European Journal of Cardiovascular Medicine

Background: Studies have demonstrated that red blood cell distribution width (RDW) is closely associated with the prognosis of patients with chronic obstructive pulmonary disease (COPD). In addition, the dynamic changes in RDW appear to play an important role. Thus, we aimed to investigate the relationship between dynamic changes in RDW and 30- day all-cause readmission of patients with acute exacerbation of COPD (AECOPD). Methods: This is a prospective and observational study was conducted in the Department of Pulmonary Medicine, J J M Medical college, Davangere Patients hospitalized for AECOPD between April 2020 to March 2021 were revised. Clinical and laboratory parameters were noted. Participants were followed to determine the incidence of readmission due to AECOPD, readmission from any cause and composite end point of readmission or death during 60 days after discharge. Result: Maximum patients in both groups were found in>60 years age group. The mean age in AECOPD group was 66.75±10.35 years and in Stable COPD was 65.31±11.25 years. Both groups were comparable. Maximum patients in both groups were presented with cough and breathlessness. Maximum patients in AECOPD group was from GOLD stage 4 and in stable COPD was also from GOLD stage 4. The difference in both group was foundstatically significant. Mean FEV1% significantly lower in AECOPD patients (43.87±14.26) as compare to stable COPD patients (50.15±22.22). The difference in both groups was found statistically significant. Mean RDW was significantly higher in AECOPD (19.65±7.75%) as compare to stable patients (15.85±5.55%). The difference in both groups was found statistically significant. Conclusion: Prolonged hospital stay was closely associated with increased RDW on admission in AECOPD patients. Elevated RDW may be an independent predictor for prolonged hospital stay in AECOPD patients

Introduction: Chronic obstructive pulmonary disease (COPD) is a common respiratory condition characterized by airflow limitation it affects more than 5% of the population and is associated with high morbidity and mortality. It is the third common cause of death worldwide, killing around 1.2 Lakh, individuals each year. As a consequence of its high prevalence and chronicity, COPD causes high healthcare expenditure with frequent hospitalizations due to acute exacerbations and the need for long term therapy (eg, supplemental oxygen therapy, medication). Aims: The aim of this study is to evaluate right ventricular function in patients with COPD by echocardiography. Materials and methods: The present study was a Descriptive and cross-sectional case control study. This Study was conducted from April, 2021to November, 2022 at Indoor and outdoor patients of medicine, chest medicine, cardiology department of NRS Medical College, Kolkata. Total 100 patients were included in this study. Result: RV function were significantly impaired in COPD patients as compared to controls. Clinical deterioration in COPD group was much more in patients with baseline abnormal RV function (89%) and patients with RV systolic pressure ≥35 mmHg (P = 0.018). All the six patients who died had three or more abnormal RV systolic function parameters

Background: Chronic Obstructive Pulmonary Disease (COPD) is defined by GOLD as a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases. [1] The most common respiratory symptoms include dyspnea, cough and/or sputum production. These symptoms may be under-reported by patients. Material and Methods: This is a Prospective, observational, comparative study was conducted in the Departments of Physiology at Index Medical College. The sample size for this research study was calculated on the basis of prevalence of abnormal left and right ventricular dysfunction of 25% in known patients of COPD at 95% confidence interval and an absolute precision of 10%. Right atrial Pressure (RAP) was estimated from the evaluation of the inferior vena cava during respiration. If the inferior vena cava diameter is normal and the segment adjacent to the right atrium collapses by at least 50% with respiration, then right atrial pressure is estimated as 5 mm Hg. Results: Number of males is slightly higher than females in the study group. But there was no significant difference in sex between the study group and the control group. There is no significant difference in age between COPD and control group. The minimum age of the patient was considered to be 35 because COPD is usually a disease of middle age and is less likely below 35 years. The mean difference in FEV1 in the study group is 1.03±0.31 and in control group is 4.23± 0.91. By applying student t test, p value was found to be significant between the two groups. The mean difference in FVC is 2.03±0.34 in COPD group and 4.61±0.88 in the control group. P value was significant between the two groups. The mean difference in the FEV1/FVC in COPD group was 53.15±9.99 and control group was 83.88±6.66. p value was significant. Conclusions: This study on clinically stable patients with COPD with a wide range of severity of airways disease provides evidence of subclinical RV dysfunction and suggests that cardiovascular comorbidities may begin early in COPD and are often occult. RIMP and RV basal strain showed largest difference between controls and COPD cases irrespective of the presence or absence of PH

Background:  Patients with the chronic obstructive pulmonary disorder (COPD) are at risk of developing postoperative respiratory failure. That is the reason they may require artificial respiration for longer periods than others. However, being on mechanical ventilation for a long time leads to lung damage and infections. Objective: The present study was undertaken to observe the relation between the severity of COPD in patients of spinal surgery and the prevalence of respiratory failure. Materials and Methods: 40 patients with COPD who had undergone spinal surgery were part of the study. The data was collected from the medical records department including the demographics, spirometry results, blood gas analysis, comorbidities, postoperative and other variables. The important outcome is a respiratory failure within one week after the surgery. Results: Data was presented in table 1 and table 2. Table 1 presents the demographic and clinical parameters of the participants. Table 2 presents the risk factors for respiratory failure of the participants. A longer duration of anesthesia was required for the mild COPD patients. Comorbidities were present in all levels of COPD patients. Table 2 presents the risk factors for respiratory failure of the participants. Length of stay was longer in patients with severe COPD. Extubating time, and endotracheal intubation after surgery were more in the severe COPD patients. Pulmonary infection is present in all groups of patients. Conclusion: There is no significant relationship between the severities of COPD with postoperative respiratory failure. However, there is a strong need to conduct a prospective study with more defined parameters to understand better these relations. So that better and more effective treatment strategies can be developed

Introduction; Increased oxidative burden plays an important role in the pathogenesis of Chronic obstructive pulmonary disease (COPD).GGT (gamma-glutamyl-transferase) has been regarded as a novel marker of oxidative stress and CRP as inflammatory marker over the last few years. There exists a delicate balance between the toxicity of oxidants and protective function of antioxidant defence systems which is critical for the maintenance of normal pulmonary functions. Aims and objectives; This study aimed to compare the serum levels of GGT & CRP during stable and acute exacerba¬tions of COPD and its relationship with inflammation. Material and Methods; The study involved 120 patients with exacerbated COPD and normal function of the liver and biliary tract (mean age, 65.8 ±9.6 years;) and 120 patients with stable COPD (mean age, 64.5 ±7.9 years;).  Serum GGT and C‑reactive protein (CRP) levels were measured and compared between the groups. Result ; Serum GGT levels in patients with exacerbated COPD (AECOPD )were significantly higher than in those with stable COPD ( 25.3 vs. 18.6 U/l; P <0.001]. Serum CRP levels were significantly higher in patients with exacerbated COPD compared with those with stable COPD (59.6 vs. 17.4mg/l;  P<0.001). Conclusions; Our study indicates that serum GGT levels as the marker of oxidative stress increase significantly during exacerbated COPD and have a positive correlation with CRP levels as compared to stable COPD

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a heterogeneous lung condition characterized by chronic respiratory symptoms (dyspnoea, cough, sputum production, exacerbations) due to abnormalities of the airways (bronchitis, bronchiolitis) and/or alveoli (emphysema) that cause persistent, often progressive, airflow obstruction. Aim: To study RCI as a marker for severity of COPD. Material and Methods: An observational study was conducted in Department of Pulmonary Medicine, K. N. Chest hospital, after approval from institution ethical committee, Dr. S. N. Medical College, Jodhpur. Result: In our study, 58 (58.0%) patients were Cigarettes, 36 (36.0%) patients were Ex-smoker and 6 (6.0%) patients were Non-Smoker. Conclusion: We conclude that, majority numbers of patients were Cigarettes in Stage 1 compared to Stage 2, Stage 3 and Stage 4 though it was not statistically significant.

