants with normal spirometry, more than half (66.6%) had impaired DLCO. A significant correlation was observed between the duration of silica exposure and the severity of DLCO impairment (p=0.003).

Conclusion: DLCO can detect lung function impairment in silica-exposed workers, particularly in asymptomatic or mildly symptomatic conditions, and the severity of impairment is significantly correlated with duration of silica exposure. Therefore, DLCO can be an effective tool for earlier intervention and potentially improve long-term outcomes in the ongoing battle against occupational lung disease.

*This article was selected for NAPCON 2025 best research award presentation.

Pattern of radiological findings in certified silicosis patients at JLN Medical College Ajmer

Elizabeth Lalremmawii , Rajveer Kuldeep

JLN Medical College, Ajmer, Rajasthan, India E-mail: elyralte99@gmail.com

Introduction: Silicosis is an occupational lung disease caused by prolonged inhalation of crystalline silica dust, most commonly affecting workers in mining, stone-cutting, and construction industries. Radiological imaging, particularly chest radiography and high-resolution computed tomography (HRCT), plays a pivotal role in the diagnosis and staging of silicosis. This study aims to evaluate and describe the pattern of radiological findings among Certified Silicosis patients.

Methods: A retrospective cross-sectional analysis was conducted on certified silicosis patients registered at Department of Respiratory Medicine, JLN Medical college between 1st April 2024- 30th June 2025. A diagnosis of silicosis was made by occupational history of exposure to silica dust and suggestive radiological abnormalities seen by Pneumoconiosis Board. Findings were categorized based on the International Labour Organization (ILO) classification system for pneumoconiosis.

Results: A total of 33 certified silicosis cases were analyzed. Silicosis is found to be predominant in Male with age group between 30-50 years. The most common radiographic finding was small rounded nodules, predominantly in the upper lung zones, observed in ~ 60% of patients. Progressive massive fibrosis (PMF) was noted in ~7% of cases, Eggshell calcification is seen in ~5% of patients. ~12% presented with silicotuberculosis. Associated findings included calcified hilar/mediastinal lymphadenopathy ~30%.

Conclusion: The study highlights the characteristic radiological patterns of silicosis. Chest x-ray that shows small round nodular opacities in upper zone and Eggshell calcification serve as highly suggestive radiographic marker of Silicosis. HRCT also plays an important role in early detection and prophylaxis. Timely radiological assessment is crucial for early diagnosis and prevention of disease progression in at-risk populations.

Keywords: CXR, eggshell calcification, PMF, radiological pattern, silicosis

*This article was selected for NAPCON 2025 best research award presentation.

Intergrated evaluation of pulmonary health in construction workers

M. S. Darsana , Muthukumaran L, Meenakshi N

Chettinad Hospital and Research Institute, Chennai, Tamil Nadu, India E-mail: darsaha@gmail.com

Introduction: Construction workers are frequently exposed to airborne pollutants, dust, and noxious agents that can impair pulmonary health over time. Traditional tools like spirometry may miss early or subclinical airway changes, particularly in individuals with poor effort or peripheral airway involvement. Recent advances in respiratory diagnostics such as fractional exhaled nitric oxide (FeNO) and impulse oscillometry (IOS) offer a noninvasive and sensitive integrated approach to detect airway inflammation and resistance changes.

Methods: This prospective observational study included 100 male construction workers with a minimum of 2 years of occupational exposure. All participants underwent detailed clinical evaluation, FeNO measurement, IOS testing, and spirometry. Data on symptomatology, smoking status, and occupational history were collected. Abnormalities in FeNO (indicative of eosinophilic inflammation) and IOS parameters (e.g., R5-R20, AX) were analyzed and compared to spirometric results to assess their utility in early detection of airway involvement.

Results: Elevated FeNO levels were observed in 32% of participants, suggestive of airway inflammation, especially in those with rhinitis or chronic cough. IOS abnormalities indicating small airway dysfunction (elevated R5-R20 and AX) were present in 41% of workers, even among those with normal spirometry. Spirometry alone failed to detect subtle small airway impairment in nearly 30% of cases where IOS was abnormal. The combination of IOS and FeNO identified early changes in a significant proportion of asymptomatic workers.

Conclusion: An integrated pulmonary evaluation using FeNO and IOS is valuable for early detection of airway inflammation and small airway dysfunction in construction workers, even in the absence of overt clinical symptoms or spirometric abnormalities. Incorporating these tools into routine occupational health screening can enable timely interventions and help prevent progression to chronic airway diseases.

Keywords: Fractional exhaled nitric oxide, impulse oscillometry, obstructive airway disease, spirometry

*This article was selected for NAPCON 2025 best research award presentation.

Respiratory Emergencies and Critical Care Including ECMO: Noninvasive ventilation for acute hypercapnic respiratory failure in neuromuscular disorders

Kewal Sethi

RD Gardi Medical College, Ujjain, Madhya Pradesh, India E-mail: ssdnkewal@gmail.com

Introduction: Neuromuscular disorders (NMD) predispose to acute type 2 (hypercapnic) respiratory failure due to progressive respiratory muscle weakness and impaired airway clearance. Noninvasive ventilation (NIV) reduces ventilatory load, improves gas exchange, and may prevent invasive ventilation. Clinical data across different NMD phenotypes in acute settings remain limited.

Methods: We report a single-center case series of five patients with NMD admitted with acute hypercapnic respiratory failure. Three had Duchenne muscular dystrophy (ages 24, 26, and 15 years) one had Becker muscular dystrophy (age 14 years), and one had myasthenia gravis (age 23 years). All patients fulfilled criteria for NIV initiation (pH <7.35 and PaCO2 >45 mmHg) and were managed with bilevel positive airway pressure in an ICU/high-dependency unit. Demographics, triggers, arterial blood gases (ABG), NIV strategies, and outcomes were analyzed.

Results: Infections (n=3) and atelectasis (n=1) were the most common triggers, while one case presented with myasthenic crisis. At admission, median pH was 7.26 and PaCO2 72 mmHg. NIV was initiated within 2–4 hours of presentation, using inspiratory pressures of 12–16 cmH2O and expiratory pressures of 4–6 cmH2O. All five patients demonstrated sustained improvement, with pH normalization within 12-24 h and =20% PaCO2 reduction by 24 h. None required intubation or invasive ventilation. Minor complications included one case of interface-related skin injury. Median ICU stay was 4-6 days and hospital stay 8 days. No in-hospital deaths occurred.

Conclusion: NIV is a safe and effective strategy to manage acute type 2 respiratory failure in neuromuscular disorders, reducing the need for invasive ventilation.

Keywords: Becker muscular dystrophy, Duchenne muscular dystrophy, myasthenia gravis, neuromuscular disorders, noninvasive ventilation

*This article was selected for NAPCON 2025 best research award presentation.

To study adaptive coping and health related quality of life in critically ill patients

Rohan Malakar , Rajnish Gupta

National Institute of Tuberculosis and Respiratory Disease, Delhi, India E-mail: drohanmalakar@gmail.com

Introduction: Patients admitted to Intensive Care Units (ICUs) often experience physical and psychological morbidity, impacting their health-related quality of life (HRQoL). Post-Intensive Care Syndrome (PICS) is a growing concern, with many survivors experiencing cognitive, psychological, and physical impairments. Objective: To assess coping and HRQoL in ICU patients using the Sickness Insight in Coping Questionnaire (SICQ) and Short Form-12 (SF-12) scores and identify factors influencing these outcomes.

Methods: A prospective study was conducted in an Indian ICU setting, enrolling 60 patients. SICQ and SF-12 scores were evaluated on admission and at 1, 3, and 6 months post-discharge.

Results: Of 60 ICU patients, 52 were analyzed (mean age 52 years; 72% male; 62% smokers). Most were admitted within 1 week of illness; 22% required invasive ventilation and 77% NIV. SICQ and SF-12 (PCS, MCS) scores improved significantly up to 6 months post-discharge (p=0.001), indicating better coping and HRQoL. Improvement was greater in males, NIV users, those with shorter ICU stay, and patients without underlying disease; the latter two showed statistically significant associations.

Conclusion: This study highlights the importance of assessing coping and HRQoL in ICU patients. SICQ and SF-12 scores can be useful tools in identifying patients at risk of PICS and tailoring interventions to improve their outcomes. Factors such as duration of ICU stay, mechanical ventilation, and underlying diseases impact coping and HRQoL. Understanding these factors can inform patient-specific recovery plans and improve post-discharge care. Implications: This studys findings can inform ICU care and post-discharge support, enabling healthcare providers to better address the complex needs of ICU survivors and improve their long-term outcomes.

Non-invasive ventilation in Type II respiratory failure: A cross-sectional study in a tertiary care

Samra , Prasanna Kumar T, F. Tanisha Saleem

M.S. Ramaiah Medical College, Bengaluru, Karnataka, India E-mail: samra.ntk@gmail.com

Introduction: Type II respiratory failure is associated with high morbidity and mortality. Non-invasive ventilation (NIV) has emerged as a safe and effective modality to reduce the need for invasive ventilation and its complications. This study aimed to evaluate the clinical outcomes, short-term complications, and treatment failure rates of NIV in patients with Type II respiratory failure in a tertiary care centre.

Methods: A cross-sectional observational study was conducted over 12 months in the ICU of a tertiary care center. Thirty-one adult patients (>18 years) with type II respiratory failure were included. All patients were initiated on BiPAP (spontaneous/timed mode) with initial IPAP/EPAP settings of 12/6 cm H2O, titrated according to clinical status and arterial blood gases. Patients were monitored for 24 hours for clinical (respiratory rate, heart rate, SpO2) and biochemical (pH, PaCO2, PaO2) changes. Chi-square/Fisher’s exact test was applied for qualitative data, while mean ± SD and ANOVA were used for quantitative comparisons. A p-value <0.05 was considered statistically significant.

Results: The mean age was 64.8 years with a male-to-female ratio of 2.1. Underlying diagnoses included acute exacerbation of COPD (AECOPD) in 23 patients (74%) and obstructive sleep apnea (OSA) in 8 patients (26%). Comorbidities were hypertension (40%), diabetes (18%), and ischemic heart disease (10%). NIV led to significant improvement in PaCO2, PaO2, SpO2, respiratory rate, and heart rate within 24 hours (p<0.01), though pH changes were not significant. Overall, NIV was successful in 19 patients (61.3%), while 12 (38.7%) required escalation. Minor complications occurred in 10% of patients, and no mortality was observed.

Conclusion: NIV is a safe, effective, and first-line therapy for Type II respiratory failure, especially in AECOPD and OSA. In this study, it achieved meaningful clinical and biochemical improvement, with a 61.3% success rate, minimal complications, and no mortality, reinforcing its utility in tertiary care practice.

Keywords: Acute exacerbation of COPD, BiPAP, noninvasive ventilation, obstructive sleep apnea, Type II respiratory failure

Usefulness of point-of-care ultrasound as a diagnostic procedure on patients admitted with respiratory distress in respiratory care unit: A cross-sectional study

Asmita Mandal , Pulak Kumar Jana, Sourindranath Banerjee

Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India E-mail: asmitamam20@gmail.com

Introduction: Point-of-care ultrasound (POCUS) is a transformative tool in respiratory medicine, offering a rapid, bedside, and non-invasive alternative to traditional diagnostic methods. Its ability to provide real-time information about the lung and pleura makes it valuable for diagnosis, management, and clinical decision-making.

Methods: An observational descriptive cross-sectional study was conducted over nine months on 86 patients admitted with respiratory distress to the Respiratory Care Unit (RCU) of the Department of Respiratory Medicine, Nil Ratan Sircar Medical College, Kolkata. Patients aged over 18 years were included. Those who experienced cardiopulmonary arrest during stabilization or had subcutaneous emphysema were excluded. Ultrasound, chest X-ray, and CT scan were used for evaluation.

Results: POCUS was performed on 86 patients (48 males, 38 females) with respiratory distress, detecting pleural effusion (22), pneumothorax (21), lung mass (21), pneumonia (16), and others. Diagnostic accuracy was high: pleural effusion (100% sensitivity, 94.4% specificity), pneumothorax (94.7% sensitivity, 96.8% specificity), lung mass (88.2% sensitivity, 94.2% specificity), and pneumonia (93% sensitivity, 96% specificity). Pericardial effusion was noted in 6 patients, pulmonary edema in 5, and ARDS in 4. Deep vein thrombosis (DVT) was confirmed in 2 patients with pulmonary embolism.

Conclusion: POCUS is a valuable tool in respiratory medicine, improving diagnostic accuracy, enabling rapid bedside assessments, and guiding procedures. Its non-ionizing nature makes it a safer alternative to traditional imaging, especially in critically ill patients.

Keywords: Bedside, point-of-care ultrasound, rapid, real-time

*This article was selected for NAPCON 2025 best research award presentation.

Dysnea to sepsis: Prognostic markers that matter

Shubhangi Prabhakar , Saood Ali, Nidhi Girdhar

N.K.P. Salve Institute of Medical Sciences, Nagpur, Maharasthra, India E-mail: shubhangivwhr@gmail.com

Introduction: Dyspnea isn’t just a symptom—it’s often the first alarm bell of a critical cascade leading to acute respiratory failure (ARF) then sepsis—conditions with high mortality. Traditional prognostic tools like SOFA and qSOFA have limitations in early detection. Serum lactate and albumin, individually, reflect tissue hypoperfusion and systemic inflammation respectively. The lactate/albumin ratio (LAR) integrates these markers, potentially enhancing prognostic accuracy in critically ill patients.

Methods: This retrospective cohort study analyzed 141 patients admitted to the Respiratory ICU at LMH Nagpur with ARF, with or without sepsis. Data included arterial blood gas parameters (lactate, PaO2, SaO2, HCO3?, pH, PaCO2), serum albumin, and qSOFA scores. Outcomes assessed were mechanical ventilation, inotropic support, hospital stay duration, and mortality. Statistical comparisons were made between LAR, lactate, albumin, and qSOFA for prognostic significance.

Results: Overall outcome: Out of 141 patients (79 males, 62 females), 45 died, 10 left against medical advice, and 86 were discharged.

LAR > 1.5: Found in 86 patients 32 deaths. Strong correlation with sepsis and ARF (71 patients).

qSOFA > 2: Present in 115 patients 38 deaths. 52 had concurrent sepsis with ARF.

Lactate > 2 mmol/L: Seen in 106 patients 41 deaths. 48 had sepsis with ARF.

Albumin < 3.5 g/dL: Found in 133 patients 41 deaths. 48 had sepsis with ARF.

Conclusion: LAR is a novel, cost-effective biomarker with strong prognostic utility in patients presenting with dyspnea progressing to sepsis. Its integration into clinical protocols may facilitate timely interventions and improve outcomes in resource-limited settings.

Keywords: Acute respiratory failure, lactate/albumin ratio, prognostic biomarkers, qSOFA, sepsis

Redefining extracorporeal membrane oxygenation outcomes in India: Survival gains through early intervention and intense individualized weaning protocols in tertiary care center in Mumbai

Taruna Rathore , Sumeet Singhania, Vatsal Kothari

Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India E-mail: taruna2595@gmail.com

Introduction: Extracorporeal membrane oxygenation (ECMO) is a vital salvage therapy for refractory respiratory and circulatory failure. In India’s critical care landscape—defined by a high prevalence of tropical infections, antimicrobial resistance, and resource variability—outcomes can be significantly influenced by local ECMO protocols, infection prevention strategies, and socioeconomic constraints. This single-center study from Kokilaben Dhirubhai Ambani Hospital, Mumbai shows impact of multifaceted refined local ECMO protocol on survival patterns in the year 2024.

Methods: A retrospective observational analysis included all adult ECMO cases from January–December 2024. Variables assessed were demographics, diagnoses, ECMO mode, complications, and survival. All patients underwent percutaneous cannulations and had Universal anidulafungin prophylaxis targeting the rising incidence of multidrug-resistant Candida auris. ECMO was initiated early in selected patients with severe but potentially reversible cardiorespiratory failure, followed by individualized early weaning upon clinical stabilization. Results were compared with Indian and international registry benchmarks.

Results: Thirty-six patients (56% male age 19–75 years) underwent ECMO: V-V ECMO: 18 patients (50%), survival 61.1% — primarily for ARDS due to pneumonia, leptospirosis, dengue, and H1N1. V-A ECMO: 14 patients (38.9%), survival 42.9% — for cardiogenic or obstructive shock. Hybrid ECMO: 4 patients (11.1%), survival 25%. Antifungal prophylaxis was associated with a marked decline in invasive fungal infections, with no Candida auris cases observed despite high baseline prevalence. Complications were rare, limited to isolated limb ischemia and one amputation.