Background: The factors that determine acute exacerbations and hospitalization in COPD patients are poorly understood. Factors that have been studied as predictors of mortality and other outcomes include FEV1, blood gases, co-morbidity, chronic mucus hypersecretion (CMH), muscle weakness, poor nutritional status, low BMI, socioeconomic status and support, number of previous physician visits or hospital admissions, influenza vaccination, pneumococcal vaccination, pulmonary rehabilitation, inhaled corticosteroids and long-term oxygen therapy. Hyperglycaemia is associated with poor outcomes from pneumonia, myocardial infarction and stroke, but the effect of blood glucose on outcomes from acute exacerbations of chronic obstructive pulmonary disease (AECOPD) has not been established. Recent UK guidelines do not comment on measurement or control of blood glucose in AECOPD. A study was therefore undertaken to determine the relationship between blood glucose concentrations, length of stay in hospital, and mortality in patients admitted with AECOPD. Materials and methods: This study was a prospective study in a tertiary care hospital over a period of 48 months. During the initial 24 months, the patients were recruited in the study and for the next 24 months all these patients were followed up systematically for stability of the disease or any adverse impact. Patients who had acute exacerbation of COPD during the initial entry period of 24 months were included in the study. The inclusion criteria were: (i) patients with a principal diagnosis of AECOPD; (ii) age over 50 years; (iii) current smokers or ex‑smokers with a history of smoking equivalent to at least 20 pack‑years; and (iv) surviving patients with stable COPD status on discharge.  Result: Of 115 COPD patients admitted for AECOPD, 54% had one or more readmission, and another 45% had two or more readmissions over a period of 2 years. There was a high prevalence of current or ex‑heavy smokers, associated co‑morbidity, underweight patients, low vaccination prevalence and use of domiciliary oxygen therapy among COPD patients. A total of 12% mortality was observed in the present study. Immediate failure rates after first exacerbation was observed to be 34.8%. Multivariate analysis showed that duration >20 years (OR = 0.43; 95% CI: 0.15‑0.91), use of Tiotropium (OR = 3.33; 95% CI: 2.16‑6.74) and use of co‑amoxiclav during first admission (OR = 3.48; 95% CI: 2.28‑6.84) were significantly associated with higher immediate failure rates.  Conclusion: it has been shown that half of all chronic obstructive pulmonary disease patients hospitalised with acute exacerbations died within 3 yrs. These findings may help clinicians with important information about the probable short- and long-term survival of these patients. Thus, low levels of serum albumin strongly predict poorer long-term outcome, and longer duration of disease and longer time elapsed since first hospitalisation appear as new mortality related independent factors. The authors believe that the current findings will provide clinicians with new insights, allowing them to implement more individualised treatment strategies by better predicting the life expectancy of chronic obstructive pulmonary disease patients.

Background: Chronic obstructive pulmonary disease (COPD) is a significant public health concern characterized by a rising global mortality rate. The association between obesity and heightened morbidity and mortality is widely recognized in the general population. However, in the context of chronic obstructive pulmonary disease (COPD), an intriguing phenomenon referred to as the "obesity paradox" has been observed. The assessment of nutritional status serves as a valuable prognostic indicator for individuals diagnosed with chronic obstructive pulmonary disease (COPD). Methods: A cross-sectional study was undertaken at a tertiary care hospital in Central India, involving a sample of 125 patients diagnosed with chronic obstructive pulmonary disease (COPD). The objective of the study was to evaluate the body mass index (BMI) of these patients using Quetelet's formula. The study participants were chosen through the utilization of a systematic random sampling technique. Results: The study findings revealed that the average body mass index (BMI) was recorded as 24.93±4.0. The health-related quality of life of individuals who are undernourished was found to be significantly impacted. A statistically significant association was observed among all the components of the St. George's Respiratory Questionnaire (SGRQ). Conclusions: The findings of the study revealed that individuals with malnourished chronic obstructive pulmonary disease (COPD) exhibited a notable decline in their health-related quality of life and experienced significant restrictions in their airflow capacity.

Background: Chronic Obstructive Pulmonary Disease (COPD) is a global health concern associated with significant morbidity and mortality. Cardiac involvement, particularly left ventricular dysfunction (LVD), has gained attention as a common comorbidity in COPD patients. This prospective study aimed to elucidate the relationship between COPD and LVD, exploring incidence, predictors, clinical implications, and potential interventions. Methods: A cohort of 300 COPD patients, aged 40 years and older, underwent baseline assessments and regular follow-up visits over 24 months. Echocardiography, spirometry, and clinical data were collected. Predictors of LVD were identified using Cox proportional hazards models. Longitudinal changes in left ventricular ejection fraction (LVEF) and clinical outcomes were analyzed. Results: Over 24 months, LVD incidence increased from 0% at baseline to 28.3%. Age (HR 1.08 per year), current smoking (HR 2.15 vs. never smokers), and severe COPD (HR 3.20, GOLD Stage 4 vs. Stage 1) were significant predictors of LVD. LVEF declined progressively (from 57.8% to 52.2%). LVD was associated with higher hospitalizations (58.3% vs. 33.3%), mortality (25% vs. 8.3%), and exacerbations (133.3% vs. 62.5%) compared to non-LVD patients. Conclusion: This study reveals the dynamic relationship between COPD and LVD. Age, smoking, and disease severity were identified as predictors of LVD. The decline in LVEF over time and its impact on clinical outcomes underscore the clinical relevance of LVD in COPD patients. Comprehensive management

Background: COPD is among the most common lung diseases, becoming a major health problem around the world. It is characterized by a persistent and commonly progressive airflow limitation consequent to an abnormal inflammatory response of the airway and lung tissue a persistent and commonly progressive airflow limitation consequent to an abnormal inflammatory response of the airway and lung tissue. Sleep disorders are frequently present in COPD patients, particularly obstructive sleep apnoea syndrome (OSAS) and the coexistence of this two is termed as overlap syndrome. Methodology-          The study was conducted in the Department of respiratory Medicine of a tertiary health care teaching hospital. The duration of the study was from December 2017 to November 2019. 105 cases of chronic obstructive pulmonary disease visiting outpatient / Inpatient section of Pulmonary Medicine department for diagnosis and fulfilling the inclusion and exclusion criteria were included. All the patients were evaluated with spirometry and polysomnography for detection of obstructive sleep apnea. Data was collected using predesigned, pre-tested, semi-structured questionnaire. Results- The prevalence of OSA in COPD (i.e. overlap syndrome) amongst study group was 27.62%. Sleep related symptoms were more prevalent in overlap group of patients as compared to patients without overlap and the difference is statistically significant between two groups for every symptom. Conclusion- Polysomnography in COPD patients is useful for early detection of OSA and to prevent them from further complications of OSA.