Conclusions: This study highlights the potential of strategic infection prophylaxis, optimized timing, and individualized care to redefine ECMO results in resource-variable, in settings of multidrug resistance infections. The findings support a scalable, protocolized approach that could transform ECMO outcomes in similar regions. Multicenter validation is warranted.

Keywords: Acute respiratory distress syndrome, anidulafungin, Candida auris , early intervention, extracorporeal membrane oxygenation

*This article was selected for NAPCON 2025 best research award presentation.

Unmasking predictors of non-invasive ventilation outcome in acute hypercapnic respiratory failure

Mostafi Ahamed , Indranil Dawn

Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India E-mail: tomostafiahamed@gmail.com

Introduction: Acute Hypercapnic Respiratory Failure (AHRF) is a frequent emergency where non-invasive ventilation (NIV) is the primary therapy. NIV failure increases morbidity & mortality. Identifying predictors of NIV outcome is essential, yet the combined role of clinical, biochemical & nutritional parameters remains underexplored, warrants systemic evaluation.

Methods: A hospital-based Longitudinal Observational study was conducted in the Department of Respiratory Medicine of NRS Medical College. 60 AHRF patients requiring NIV were enrolled as defined criteria. Outcomes (NIV success/failure) were analyzed accordingly.

Results: Among 60 patients with acute hypercapnic respiratory failure, 36 (60%) had successful NIV outcomes (Group I) while 24 (40%) required intubation (Group II). The mean age was 61.63 ± 11.91 years. Multivariate analysis with binary logistic regression showed significant association (p < 0.005) between lower GCS, lower serum sodium, calcium, and magnesium, reduced pH and PF ratio, and higher BMI with NIV failure. Univariate Analysis showed significant association between higher respiratory rate, mid-upper arm and calf circumference, HbA1C with NIV failure. Among the total study population (N=60), majority were COPD patients (78.33%). NIV failure was found to be higher (72.22%) amongst patients with undiagnosed Diabetes mellitus than known Diabetics or Non-Diabetics (p < 0.005). Reduced Vitamin D3 was prevalent across the cohort.

Conclusion: Early recognition of high-risk patients, particularly those with deranged electrolytes, poor nutritional indices, and undiagnosed diabetes, may enable timely escalation of care. Integrating these multidimensional predictors into clinical assessment can refine prognostication, optimize patient selection for NIV, and reduce failure rates, thereby improving outcomes in AHRF.

Keywords: Acute hypercapnic respiratory failure, chronic obstructive pulmonary disease, noninvasive ventilation, predictors of outcome, undiagnosed diabetes mellitus

Leptospira lung: Lessons from a 3-year retrospective case series from a tertiary care centre ICU

Rutvee Kakkad , Mithilesh Rathi, Alpa Dalal

Jupiter Hospital, Thane, Maharashtra, India E-mail: rutvee.kakkad@gmail.com

Introduction: Leptospirosis can present with severe pulmonary complications, including acute respiratory distress syndrome (ARDS) and pulmonary hemorrhage, associated with high mortality.

Methods: We retrospectively reviewed 24 confirmed Leptospirosis cases admitted to the ICU between 2022 and 2025. Demographic data, clinical features, pulmonary involvement, interventions, and outcomes were analyzed, with a focus on patients with lung manifestations.

Results: Mean age was 43 years 71% were male. Multiorgan dysfunction was nearly universal: renal (92%), hepatic (92%), and thrombocytopenia (96%). Pulmonary involvement occurred in 18 patients (75%), most often ARDS (8 cases) and pulmonary hemorrhage (5 cases). Median PaO2/FiO2 ratio was 148 22% met criteria for severe ARDS (<100). Median SOFA score was 11, reflecting high burden of organ failure. Among pulmonary cases, 67% required invasive ventilation, 17% underwent proning, and 6% required ECMO. Steroids were administered in 58%. Mortality was 28% in pulmonary cases and 33% in non-pulmonary cases, with overall mortality of 29%. Non-survivors had lower PaO2/FiO2 ratios (median 77) and higher SOFA scores (median 13.5) compared to survivors (150 and 11, respectively), though these differences were not statistically significant. Cases clustered in July–August, reflecting monsoon seasonality. Pulmonary leptospirosis in this series was frequent, severe, and strongly seasonal. The clustering during monsoon highlights risk due to environmental exposure. The trends in PaO2/FiO2 ratio and SOFA score suggest prognostic value and may help triage patients needing early advanced therapies, including ECMO.

Conclusion: Despite advanced ICU measures, including ECMO in selected patients, mortality approached 30%, emphasizing that outcomes are driven not by lung disease alone but by the combination of severe hypoxemia and multiorgan dysfunction. These findings reinforce leptospirosis as a critical monsoon-associated cause of ARDS in India and highlight the need for larger studies to define optimal and timely management.

Keywords: Acute respiratory distress syndrome, critical care, extracorporeal membrane oxygenation, leptospirosis, pulmonary hemorrhage

Can procalcitonin predict outcomes in sepsis? Insights into ICU stay and mortality

Swati Soni

Rajiv Gandhi Superspeciality Hospital, North East Delhi, India E-mail: swatisoni.ss88@gmail.com

Introduction: Sepsis and pneumonia are leading causes of ICU mortality and prolonged hospital stay. Procalcitonin (PCT) rises rapidly with bacterial infection and may offer superior prognostic utility over traditional biomarkers for predicting outcomes. This study evaluates the association between serum PCT levels and ICU length of stay (LOS) and mortality in patients with pneumonia and sepsis.

Methods: A prospective observational study was conducted over six months in a North Indian tertiary Respiratory ICU (RICU). Adults (>18 years) admitted with suspected sepsis per Surviving Sepsis Guidelines 2021 were enrolled. Exclusions included recent trauma/surgery, malignancy, and immunocompromised states. Clinical data, SOFA scores, and laboratory values including serial PCT were collected. Primary and secondary outcomes were ICU Length of Stay and mortality, analyzed with R software.

Results: Among 69 enrolled patients (mean age 56.8 years), median admission PCT was 1.29 ng/mL. Mortality was 28%. Survivors showed a significant PCT decline at 48 h (0.9 ng/mL) and 96h (0.2 ng/mL), while non-survivors had persistently high levels (3.6 and 1.8 ng/mL, respectively). Persistently elevated PCT correlated with higher SOFA scores and mortality. Mean ICU stay was 12.8 days.

Conclusion: Persistently elevated PCT levels beyond 48-96 hours are strongly associated with increased mortality, higher SOFA scores, and prolonged ICU stay. Serial PCT monitoring serves as a valuable prognostic biomarker in critically ill septic patients, aiding in risk stratification and clinical decision-making.

*This article was selected for NAPCON 2025 best research award presentation.

Comparison of three strategies for withdrawal of non-invasive ventilation (NIV) postextubation

Prakhar Sharma , Ganesh Sanjan, Deepansh Gupta

AIIMS, Rishikesh, Uttarakhand, India E-mail: prakhar.pulm@aiimsrishikesh.edu.in

Introduction: Non-Invasive Ventilation (NIV) is commonly required post-extubation in patients with Acute Exacerbation of COPD (AECOPD) and acute Hypercapnic Respiratory Failure (HcRF) following invasive mechanical ventilation (IMV). This randomized controlled trial (RCT) compares three NIV withdrawal strategies to determine the most effective approach for minimizing reintubation, reducing ICU stay, and improving patient outcomes.

Methods: This 18-month RCT included 76 AECOPD patients post-IMV requiring NIV, randomized into three groups: Immediate withdrawal (n = 23, Group A), Stepwise pressure support reduction (n = 25, Group B), and Stepwise duration reduction (n = 28, Group C). The primary outcome was successful NIV withdrawal. Secondary outcomes included reintubation rates, total NIV duration, ICU length of stay, and NIV comfort scores.

Results: The mean age was 63.66 years (SD 8.24), with 72.4% males. Success rates were similar across groups (73.91% (A), 72.00% (B), 75.00% (C), p = 0.969). Reintubation rates were 21.74% (A), 20.00% (B), and 14.29% (C) (p = 0.835). Comfort scores showed no significant differences (p > 0.05). Median NIV duration was 80 hours (A), 62 hours (B), and 65 hours (C) (p = 0.108). Median ICU stay was 7 days (A), 7 days (B), and 5 days (C) (p = 0.340).

Conclusion: Immediate NIV withdrawal is not inferior to stepwise weaning strategies in terms of success and reintubation rates. With a 35% non-inferiority margin, immediate withdrawal may reduce NIV exposure without compromising safety. Larger studies are needed to confirm these findings and refine clinical guidelines.

*This article was selected for NAPCON 2025 best research award presentation.

Intelligent volume-assured pressure support versus spontaneous/timed mode as a noninvasive weaning strategy in postextubation chronic obstructive pulmonary disease patients: Pilot randomized controlled trial

Prakhar Sharma , Ganesh Sanjan, Deepansh Gupta

AIIMS, Rishikesh, Uttarakhand, India E-mail: prakhar.pulm@aiimsrishikesh.edu.in

Introduction: Non-invasive ventilation (NIV) is used post-extubation in chronic obstructive pulmonary disease (COPD) patients to prevent post-extubation failure (PEF). The effectiveness of Intelligent Volume-Assured Pressure Support (iVAPS) compared to the conventional Spontaneous/Timed (S/T) mode remains unclear. Objectives: To compare the success rate, reintubation rates, length of ICU stay, NIV duration, and patient comfort between iVAPS and S/T modes post-extubation in COPD patients.

Methods: This randomized controlled trial included 75 COPD patients requiring NIV post-extubation. Patients were randomized into two NIV modes: S/T (n = 42, 55.3%) and iVAPS (n = 33, 44.7%). The primary outcome was NIV success. Secondary outcomes included reintubation rates, length of ICU stay, duration of NIV, and patient comfort.

Results: The mean age was 63.92 ± 8.33 years, with 55 males (72.4%). NIV success rates were similar (S/T: 88.1% vs. iVAPS: 84.85%, p = 0.741). Reintubation rates did not differ significantly (S/T: 16.67% vs. iVAPS: 15.15%, p = 0.604). Median ICU stay was comparable (S/T: 7 days [IQR: 5–10] vs. iVAPS: 6 days [IQR: 4–7.5], p = 0.119). Median NIV duration also showed no significant difference (S/T: 72 hours [IQR: 26–88.5] vs. iVAPS: 48 hours [IQR: 36–75], p = 0.446). Comfort scores from 12 hours post-initiation until NIV withdrawal were similar across both groups (p > 0.05).

Conclusion: iVAPS is non-inferior to S/T mode within a 20% margin, making both effective post-extubation NIV strategies in COPD patients. Hence, mode selection should be individualized based on patient characteristics and clinician preference.

Role of HACOR score in prediction of non-invasive ventilation failure in acute hypoxemic respiratory failure

Konathala Hari Jagan , S. Praveena, M. Pradeepika

Andhra Medical College, Visakhapatnam, Andhra Pradesh, India E-mail: konathalaj9@gmail.com

Introduction: Noninvasive ventilation (NIV) is commonly used to treat acute hypoxemic respiratory failure (AHRF) with the goal of preventing endotracheal intubation (ETI). But NIV failure causes delayed intubation, which eventually has been associated with increased morbidity and mortality. Therefore HACOR score helps to predict patients likely to fail NIV for AHRF. Its utility will be useful for early intubation and management.

Methods: Prospective observational study done on 100 patients with Acute hypoxemic respiratory failure who were receiving NIV enrolled in our study. All the variables of HACOR score was calculated to predict NIV treatment failure AHRF.

Results: Among 100 patients treated with NIV. 62 Patients with HACOR score < 5 successfully recovered from NIV and 38 patients with HACOR score > 5 shows NIV failure which was determined through ROC curve. Patients with higher HACOR score had NIV failure than those with success group at 1hour, 12 hours, 24 hours.

Conclusion: The HACOR scale is a clinically useful bedside tool for the prediction of NIV failure in AHRF patients and Early intubation in high HACOR score patients may reduce the hospital mortality rate.

Keywords: Acidosis, consciousness, heart rate, oxygenation, respiratory rate

*This article was selected for NAPCON 2025 best research award presentation.

Arterial blood gas (ABG) analysis trends in intensive care unit (ICU): A case series of 40 patients

Bhaumik Kamdar

Padmashree Dr. D. Y. Patil Medical College, Navi Mumbai, Maharashtra, India E-mail: bhaumik.kamdar@gmail.com

Introduction: Arterial blood gas (ABG) analysis is a vital tool in the management of critically ill patients, offering real-time assessment of acid–base balance, ventilation, and oxygenation. Serial monitoring of ABG parameters can provide valuable insights into disease progression and therapeutic response in both respiratory and non-respiratory disorders.

Methods: This case series included 40 patients admitted to the intensive care unit (ICU). ABG reports were analyzed for pH, pCO2, pO2, SO2, HCO3?, and base excess. Measurements were performed twice daily (8 AM and 8 PM) for the initial 2 days, and thereafter as clinically indicated. Trends were charted and subjected to statistical comparison between respiratory and non-respiratory disease groups.

Results: Distinct patterns in pH and pCO2 were observed. Affirmative trends were noted in respiratory diseases such as COPD, interstitial lung disease, and pneumonia, as well as in non-respiratory conditions including cerebrovascular accidents, epilepsy, and renal and hepatic dysfunction. These findings were consistent across both acute and chronic presentations.

Conclusion: Serial ABG analysis is a practical and valuable ICU surveillance tool. It assists in predicting disease course, assessing prognosis, and improving outcome-based decision-making in both respiratory and systemic conditions.

Keywords: Arterial blood gas, intensive care unit, pCO 2 , pH, respiratory disorders

Microbiological spectrum and antimicrobial resistance patterns in critically ill patients

Easwaran

Saveetha Medical College, Chennai, Tamil Nadu, India E-mail: easwarandxb@gmail.com

Introduction: Lower respiratory tract infections (LRTIs) are a major cause of morbidity and mortality in critically ill patients. Rising antimicrobial resistance (AMR) complicates empirical therapy, emphasizing the need for accurate microbiological surveillance. This study aimed to analyze the pathogen spectrum and resistance patterns using bronchoalveolar lavage (BAL), Mini-BAL, and endotracheal aspirate (ETA) samples.

Methods: A prospective cohort of 70 ICU patients with suspected LRTIs was studied. Respiratory samples were collected via BAL, Mini-BAL, and ETA. All isolates underwent bacterial and fungal culture, followed by antimicrobial susceptibility testing according to CLSI guidelines. BAL served as the reference method, while comparative analysis across techniques was performed.

Results: Gram-negative bacilli predominated, with Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii being the most frequent isolates. Gram-positive organisms (Staphylococcus aureus, including MRSA) and fungi (Candida, Aspergillus) were also identified. Resistance rates to carbapenems and fluoroquinolones were high, particularly among Klebsiella and Acinetobacter. BAL yielded the most reliable microbiological profiles, Mini-BAL demonstrated comparable pathogen distribution, while ETA was often confounded by upper airway contaminants.

Conclusion: BAL and Mini-BAL provide dependable pathogen and resistance profiles in critically ill patients, guiding appropriate antimicrobial therapy. The high prevalence of multidrug-resistant Gram-negative bacteria underscores the urgent need for stringent infection control and rational antibiotic use in ICUs.

Keywords: Antimicrobial resistance, bronchoalveolar lavage, endotracheal aspirate, intensive care unit, lower respiratory tract infection, Mini-BAL, multidrug resistance

Sleep and Related Disorders: Ultrasonographic assessment of diaphragmatic function in relation to obstructive sleep apnea severity

Srishankar , Eldhos S, Ajither PA

Father Muller Medical College, Mangaluru, Karnataka, India E-mail: srishankarabairy2012@gmail.com

Introduction: Obstructive sleep apnea (OSA) is a prevalent disorder linked to impaired respiratory mechanics and systemic complications. Diaphragmatic dysfunction has been hypothesized to influence disease severity, and ultrasonography offers a non-invasive approach to evaluate diaphragmatic performance.

Methods: This cross-sectional study included 62 patients with polysomnographically confirmed OSA. Demographic, anthropometric, and clinical data were collected. Diaphragmatic function was assessed using ultrasonography, measuring excursion, inspiratory and expiratory thickness, and deep tidal volume of both hemidiaphragms. Statistical analyses included Spearman’s correlation, Kruskal–Wallis test, and ordinal logistic regression adjusted for age, gender, and BMI. Diagnostic performance for detecting moderate-to-severe OSA (AHI = 15) was evaluated using ROC analysis.