Abstract:Introduction: COPD is a leading global cause of mortality, expected to rise in prevalence over the next four decades. Patients often find the early hours of the day troublesome, impacting their health-related quality of life (HRQoL). This study aims to address the commonly overlooked issue of morning symptoms in COPD patients, focusing on their severity and correlation with the CAT score and BODE index. The research underscores the significance of understanding and managing morning symptoms to improve the overall well-being of individuals with COPD. Materials and methods: A cross-sectional study involving 128 COPD patients meeting inclusion/exclusion criteria was conducted in hospitals affiliated with Bangalore Medical College & Research Institute. Comprehensive investigations were carried out, and morning symptoms were evaluated using the CDLM questionnaire. Patients were clinically classified into GesEPOC phenotypes and GOLD stages based on FEV1 (%). The severity of COPD was assessed through the BODE index and CAT score, with correlations examined against the CDLM questionnaire. Results: In this study of 128 COPD patients, predominantly males with a mean age of 63 years, the first tertile demonstrated lower CDLM scores, indicating a higher morning impact and more respiratory symptoms. These patients also had lower FEV1%, higher CAT and BODEx scores, and increased exacerbations. Higher CDLM scores were associated with the Non-Exacerbator clinical phenotype of GesEPOC Spanish Classification. Multivariate analysis revealed that lower CDLM scores were independently linked to higher CAT and BODEx scores, lower FEV1%, and increased exacerbations. Conclusion: Evaluation of morning symptoms using capacity of daily living during morning (CDLM) questionnaire revealed there was a strong association with markers of COPD severity. The significant association was found with CAT and BODE index score and GesEPOC phenotypes. The strong negative correlation was learned for CDLM with CAT score and BODE Index score independently. However, the CDLM questionnaire exhibits a ceiling effect, limiting its ability to effectively differentiate between low and high impacts of morning symptoms.

Respiratory diseases impose a big global health burden. Around 65 million people have moderate to severe chronic obstructive pulmonary disease (COPD), from which about 3 million die each year. Chest diagnostic imaging is vital in managing a critically ill patient. Right now, direct visualization of the lung parenchyma is done using a chest x-ray (CXR) and computed tomography (CT), with the patient in the supine position in the Intensive Care Unit (ICU). Aims & Objectives: To assess the efficacy of BLUE protocol in diagnosing patients with respiratory failure in intensive care unit. To evaluate the USG findings among study participants and to compare the USG Diagnosis and CT Diagnosis of Patients. Methodology: This was a hospital based cross-sectional, descriptive, prospective study conducted among 150 patients who were admitted into ICU at NRI Medical College suspected with Acute Respiratory Failure in a period of 18 months. Patients admitted to the ICU with respiratory failure were tested initially using LUS and BLUE protocol without interrupting other management. Final diagnosis was done based on history, clinical examination, CT scan, CXR, clinical progression under treatment, and evaluation of cardiac function using echocardiography, functional tests. Data was entered on a Case record form and was represented as frequency and simple percentages. Data analysis was done using Microsoft excel 2019 and IBM SPSS software version 23.0. Sensitivity, specificity, NPV and PPV were calculated for BLUE Protocol using CT diagnosis. Results: A total of 150 patients who were admitted into ICU with various respiratory disorders were evaluated in this study. The age of patients involved in this study ranged from 21-70 years with mean age of 52.27 years. The most common organism isolated was E Coli. Most of the patients had Pneumothorax in the current study. Accuracy was 90.48% in diagnosing pulmonary edema using USG in ICU. Conclusions: LUS is a multifaceted option with low radiation doses for ARF management in critical care settings. LUS is an accurate method for diagnosing pneumothorax, alveolar- interstitial syndromes, parenchymal consolidations, pleural effusion.

BACKGROUND This study was conductedto assess the BODE index (Body mass index, airflow Obstruction, Dyspnea, and Exercise capacity) in order to forecast the severity of COPD (Chronic Obstructive Pulmonary Disease) patients' condition and its relationship to pulmonary hypertension.METHODS This was a hospital-based cross-sectional prospective study conducted among 81 patientsclinically diagnosed to have COPD at the Department of General Medicine, Kurnool Medical College, Kurnool, from February 2021 to September 2022, after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. RESULTS The majority,i.e., 35.8% of the patients had mild PHT, followed by 33.3% with severe pulmonary hypertension, according to ECHO findings. According to BODE index scoring, 48.1% of COPD patients attending the hospital had mild severity, and 30.9% had severe COPD. A statistically significant increase in pulmonary hypertension intensity and COPD severity was seen. There was a statistically significant associationbetween theseverity of COPD and the number of exacerbations, pack years of smoking, Hbg%, BODE score, MMRC score, and ECG changes. As the severity increased, the number of exacerbations andpack years increased,while HB% was decreasing. No association with BMI, height, or weight was seen. ECG findings were co-related to pulmonary hypertension, which was statistically significant. A statistically significant increase in BODE score with a pulmonary hypertension grading increase was seen. The BODE score significantly assesses the chances of exacerbations according to the ROC curve. CONCLUSION The BODE index can provide an effective, superior, and alternative technique to evaluate the severity of the disease. It may also assist in patient follow-up. The BODE index can be of significant practical utility in a primary healthcare setting to identify people who require additional evaluation at higher referral centers and for improved management of these patients because it just takes a spirometer, which is affordable and easily made available.

Introduction: COPD, as defined by GOLD 2023, is a lung condition that is characterised by chronic respiratory symptoms such as dyspnoea, cough, expectoration, and exacerbations. These symptoms are caused by abnormalities in the airways (bronchitis, bronchiolitis) and/or alveoli (emphysema), which result in persistent and often progressive airflow obstruction (1). Airflow blockage is characterised by a forced expiratory volume in one second to forced vital capacity ratio (FEV1/FVC) of less than 0.70. FEV1 is classified as Mild when it is greater than 80% of the predicted value, Moderate when it is between 50% and 80% of the predicted value, Severe when it is between 30% and 50% of the projected value, and Very Severe when it is less than 30% of the predicted value. In 2019, Chronic obstructive pulmonary disease (COPD) resulted in 3 million fatalities globally, making it the third most common cause of death (2). Cardiovascular diseases (CVDs) are a major health issue that often occurs alongside chronic obstructive pulmonary disease (COPD) and greatly increases the chance of death (3). Ischaemic heart disease (IHD), heart failure, and arrhythmias are often observed as cardiovascular diseases (CVDs) in patients with chronic obstructive pulmonary disease (COPD). The incidence rates of ischaemic heart disease (IHD), heart failure, and arrhythmias in individuals with chronic obstructive pulmonary disease (COPD) range from 19% to 61%, 11% to 31%, and 9% to 16%, respectively, depending on the specific characteristics of the research population (4,5,6). The prevalence of cardiovascular disease (CVD) was much greater in patients with chronic obstructive pulmonary disease (COPD) compared to those without COPD. Specifically, 59.7% of COPD patients had CVD, while only 28.5% of non-COPD patients had CVD (7). COPD can cause a range of abnormalities in the structure and blood flow of the heart, which can in turn affect several aspects of the electrocardiogram (ECG). The main causes of ECG changes in patients with COPD are increased airway obstruction, higher pressure on the right side of the heart, displacement of the diaphragm due to excessive inflation of the lungs, rotation of the right side of the heart in a clockwise direction, and changes in body mass index that are associated with clockwise rotation of the QRS-vector in the front of the heart(8,9). The objective of our study was to examine the alterations in electrocardiography among patients with chronic obstructive pulmonary disease (COPD) and to establish a correlation between ECG findings and the severity of COPD based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Criteria. Materials And Methods: This is a cross sectional, observational study done in patients who attended OPD and admitted in wards in department of General Medicine and department of Pulmonary Medicine in Maharajah Institute of Medical Sciences, Vizianagaram. Results: In our study most of the patients belong to age group of 51-70 years (73.2%), most common in 61- 70 years (38.6%) with male preponderance (85.3%). 59 of 64 males were smokers and 4 of 11 females has history of smoking. Conclusion: COPD is a common condition in patients with smoking and is associated with ECG abnormalities. RAD (Right Axis Deviation) is the most common ECG change observed in the study.  As the severity of the disease increases, ECG abnormalities become more common. All patients should undergo ECG to prevent cardiovascular morbidity and mortality.

Purpose:  To compare cardiopulmonary exercise test (CPET) parameters, including VO2, VCO2, respiratory exchange ratio (RER), respiratory rate (RR), heart rate (HR), oxygen saturation (SpO2), and blood pressure (BP), between COPD smokers and healthy smokers, and to assess their relationship with 6-minute walking distance (6MWD) and spirometric values. Methodology: The study employed an evaluative approach to compare CPET parameters between COPD smokers and healthy smokers. Ethical approval was obtained, and the sample included 50 participants from each group. Data collection involved spirometry, 6-minute walking tests, and CPET using a treadmill under the modified Bruce Protocol. Parameters such as VO2, VCO2, RER, heart rate, and oxygen saturation were measured pre- and post-exercise. Pulmonary function was assessed using spirometry, and the results were analyzed using statistical tests, including Chi-square, with significance determined at p < 0.05. Result: This evaluative study, conducted over 15 months, enrolled 100 participants equally divided between chronic obstructive pulmonary disease (COPD) smokers and healthy smokers, revealing a male predominance (96%). Key findings included significant differences in cardiopulmonary exercise testing (CPET) parameters: COPD smokers had a mean VO2 of 429.20 ± 158.88 ml/min compared to 1569.88 ± 356.74 ml/min in healthy smokers (P < 0.001). Correlation analysis demonstrated a strong relationship between FEV1 (%) and FEV1/FVC (%) (R = 0.906, P < 0.001), while lower oxygen saturation was associated with decreased exercise performance (R ranging from -0.719 to -0.805). Post-CPET assessments showed significantly higher respiratory rates (28.24 ± 1.64 vs. 25.52 ± 3.03, P < 0.01) and heart rates (158.96 ± 7.81 vs. 169.28 ± 7.06, P < 0.01) in COPD smokers, alongside elevated O2 desaturation (9.92 ± 2.23 vs. 1.28 ± 1.05, P < 0.01). Notably, the 6-Minute Walk Distance (6MWD) was significantly lower in COPD smokers with higher smoking indices, with a mean 6MWD of 308.75 ± 49.53 meters for those with a smoking index of 151-250 (P = 0.04), illustrating the adverse effects of smoking exposure on physical performance. Conclusion: Overall, these results highlight the utility of Cardiopulmonary Exercise Testing (CPET) in identifying the underlying causes of exercise limitation and assessing the maximal exercise capacity in COPD patients. In situations where CPET is unavailable, the 6MWD serves as a practical alternative exercise test that closely correlates with CPET parameters, making it a valuable tool for evaluating the functional status of COPD patients.

Background: The term 'Non-Invasive Ventilation' (NIV) refers to the application of artificial ventilation without any conduit access to the airways, i.e., without an endotracheal or tracheostomy tube. Earlier negative pressure ventilation was used, but in the modern era, positive pressure ventilation has supplanted negative-pressure ventilation as the major mode of delivery of Non-Invasive Ventilation. The mention of Non-Invasive Ventilation will refer to Non-invasive Positive-Pressure Ventilation (NIPPV). It is used as an alternative conventional Mechanical Ventilation through an Endotracheal Tube (Endotracheal Tube Mechanical Ventilation or ETMV), in more severe patients deem to require ventilatory assistance. Materials and Methods: The study was conducted among 40 patients with COPD with Acute Respiratory Failure, who were admitted under The Department of Respiratory Medicine, Tertiary Care Teaching Hospital from January 2024 to June 2024. The patients included were those with COPD and hypercapnia acute respiratory failure, who worsened despite medical treatment in the ward and were deemed to require mechanical ventilation. The diagnosis of COPD was based on clinical history, physical examination, and prior Pulmonary Function Tests. A study of patients with COPD with Acute Respiratory Failure falling in the age group between 40 and 80 years were included, with the below mentioned inclusion and exclusion criteria. Results: The mean age of the study population in NIV group is 59.45 years and 62.75 years in the ETMV group. The majority of the subjects were in the age range of 60-69 years in both NIV and ETMV groups, consisting of 45% and 50% respectively. The most common symptom on presentation was dyspnea seen in the enrolled subjects. Cough was present in the about 55% of the subjects, fever in 15% and chest pain was present in 12.5% of the subjects. The mean respiratory rate in the NIV group is 35.95 ± 4.26 breaths per minute whereas the mean respiratory rate in the ETMV group is 37.20 ± 2.44 breaths per minute. Higher respiratory rate indicates the severity of dyspnea. Conclusion: In the patients with COPD-AE with severe acute respiratory failure, the modality of management is ETMV, however NIV provides a few advantages over conventional invasive ventilation. The use of NIV is not only a cost effective ventilatory modality, but also a treatment that is associated with significant improvements in clinical and biochemical outcomes. Usage of NIV in ventilator required patients had a high rate of NIV failure and got intubated. NIV trial did not produce any significant difference in the mortality rate or in the length of the ICU stay.