Results: The mean age of participants was 50.7±13.7 years, with 72.6% being male. Mean BMI was 31.7±4.7 kg/m². Based on AHI, 37.1% had mild, 21.0% moderate, and 41.9% severe OSA. A significant weak positive correlation was observed between AHI and left diaphragmatic excursion (? = 0.274, p = 0.031). Multivariate analysis identified left diaphragmatic excursion as an independent predictor of OSA severity (OR: 1.125, 95% CI: 1.026–1.249, p = 0.017). ROC analysis demonstrated an AUC of 0.72 (95% CI: 0.59–0.85, p = 0.0021), with an accuracy of 66%, sensitivity of 59.0%, and specificity of 78.3%.

Conclusion: Ultrasonographic assessment of diaphragmatic function, particularly left diaphragmatic excursion, correlates with OSA severity and may serve as a supportive tool in the clinical evaluation of suspected cases.

Keywords: Diaphragm, obstructive sleep apnea, respiratory mechanics, sleep-disordered breathing, ultrasonography

*This article was selected for NAPCON 2025 best research award presentation.

Comparison of full-night and intranight apnea-hypopnea index in assessing obstructive sleep apnea severity

Harise

Mahatma Gandhi Medical College and Research Institute, Puducherry, India E-mail: harisemohan@gmail.com

Introduction: Obstructive sleep apnea (OSA) diagnosis is traditionally based on the apnea–hypopnea index (AHI) calculated during respiratory events obtained from full-night polysomnography (PSG). Since OSA severity varies across different sleep periods, this study compared conventional overnight AHI with 2-hour AHI to evaluate disease severity.

Methods: This cross-sectional observational study was conducted among patients with OSA attending the outpatient department or admitted to a tertiary care center in Puducherry. Following detailed clinical evaluation and screening, all patients underwent PSG, from which both full-night AHI and 2-hour AHI were derived and compared with clinical parameters.

Results: Of 23 patients included, 65.2% were male, with a mean age of 55.95 ± 14.33 years. The mean total sleep time was 315.73 ± 69.88 minutes. The mean full-night AHI was 40.81 ± 21.84, while the mean 2-hour AHI was 50.17 ± 22.35. The 2-hour AHI was significantly higher than the full-night AHI (mean difference = -9.36, p <0.001). Full-night AHI demonstrated a strong correlation with oxygen desaturation (r = 0.702, p < 0.01), while the 2-hour AHI showed a moderate-to-strong correlation (r = 0.623, p = 0.001). Both indices correlated strongly with the respiratory disturbance index (RDI) (p < 0.01). As total AHI is based on overnight TST and total respiratory events, 2Hour AHI is based on 2Hr sleep time and total respiratory events in that 2 hours. Hence the Peak 2Hour AHI is taken into account in this study for disease categorization.

Conclusion: Two-hour AHI estimates OSA severity and correlates well with oxygen desaturation and RDI compared to full night AHI, suggesting that 2-hour AHI may serve as a useful complementary marker for disease categorization and treatment planning of OSA patient.

Keywords: 2-hour Apnea Hypopnea Index, Apnea Hypopnea Index, total sleep time

*This article was selected for NAPCON 2025 best research award presentation.

Prevalence and severity distribution of obstructive sleep apnea syndrome in patients with resistant hypertension assessed by Type 2 sleep study

Parikshit Thakare

Radiant Hospital, Amravati, Maharashtra, India E-mail: pht90175@gmail.com

Introduction: Resistant hypertension (RH) is frequently associated with obstructive sleep apnea syndrome (OSAS), a modifiable contributor to poor blood pressure control via mechanisms including sympathetic activation and endothelial dysfunction. This study evaluates the burden and severity distribution of OSAS in patients with RH using Type 2 sleep studies.

Methods: Design: Observational, cross-sectional analysis. Population: Fifty consecutive adult patients with resistant hypertension. Assessment: Unattended Type 2 sleep study performed in all participants. OSAS Classification: Severity categorized per standard apnea–hypopnea index (AHI) thresholds into mild, moderate, and severe OSAS. Outcomes: Primary—prevalence and severity distribution of OSAS.

Results: OSAS was identified in all 50/50 patients (100%). Severity distribution: Severe OSAS: 27/50 (54%), Moderate OSAS: 14/50 (28%), and Mild OSAS: 9/50 (18%).

Conclusion: This cohort of resistant hypertension patients demonstrated a very high burden of OSAS, with over half exhibiting severe disease. Among patients with resistant hypertension evaluated by Type 2 sleep study, OSAS was universal, with 82% having moderate-to-severe disease. Systematic screening for OSAS in RH populations is warranted, with prompt referral for sleep-directed therapy to optimize cardiovascular outcomes.

Keywords: Apnea–hypopnea index, cardiovascular risk, CPAP, obstructive sleep apnea syndrome, obstructive sleep apnea, polysomnography, resistant hypertension, sleep-disordered breathing, Type 2 sleep study

Ultrasonographic evaluation of diaphragm in the patients of obstructive sleep apnea

Rahul Chakraborty , Sajal De, Praveen Kumar Dubey

AIIMS, Raipur, Chhattisgarh, India E-mail: rahul.chakraborty009@gmail.com

Introduction: Obstructive Sleep Apnea (OSA) is a sleep disordered breathing that involves a decrease or complete halt in airflow despite an ongoing effort to breathe. The Apnea –Hypopnea Index (AHI) is the standard metric used to describe the severity of sleep apnea. It represents the combined number of apnea and hypopnea that occurs per hour of sleep. OSA is classified into mild, moderate and severe according to AHI. USG or Ultrasonography is a simple non invasive and cost effective tool. There are only few studies evaluating the role of diaphragmatic dimensions in prediction of severity of OSA. Study Design: Cross-sectional.

Methods: Patients above 18 yrs age diagnosed as Obstructive Sleep Apnea by overnight in lab polysomnography were recruited. Diaphramatic ultrasound had been performed on them. Hemidiaphragmatic Thickness on inspiration, expiration on both side had been measured. Hemidiaphragmatic excursion and thickness fraction on both side had been measured. Correlation of diaphragmatic dimensions has been made with Apnea-hypopnea Index using Spearsman statistical correlation test.

Results: Positive correlation has been found between Right hemidiaphragmatic thickness on end inspiration with AHI (rho=0.298, p=0.0654). Statistically significant correlation has been found between end inspiratory thickness of left hemidiaphragm with AHI (rho=0.381, p=0.016) and end expiratory thickness of left hemidiaphragm with AHI (rho=0.342, p=0.0333). Statistically significant correlation has been found between Right hemidiaphragmatic Thickness Fraction with AHI (rho=0.358, p=0.023). No significant correlation has been found between diaphragmatic excursion and AHI. Significance and implications: We tried to obtain information about the relationship of diaphragm and OSA with the ultimate aim of preventing OSA related complications.

Conclusion: Inspiratory thickness of diaphragm positively correlated with AHI which is a severity marker of OSA. Positive association also have been found with right diaphragmatic thickness fraction with AHI.

Keywords: Apnea Hypopnea Index, obstructive sleep apnea, ultrasonography

Exploring polysomnography evaluation in patients with obstructive sleep apnea

Mahak Mundra

RD Gardi Medical College, Ujjain, Madhya Pradesh, India E-mail: mahakmundra13@gmail.com

Introduction: Obstructive sleep apnea (OSA) is a common disorder with significant cardiovascular, metabolic, and neurocognitive consequences. Polysomnography (PSG) is the gold standard for diagnosis, providing detailed insights into sleep architecture and respiratory disturbances. This study evaluated the clinical and polysomnographic profile of patients with suspected OSA at a tertiary care center.

Methods: Seventeen patients (11 male, 6 female) underwent comprehensive evaluation and overnight PSG at R.D. Gardi Medical College, Ujjain. Clinical parameters including age, sex, body mass index (BMI), neck circumference, and Mallampatti scale were recorded. Apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and sleep architecture were analyzed. Associations between clinical variables and OSA severity were assessed through comparative evaluation.

Results: Moderate to severe OSA was predominantly observed among obese and morbidly obese patients. Higher AHI values correlated with BMI and increased neck circumference (>44 cm in males, >43 cm in females). Supine position was associated with greater apnea and hypopnea events. Oxygen desaturation indices showed significant SpO2 drops during respiratory disturbances. Sleep architecture was altered, with reduced deep sleep (N3) and increased fragmentation. These findings highlight the importance of both anthropometric and positional factors in determining OSA severity. The study reinforces obesity and anatomical risk factors as major predictors of OSA severity. PSG provided crucial insights beyond clinical suspicion, particularly regarding positional effects and desaturation patterns. Such findings underline the importance of personalized management, guiding therapeutic strategies including CPAP, weight reduction, positional therapy, and comorbidity management.

Conclusion: PSG is vital for accurate diagnosis and risk stratification of OSA. Tailored management approaches incorporating lifestyle modification, CPAP, and targeted interventions are essential for improving patient outcomes and preventing long-term complications.

Utility of the STOP-BANG questionnaire for obstructive sleep apnea screening in obese adults

Harsh Rajesh Patel , Dipak Onkar Patil

Dr. Ulhas Patil Medical College and Hospital, Jalgaon, Maharashtra, India E-mail: drharshrpatel@gmail.com

Introduction: Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder strongly associated with obesity. Polysomnography remains the diagnostic gold standard, but resource constraints necessitate validated screening tools. The STOP-BANG questionnaire is widely recommended for risk stratification in obese populations.

Methods: This cross-sectional hospital-based study included 100 obese adults (=18 years) attending a tertiary care center. Obesity was classified using Asian BMI criteria (Obesity I: 25.0–29.9 kg/m², Obesity II: =30.0 kg/m²). Demographics, anthropometric measurements, and hypertension history were recorded. The STOP-BANG questionnaire was administered, and participants were categorized into low (0–2), intermediate (3–4), or high (5–8) risk groups.

Results: Among 100 participants, 49% were at intermediate risk, 34% low risk, and 17% high risk for OSA. High STOP-BANG scores were more prevalent in patients with Obesity II (=30 kg/m²), advancing age (especially 50–69 years), and hypertension (24.3% vs. 12.7% in normotensives). Marked sex differences were observed: all high-risk individuals were male, while most females were classified as low risk.

Conclusion: The STOP-BANG questionnaire is an effective, simple screening tool to identify obese adults at risk for OSA. Nearly two-thirds of obese patients were classified as intermediate or high risk, with strong associations observed with higher BMI, older age, male sex, and hypertension. Early screening may facilitate timely referral for confirmatory testing and management.

Keywords: STOP -BANG, Obstructive sleep apnea, Hypertension, Obesity.

Severity of obstructive sleep apnea (OSA) in different stages of sleep in Kashmiri patients with OSA – An observational study

Zaid Khan , Mir Elias, Mehvish Mushtaq

SKIMS Medical College and Hospital, Srinagar, Jammu & Kashmir, India E-mail: niazizaidkhan@gmail.com

Introduction: Obstructive sleep apnea (OSA) is the most prevalent sleep-disordered breathing (SDB), recognised as a significant risk factor for cardiovascular disease. In polysomnography, sleep architecture is almost always abnormal, but it is not known which of the sleep-stage abnormalities are related to symptoms. Finding key sleep-stage abnormality that cause symptoms may be of therapeutic importance to alleviate symptoms.

Methods: This is an observational study performed in Dept. of Chest Medicine SKIMS-MCH. Potential participants were screened using inclusion and exclusion criteria. Informed consent will be obtained from all participants prior to inclusion in the study. After undergoing polysomnography, various stages of sleep was correlated with severity of OSA. Study Population: Sample size: 323, Calculated by Cochrane’s formula with a prevalence of 30%.

Results: OSA Severity Across Sleep Stages: NREM (N1 + N2 + N3): AHI: 21.8 ± 8.4 events/hr with mean oxygen desaturation: 4.6%. REM sleep: AHI: 34.7 ± 12.1 events/hr with mean oxygen desaturation: 7.8%. OSA was significantly more severe in REM sleep compared to NREM (p < 0.01).

Conclusion: Obstructive sleep apnea severity was significantly greater during REM sleep compared to NREM stages. The higher AHI and deeper oxygen desaturations observed in REM sleep indicate that REM-related physiological changes contribute to increased airway collapsibility and hypoxemia.

Prevalence of obstructive sleep apnea among patients with chronic obstructive pulmonary disease

Hariharan T L , Sathya

Government Stanley Medical College and Hospital, Chennai, Tamil Nadu, India E-mail: haran.logu123@gmail.com

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a heterogeneous lung condition characterized by chronic respiratory symptoms due to abnormalities in Airways and alveoli that cause persistent, often progressive, airflow obstruction. The coexistence of COPD and Obstructive Sleep Apnea (OSA), termed overlap syndrome by Flenley, is reported in about 50% of COPD patients. Untreated OSA increases the risk of exacerbations and mortality, with studies showing a sevenfold rise in death risk. Identifying OSA in COPD patients is therefore essential to explain their high cardiovascular morbidity and mortality.

Methods: Study Design: cross sectional study. Duration of study: 1 year. 60 patients with a primary diagnosis of COPD were subjected to sleep questionnaires and polysomnography. The apnea -hypopnea index (AHI) was calculated, with severity classified as mild (5–15 events/hour), moderate (15–30), and severe (>30).

Results: OSA was diagnosed in 29 patients, giving a prevalence of 48.3%. The prevalence was significantly higher with increasing grades of airflow obstruction. Among the OSA group, obese patients had significantly higher STOP-Bang scores, Epworth Sleepiness Scale (ESS), modified Medical Research Council (mMRC) dyspnea scores, AHI, respiratory disturbance index (RDI), and oxygen desaturation index (ODI). Both obese and non-obese COPD patients showed significant positive correlations between AHI and smoking index, STOP-Bang, ESS, mMRC, ODI, and neck circumference.

Conclusion: OSA is common in COPD patients, with prevalence increasing alongside the severity of airflow obstruction. These results emphasize the importance of routine screening for sleep-disordered breathing in COPD, as early diagnosis and management help reduce cardiovascular comorbidities and mortality.

Keywords: Chronic obstructive pulmonary disease, obstructive sleep apnea, polysomnography

Comparative study of Berlin questionnaire and Epworth Sleepiness Scale to identify the better screening tool

Nikhila Abraham , Unni R. Baby

Jubilee Mission Medical College, Thrissur, Kerala, India E-mail: nikhilamuthu@gmail.com

Introduction: Obstructive sleep apnea (OSA) is a common disorder marked by intermittent upper-airway obstruction, hypoxia, and fragmented sleep, increasing cardiovascular risk. Polysomnography (PSG) is the diagnostic gold standard but is expensive and less accessible, creating the need for simple screening tools. The Epworth Sleepiness Scale (ESS) and Berlin Questionnaire (BQ) are used this study compared their diagnostic performance for OSA screening in a tertiary-care setting.

Methods: An 18-month prospective observational study was performed at a tertiary hospital in Kerala. Eighty adults with clinical suspicion of OSA gave informed consent, BQ and ESS, and underwent a level-3 sleep study to determine apnea–hypopnea index (AHI). Sensitivity, specificity, predictive values, accuracy, and receiver operating characteristic (ROC) curves were calculated using IBM SPSS version 25.

Results: Mean age was 54 years 56 % were female. OSA of any severity was detected in 77.5 %. Significant risk factors included age > 50 years, BMI = 35 kg/m², neck circumference = 40 cm, diabetes, hypertension, dyslipidemia, higher Mallampati score, and pulmonary hypertension (all p < 0.05). ESS (>10) showed low sensitivity (29.0 %), specificity (38.9 %), and accuracy (31.3 %). BQ achieved higher sensitivity (83.9 %), accuracy (70.0 %), and PPV (78.8 %) with modest specificity (22.2 %). ROC analysis confirmed BQ’s superior discrimination (AUC > 0.80 vs ESS ˜ 0.55). By integrating symptoms and comorbidities, Berlin Questionnaire detects OSA more effectively than ESS, which mainly measures subjective daytime sleepiness. These results are consistent with international evidence validating BQ as a dependable first-line screening tool.

Conclusion: Berlin Questionnaire outperforms Epworth Sleepiness Scale in screening for obstructive sleep apnea and is recommended as a simple, cost-effective primary tool, particularly in resource-limited settings, with added value when combined with anthropometric risk factors.

Keywords: Berlin questionnaire, Epworth sleepiness scale, obstructive sleep apnea, screening, sensitivity

*This article was selected for NAPCON 2025 best research award presentation.

Evaluating the relationship between systemic immune inflammation index and obstructive sleep apnea syndrome

Amulya B C , Pragati Rao D, F. Tanisha Saleem

M S Ramaiah Medical College, Bengaluru, Karnataka, India E-mail: amulyabc0498@gmail.com

Introduction: Obstructive sleep apnea syndrome (OSAS) is a chronic inflammatory syndrome characterized by recurrent complete or partial upper airway obstruction during sleep resulting in decreased blood oxygen saturation during sleep and increased daytime sleepiness. Vascular dysfunction, oxidative stress and systemic inflammation are responsible for the pathophysiology of OSAS. The systemic immune inflammation (SII) index provides information about the inflammatory status. In this study we aimed to study the relationship between SII and OSAS.

Methods: A total of 49 patients with excessive daytime sleepiness, snoring or apneas between November 2023 to July 2025 were included. All patients underwent an overnight polysomnography and CBC. The patients were divided into three groups based on their AHI – Mild (5 = AHI < 15), moderate (15 =AHI < 30), and severe (AHI =30). The SII was calculated by (neutrophil x platelet) / lymphocyte.

Results: In 49 patients (11 mild, 8 moderate, 30 severe OSA), SII shows the most progressive increase across severity groups (4.85?7.94?12.67 +161%), with highest significance (p<0.001) and effect size (?²=0.418). It correlates strongest with AHI (r=0.647, p<0.001), explaining 41.9% variance. SII shows excellent discrimination for OSA (AUC=0.789) and severe OSA (AUC=0.847). In multivariable analysis (adjusted for age, BMI, confounders), only SII remains an independent predictor (OR=1.284, p=0.003).

Conclusion: In this study we have showed that an increased SII index was associated with the presence and severity of OSAS. The SII index has a better informative value than other CBC parameters in patients with OSAS. SII index can be used as a novel, cost effective inflammatory marker for knowing the presence and severity of OSAS.

Keywords: AHI, NLR, obstructive sleep apnea syndrome, PLR, systemic immune inflammation

*This article was selected for NAPCON 2025 best research award presentation.

Sequential questionnaire triage for obstructive sleep apnea: A retrospective single-centre study

B. Pushpapriya , Dhanasekar

Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India E-mail: priyaa8091@gmail.com

Introduction: Sleep laboratories in resource-limited settings need referral strategies that prioritise patients most likely to have obstructive sleep apnoea (OSA). We evaluated a pragmatic two-stage triage using STOP-BANG followed by ESS to improve diagnostic yield and operational efficiency. Objectives: To compare the sequential pathway against each questionnaire alone with respect to: (i) diagnostic yield for moderate–severe OSA, (ii) reduction in negative sleep studies, and (iii) operational impact on time to test and treatment.

Methods: Single-centre retrospective cohort of consecutive adults referred for polysomnography. Index tests included STOP-BANG (positive at =3) and ESS (positive at =10). The sequential rule classified patients as triage-positive if STOP-BANG was positive, or if ESS was positive when STOP-BANG was negative. The reference standard was AHI, with moderate–severe OSA defined as AHI =15. Prespecified analyses estimated diagnostic performance, yield, negative-study rates, subgroup consistency and operational intervals.

Results: In this single-centre retrospective cohort, the sequential triage pathway (STOP-BANG followed by ESS) identified patients with moderate-to-severe OSA more efficiently than either questionnaire alone.

Conclusions: A simple STOP-BANG, followed by ESS triage improved diagnostic yield, reduced negative studies, and accelerated care compared with single-questionnaire strategies. This pathway is readily adoptable in sleep services seeking better resource utilisation.

Keywords: AHI, Epworth sleepiness scale, obstructive sleep apnea, STOP-BANG, triage diagnostic yield

Identifying various phenotypes of obstructive sleep apnea

Swetha

Sri Ramachandra Medical College, Chennai, Tamil Nadu, India E-mail: swetanaveen99@gmail.com

Introduction: The clinical aspects of obstructive sleep apnea (OSA) can be very variable, and the apnea–hypopnea index (AHI) on its own does not capture this variation well. Cluster analysis can lead to identification of groups with similar patterns of symptoms and comorbidities and can aid in better risk stratification.

Methods: We studied the demographic, anthropometric, clinical, and polysomnographic data of the patients assessed for OSA in detail. Variables studied were age, gender, body mass index (BMI), waist and neck circumference, Mallampati score, ESS, STOP-BANG, AHI, REM isolated AHI, oxygen desaturation burden, and comorbid conditions. We employed cluster analysis on data to find distinct subgroups within this patient population.

Results: Incorporating clinical information, the cluster analysis indicated the presence of multiple distinct phenotypes of OSA. One cluster included middle-aged, obese men with a high AHI, severe desaturation, and cardiovascular comorbidities. A second cluster included younger patients with moderate AHI and high daytime sleepiness (ESS), with a disproportionate daytime sleepiness. A third cluster included patients with mild OSA who had very low symptoms, reasonable oxygen sensitization despite a high risk score, and good oxygenation. These patterns demonstrate the heterogeneity of OSA in this cohort.

Conclusion: Cluster analysis is a feasible method for stratifying OSA phenotyping through which treatment options can be explored with a more personalized approach rather than a one-size-fits-all conventional AHI-based management.

Keywords: Novel approaches, obstructive sleep apnea, phenotyping, statistical analysis

*This article was selected for NAPCON 2025 best research award presentation.

Study of prevalence of sleep disordered breathing (SDB) in patients with diaphragmatic dysfunction

Bharti Kumari , Manu Chopra

AFMC, Pune, Maharashtra, India E-mail: bharti.drko@gmail.com

Introduction: The diaphragm is essential for effective ventilation, and its dysfunction, such as in eventration or paralysis, leads to impaired ventilation and perfusion. This results in ventilation/perfusion mismatch, reduced lung compliance, and dyspnea. Patients with diaphragmatic dysfunction (DD) often experience disturbed sleep, including increased nocturnal arousals and sleep-disordered breathing (SDB), such as obstructive and central sleep apnea. Bilateral DD, especially with neuromuscular weakness, is strongly linked to alveolar hypoventilation and ventilatory failure, particularly during REM sleep due to reduced respiratory muscle activity. Obstructive sleep apnea syndrome (OSAS) is a common condition, and decreased lung volumes in DD contribute to airway collapse, increasing OSAS risk. Given their shared pathophysiology, patients with DD may have a higher likelihood of developing SDB. However, studies on SDB in DD patients are limited, necessitating further research to explore the correlation between DD and SDB severity.

Methods: This prospective observational study was conducted from December 2023 to December 2024 at a tertiary respiratory care center. 45 patients aged >12 years with abnormal chest radiograph were further evaluated diaphragmatic dysfunction, which was confirmed by ultrasonography and fluoroscopy. These patients then underwent functional evaluation with spirometry and polysomnography. Their results were analyzed and interpreted.

Results: In a cohort of 45 patients with abnormal chest radiograph (mean age: 58 years) who underwent ultrasound chest for diaphragmatic excursion 20 patient (5 females and 15 males) were detected to have diaphragmatic dysfunction (44%). Among the 20 patients diagnosed with DD (mean age: 58 years 5 females, 15 males), 18 (90%) had significant SDB (AHI >5/hr, mean = 12.5). Additionally, 19 (95%) had sleep-related hypoxemia (SpO2 <90%), with a mean lowest saturation of 75.5% and a minimum recorded saturation of 49%. All patients with DD have reduced FVC, FEV1, consistent with restrictive pathology also responsible for ventilation perfusion mismatch. Emphasizing that patients with diaphragmatic dysfunction have increased tendency for sleep disordered breathing.

Conclusion: Diaphragmatic dysfunction (DD) increases the risk of mortality in COPD and ventilator-induced dysfunction, while OSAS contributes to cardiovascular complications through sympathetic activation, oxidative stress, and inflammation. Both DD and OSAS/SDB significantly impact health and patient with DD have increased tendency for SDB, necessitating early screening and diagnosis leading to prompt treatment and prevention of complication.

*This article was selected for NAPCON 2025 best research award presentation.

Coexisting hypothyroidism in obstructive sleep apnea: Findings from a descriptive cross-sectional study

Prakash Singh

Institute of Respiratory Disease, S.M.S. Medical College, Jaipur, Rajasthan, India E-mail: prakash.singh6969@gmail.com

Introduction: Obstructive sleep apnea (OSA) and hypothyroidism often coexist, with possible bidirectional interactions. Hypothyroidism may worsen OSA by narrowing airways and impairing respiratory control. Recognizing this association is vital, as treating hypothyroidism can improve OSA outcomes. This paper reviews hypothyroidism prevalence in OSA and its clinical significance.

Methods: We conducted a descriptive hospital based cross sectional study in 40 patients over a period of 1 year June 2024 to 2025. All patients underwent comprehensive evaluation, including detailed history with sleep questionnaires, assessment of pulmonary symptoms, physical examination, diagnostic polysomnography (PSG), laboratory tests (serum TSH and free T4), and chest radiography.

Results: There were two groups of OSAS participants (hypothyroid and euthyroid). Hypothyroidism was present in 12% (6 patients). According to AHI-based classification, 6, 17, and 21 euthyroid patients had mild, moderate, and severe OSAS, respectively. Epworth Sleepiness Scale scores were significantly higher in the hypothyroid group, with a mean score of 19.0?±?4.9 compared to 15.5?±?5.2 in the euthyroid group (P = 0.020). BMI, AHI, and RDI were also significantly higher in the hypothyroid group. Other polysomnographic parameters showed no significant differences between groups. AHI demonstrated a positive but statistically insignificant correlation with both serum TSH (r = 0.25, P = 0.08) and free T4 levels (r = 0.19, P = 0.16).

Conclusion: In this study of 50 OSAS patients, hypothyroidism (TSH >10 mIU/mL) was identified in 12% of individuals and was associated with higher BMI, AHI, RDI, and ESS scores compared to euthyroid patients. Severe OSAS was more frequent among hypothyroid individuals.

Tuberculosis: To determine the prevalence of resistance patterns among anti-tubercular drugs in CBNAAT-positive patients

Tanishq Dharaneppanavar , G. S. Gaude, Gautam S

KLEs Jawaharlal Nehru Medical College, Belagavi, Karnataka, India E-mail: tanishqvd@gmail.com

Introduction: Tuberculosis (TB) is a major global health concern, with India contributing a quarter of the global burden. The rise of drug-resistant TB, especially multidrug-resistant (MDR) and pre-extensively drug-resistant (pre-XDR) strains, poses significant challenges. Rapid, accurate detection of resistance to first-line and second-line antitubercular drugs is crucial for timely treatment and transmission control. Molecular diagnostics like the Line Probe Assay (LPA) offer faster, more specific alternatives to traditional culture-based drug susceptibility testing (DST). Objective: To determine the prevalence of resistance patterns among anti-tubercular drugs in CBNAAT-positive patients using first- and second-line LPA in Belagavi district.

Methods: This prospective observational study included 1,915 CBNAAT-positive pulmonary and extrapulmonary TB samples in Belagavi over one year. Samples underwent first- and second-line LPA accordingly. First-line LPA (Genotype MTBDRplus) detects rifampicin resistance (rpoB gene) and differentiates high-level (katG) and low-level (inhA) isoniazid resistance. Samples with resistance underwent second-line LPA (Genotype MTBDRsl) to assess fluoroquinolone (gyrA, gyrB) and injectable drug (rrs, eis) resistance. Data was analyzed with SPSS v22.

Results: Rifampicin resistance was detected in 61 (3.18%) samples by CBNAAT and confirmed in 34 (1.77%) by LPA. High and low-level isoniazid resistance were found in 100 (5.22%) and 24 (1.25%) cases, respectively. Triple resistance to rifampicin and both isoniazid forms was seen in 3 (0.16%) patients. Fluoroquinolone resistance appeared in 22 cases, 12 (0.63%) high-level and 10 (0.52%) low-level. No resistance to second-line injectables was observed.

Conclusion: Integrating CBNAAT and LPA enables timely detection, treatment initiation, and transmission control. LPA improves detection of isoniazid and fluoroquinolone resistance compared to CBNAAT alone. Significant resistance to both first and second-line drugs in this population underscores the ongoing threat of MDR and pre-XDR TB.

Keywords: CBNAAT, drug-resistant tuberculosis, line probe assay, multidrug-resistant, pre-extensively drug-resistant, tuberculosis

To determine the effects of bedaquiline on QT interval and its cardiac safety in patients with multidrug and RR tuberculosis

Nithyashree B M , Nikhil Reddy L

Mysore Medical College and Research Institute, Mysore, Karnataka, India E-mail: nithyanikhil2025@gmail.com

Introduction: Treatment of Multidrug and RR Tuberculosis were difficult. With the introduction of new and repurposed drugs such as Bedaquiline, Delamanid, Linezolid, Clofazamine and Pretomanid, improvement of treatment outcomes of MDR/RR-TB has been reported. Bedaquiline, Fluoroquinolone, Clofazamine are associated with QT prolongation. Values above QTcF 450 in males,470 in females are referred to as prolonged. QT prolongation can result in ventricular arrhythmias (Torsades de Pointes) and sudden death.

Methods: A retrospective cohort study was carried out in the department of respiratory medicine from November 2018 to June 2025 at PKTB&CDH, Mysore. Patients aged =18 yrs were included in the study. Serial ECGs were done from day 1-5, at 2 weeks, 1st, 2nd, 3rd and 4 th month. QT intervals were assessed by electrocardiogram and corrected for the effect of heart rate using Fridericia’s formula (QTcF).

Results: Of the 483 patients treated at PKTB & CDH between November 2018 and June 2025, 5 patients had QTcF prolongation ranging from Grade 1-2. Of the 5 patients who had developed QTcF prolongation no arrythmias or deaths were noted, in 3 patients Bedaquiline was withdrawn from the regimen and patients were started on Modified regimens, in other 2 patients Bedaquiline was withheld and restarted once QTcF was normalized.

Conclusion: This study evaluated the cardiac safety of regimen containing Bedaquiline in DR-TB and showed that Bdaquiline is safe to be used in treatment of DR-TB patients.

Keywords: Bedaquiline, electrocardiography, multidrug resistant tuberculosis, QT prolongation

A study of 100 cases of clinical, radiological patterns and outcomes of positive cases of tuberculosis

Vishvajit Lavadiya , Bina H. Modi

Pandit Deendayal Upadhyay Medical College & Hospital, Rajkot, Gujarat, India E-mail: murlidharahir444@gmail.com

Introduction: Tuberculosis (TB) and diabetes mellitus (DM) are major public health concerns, each influencing the course and outcome of the other. DM predisposes individuals to TB through immune dysfunction, increasing severity, atypical radiological presentations, delayed sputum conversion, and adverse treatment outcomes. The growing DM burden in TB-endemic countries like India may sustain or worsen the TB epidemic.

Methods: A prospective observational study was conducted over 1.5 years at PDU Medical College, Rajkot, including 100 newly diagnosed pulmonary TB patients with coexistent DM (HbA1c >6). Clinical profiles, sputum smear results, radiological features, and treatment outcomes were recorded and analysed. Diagnosis was based on microbiological, radiological, and clinical criteria following NTEP guidelines.

Results: Most patients were male, aged 41–60 years. Common symptoms included cough, fever, and weight loss. Radiologically, lower-lobe involvement and multiple cavitary lesions were more frequent than in non-diabetic TB. Sputum positivity at baseline was high, with delayed conversion in poorly controlled diabetics. Uncontrolled DM correlated with extensive disease, higher bacillary load, and prolonged infectivity. Mortality and relapse rates were higher compared to TB-only cases. Discussion: Findings reinforce that DM alters TB’s clinical and radiological spectrum, often producing atypical lower-lobe, cavitary disease with slower bacteriological clearance.

Conclusion: DM significantly modifies TB presentation and outcome, contributing to atypical radiology, delayed sputum conversion, and higher relapse. Early detection, strict glucose control, and coordinated management strategies are essential for effective TB control in diabetic populations.

Keywords: Diabetes mellitus, radiological patterns, sputum conversion, treatment outcomes, tuberculosis

A cross-sectional study to assess the prevalence of sepsis in pulmonary tuberculosis patients

Rakesh , Anugraha H

Stanley Medical College, Chennai, Tamil Nadu, India E-mail: gvkr26@gmail.com

Introduction: Sepsis and tuberculosis cause approximately 11 million and 1.5 million deaths annually, respectively. Nearly half of sepsis cases in tuberculosis remain undiagnosed. In TB-endemic settings, broadening the evaluation of sepsis etiology in TB patients is essential. Pulmonary TB patients are particularly susceptible due to immune dysregulation, chronic lung damage and comorbidities. Understanding the prevalence, risk factors, and clinical patterns of sepsis in this population is vital to optimize patient care, guide timely interventions, and reduce preventable mortality.

Methods: Cross-sectional study over 10 months (October 2024 – July 2025) at Government Stanley Medical College, Chennai, and Government Hospital of Thoracic Medicine, Tambaram.