Introduction: Dyspnoea, coughing, and increased production and purulence of sputum are symptoms of chronic obstructive pulmonary disease (COPD), which can sometimes deteriorate rapidly. Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) describes this extreme worsening of symptoms all at once. Aims: To study the level of serum electrolytes in patients with acute exacerbation of COPD. Assessment of acute exacerbation of COPD based on severity of dyspnea using modified medical research council dyspnoea scale, clinical examinations and pulmonary function tests. Materials and Methods: The present study was a prospective hospital-based study. This Study was conducted from July 2022 to December 2023, spanning 18 months at Katihar Medical College and Hospital in Bihar, India. Result: In our study, 63 (63%) of the patients had fever, 100 (100%) had cough, 73 (73%) had crepitations, and 90 (90%) had wheeze. In our study, 77 (77%) patients had SPO2 levels between 94-85, 22 (22%) had SPO2 levels between 84-75, and 1 (1%) had SPO2 levels below 75. In our study, 25 (25%) patients had one mMRC Scale, 35 (35%) had two mMRC Scales, 25 (25%) had three mMRC Scales, and 15 (15%) had four mMRC Scales. In our study, 44 (44%) patients had <135 (hyponatremia), while 56 (56%) had 135-145 (normal). In our study, 49 individuals (49.0%) had <3.5 (hypokalemia), while 51 (51.0%) had 3.5-5.0 (normal). Conclusion: The findings suggest that serum electrolyte imbalances are common in acute exacerbations of COPD and may exacerbate respiratory symptoms. Monitoring and managing electrolyte levels could be essential in improving patient outcomes during acute exacerbations. Further studies are recommended to explore the therapeutic implications of these findings.

Background: Asthma and chronic obstructive pulmonary disease (ACO) were considered two different diseases, but recently it was found that some patients have features of both asthma and chronic obstructive pulmonary disease (COPD), and they were defined as having ACO. It has been suggested that patients with ACO may have special characteristics such as greater airway hyperresponsiveness, higher sputum and blood eosinophils and better response to inhaled corticosteroids (ICS) than patients with COPD. History of atopy, eosinophilic inflammation and serum IgE had been emphasized by Hattori to identify patients with ACO among those with COPD.  Materials and methods: This cross‑sectional study included outpatients who applied to our pulmonology outpatient clinic with the previous diagnosis of asthma and COPD. These participants were evaluated to determine whether they met criteria of ACO. The diagnostic criteria in Global Initiative for Asthma (GINA)‑Chronic Obstructive Lung Disease (GOLD), Spanish, and American Thoracic Society (ATS) Guidelines were used as the diagnostic assessment for ACO. Patients were divided into three groups following evaluation of ACO criteria such as the asthma group, the COPD group, and the ACO group. The characteristics and some parameters of these three groups were compared. Result: This study was conducted on 65 patients with chronic airway diseases (COPD, asthma and asthma COPD overlap) were selected. It included 72 (80%) males and 18 (20%) females. Among the studied participants, 36 (40%) patients were diagnosed as having ACO, 23 (25.6%) patients were diagnosed as having asthma and 31 (34.4%) patients as having COPD. Regarding the age difference between groups, it was found that patients who were diagnosed as having ACO were older than asthmatic patients with mean age of 53.48±8.38 and 41.58±6.28 years, respectively. The men age of patients with COPD was 56.29±8.32 which was older than both ACO and asthmatic patients.   Conclusion: Many patients who have asthma or COPD have symptoms from both diseases. The use of a syndromic approach to chronic airway diseases may result in the diagnosis of ACO in many patients who were previously treated for COPD or asthma. According to the findings of this study, patients with ACO have a distinct phenotype in terms of clinical presentation and HRCT features. HRCT features may aid in distinguishing ACO patients from COPD and asthma patients and may be included in future ACO diagnostic guidelines.

Background: Cigarette smoking is a leading cause of preventable respiratory morbidity and mortality. Small airway obstruction is an early manifestation of smoking-related lung damage and often precedes overt airflow limitation detectable by spirometry. Impulse Oscillometry (IOS) is a noninvasive tool that measures respiratory mechanics and offers potential advantages in detecting early small airway dysfunction in smokers. Methods: A cross-sectional observational study was conducted in the Department of Respiratory Medicine, SAIMS PGI, involving 96 smokers aged 18–60 years with a smoking history of ≥10 pack-years. Participants underwent detailed clinical evaluation, spirometry, and IOS testing. IOS parameters, including resistance at 5 Hz (R5), resistance at 20 Hz (R20), reactance at 5 Hz (X5), and R5–R20, were analyzed and compared with spirometry parameters such as FEV₁ and FVC. Statistical analysis evaluated the correlation between smoking intensity (pack-years) and airway obstruction. Results: The study included 96 smokers (mean age 55.2 ± 10.4 years; 70 males, 26 females) with an average smoking history of 30.5 ± 15.6 pack-years. IOS detected significant increases in R5 (6.2 ± 1.5 cm H2O/L/s) and R20 (4.5 ± 1.0 cm H2O/L/s), along with a decrease in X5 (-0.5 ± 0.4 cm H2O/L/s) compared to normal ranges (p < 0.001). These abnormalities were observed even in smokers with normal spirometry. Correlation analysis revealed a significant association between pack-years and IOS parameters (p < 0.05). Conclusion: Impulse Oscillometry is a sensitive and noninvasive tool for early detection of small airway obstruction in smokers. By detecting changes undetectable by spirometry, IOS offers potential for earlier diagnosis and intervention, reducing the risk of progression to chronic obstructive pulmonary disease.

Introduction Given the paucity of research on asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) and the high prevalence of co-morbidities and healthcare utilization associated with it, the current study looked at the prevalence of ACO and its clinico-radiological phenotype in patients with chronic airflow obstruction. The study was conducted at a tertiary care hospital in North India. Patients over 50 with COPD or asthma were screened for inclusion in the ACO, asthma, and COPD groups. The ACO and COPD groups were further investigated. The clinical characteristics, lung functions, health-related quality of life, and radiological features of both groups were investigated and compared. ACO was discovered in 16.3% of patients with chronic airflow obstruction (asthma and COPD). The most commonly observed symptoms at presentation in the evaluated ACO patients (n=77) were shortness of breath, wheezing, cough, and expectoration (mean age at presentation: 57.9; mean duration of illness: 8.62 years). Exacerbation rates in ACO patients were significantly higher than in COPD patients (p<0.001). The ACO group had a significantly greater mean change in FEV1 post-bronchodilator in millilitres (ml) and percentage (379.61 ml and 37.72%) than the COPD group (p<0.001). The proportion of patients with emphysema was lower in the ACO group than in the COPD group (p<0.001). The ACO and COPD groups did not differ significantly in major airway wall thickness (p=0.3), but the COPD group had a significantly higher proportion of patients with vascular attenuation and distortion (p<0.001). Patients with COPD had a higher degree of hyperinflation, according to high resolution computed tomography (HRCT) indices. This study found that patients with ACO have a distinct phenotype in terms of clinical presentation and HRCT features. More research on the radiological features of ACO is required to identify the anatomical abnormalities involved in the disease's pathogenesis and to validate the radiological features of ACO. Methods The Respiratory Effectiveness Group conducted a cross-sectional study of individuals ≥40 years old and with ≥2 outpatient primary care visits over a 2-year period in the UK Optimum Patient Care Research Database. Patients were classified into one of three source populations based on diagnostic codes: 1) COPD only, 2) both asthma and COPD, or 3) asthma only. ACO was defined as the presence of all of the following 1) age ≥40 years, 2) current or former smoking, 3) post-bronchodilator airflow limitation (forced expiratory volume in 1 second/forced vital capacity <0.7), and 4) ≥12% and ≥200 ml reversibility in post-bronchodilator forced expiratory volume in 1 second. Conclusions In summary, it has been already understood the specificity of a separate clinical entity called ACOS. Even though ACOS develops indistinct clinical and pathophysiological features that often are complicated with those of asthma or COPD, we must emphasize the importance of the syndrome. Studying further the syndrome may we discover mechanistic pathways leading to the development of COPD. And this is important because it is widely known that patients with COPD often are underdiagnosed, possibly for decades. By recognizing common risk factors it will, maybe, become possible to understand and modify the progressive deterioration of lung function, which leads to COPD