Results: Sepsis occurred in 44% of TB patients who were hospitalized. Diabetes was the most frequent comorbidity, followed by chronic kidney disease. Personal habits do play a role. Poor ATT adherence and delayed therapy initiation were causes of critically ill patients. Predominant clinical features includes persistent fever indicating systemic inflammation. Overall mortality was 24% others are saved by timely interventions such as Antibiotics, ATT, etc.

Conclusion: Sepsis in pulmonary TB is a serious complication requiring vigilant monitoring. Early recognition of high-risk patients, proactive management of comorbidities, and timely intervention are crucial. Emphasizing treatment adherence, integrating sepsis monitoring into TB care pathways, and implementing targeted strategies can reduce preventable mortality, optimize healthcare resources, and strengthen TB management in endemic settings.

Study on adverse drug reactions induced by first line antitubercular drugs

Mugdha Kadam

Symbiosis Institute of Health Sciences, Pune, Maharashtra, India E-mail: kadammugdha21@gmail.com

Introduction: Antitubercular drugs are critical in the fight against tuberculosis (TB), a contagious disease that primarily affects the lungs but also affects other organs. The standard regimen for TB typically includes fixed dose combination (FDC) of drugs such as isoniazid, rifampicin, pyrazinamide, and ethambutol which work synergistically to eradicate the pathogen. Although these medications are effective, they are also associated with a range of adverse drug reactions (ADRs). These reactions can significantly affect patient outcomes, leading to treatment interruptions, reduced efficacy, and increased healthcare costs. Early recognition and prompt management of ADRs can mitigate their impact, allowing for timely adjustments to treatment regimens. This may involve dose modifications, switching to alternative therapies, or implementing supportive care measures.

Methods: This observational cross-sectional study was conducted in Department of Respiratory Medicine, Symbiosis Hospital. Written informed consent was taken prior to the study of each participant.

Results: Among 590 patients with tuberculosis, 60 (10.16%) patients had Adverse Drug Reactions to antitubercular treatment. Of the total 60 patients, 40 (67%) patients had pulmonary tuberculosis and remaining 20 (33%) patients had extra pulmonary tuberculosis, and 3 (5%) patients had both. Hepatitis was the most common ADR followed by arthralgia. The frequency of ADRs was more common in Extrapulmonary TB. Gastrointestinal symptoms, yellowish discoloration of sclera, joint pain and blurring of vision was higher in patients with Extrapulmonary TB. Fever and diarrhoea were more common in patients with Pulmonary TB and skin rashes were found in both types equally.

Conclusion: A comprehensive approach that includes patient education, vigilant monitoring, and effective management strategies is essential for optimizing treatment and improving patient safety in the fight against tuberculosis. KEY-WORDS: Adverse Drug Reactions, Tuberculosis, Fixed Dose Combination.

Clinical and microbiological predictors of treatment outcomes in tuberculosis

Utham , Ramya Ramadoss

Mahatma Gandhi Medical College, Puducherry, India E-mail: utham610@gmail.com

Introduction: Treatment outcomes in tuberculosis (TB) vary widely, with some patients achieving recovery while others experience relapse, complications, or failure. Early identification of high-risk patients could enable timely clinical-interventions, reduce poor outcomes, and optimize resource-allocation. Machine learning (ML), applied to routinely collected clinical data, may provide a practical approach to outcome prediction.

Methods: A clinical dataset of 110 patients from the Puducherry Intermediate Reference Laboratory (IRL) - drug sensitive TB (DSTB), and DRTB registries (2022–2023) was analysed. The dataset comprised demographic, drug resistance, and treatment-related variables. Regression analysis and three ML models—Random Forest (RF), Extreme Gradient Boosting (XGBoost), and Deep Neural Networks (DNN) were used to explore predictors of treatment outcomes.

Results: Of 110 patients, 90 had drug-sensitive TB (DSTB) and 20 had drug-resistant TB (DRTB). The mean age was 43.5 ± 17.6 years, with 62.7% male. Regression analysis indicated that demographic and clinical predictors were not statistically significant (p > 0.05), though smoking showed a non-significant association with poorer outcomes (OR = 0.306, p = 0.129). Drug resistance status was the strongest predictor (p < 0.001), with DRTB patients less likely to achieve favourable outcomes (OR = 0.141). Among ML models, RF outperformed others (Accuracy = 0.80, F1 = 0.808, ROC AUC = 0.795). Feature importance analysis highlighted age, BMI, disease classification, and sputum reports as key predictors.

Conclusion: Drug resistance status remains the strongest determinant of outcome. RF-based models using routine clinical features offer a scalable tool for predicting TB-treatment outcomes and reducing treatment failures.

Keywords: Clinical prediction, machine learning, personalized medicine, random forest, treatment outcomes

Prospective evaluation of clinical profile and outcomes among patients with extrapulmonary tuberculosis

Gopika Shanavas , Supriya Adiody

Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India E-mail: gopikashanavas@gmail.com

Introduction: Extrapulmonary tuberculosis (EPTB) contributes to 15–25% of TB cases in India and is diagnostically challenging due to diverse presentations. This study evaluated the clinical spectrum, diagnostic modalities, and treatment outcomes of EPTB in a tertiary care setting.

Methods: A prospective observational study was conducted in the Department of Respiratory Medicine, Jubilee Mission Medical College, Thrissur, over 18 months. Fifty newly diagnosed EPTB patients were enrolled based on clinical, radiological, microbiological, or histopathological evidence. Patients with pulmonary TB, HIV, pregnancy, or malignancy were excluded. Data were analysed for clinical features, comorbidities, diagnostic yield, and treatment outcomes.

Results: Among 50 patients, 54% were females and 56% were aged 18–45 years. Diabetes mellitus was the most common comorbidity (57%). Lymph node TB (44%) and pleural TB (22%) were the predominant forms, followed by genitourinary (10%), spinal (8%), abdominal (8%), CNS (6%), and bone TB (2%). Diagnosis was clinical in 66%, mainly via histopathology (36%), while 34% had microbiological confirmation, with CBNAAT outperforming AFB smear. Most patients (70%) completed a 6-month regimen, while 26% required extended therapy. Treatment outcomes were favourable, with 86% completing therapy successfully, though 48% reported residual morbidity, mainly pain and swelling.

Conclusion: EPTB commonly involved lymph nodes and pleura, with diabetes strongly associated. Treatment outcomes were favourable, though long-term morbidity remains a concern.

Keywords: Diabetes mellitus, extrapulmonary tuberculosis, lymph node tuberculosis, treatment outcome

Clinico radiological presentation and outcome in patient of H-Mono/Poly resistance tuberculosis

Gayatri Padhan

SCB Medical College, Cuttack, Odisha, India E-mail: drgayatripadhan@gmail.com

Introduction: The emergence and spread of drug-resistant tuberculosis poses a significant challenge to control and successful eradication of TB. According to the first National Antituberculosis Drug Resistance Survey (NRDS) done India, the incidence of any isoniazid – resistant TB is 11.6% in new TB patient, while in previously treated patients, the incidence is 25%. Hence isoniazid mono resistant should be specifically looked for and treated as per recommendation.

Methods: This prospective observational study was conducted at Nodal DRTB Centre, SCBMCH, Cuttack on patient with H MONO/ POLY resistance TB, diagnosed by First Line probe assay. Thereafter H Mono/ poly regimen started among 29 patients who are enrolled between march 2023 to October 2025. A comprehensive demographic, clinical, radiological profile were collected, summarized and analysed.

Results: Among 29 patients highest concentration of patient is in 15-24 age group ((27.59%), males (55.17%), female 44.83%, 40-54 kg/wt band contains highest patient. Comorbidity: 93.1% having BMI less than 18.5, 55.2% had no associated comorbidities. Diabetes is the predominant comorbidity (31%). Addiction: no addiction 58.6%, Tobacco chewing 17.2%, smoking 13.8%, alcohol 6.9%, combined 3.4%. Contact History: 81.2% no history of TB contact, 6.2% drug susceptible TB contact, 3.1% MDR TB contact, 51.7% had history of DS-TB regimen, 41.4% no previous history of ATT, 6.1% history of DRTB regimen. Symptoms: Cough 96.6%, Anorexia 65.5%, fever and weight loss 62.19%, chest pain 13.8%, shortness of breath 24.1%, haemoptysis 3.4%. Radiological Finding: Cavitation 24.14%, Consolidation 20.69%, Fibrosis 10.34%, Infiltrates 20.69%, Pleural effusion 13.79%, Nodular lesions10.34%. Gene Type: Kat-G gene high resistance 84.4%, InhA gene low resistance 6.2%. Treatment Outcome: Cured 51.7%, Completed treatment 24.1%, treatment failure 10.3%, loss to follow up 6.9%, regimen change 3.4%, death 3.4%.

Conclusion: The study reports a high overall treatment success rate, highlighting the efficacy of current treatment regimen when combined with diligent patient monitoring and follow-up. The findings emphasize the need for a multifaceted approach in the management of INH mono resistance TB.

Keywords: H mono/poly resistance, high resistance, InhA gene, Kat-G gene, low resistance

*This article was selected for NAPCON 2025 best research award presentation.

Cardiac dysfunction in active pulmonary tuberculosis and its response to treatment

Palaparthi Vijay Krishna Prasad

Maulana Azad Medical College, New Delhi, India E-mail: vijaypalaparthi9@gmail.com

Introduction: Tuberculosis (TB) remains a major global health burden. In 2023, more than 8.2 million people were diagnosed worldwide, with 1.25 million deaths. Although primarily a pulmonary disease, TB can affect multiple organs, including the heart, where involvement may present as pericardial disease, myocardial dysfunction, or pulmonary hypertension. These manifestations are often under-recognized. Objectives: To evaluate the proportion of cardiac dysfunction in active pulmonary TB and assess its response to anti-tubercular therapy (ATT).

Methods: This prospective study included 40 adults with active pulmonary TB. Baseline investigations included ECG, chest X-ray, spirometry, and echocardiography. All patients received standard ATT. Cardiac function was reassessed by echocardiography at 2 and 6 months.

Results: Eight patients showed significant cardiac abnormalities at presentation. Several had global hypokinesia with left ventricular systolic dysfunction and reduced ejection fraction (30–40%), accompanied by mild pulmonary hypertension. Two had mild pericardial effusion, while one demonstrated grade 3 diastolic dysfunction. After six months of ATT, most patients showed improvement. Ejection fraction improved to ~50% in those with systolic dysfunction, pulmonary pressures decreased, and pericardial effusions resolved. Diastolic dysfunction improved partially, though some abnormalities persisted. Cardiac dysfunction in pulmonary TB arises from chronic inflammation, hypoxemia, pulmonary vascular changes, and pericardial involvement. These effects can cause both systolic and diastolic impairment, often overlooked due to nonspecific presentation. Importantly, many changes are reversible with effective therapy.

Conclusion: Cardiac dysfunction is a significant but under-recognized complication of pulmonary TB. Routine cardiac assessment in TB patients can enable early detection of subclinical disease and improve outcomes, as many abnormalities respond favorably to anti-tubercular treatment.

Incidence and timing of breakthrough tuberculosis after tuberculosis preventive therapy (TPT) in people living with HIV

Pragati Tyagi

Government Medical College, Bhavnagar, Gujarat, India E-mail: pragatityagi98@gmail.com

Introduction: Tuberculosis (TB) is the most common opportunistic infection in people living with HIV (PLHA) and a leading cause of mortality. Tuberculosis Preventive Therapy (TPT) reduces the risk of progression from latent to active TB, yet breakthrough TB may occur. This study evaluates the incidence and timing of TB requiring anti-tubercular treatment (AKT) in PLHA who received TPT compared with those who did not, over seven years at Sir T Hospital, Bhavnagar.

Methods: This retrospective observational study included PLHA registered between April 2018 and July 2025. Records were reviewed for TPT initiation/completion, occurrence of active TB, and AKT initiation. Incidence of TB was compared in TPT and non-TPT groups. Relative risk (RR) with 95% CI and chi-square test were applied. The mean interval between TPT completion and AKT initiation was also calculated.

Results: Of 6,650 PLHA, 6,510 (97.9%) received TPT and 140 (2.1%) did not. Among TPT recipients, 288 (4.4%) developed active TB, including 219 (76.0%) pulmonary and 69 (24.0%) extrapulmonary cases. In contrast, 60/140 (42.9%) without TPT developed TB. The risk of TB was 9.7 times higher in the non-TPT group (RR 9.69, 95% CI 7.76–12.10 ?² = 408.2, p < 0.001). The mean interval was 24 months between TPT completion and AKT initiation, suggesting delayed breakthrough disease.

Conclusion: TPT markedly reduces TB incidence among PLHA, but continued monitoring, adherence support, and timely AKT initiation are crucial to optimize outcomes.

Keywords: Breakthrough tuberculosis, HIV, incidence, preventive therapy, tuberculosis

Prevalence of post-tuberculosis sequelae and their impact on pulmonary function in treated pulmonary tuberculosis

Diksha

Pacific Institute of Medical Sciences, Udaipur, Rajasthan, India E-mail: diksha.aghi9@gmail.com

Introduction: India continues to carry the world’s highest tuberculosis (TB) burden. Although effective treatment achieves microbiological cure, a large proportion of patients develop irreversible sequelae such as bronchiectasis, fibrosis, and cavitary changes. These contribute to long-term respiratory disability, yet remain under-recognized in TB control programs. Quantifying the burden of post-TB sequelae and establishing their impact on lung function is critical to designing comprehensive post-TB care strategies.

Case Description: A cross-sectional study was conducted at the Pacific Institute of Medical Sciences, Udaipur, enrolling 100 patients with successfully treated pulmonary TB. Detailed clinical evaluation, chest radiography, high-resolution computed tomography (HRCT), and spirometry were performed. Pulmonary function was classified according to GOLD/ATS criteria, and correlation between radiological severity and spirometric impairment was statistically analyzed.

Results: Radiological sequelae were observed in 68% of patients, with bronchiectasis (42%), fibrotic bands (33%), and cavitation (12%) as the most common findings. Spirometry demonstrated obstructive defects in 44%, restrictive in 21%, and mixed patterns in 11%. The extent of radiological abnormality showed a strong correlation with decline in FEV1 (p < 0.001). Multi-lobar or combined sequelae were associated with the most severe functional limitation.

Conclusion: Structural sequelae following TB cure are highly prevalent and strongly linked with functional impairment. This study underscores the urgent need to incorporate systematic post-TB surveillance and rehabilitation into India’s National TB Elimination Program. Addressing post-TB lung health is essential to preserve quality of life, reduce chronic respiratory burden, and achieve sustainable TB control.

Keywords: Bronchiectasis, fibrosis, post-tuberculosis sequelae, pulmonary function impairment, spirometry

Assessment of pneumothorax in tuberculosis patients

Gurwinder Batti , Shubham Dwivedi, Jitendra Agarwal

KD Medical College Hospital and Research Center, Mathura, Uttar Pradesh, India E-mail: gurwinderbatti@gmail.com

Introduction: Tuberculosis (TB) remains a significant cause of secondary spontaneous pneumothorax (SSP), particularly in endemic regions. Although relatively frequent, detailed studies on its presentation, management, and outcomes remain limited.

Methods: A retrospective clinical study was conducted at Kanti Devi Medical College, Mathura, over 12 months (July 2024–July 2025). Patients with sputum-positive TB and radiologically confirmed SSP were included. Clinical data, laboratory findings, imaging, treatment details, and outcomes were analyzed.

Results: Of 200 TB patients, 33 (16.5%) developed SSP. The mean age was 38 years (22–63). Clinical manifestations included cough (63%), dyspnea (21%), chest pain (12%), and hemoptysis (4%). Most patients presented with poor general health, fever, and weight loss. Imaging revealed unilateral SSP, commonly right-sided, with cavitary lesions and reticulonodular opacities. Bacteriological confirmation was obtained in 10 cases. All patients received standard anti-TB therapy and intercostal chest drainage (mean duration 23 days). The mean hospital stay was 34 days. Favorable outcomes were observed in only 5 patients, while complications included delayed bacillary clearance and pulmonary embolism.

Conclusion: SSP in TB patients is strongly associated with advanced cavitary disease and delayed diagnosis. Although antitubercular therapy and chest drainage yield generally favorable results, residual pleural sequelae may cause long-term functional impairment. Early TB detection and treatment are crucial to preventing severe complications such as pneumothorax.

Aspergillus sensitisation in the aftermath of tuberculosis: A prospective observational study

Shreeja Nair , Neha Dixit, Gaurav Sahu

MGM Medical College, Navi Mumbai, Maharashtra, India E-mail: drshreejakumar@gmail.com

Introduction: It has been found that following complete treatment and microbiological clearance of active pulmonary tuberculosis, over two thirds of patients develop significant structural abnormalities in the lungs. Post TB lung disease has many complications, one of which is residual pulmonary cavities that serve as a nidus for Aspergillus colonisation. Pulmonary Aspergillosis presents as various diseases such as Aspergilloma, Chronic pulmonary aspergillos, Invasive pulmonary aspergillosis and Allergic bronchopulmonary aspergillosis. This study was done to assess the prevalence of Aspergillus sensitisation in patients with Post TB fibrocavitary disease and to evaluate the severity of pulmonary function abnormalities in these patients.

Methods: This was a prospective observational study conducted for a year in a tertiary care centre attached to a medical college in Maharastra which holds a district TB centre. 70 patients with post TB fibrocavitary disease (as diagnosed on chest xray or CT chest) underwent skin prick testing to five different species of Aspergillus namely, A. Fumigatus, A. Niger, A. Flavus, A. Tamarii, A. Vesicolor. All these patients also underwent spirometry to find the extent of lung impairement.

Results: 70 patients were enrolled in the study. We found that 37% of the patients tested had positive test to atleast one of the subspecies of Aspergillus, A. fumigatus being the most prevalent. 61% of the patients were males. Most patients were between the ages of 31 to 50 years. More than 50% of the subjects were smokers.

Conclusion: This study underlines the importance of doing simple investigations such as skin prick testing for fungus in all patients who have significant structural damage in lungs post Tuberculosis, as there is a positive correlation between having sensitisation to Aspergillus and severity in impairment of lung function. This will help us tailor individualised treatment plan for these patients.

Keywords: Aspergillus, lung cavities, post-tuberculosis lung disease, skin prick test

Extrapulmonary tuberculosis in HIV: Clinical spectrum, CD4 correlation, and treatment outcomes

Moravapalli Pravallika

Andhra Medical College, Visakhapatnam, Andhra Pradesh, India E-mail: moravapallipravallika@gmail.com

Introduction: Extrapulmonary tuberculosis (EPTB) remains a major opportunistic infection among people living with HIV (PLHIV), with diagnostic challenges and significant mortality. HIV-associated immunosuppression alters the clinical spectrum of TB, making early recognition essential. This study assessed the prevalence, clinical profile, CD4 correlation, and treatment outcomes of EPTB in PLHIV at a tertiary care hospital.

Methods: A hospital-based cross-sectional study was conducted at the ART Centre, Government Hospital for Chest and Communicable Diseases, and King George Hospital, Visakhapatnam. One hundred HIV-positive patients aged >18 years were enrolled. Clinical history, examination, and investigations (FNAC, CBNAAT, imaging, histopathology) were performed. CD4 counts were recorded at diagnosis. Data were analyzed using SPSS v22, with Chi-square and ANOVA applied p < 0.05 was considered significant.

Results: Of 100 patients, 52% had EPTB, with male predominance (70%) and peak incidence in the 31–45 year age group (60%). The most common presentation was lymph node TB (50%), followed by pleural effusion (20%), abdominal TB (10%), bone/joint TB (8%), CNS TB (7%), and pericardial effusion (3%). The mean CD4 count among EPTB cases was ~180 cells/µL, with CNS TB patients showing the lowest levels (~50 cells/µL). Smoking, alcohol use, and prior TB history were significantly associated with EPTB. Rifampicin resistance was seen in 25% of microbiologically confirmed cases. Treatment outcomes showed 60% completion, 27% lost to follow-up, and 13% mortality.

Conclusion: EPTB contributes substantially to morbidity in PLHIV. Early screening, CD4 monitoring, drug resistance testing, and adherence support are critical for improved outcomes. Strengthening preventive strategies and timely initiation of ART and TB treatment remain vital.

Keywords: CD4 count, clinical spectrum, extrapulmonary tuberculosis, HIV, rifampicin resistance, treatment outcomes

Outcomes of pulmonary rehabilitation in post-tuberculosis sequelae

Manudev Mehta

J.L.N Medical College, Ajmer, Rajasthan, India E-mail: manudevmehta@gmail.com

Introduction: Post-tuberculosis sequelae (PTBS) contribute significantly to chronic respiratory morbidity and impaired quality of life, yet remain under-recognized in tuberculosis control programs. Pulmonary rehabilitation (PR) is known to improve functional and psychosocial outcomes in chronic respiratory diseases. However, comparative evidence on home-based versus hospital-based PR in PTBS is still lacking.

Methods: Fifty subjects with PTBS were enrolled and assigned to home-based (n = 30) or hospital-based (n = 20) PR groups. Baseline demographic and clinical profiles were recorded. Outcomes assessed at 0, 12, and 24 weeks included dyspnea (mMRC), quality of life (SGRQ), psychological status (DASS-21), nutritional status (BMI), pulmonary function (FEV1, FVC, FEV1/FVC, FEF25–75), and 6-minute walk distance (6MWD).

Results: Significant improvements were observed in both groups across all parameters. Hospital-based PR was linked with more pronounced reductions in dyspnea (Grade 1 mMRC in 75% at 24 weeks), higher gains in FEV1 (from 47.15% to 60.9% pre-BD), superior quality of life improvement (SGRQ reduced to 25.1), and greater increase in 6MWD (from 308 m to 429 m) comparison to home-based PR. However, no statistically significant differences were observed in the parameters when comparing the two interventions. Psychological and nutritional outcomes also favoured hospital-based PR.

Conclusions: Both home- and hospital-based PR led to substantial clinical, functional, and psychological improvements in PTBS patients. Hospital-based PR shows marginally superior outcomes, emphasizing the value of supervised, multidisciplinary care. Home-based models remain a feasible alternative in resource-limited settings. Structured PR should be integrated into routine post-TB care to reduce long-term disability.

Keywords: Exercise capacity, home versus hospital rehabilitation, post-tuberculosis sequalae, pulmonary rehabilitation, quality of life

Treatment outcome and adverse drug events of patients on isoniazid mono drug resistant regimen

Ashish Anshuman Panda , Biswal Pradipta Trilochan, Arnab Swain

PGIMER & Capital Hospital, Bhubaneswar, Odisha, India E-mail: ashishanshumanpanda@gmail.com

Introduction: Isoniazid-resistant but rifampicin-susceptible tuberculosis (Hr-TB) is the most common form of drug-resistant TB worldwide, yet Indian data remain limited. Mutations in katG and inhA genes show distinct resistance patterns that may influence treatment outcomes. This study assessed treatment results and adverse drug events (ADEs) in Hr-TB patients at a tertiary care centre.

Methods: This observational study included all Hr-TB patients registered in the DR-TB registry at PGIMER & Capital Hospital, Bhubaneswar, between Dec 2024 and May 2025. Demographic, clinical, radiological, and microbiological data were collected, including prior TB treatment history and comorbidities. Hr-TB diagnosis was confirmed using Line Probe Assay for katG and inhA mutations. Patients received a standardized levofloxacin-based regimen per NTEP guidelines, with monthly follow-up for adherence, clinical assessment, and laboratory monitoring. Treatment outcomes were classified according to national TB programme definitions, and ADEs were recorded prospectively and graded for severity.

Results: Twenty-two patients were analysed (68% male 95% pulmonary TB), with cavitary lesions in nearly two-thirds. Unfavourable outcomes were higher in katG mutants (40%) compared to none in inhA mutants (p < 0.05). Previously treated cases had worse outcomes than new cases (p = 0.045). ADEs were mostly mild: gastrointestinal upset (31.8%), rash (13.6%), and hepatotoxicity (9.1%). katG mutations and prior TB treatment were associated with poorer outcomes, whereas inhA mutations responded well. The levofloxacin-based regimen was effective and generally well tolerated. Early molecular testing and structured follow-up are key to optimizing Hr-TB management, preventing treatment failure, and minimizing adverse events.

Conclusion: Levofloxacin-based therapy is a safe and effective option for Hr-TB. Targeted treatment guided by molecular testing, along with close follow-up, can improve patient outcomes.

Keywords: Adverse drug events, inhA mutation, isoniazid mono-resistant tuberculosis, katG mutation, treatment outcomes

*This article was selected for NAPCON 2025 best research award presentation.

Impact of posttuberculosis sequelae on the health-related quality of life and its correlation with spirometry

Kamali K , Akshata Js, Swapna R

SDS TRC and Rajiv Gandhi Institute of Chest Diseases, Bengaluru, Karnataka, India E-mail: kamalikannan99@gmail.com

Introduction: Post Tuberculosis sequalae is characterized by morphological and physiological changes in the lungs and chest wall following treatment completion. Around 30 to 40% of patients have significant functional impairment and around 46-78% have reduced quality of life (QOL). This study aims to estimate the impact of post pulmonary tuberculosis (PTB) sequalae on health-related QOL and its correlation with spirometry.

Methods: This retrospective study analyzed the case records of individuals with treated pulmonary tuberculosis (PTB) who were admitted from November 2024 to June 2025. Clinico-radiological and Spirometric parameters were collected. QoL was assessed using the English version of St. Georges Respiratory Questionnaire (SGRQ) for which permission was obtained from the St. George’s University of London. SGRQ scores were calculated using the validated excel-based algorithm.

Results: 137 patients were included. The mean age was 55.13 years, with a male predominance (54.68%), and majority were non-smokers (62.02%). Most patients had microbiologically confirmed PTB (92.7%) and received an average of 6.3 months of treatment. Drug-sensitive PTB were observed in 71.53% with 83.21% treatment compliance. The most common post-PTB symptoms were cough (99.27%) followed by shortness of breath (89.05%). Spirometry revealed predominately restrictive (48.18%) followed by moderate obstruction (28.47%), severe obstruction (10.22%), normal (7.3%) and mild obstruction (2.92%). Health-related QOL was significantly impaired, with a mean SGRQ total score of 52.51. Correlation analysis between spirometry parameters (Fev1/FVC, Fev1 and FVC) and SGRQ domain scores showed a weak negative correlation (r = -0.22 to -0.03) which was statistically insignificant (p >0.05).

Conclusion: This study suggests that objective spirometry findings do not adequately reflect patient’s perceived health-related QOL, thereby emphasizing the need for including QOL assessment in all post-PTB patients, regardless of their symptom severity and lung function impairment for better management.

Keywords: Post-tuberculosis lung disease, quality of life impairment, restrictive lung disease, spirometric correlation, St. Georges respiratory questionnaire scores

Therapeutic effect of transcutaneous electrical nerve stimulation in linezolid-induced peripheral neuropathy

Hemank Surolia , Faiz Khan

Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India E-mail: hemank6@gmail.com

Introduction: Linezolid is an integral component of multi drug-resistant tuberculosis (MDR-TB) regimens but is frequently limited by peripheral neuropathy, a debilitating adverse effect that hampers adherence. Conventional pharmacological interventions often provide limited relief. Transcutaneous electrical nerve stimulation (TENS), a non-invasive neuromodulatory technique, has shown promise in neuropathic pain syndromes. This study evaluates the therapeutic effect of TENS in linezolid-induced peripheral neuropathy.

Methods: A prospective study was conducted in MDR-TB patients with clinically and electrophysiologically confirmed linezolid-induced peripheral neuropathy. Patients underwent TENS sessions thrice weekly for eight weeks in addition to standard management. Neuropathy severity was assessed using the Toronto Clinical Scoring System (TCSS) and Basic peripheral neuropathy screening (BPNS) score, at four weeks, and eight weeks. Data were analyzed using paired t-tests and repeated measures ANOVA.

Results: Forty patients (mean age 36.4 ± 9.2 years 60% male) were enrolled. At baseline, 62.5% had moderate and 37.5% severe neuropathy. After eight weeks of TENS, 67.5% of patients showed no neuropathy and 32.5% had only mild neuropathy (TCSS =8). Severity grading improved markedly: before TENS, 100% were Grade 3–4 after therapy, 80% shifted to Grade 1–2 with only 20% persisting as Grade 3–4. Overall, 80% achieved clinically meaningful reduction in neuropathy severity, with statistical significance (p < 0.0001).

Conclusion: TENS therapy significantly reduced neuropathy severity and improved clinical outcomes in MDR-TB patients with linezolid-induced peripheral neuropathy. Its integration into routine management could enhance treatment tolerability and long-term adherence.

Keywords: Linezolid, multidrug-resistant tuberculosis, neuropathic pain, peripheral neuropathy, transcutaneous electrical nerve stimulation

Vitamin D supplementation and its impact on treatment outcome of TB patients enrolled under Nikshay Mitra initiative

Chitra Iravatham , Sabita V

Dr. Iravatham’s Clinical Laboratory, Hyderabad, Telangana, India E-mail: iravathamslab@gmail.com

Introduction: Vitamin D has immunomodulatory effects, including induction of antimicrobial peptides and enhancement of macrophage activity against Mycobacterium tuberculosis. Clinical trials suggest that high-dose vitamin D may accelerate sputum conversion, though results remain mixed. As deficiency is widespread among TB patients, supplementation has potential as an adjunctive intervention. Under the Nikshay Mitra initiative, TB patients receive nutritional support, supplements, and diagnostic investigations from donors for six months.

Methods: Fifteen confirmed TB patients underwent baseline investigations, including smear microscopy, chest X-ray, culture, GeneXpert, hemogram, random blood sugar, ESR, liver function tests, and vitamin D assay. Baseline vitamin D levels were also measured in household contacts and healthy controls. Patients were followed monthly until treatment completion and received a government-approved nutritional kit plus weekly oral vitamin D (60,000 IU). Final follow-up was conducted at 12 months.

Results: At baseline, TB patients had a mean serum vitamin D of 10.28 ng/ml. All showed improvement post-supplementation. Paired data (n=8) revealed a mean rise of 37.8 ng/ml (SD = 21.3) after one month, statistically significant (t(7) = 5.01, p = 0.0015 W = 0, p = 0.0078). Household contacts had mean vitamin D of 20.59 ng/ml, while healthy controls averaged 38.75 ng/ml. Thirteen patients achieved sputum conversion within two weeks one converted at three months due to comorbidities. Five developed drug-induced jaundice during the first week, which resolved, and one patient with juvenile diabetes died early in treatment. At one year, all surviving patients were symptom-free, with significant weight gain and improved BMI, though six continued to show low vitamin D. None of the household contacts developed TB.

Conclusion: Weekly vitamin D supplementation with nutritional support was associated with favorable clinical outcomes. Early liver function monitoring is advised. Larger studies incorporating environmental and genetic factors are required to better define vitamin D’s role as an adjuvant in TB management.

Using artificial intelligence and CT scans to diagnose recurrent pulmonary tuberculosis

Prem Thilak Palani , Animesh Ray, Anup Singh

All India Institute of Medical Sciences, New Delhi, India E-mail: premt2499@gmail.com

Introduction: Pulmonary tuberculosis continues to be a major public health problem worldwide despite significant advances in diagnostic methods and treatment options. Recurrent pulmonary TB (rPTB), in particular, poses diagnostic challenges due to clinical overlap with post-TB lung disease (PTLD) and other conditions such as chronic pulmonary aspergillosis (CPA). While CT scans offer better differentiation between active disease and post-infectious changes, they require trained manpower for interpretation.

Methods: We developed an artificial intelligence (AI) model using CT scans to diagnose rPTB and to differentiate it from PTLD and CPA. We ambispectively enrolled patients presenting to our tertiary health care centre with a history of pulmonary tuberculosis and symptoms suggestive of active disease. 66 patients with past TB and new respiratory symptoms were studied. A convoluted neural network (CNN) was trained on CT scans from these patients, using radiologist input and clinical/microbiological data as a gold standard. The scans were labelled by an experienced user, segmented using 3D Slicer (an open-source, medical image editing software) and classified based on labels. The CNN was then tested using 5 folds of the scans each scan was used to test the model once and to train it 4 times.

Results: Our model had a sensitivity, specificity and overall accuracy of 91.67%, 90.74% and 90.91% respectively for diagnosing rPTB, with a ROC curve AUC of 0.93. Application of such AI models (once they have been validated on larger image sets) in public health might enable faster diagnosis of rPTB and rapid initiation of treatment, even in settings where trained radiologists are not available.

Conclusion: Our AI model accurately diagnosed rPTB and differentiated it from close clinical mimics like PTLD and CPA.

*This article was selected for NAPCON 2025 best research award presentation.

Evaluating effective pharmacotherapy for post-TB COPD: A multicentric real-world observational study

Sujata Chauthmal , Deesha Ghorpade, Suhas Bardapurkar, Kalpesh Panchal

Chest Research and Training Pvt. Ltd., Pune, Maharashtra, India E-mail: rcarise2022@gmail.com

Introduction: India is home to nearly 40 million of the estimated 155 million TB survivors globally. COPD is the most common post-TB sequela however, effective pharmacotherapy for post-TB COPD remains unknown. This study aimed to evaluate treatment outcomes with various inhaled pharmacotherapies in Post-TB COPD patients.