Introduction: Exacerbations in COPD have a considerable impact on morbidity, mortality, and quality of life as it affects the health status of patients by accelerating the progression of the disease. It has been estimated that approximately 40%- 50% of acute exacerbation of COPD cases are due to bacterial infections and the cause of approximately one third of severe exacerbation cannot be identified.  Present study was aimed to study serum procalcitonin levels combined with CRP as a diagnostic marker in acute exacerbation of chronic obstructive pulmonary disease to differentiate cause for exacerbation from bacterial infections and other causes. Material and Methods: 120 patients presenting with symptoms and signs of AECOPD were included. Serum procalcitonin levels and CRP levels were correlated with growth in sputum culture. Results: Analysing the data statistically for the correlation between serum procalcitonin levels, CRP and sputum culture growth shows positive correlation between serum procalcitonin levels and CRP with Pearson Correlation coefficient of 0.73. Among patients having serum procalcitonin levels >0.5ng/dl 82.5% patients had positive sputum culture. (p<0.001) Among patients having CRP levels >6mg/L, 65.9% patients had positive sputum culture. (p=0.56). Among patients having both serum procalcitonin levels >0.5ng/dl and CRP levels >6mg/L, 87.5% patients had positive sputum culture. (p<0.001) Conclusion: Since there was good correlation between biomarkers and sputum culture growth in AECOPD, biomarkers like serum procalcitonin combined with CRP can be used as diagnostic markers in differentiating cause of acute exacerbation of COPD and to guide the antibiotics. 

Introduction Bronchiectasis a chronic lung condition, defined as the abnormal, irreversible dilation of the bronchi and bronchioles, where the elastic and muscular tissue is destroyed by acute or chronic inflammation and infection.  This anatomical definition has been evolved from the original description of ectatic bronchi found in pathological specimens in the year 1819. Bronchi, mostly medium sized, are abnormally dilated and bronchial wall shows inflammatory changes. Such changes result from disordered anatomy of bronchial tree, bacterial colonization and chronic host inflammatory response. Materials and Methods This is a prospective study was conducted in the Department of Respiratory medicine at Tertiary Care Teaching Hospital. Data were collected from inpatients diagnosed with bronchiectasis with or without asthma over a period of 1 year. Patients who had not received a chest HRCT scan examination or who had indecipherable HRCT scan images were excluded. Patients with other diseases (e.g. chronic obstructive pulmonary disease, allergic bronchopulmonary aspergillosis, α1-antitrypsin deficiency, significant immunodeficiencies and respiratory carcinomas) were also excluded. All aspects of the study were performed in accordance with relevant guidelines and regulations. Results In the present study, 618 BE were analyzed and divided into 2 groups into BE with asthma (n = 144, 23.3%) and those without asthma (n = 474, 76.6%). The characteristics of the patients are shown in Table 1. Among the 518 patients, 242 (53.3.%) were female and the median age of all patients was 65.6 years (IQR, 59.8–71.5 years). BE with asthma had higher BMI (23.8 vs. 100 Patients with asthma had more frequent hospitalizations, outpatient visits, and antibiotic usage compared to those without asthma. Conclusion The presence of bronchiectasis in patients with asthma was associated with greater asthma severity. There are important therapeutic implications of identifying bronchiectasis in asthmatic patients.

Introduction: Pulmonary hypertension (PH) is a common and serious complication of chronic obstructive pulmonary disease (COPD), contributing to increased morbidity and mortality. Identifying the prevalence and associated risk factors of PH in COPD patients is crucial for early detection and management. Objectives: To estimate the prevalence of PH in patients with COPD and identify significant risk factors contributing to its development. Methods: This cross-sectional observational study included 200 COPD patients meeting the GOLD criteria. Clinical data, spirometry results, and echocardiographic measurements were collected to assess the presence of PH (defined as RVSP > 25 mmHg). Multivariate logistic regression was performed to identify independent risk factors for PH. Results: The prevalence of PH in the study population was X% (exact value derived from analysis). Key risk factors associated with PH included advanced GOLD stage, severe airflow limitation (FEV1 < 50%), prolonged smoking history (>20 pack-years), chronic hypoxemia (SpO2 < 90%), and elevated BMI (>30 kg/m²). Patients with PH had significantly worse clinical outcomes and quality-of-life scores compared to those without PH. Conclusions: PH is prevalent in COPD patients, particularly in those with advanced disease and specific risk profiles. Early identification of at-risk patients through regular echocardiographic screening and risk stratification could improve clinical outcomes and guide targeted therapeutic interventions

Introduction: Acute respiratory distress (ARD) remains a critical challenge in emergency settings, presenting with varied causes and influencing patient outcomes differently. This study evaluates the clinical characteristics, treatment approaches, and outcomes of patients with ARD in an emergency department (ED). Methods: We analyzed data from 240 adult patients (aged ≥18 years) who presented with symptoms of ARD—defined as acute shortness of breath, low blood oxygen levels, or respiratory failure—to a tertiary ED over one year. Information on patient demographics, existing health conditions, clinical signs, diagnostic tests, treatments, and outcomes (hospitalization, ICU admission, death) was collected from electronic health records. Statistical analysis involved descriptive statistics, chi-square tests, and logistic regression. Results: Patients (average age 62.4 ± 15.2 years; 55% male) frequently had comorbidities such as hypertension (48%), chronic obstructive pulmonary disease (32%), and heart failure (25%). The leading causes of ARD were pneumonia (28%), acute exacerbations of asthma/COPD (24%), and pulmonary edema (19%). A significant portion (64%) exhibited hypoxemia (SpO₂ <90%), and 38% needed non-invasive or mechanical ventilation. The hospitalization rate was 82%, with 26% requiring ICU care. The in-hospital mortality rate was 12%, with higher risks associated with older age (OR 1.05, 95% CI 1.01–1.09), septic shock (OR 3.2, 95% CI 1.4–7.1), and multiorgan failure (OR 4.8, 95% CI 2.1–11.0). Delays in ED intervention over two hours were linked to increased ICU admissions (p=0.03). Conclusion: ARD results from diverse etiologies and is significantly affected by patient age, comorbidities, and the timeliness of medical interventions. Prioritizing early identification and standardized treatment protocols may enhance patient survival and decrease the demand for intensive care services.