Methods: 183 post-TB-COPD patients (post-bronchodilator FEV1/FVC<70%), from 12 clinics across India participated. Treatment arms evaluated were LABA+LAMA, LABA+ICS and LABA+LAMA+ICS. Demographics, symptoms, history of hospitalizations, CAT scores, and spirometry indices were recorded at baseline and after 3 months.

Results: Across treatment groups, LABA+LAMA (n=40), LABA+ICS (n=10), and LABA+LAMA+ICS (n=54), mean age was comparable, with a predominance of males. At 3 months, LABA+LAMA and LABA+LAMA+ICS showed significant improvements in symptoms (cough, dyspnea, wheeze, chest tightness), reduced hospitalizations, and improved spirometry (FEV1, FVC) and CAT scores, while LABA+ICS showed minimal changes. LABA+LAMA yielded the most consistent improvements in both symptoms and lung function, whereas LABA+ICS had limited efficacy. Overall, LABA+LAMA+ICS also showed benefits but with less pronounced improvement in small airway obstruction compared to LABA+LAMA. Discussion: Post-TB COPD patients receiving LABA+LAMA or LABA+LAMA+ICS showed significant improvements in symptoms, CAT scores, and spirometry indices. LABA+ICS use resulted in limited clinical and spirometric benefits, which may be attributed to the smaller sample size in this group.

Conclusion: Our findings suggest that dual bronchodilator or triple therapy may be effective in improving symptoms and lung function outcomes in post-TB COPD patients.

Keywords: Post tuberculosis and chronic obstructive pulmonary disease, post tuberculosis and triple drug therapy, post tuberculosis pharmacotherapy

*This article was selected for NAPCON 2025 best research award presentation.

Evaluation of stool as an alternative noninvasive specimen for the diagnosis of pediatric pulmonary TB

Rashmi Ranjan Das , Sutapa Rath, Nishu Kaushik

AIIMS, Bhubaneswar, Odisha, India E-mail: rrdas05@gmail.com

Introduction: Diagnosis of pediatric tuberculosis continues to be a major challenge due to the inability to expectorate and paucibacillary nature of the disease. In endemic settings, the diagnosis of pediatric TB depends mainly on clinical and radiological features as gastric aspirate is an unpleasant procedure and requires expertise as well as hospital admission. This study aims to evaluate the use of a less invasive, alternative specimen like stool for the microbiological confirmation of pediatric pulmonary TB.

Methods: Gastric aspirate (GA) or induced sputum (IS) and stool samples (at least 2 gm) samples were collected from children of age =14 years old with suspected pulmonary TB admitted in the ward. IS and GA were tested as per the NTEP protocol by Xpert MTB/RIF-Ultra assay. Processing of stool samples was standardised and appropriate protocol followed for Xpert MTB/Rif-Ultra assay.

Results: A total of 104 pairs GA and IS samples were tested by Xpert-Ultra assay. Eighteen of 104 respiratory samples were Xpert-Ultra positive of which stool Xpert-Ultra assay was positive in 15 cases. The bacterial load in 2 of these samples was low and very low in one. All GA with medium and high bacterial load were detected by Stool Xpert-Ultra assay. Stool Xpert assay was positive in 5 GA Xpert Ultra negative samples. Sensitivity of Stool-Xpert assay is comparable to that of GA, and stool can be a potential non-invasive, alternative sample that can transform the diagnostic algorithm into a child-friendly approach. This study provides further evidence for WHO’s latest recommendation that fresh stool can be an acceptable specimen for TB CBNAAT testing in young children, who are not able to produce sputum sample.

Conclusion: Stool can be used as an alternative sample for the diagnosis of pediatric pulmonary tuberculosis.

Keywords: Stool, tuberculosis, Xpert MTB/RIF-Ultra assay

Changes in oscillometry parameters observed in post-TB COPD patients treated with LABA+LAMAand LABA+LAMA+ICS over 3 months: An Indian observational multicentric study

Deesha Ghorpade , Suhas Bardapurkar, Vivek Vardhan, Kalpesh T. Panchal

Chest Research and Training Pvt. Ltd., Pune, Maharashtra, India E-mail: deesha.ghorpade@yahoo.in

Introduction: 10.8 million cases of Pulmonary Tuberculosis (TB) are diagnosed every year globally, of which 88% are cured. TB survivors remain at a heightened risk of developing respiratory diseases, particularly COPD, with a reported prevalence of 99% small airways obstruction, due to lung damage and remodelling in the airways. We aimed to evaluate the efficacy of LABA+LAMA and LABA+LAMA+ICS treatments in post-TB COPD patients on small airway obstruction using lung oscillometry parameters.

Methods: Cured post-TB-COPD patients (FEV1/FVC=70%) were recruited from 12 clinics across India in this observational multicentric study. Demographics, symptoms, CAT score, spirometry and lung oscillometry indices were captured at baseline and at 3-months follow-up in patients on LABA+LAMA and on LABA+LAMA+ICS

Results: Of the 183 post-TB COPD patients recruited in the observational study, 3-month follow-up data for lung oscillometry parameters were available for 94 patients receiving LABA+LAMA (n=40) and LABA+LAMA+ICS (n=54). Baseline characteristics were comparable, except for a longer TB duration in the LABA+LAMA+ICS group (p=0.020). Both regimens significantly reduced cough and shortness of breath at 3 months, with a greater decline in symptoms in the LABA+LAMA group. Oscillometry showed significant improvements in R5, R20, AX, and X5 in both groups, with marked reduction in small airways obstruction (R5–R20) in LABA+LAMA (p<0.001) but not in LABA+LAMA+ICS. Overall, LABA+LAMA demonstrated more consistent improvements across symptoms and oscillometry indices.

Conclusion: Lung oscillometry can be an effective tool to evaluate treatment response in Post-TB COPD patients. Incorporating oscillometry into routine practice could enhance the monitoring of therapeutic outcomes.

Keywords: Chronic obstructive pulmonary disease, lung oscillometry, post tuberculosis

Correlation of sociodemographic profile with treatment outcome in treated pulmonary tuberculosis patients

Hanuman Prasad Sharma , Neeraj Gupta, Ramakant Dixit

JLN Medical College, Ajmer, Rajasthan, India E-mail: sushilsharma229@gmail.com

Introduction: Tuberculosis (TB) remains one of the most important public health challenges in India, despite decades of progress in diagnostic capacity, therapeutic regimens, and national control measures, This study was undertaken to assess the correlation between key sociodemographic variables with final treatment outcomes among drug-sensitive pulmonary TB patients at a 5-year post-treatment evaluation.

Methods: A hospital-based retrospective observational study was conducted on 304 drug-sensitive pulmonary TB patients treated under NTEP at a tertiary care hospital in central Rajasthan. Age, gender, and socioeconomic status (classified per modified Kuppuswamy scale) were documented. Final outcomes at 5-year follow-up were categorized as: Cured, Clinico-radiologically diagnosed pulmonary TB, Extrapulmonary TB (EPTB), Rifampicin-resistant PTB, and Rifampicin-sensitive PTB. Chi-square tests were used to evaluate associations, with p<0.05 considered significant.

Results: At 5 years, 276 patients (90.8%) remained cured, with 8 (2.6%) having clinico-radiologically diagnosed PTB, 8 (2.6%) developing EPTB, 2 (0.7%) having rifampicin-resistant PTB, and 10 (3.3%) having rifampicin-sensitive PTB. Cure rates were consistently high across socioeconomic groups, ranging from 84.4% in the lower class to 100% in the upper class, with the upper lower group showing the largest share of total cured cases (91.9%). Gender analysis revealed that females accounted for most EPTB cases, whereas males had more clinico-radiologically diagnosed PTB and all rifampicin-resistant cases overall cure rates were similar between sexes. Age distribution showed that the 30-60 year group contributed most of the cured cases (65.2%), while patients >60 years had the lowest cure rate (81.3%).

Conclusion: Socioeconomic class, gender, and age were significantly associated with long-term TB treatment outcomes. These findings emphasize the importance of targeted interventions for vulnerable groups, including elderly patients and those in lower socioeconomic strata, to sustain the gains of NTEP and progress toward TB elimination.

Keywords: Long-term follow-up, NTEP, sociodemographic profile, socioeconomic status, treatment outcome

An online registry for tuberculosis: Integrating technology and tuberculosis surveillance

Gayathri S. Rajeev , Irfan Ismail Ayyub

Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India E-mail: gayathrisrajeev@gmail.com

Introduction: Integrated patient care and intensified research are two pillars of END TB strategy. Though tuberculosis (TB) is notified by practitioners, only basic details are collected and utilising these details for research is cumbersome. To overcome this, an easy to use registry with extensive details of TB patients was created in collaboration with software team.

Methods: The online registry included: 1. patients demography, 2. anthropometry 3. contact information, 4. site of disease, 5. microbiologically confirmed/clinically diagnosed, 6. investigation results, 7. diabetes and HIV status, 8. drug sensitivity 9. treatment initiation date and 8. medication details. Drop downs were given for each options. Pharmacy, laboratory and radiology softwares were integrated. The details can be saved only after entering Nikshay number. “Report” option was added to collect the saved details as either seperate report or consolidated spreadsheet. A committe was formed and staffs assigned to track cases and make entries.

Results: TB notification and integration to Nikshay improved. Treatment given was monitored. Scrutinization of the tests done improved number of microbiologically confirmed cases. A database of TB patients were created. Maintaining an online TB Registry helps in creating a huge database, which can be used for research purposes and in creating new innovations and guidelines. Monitoring the treatment can ensure that all patients receive standardised regimens. Assessing the tests done, can help in identifying lacunaes and give training to practitioners on relevant tests, to improve microbiological confirmation. By making Nikshay ID mandatory, all cases are integrated into NTEP. Providing drop downs made the entry process easy and uniform. Option to get consolidated reports made data collection simple and organised.

Conclusion: Maintaining an online TB Registry will help in improving quality of patient care and research.

Keywords: Tuberculosis, surveillance, registry, technology

An observational study to analyse the pattern of KatG and InhA genes mutation in isoniazid monoresistant and multidrug-resistant tuberculosis patients at a tertiary care centre of western Rajasthan

Vishram Kumar Kumawat

Dr SN Medical College, Jodhpur, Rajasthan, India E-mail: vishramkumar7344@gmail.com

Introduction: Isoniazid (INH) resistance poses a significant challenge to tuberculosis (TB) control, largely driven by mutations in the KatG and InhA genes. Objective: To evaluate the demographic profile and mutation patterns of KatG and InhA genes among patients with INH mono-resistance and multidrug-resistant TB (MDR-TB).

Methods: A descriptive observational study was carried out at Kamala Nehru Chest Hospital, Dr. S.N. Medical College, Jodhpur, from October 2024 to June 2025. A total of 150 sputum-positive INH-resistant patients (mono-resistant and MDR-TB) were included. CBNAAT and Line Probe Assay (GenoType MTBDRplus) were used for diagnosis and mutation detection. Demographic and genetic data were systematically analyzed.

Results: Of the 150 patients, most were male (72%), residents of rural areas (61.3%), and aged 31–40 years (25.3%), with a mean age of 40.67 years. Labourers (23.3%) and farmers (22.0%) were the most affected occupational groups. KatG mutations were predominant (82.7%), followed by InhA mutations (9.3%) and combined KatG + InhA mutations (8.0%). The most frequent variant was KatG MUT1 (S315T1), detected in 97.6% of KatG-positive cases. InhA mutations were mainly MUT1 (C15T). True resistance (WT absent with MUT present) accounted for 80% of cases, while heteroresistance was observed in 20%. Dual mutations were more frequent in MDR-TB than in mono-resistant cases.

Conclusion: KatG mutations, particularly S315T1, constitute the major mechanism of INH resistance in Western Rajasthan. Region-specific molecular profiling is essential to guide rapid diagnostics and optimize individualized treatment strategies.

Keywords: KatG, InhA, isoniazid resistance, MDR-TB, mutation profile, Line Probe Assay

Diagnostic accuracy of GeneXpert G4 and GeneXpert Ultra for pleural tuberculosis in a high-endemic region

Sanjitha Muneeswaran

PD Hinduja Hospital, Mahim, Mumbai, India E-mail: sanjithamunish98@gmail.com

Introduction: Tuberculous pleural effusion (TPE) is the second most common form of extrapulmonary tuberculosis in India. The diagnosis remains challenging due to the paucibacillary nature of the disease. This study assessed the diagnostic accuracy of GeneXpert G4 and GeneXpert Ultra in pleural fluid and pleural tissue samples.

Methods: A retrospective observational study was conducted at a tertiary care hospital in Mumbai, India. Pleural fluid and pleural tissue samples tested between January 2015 and December 2024 were included. All specimens underwent molecular testing (GeneXpert G4 or Ultra) and Mycobacteria Growth Indicator Tube (MGIT) culture was the reference standard. Sensitivity, specificity, positive and negative predictive values and concordance with drug susceptibility testing (DST) were calculated.

Results: A total of 6000 samples (5572 pleural fluid, 428 pleural tissue) were analysed. Culture positivity was observed in 657 pleural fluid and 88 pleural tissue samples. In pleural fluid samples, sensitivity and specificity were 36.0% and 95.0% for GeneXpert G4, and 60.8% and 90.0% for Ultra, respectively. In pleural tissue, GeneXpert G4 showed sensitivity and specificity of 65.4% and 90.7%, while Ultra showed 75.0% and 77.4%. Rifampicin resistance detection showed high concordance with phenotypic DST.

Conclusion: GeneXpert Ultra improved sensitivity compared to G4, particularly in pleural tissue samples. However, given variable specificity and indeterminate resistance results, cautious interpretation is warranted. A balanced diagnostic approach, combining molecular assays with clinical history and examination is essential.

Keywords: Diagnostic accuracy, GeneXpert, pleural tissue, tuberculous pleural effusion, ultra

To assess the resistance patterns in tuberculosis patients with extensively drug-resistant cartridge-based testing

Darshit Chouhan , Aashish Singh

Institute of Respiratory Disease, S.M.S. Medical College, Jaipur, Rajasthan, India E-mail: chouhandarshit09@gmail.com

Introduction: Extensively drug-resistant tuberculosis (XDR-TB) is a severe form of multidrug-resistant (MDR)-TB associated with high mortality. Xpert MTB/XDR is a rapid nucleic acid amplification test for detection of tuberculosis and drug resistance in one test suitable for use in peripheral and intermediate level laboratories. In addition, for detection of tuberculosis it also detects resistance for Isoniazid (INH), Fluoroquinolones (FQ), Ethionamide (Eto), Amikacin (Am), Kanamycin (Km), Capreomycin (Cm).

Methods: An observational study cross-sectional study was conducted at Department of Respiratory Medicine, SMS Medical College, Jaipur from June 2025 to August 2025. The study included 49 tuberculosis patients attending Institute of Respiratory Diseases, Jaipur. Each patient was subjected to Chest Xray, Sputum CBNAAT, Sputum XDR-NAAT.

Results: 49 consecutive patients were enrolled and divided into 2 arms according to Rifampicin sensitivity using CBNAAT. First arm was of rifampicin resistance (containing 32 patients), in addition, resistance to INH was found in 9(28.12%), FQ in 1(6.25%), INH + FQ in 12(37.5%), INH + FQ + Eto in 3(9.38%) and INH + Eto in 2(6.25%) patients. Second arm (17 patients) consisted of Rifampicin sensitive patients, having no response to drug sensitive regimen. In XDR panel, monoresistance to INH was seen in 4(23.52%), monoresistance to FQ in 2(11.76%) patients and polyresistance to INH + FQ was seen in 5(29.41) & polyresistance to INH + FQ + Eto was seen in 1(5.88%) patient. 1(5.88%) patient had INH indeterminate and FQ resistance. Overall, resistance to INH was 26.53%, FQ was 8.16%. There was no resistance to Eto, Am, Km, Cm.

Conclusion: Xpert MTB/XDR nucleic acid amplification test cartridges are helpful to study the resistance pattern in non-responding patients and help to decide a treatment regimen to reduce morbidity and emergence of resistance.

Keywords: Isoniazid, polydrug resistance, rifampicin sensitivity, second line antitubercular drug, XDR-NAAT

*This article was selected for NAPCON 2025 best research award presentation.

Comparative analysis of comorbidities, clinical profiles, and treatment outcomes among geriatric and nongeriatric tuberculosis patients

Divyendu Sharma , Isham Goel, Manish

Dr. Baba Saheb Ambedkar Medical College and Hospital, Delhi, India E-mail: divyendusharma88@gmail.com

Introduction: Tuberculosis (TB) disproportionately affects geriatric patients (=60 years) due to immunosenescence and a higher burden of comorbidities, leading to poorer outcomes. NTEP currently lacks specific guidelines for this vulnerable population. This study aimed to compare clinical profiles and treatment outcomes between geriatric and non-geriatric TB patients to identify factors influencing treatment success.