Background: Chronic Obstructive Pulmonary Disease (COPD) is currently among the leading three causes of death globally, with 90% of these fatalities occurring in low- and middle-income countries (LMICs).1 In 2012, over 3 million individuals lost their lives due to COPD, which accounted for 6% of all deaths worldwide. OBJECTIVES:  To compare the duration of smoking in pack years first-day values of pH PaCO2 in predicting the need for mechanical ventilation in Acute Exacerbation of COPD. To compare S. Albumin, Glasgow coma scale, APACHE II score and Premorbid functional status to predict the need for mechanical ventilation in Acute Exacerbation of COPD. MATERIAL & METHODS:  Study Design: Prospective hospital-based observational study. Study area:  The study was conducted in the Department of Pulmonary Medicine, Katuri Medical College and Hospital, Guntur.  Study Period:  June 2022 to May 2023. (1 year).  Sample size: The study consisted of 100 subjects. Study population: The present study was conducted on 100 cases, including males and females, from Pulmonology OPD, Katuri Medical College and Hospital, Guntur.  Sampling method: Simple random Sampling Technique.Results: Of the 100 COPD patients, 39 had a GCS < 13, of whom 29 eventually needed mechanical ventilation, whereas only 20 of 61 patients with GCS >13 eventually needed mechanical ventilation. The p-value of <0.03 obtained by our study indicates that GCS< 13 is an independent predictor of the need for mechanical ventilation in COPD patients. CONCLUSION: In conclusion, COPD predominantly affects males and individuals over 50, with smoking being the leading cause. Key predictors for mechanical ventilation in acute exacerbations include long smoking history, low arterial pH (<7.2), altered mental state (GCS <13), high APACHE II score (>15), low serum albumin (<3.5 g/dl), elevated PaCO2 (>60 mm Hg), and poor pre-existing functional status (Menzies Grade III/IV). These factors help identify high-risk patients early, enabling timely intervention.

Background: Left ventricular (LV) pseudoaneurysm is a rare but serious cardiac condition resulting from a myocardial rupture contained by pericardial adhesions or thrombus. Unlike true aneurysms, pseudoaneurysms lack a complete myocardial wall, posing a high risk of rupture and necessitating prompt surgical intervention. AIM: This study presents a retrospective analysis of surgical outcomes in LV pseudoaneurysm management over an 15 year period. Methods: A retrospective review was conducted on 11 patients diagnosed with LV pseudoaneurysm between May 2009 to December 2024. The mean age was 38.7 years (range: 7–73 years), with 9 males and 2 females. Clinical data, imaging findings, surgical techniques, and postoperative outcomes were analyzed. All patients underwent surgical repair, including patch closure with PTFE, Dacron, or autologous pericardium, with or without concomitant procedures such as mitral valve repair/replacement or coronary artery bypass grafting (CABG). Results: The predominant etiology was myocardial infarction (54.5%), followed by infective endocarditis (36.4%) and trauma-related pseudoaneurysm (9.1%). Surgical repair resulted in no perioperative mortality. One late mortality (9.1%) occurred due to chronic obstructive pulmonary disease (COPD). At discharge, 90.9% of patients were in NYHA Class I or II, with no recurrence or reintervention during a mean follow-up of 13 months. Conclusion: LV pseudoaneurysm requires early diagnosis and surgical intervention to prevent catastrophic rupture. Surgical repair demonstrates excellent functional recovery, low mortality, and durable long-term outcomes.

Background: Chronic obstructive pulmonary disease (COPD) significantly impacts cardiac function, particularly affecting the right ventricle, left ventricle, and pulmonary vasculature. Cardiovascular complications contribute substantially to COPD-related mortality. Echocardiography provides a non-invasive and effective method for evaluating cardiac changes in COPD patients. To analyze the cardiac alterations associated with COPD using echocardiography and to determine the correlation between echocardiographic findings and COPD severity based on GOLD classification. Materials and Methods: This prospective observational study was conducted over 16 months at the Department of Respiratory Medicine, MIMS, Vizianagaram. A total of 50 COPD patients aged above 40 years were enrolled. Exclusion criteria included active tuberculosis, HIV, terminal cancer, hepatic or renal diseases, and pregnancy. Patients underwent clinical evaluation, electrocardiography (ECG), spirometry, arterial blood gas (ABG) analysis, and echocardiography. Data were analyzed for associations between echocardiographic findings and COPD severity. Results: Echocardiographic findings revealed that 24% of patients had pulmonary hypertension, 24% had increased right ventricular (RV) thickness (>0.5 mm), and 20% had left ventricular diastolic dysfunction (LVDD). The mean ejection fraction did not significantly differ between patients with and without pulmonary hypertension (61.6% vs. 60.5%). Echocardiographic abnormalities were more frequent in severe and very severe COPD cases. Conclusion: COPD is associated with significant cardiovascular changes, including pulmonary hypertension, RV hypertrophy, and LV dysfunction. Routine echocardiographic screening every six months is recommended to detect early cardiac complications and improve clinical outcomes.

Background: COPD (Chronic Obstructive Pulmonary Disease) is a chronic inflammatory illness. Air trapping and gradual airflow limitation are two consequences of these pathological alterations that can directly result in dyspnoea and other hallmark symptoms, as well as a decline in health. The CAT is a useful tool for assessing a patient's health and the severity of their COPD symptoms. CAT is a patient-completed questionnaire; certain issues including subjectivity and unilaterally are unavoidable during the assessment. We aim to study the relationship between COPD Assessment Test (CAT) score and severity of Airflow obstruction in stable COPD patients and to determine whether higher CAT score correlates with the frequency of COPD exacerbation. Method: Hospital based cross-sectional observational study conducted among 131 patients, age range between 43 to 90 years, in all stable COPD patients. Assessment was done by CAT (COPD assessment test) score and severity of airflow obstruction by spirometry in the Department of Respiratory Medicine, from January 2023 to December 2024. Results: Mild airflow obstruction was found in 46.6% of cases, moderate in 42.7%, severe in 10.7%, and none had very severe obstruction. The severity distribution was significantly related to gender, history of childhood respiratory infections, disease impact level based on CAT scores, and frequency of exacerbations. Higher CAT scores correlated with more severe airflow obstruction. Patients with a "very high" CAT score had a significantly higher prevalence of severe airflow obstruction (P-value < 0.05). A significant relationship was observed between the frequency of exacerbations and both the CAT scores and airflow obstruction severity. Patients with more frequent exacerbations exhibited higher CAT scores and more severe airflow obstruction (P-value < 0.05).There was a significant inverse relationship between the CAT score levels and the mean FEV1 (% predicted), indicating that a higher disease impact level correlates with worse lung function (P-value < 0.05). Conclusion: The importance of regularly using CAT scores in clinical practice to better understand the severity of COPD and to tailor treatment plans according to individual patient risk factors, such as age, gender, smoking history, and past respiratory health. This approach can help improve disease management and outcomes for COPD patients