Methods: This retrospective comparative cohort study was conducted at a tertiary care hospital in New Delhi. Data was collected from DOTS records and NIKSHAY portal for 951 drug-sensitive TB patients (433 geriatric 518 non-geriatric) enrolled between September 2024 and February 2025. Patients with MDR TB or those under 18 years were excluded. Data on demographics, comorbidities, and outcomes were statistically analysed.

Results: Significant disparities in treatment outcomes were found. The geriatric cohort had a substantially lower cure rate (32.1%) compared to non-geriatric group (50.2%). Conversely, mortality (14.8% vs 3.1%) and loss to follow-up rates (13.6% vs 1.5%) were significantly higher among elderly. Diabetes was the most common comorbidity in the geriatric group (23.3%) and was significantly associated with adverse outcomes (p=0.01), as was lower socioeconomic status (p=0.03).

Conclusion: Geriatric TB patients demonstrate significantly poorer treatment outcomes under the current NTEP framework, largely driven by a higher burden of comorbidities. There is an urgent need to develop and implement age-sensitive policies and integrated management strategies to improve TB control in this high-risk population.

Keywords: Comorbidities, geriatric, NTEP, tuberculosis

Clinical characteristics, diagnosis, and treatment outcomes of mediastinal lymph node tuberculosis

Jagbir Singh , Anant Mohan, Vijay Hadda

AIIMS, New Delhi, India E-mail: jagbirnehra95@gmail.com

Introduction: Most guidelines on tubercular lymphadenitis are derived from studies on cervical node TB, while the profile of isolated mediastinal lymph node TB (LNTB) is less understood. Mediastinal disease often presents with vague features, making diagnosis difficult. With the increasing use of endosonographic sampling, there is a need to describe the clinical spectrum and outcomes of mediastinal LNTB.

Methods: We conducted an ambispective cohort study at AIIMS New Delhi (2013–2025). Patients with suspected LNTB underwent clinical, radiological, and microbiological evaluation. Tissue sampling was via bronchoscopy, TBNA, or EBUS-TBNA. Microbiological confirmation included smear, culture, or CBNAAT. Others were diagnosed on clinico-radiological and histopathological features with treatment response. Patients were followed =6 months after anti-tubercular therapy (ATT). Outcomes were categorized as resolution, improvement, stabilization, or worsening.

Results: 197 patients were included (mean age 35 years, slight male predominance). Most had constitutional symptoms 9.6% were detected incidentally. Extra-mediastinal involvement was seen in 57.3%, and ocular TB was the first manifestation in 12%. On CT, mean nodal short-axis was 18.6 ± 7.7 mm. Right paratracheal and subcarinal nodes were most frequent (77.7% each). 52% had multistation disease, and 65% showed necrotic morphology. Microbiological confirmation was achieved in 44.7% (Xpert 43%, smear 14%, culture 10%). Histopathology showed necrotizing granulomas 30.8%, non-necrotizing 38.7%, necrosis-only 5.1%. At 6 months, 93.2% were clinical responders. CT was available in 112 patients: resolution 75 (39.3%), improvement 20 (10.5%), stabilization 7 (3.7%), worsening 10 (5.2%). Persistent lymphadenopathy (>1 cm) occurred in 27 predictors were larger baseline nodes and microbiological positivity (OR 3.33, 95% CI 1.44–7.69).

Conclusion: Mediastinal LNTB usually presents with systemic symptoms but may be incidental. It typically involves paratracheal/subcarinal nodes with necrotic morphology. EBUS-TBNA with molecular assays offers high diagnostic yield. Most respond to 6-month ATT, though persistent lymphadenopathy is common in bulky or microbiologically positive nodes, warranting close follow-up and evaluation of extended therapy.

Keywords: Endobronchial ultrasound, mediastinal lymph node tuberculosis, persistent lymphadenopathy

*This article was selected for NAPCON 2025 best research award presentation.

Urinary neopterin a surrogate marker of active tuberculosis and assessment of treatment outcome

Alok Chandra

United Institute of Medical Sciences, Prayagraj, Uttar Pradesh, India E-mail: alok_chandra13@yahoo.in

Introduction: Tuberculosis lacks specific biomarkers to differentiate active from latent infection. Early diagnosis is paramount for transmission prevention and curtailing MDR/XDR emergence. While chest X-ray with sputum microscopy confirms pulmonary disease, these fail in non-expectorating patients and cannot distinguish latent from active disease without invasive procedures. Indias extrapulmonary TB cases increased from 26% (2010) to 40% (2021), necessitating non-invasive diagnostics for NTEP elimination goals. Neopterin, produced by activated macrophages upon interferon-gamma stimulation, is excreted unaltered in urine and measurable by ELISA, prompting evaluation as a TB biomarker.

Methods: This prospective study (July 2021-July 2022) enrolled 50 subjects at UIMS, Prayagraj: active TB (n=26) confirmed by symptoms, TST/IGRA, chest X-ray, and bacteriology latent TB infection (n=12) with positive TST/IGRA without active disease healthy controls (n=12) with negative TST/IGRA. Morning spot urine samples were analyzed for neopterin using ELISA with 90-minute turnaround. Measurements occurred at baseline, 3 months, and treatment completion. Statistical analysis employed ANOVA with post-hoc tests (p<0.05).

Results: Baseline urinary neopterin in active TB (5.67±1.82 nmol/L) significantly exceeded LTBI and controls (p<0.001). Progressive decline occurred during treatment: 3.33±0.95 nmol/L at 3 months (41% reduction, p<0.05) and 2.61±0.56 nmol/L at completion (54% reduction, p<0.05 versus baseline). The plateau between 3 months and completion (p>0.05) indicates early treatment response. All active TB cases showed elevated baseline neopterin. Both pulmonary (n=19) and extrapulmonary TB (n=7) demonstrated similar kinetics.

Conclusion: Urinary neopterin is a reliable non-invasive marker for active TB diagnosis and treatment monitoring, potentially enhancing TB elimination efforts through improved case detection and monitoring in resource-limited settings.

Keywords: Extrapulmonary tuberculosis, NTEP, treatment monitoring, tuberculosis, urinary neopterin

Human immunodeficiency virus infection among newly diagnosed tuberculosis patients and their sociodemographical profile

Ravi Shankar Mahawar

SMS Medical College, Jaipur, Rajasthan, India E-mail: mahawarravishankar@gmail.com

Introduction: People living with HIV are 18 times more likely to develop the TB than people without HIV. Tuberculosis is leading cause of hospitalization and death among adult and children living with HIV accounting for 1 in 5 HIV related death globally. HIV positive TB incidence in India – 54000 and globally 703000. HIV positive tuberculosis mortality 11000 in India and 187000 globally. Aim: To assess the Prevalence of human immunodeficiency virus among newly diagnosed tuberculosis patients and their socio-demographical profile. Objectives: To evaluate Prevalence of human immunodeficiency virus among newly diagnosed tuberculosis patients and to assess socio-demographical profile of human immunodeficiency virus among newly diagnosed tuberculosis patients.

Methods: This is a hospital based observational study which was conducted at Institute of respiratory disease SMS medical college Jaipur from July 2024 to June 2025 After necessary permission will be taken from Institutional Research Review Board and Ethics Committee of S.M.S. Medical College, Jaipur.

Results: Maximum TB-HIV co-infection cases were found in 26-45 years of age, and the cases of co-infection were more in males (6.08%) as compared to females (1.84%). There was no significant variation found amongst TB-HIV co-infected cases by religion, however more TB-HIV co-infected cases were significantly found in illiterate group.

Conclusion: TB-HIV co-infection deserves special attention. Screening of HIV among TB patients should be attached more importance, which would be much more helpful for treatment and outcome of both diseases.

A study on lung function of post tuberculosis lung disease in rural V/S urban and smoker V/S nonsmokers

Tariq Mahmood , Deepak Kumar, Praveen Rana

MLN Medical College, Prayagraj, Allahabad, Uttar Pradesh, India E-mail: mlnmctariqmahmood@gmail.com

Introduction: Post-tuberculosis lung disease (PTLD) is a chronic condition characterized by persistent structural and functional damage to the lungs even after successful tuberculosis (TB) treatment. Smoking, biomass fuel exposure, and co- morbidities may worsen lung function in these patients. Objective: To compare spirometric profiles and associated clinical characteristics of post-TB patients from urban and rural populations.

Methods: This observational, comparative study was conducted in the Department of Pulmonary Medicine, SRN Hospital, MLN Medical College, Prayagraj. Patients aged 18–65 years with a past history of adequately treated pulmonary TB presenting with respiratory complaints were included. Spirometry was performed before and 15 minutes after salbutamol inhalation. Patients were grouped as urban and rural, and results were analyzed according to smoking status and biomass fuel exposure. Statistical tests included Student’s t-test and Chi-square, with p < 0.05 considered significant.

Results: A total of 385 patients were studied (urban: 122 rural: 263). Obstructive abnormality was the most common spirometric pattern, followed by restrictive changes. Urban smokers showed lower baseline lung function and reduced bronchodilator response compared to rural smokers. Biomass fuel exposure further worsened lung function in both groups, with a more marked decline in rural patients. Non-smokers had relatively preserved lung function, and rural non-smokers demonstrated a better bronchodilator response.

Conclusion: Post-TB patients from urban areas, particularly smokers with comorbidities, had poorer lung function compared to rural patients. Smoking and biomass fuel exposure were major contributors to reduced pulmonary function. Targeted interventions such as smoking cessation, reducing biomass fuel use, better management of comorbidities, and regular spirometry are essential for improving long-term outcomes in PTLD patients.

Keywords: Chronic obstructive pulmonary disease, obstructive airway disease, post-tuberculosis lung disease

Neonatal BCG vaccination of preterm infants – Is current practice acceptable

Venugopal Kunjupillai , Gopika Venugopal

General Hospital, Alappuzha, Kerala, India E-mail: dtovenu@gmail.com

Introduction: WHO recommends universal BCG vaccination of neonates in high prevalence countries. When preterms are concerned, there are suspicions regarding its efficacy, safety in view of their immunological immaturity. Tuberculin conversion following vaccination and resistance attained to TB infection are dissociable phenomena. But with a potent vaccine and good vaccination technique, these two parallel each other. Hence until long term prospective studies are undertaken tuberculin sensitivity may be taken as an indirect indicator of vaccine uptake. The present study was intended to compare the vaccine uptake rate in preterm and term neonates following BCG vaccination at birth.

Methods: All preterm babies delivered in our institution during 6 month were studied. Similar healthy term babies were taken as controls. Exclusion criteria were set. Babies were vaccinated within 2 weeks of birth and followed up to 10-14 weeks. Tuberculin sensitivity was tested between 10-14 weeks, scar positivity and complications were looked for, results were compared and statistical significance analysed by test of proportion.

Results: Among 128 cases and 256 controls only 58 and 56 returned for follow up. Gestational age of cases ranged from 31-36 weeks with a mean 33.8 weeks. The mean tuberculin response among preterm was 4.3 mm with 34% showing induration >5 mm. Corresponding values in control group was 6.4 mm and 71%. Scar positivity was 65% and 93% respectively. Complications were nil in both groups.

Conclusion: (1) Preterms showed a significantly lower tuberculosis response (34% Vs 71%). (2) Scar positivity rate was lower in preterm (655 Vs 93%).

Role of intrapleural streptokinase in loculated pleural fluid of various etiologies

Aanchal Sharma

Institute of Respiratory Diseases, SMS Hospital, Jaipur, Rajasthan, India E-mail: aanchalsharma1998.21@gmail.com

Introduction: Pleural effusion involves the accumulation of fluid between the parietal and visceral pleura. When complicated by severe intrapleural inflammation, septations can form, leading to loculated effusions that are challenging to manage. Intrapleural fibrinolytic therapy, such as streptokinase instillation, has shown potential in enhancing drainage and resolving adhesions.

Methods: This cross-sectional study included 35 patients with septated pleural effusions of various etiologies. All underwent ultrasound-guided intercostal chest tube insertion, followed by intrapleural administration of streptokinase. Data were collected on daily fluid drainage, imaging findings, and overall treatment response until discharge.

Results: The most common causes of effusion were tuberculosis (40%) and parapneumonic infection (28.57%). Streptokinase therapy significantly increased mean fluid drainage from 260.77 mL to 1306.86 mL (p < 0.0001). Radiologic improvement was noted in most patients, with 22 cases (62.86%) achieving successful outcomes. Adhesion dissolution was observed in the majority, with complete resolution in 3 cases (8.57%). There was no statistically significant association between the underlying etiology and treatment response.

Conclusion: Intrapleural streptokinase is a safe and effective treatment for loculated pleural effusions. It markedly enhances fluid drainage and may reduce the need for surgical intervention, regardless of the underlying cause.

Bronchoscopic features of endobronchial tuberculosis

Priyanka Ubale , Pankaj Magar, Anubhuti

Smt Kashibai Navale Medical College and Hospital, Pune, Maharashtra, India E-mail: priyankaubale10@gmail.com

Introduction: Endobronchial Tuberculosis (EBTB) is a form of tuberculosis involving the tracheobronchial tree, often presenting with non-specific symptoms and radiographic findings. Timely diagnosis is critical to prevent complications such as airway stenosis. Bronchoscopy plays a key role in identifying characteristic lesions. Chung’s classification categorizes EBTB into seven bronchoscopic subtypes.

Methods: This observational study was conducted over a two-year period in a tertiary care hospital in Pune. Patients with chronic cough, sputum smear-negative for acid-fast bacilli (AFB), and/or persistent radiographic consolidation were enrolled after informed consent. All underwent fiber-optic bronchoscopy, and findings were classified according to Chung’s criteria.

Results: Five patients were diagnosed with EBTB. The most common bronchoscopic subtypes were oedematous/hyperaemic (Type 2) and actively caseating (Type 1), each found in 2 patients (40%). Fibrostenotic (Type 3) changes were observed in 1 patient (20%). No cases of tumourous, ulcerative, granular, or non-specific bronchitic types were identified. The predominance of oedematous and caseating forms in this study aligns with patterns commonly seen in early-stage EBTB. Fibrostenotic changes, though less frequent, highlight importance of early detection to prevent irreversible airway damage. Bronchoscopy remains indispensable in diagnosing EBTB, especially in sputum-negative cases.

Conclusion: Oedematous and actively caseating lesions were the most frequent bronchoscopic findings in EBTB, with fibrostenotic changes also present. Early bronchoscopy and subtype recognition are crucial for appropriate management and prevention of complications.

Keywords: Bronchoscopy, caseating type, endobronchial tuberculosis, fibrostenotic type

Aetiology and clinical profile in the patients with pleural effusion

Shreya Shah

SBKS Medical Institute and Research Centre, Vadodara, Gujarat, India E-mail: shahshreyaankur@gmail.com

Introduction: Pleural effusion is a common clinical condition caused by diverse etiologies. In India, tubercular effusion is the most frequent cause of exudative effusion, followed by malignant and parapneumonic effusions. Differentiating between exudative and transudative effusions is essential for management, though diagnostic overlap often complicates evaluation.

Methods: A hospital based study was conducted over 12 months in tertiary care center, pipariya, Vadodara. A total of 40 patients were enrolled. Detailed history,clinical examination, routine investigations, radiological investigations (chest x ray,usg thorax/CT scan) were done. After pleural tapping following investigations like Pleural fluid Ada, Ldh, routine microscopy, cytology,pleural fluid Afb and Cbnaat under NTEP was done. Data were statistically analysed to assess various etiologies of pleural effusion.

Results: Out of 54 patients, males (67.9%) were more affected than females (32.1%), with the majority aged 41-60 years. Breathlessness (85.1%), loss of appetite (64.8%), and chest pain (64.8%) were the most common presenting symptoms. According to Lights criteria, 84% were exudative and 15% transudative. Among exudates, tuberculosis (31.4%) was the leading cause, followed by paramalignant effusions (22.2%), malignancy (12.9%), and parapneumonic effusions (11.1%). Transudates were mainly due to cardiovascular disease (42.8%) and chronic kidney disease (25%).

Conclusion: Pleural effusion has varied etiologies with tuberculosis as the most common cause in this region. Accurate differentiation between exudative and transudative effusions requires a multiparametric diagnostic approach. Incorporating newer biomarkers and molecular tools alongside Lights criteria can enhance early and precise diagnosis, ensuring timely management.

Keywords: Adenosine deaminase, exudative effusion, lights criteria, pleural effusion, transudative effusion