Background: and Aim: Chronic Obstructive Pulmonary Disease (COPD) is often associated with cardiovascular complications that significantly impact prognosis and quality of life. This study aimed to evaluate echocardiographic findings in COPD patients to identify cardiac manifestations and their relationship with disease severity.  Material and Methods: A cross-sectional study was conducted on 44 COPD patients at a tertiary care hospital from January to December 2023. All patients underwent spirometry for disease staging and transthoracic echocardiography to assess cardiac involvement.Results: Pulmonary arterial hypertension (PAH) and right ventricular (RV) enlargement were more prevalent in patients with advanced COPD. PAH was observed in 100% of Stage IV patients, while RV enlargement increased progressively with severity, being absent in Stage I and present in all Stage IV cases.  Conclusion: The study underscores the importance of echocardiographic screening in COPD patients, particularly in moderate to severe stages, for early detection of cardiac complications and timely intervention.

Background: Chronic Obstructive Pulmonary Disease (COPD) is associated with chronic systemic inflammation, and C-reactive protein (CRP) is a key biomarker. This study evaluates CRP levels in stable COPD patients compared to healthy controls. Methods: A case-control study included 40 stable COPD patients (GOLD stages 1–4) and 40 age- and sex-matched healthy controls. Serum CRP was measured using high-sensitivity CRP (hs-CRP) assay. Spirometry confirmed COPD severity. Statistical analysis was performed using SPSS v26. Results: Mean CRP was significantly higher in COPD patients (5.2 ± 2.1 mg/L) vs. controls (1.8 ± 0.9 mg/L) (p < 0.001). CRP increased with GOLD stages (Stage 1: 3.1 ± 1.2 mg/L, Stage 4: 7.5 ± 2.4 mg/L; p < 0.01). No significant difference was found between current and ex-smokers (p = 0.45). Conclusion: Elevated CRP in stable COPD suggests persistent systemic inflammation, correlating with disease severity. CRP may aid in monitoring disease progression and guiding therapy.

Background: About 3 billion people are exposed to smoke from biomass fuel, a major risk factor for COPD, particularly in developing countries, where it accounts for around 50% of COPD-related deaths, mainly affecting women. Objectives: To estimate the prevalence of COPD in non-smoking females over the age of 40 years with chronic respiratory symptoms. To identify the association of COPD with risk factors. Materials & Methods:  A cross-sectional study was conducted over six months in the Department of Respiratory Medicine at a tertiary care teaching hospital among women over 40 who are never smokers and have smoked fewer than 100 cigarettes, per CDC guidelines. Results: In this study, the prevalence of COPD in non-smoking females is 15.29%. It was found that 94.6% of the study subjects had restrictive PRISM, whereas only 5.35% had Non-restrictive PRISM. In this study, 10 of 13 COPD patients were exposed to biomass fuel, 2 to dust and fumes, and 3 had a history of recurrent childhood respiratory infections. All 3 participants with non-restrictive PRISM were exposed to biomass fuel, with 1 having a history of pulmonary tuberculosis. Among 32 patients with small airway obstruction, 27 were exposed to biomass fuel, 5 to dust and fumes, and 15 had recurrent childhood respiratory infections. Conclusion: Risk factors for COPD in women include exposure to biomass fuels, pollutants, recurrent respiratory infections, tuberculosis history, and dust or fumes. Recognizing these factors and using spirometry for diagnosis can help reduce COPD-related mortality and morbidity in at-risk females.

Aim: The aim of the present study was to determine the frequency of left ventricular dysfunction in patient with chronic obstructive pulmonary disease. Methods: A prospective observational study was conducted in which all eligible indoor and outdoor male and female patients above 40 years of age participated after meeting the inclusion and exclusion criteria from 1st May 2023 to 30 Nov 2024. A total of 151 individuals diagnosed with COPD were enrolled as cases in this hospital-based study. Results: The distribution of sex was nearly equal, with 49.7% males and 50.3% females. Most participants were Hindu (57.0%), followed by Muslims (31.1%) and Sikhs (11.9%). Regarding occupation, teachers formed the largest group (25.2%), followed by unemployed individuals (21.9%) and shopkeepers (21.2%). A larger proportion of the study population resided in urban areas (57.0%) compared to rural regions (43.0%). No statistically significant differences were observed in pulse rate (p=0.266), respiratory rate (p=0.913), systolic BP (p=0.286), diastolic BP (p=0.342), or pulse oximetry (p=0.276) across COPD stages. The values for these parameters remained consistent across all three groups, suggesting similar hemodynamic and respiratory baseline characteristics despite differing spirometric severity.  Conclusion: This study highlighted the intricate relationship between chronic obstructive pulmonary disease (COPD) severity and cardiac function. Through a comprehensive assessment of clinical, biochemical, radiological, pulmonary, and echocardiographic parameters across GOLD- defined COPD stages, it was observed that systemic and cardiac involvement becomes more pronounced with advancing disease. Key laboratory markers, including hemoglobin, TLC, liver and renal function tests, and differential leukocyte count, demonstrated significant deterioration in higher COPD stages, reflecting systemic inflammation and hypoxic burden.

Background: Chronic Obstructive Pulmonary Disease (COPD) is characterized by persistent airflow limitation and episodic exacerbations. Identifying reliable biomarkers to predict exacerbations is crucial for optimizing clinical management. Elevated blood eosinophil counts and serum Immunoglobulin E (IgE) levels have been proposed as potential predictors of COPD exacerbations. Methods: We conducted an observational cross-sectional study at a tertiary care center in Jaipur, India, recruiting 96 COPD patients (both OPD and IPD). Participants underwent clinical evaluation, spirometry, and laboratory tests, including absolute eosinophil count (AEC) and serum IgE measurement. COPD severity was classified according to GOLD stages. Exacerbations were identified using Anthonisen’s criteria. Statistical analyses included descriptive statistics, comparative tests (Chi-square, t-tests, ANOVA), and correlation analyses. Results: Of the 96 participants, 70.83% were male and 29.17% were female, with a mean age of 60.3 ± 8.5 years. The mean AEC progressively increased from GOLD stage A (468 ± 102.26) to stage B (696.5 ± 234.59) and stage E (832.24 ± 115.05) (p < 0.0001). Similarly, serum IgE levels were significantly higher in stage E (1641.84 ± 580.50) than in stages A (271.15 ± 86.44) and B (778.86 ± 468.30) (p < 0.0001). A strong positive correlation (r = 0.793, p < 0.0001) was observed between AEC and serum IgE. Patients with higher eosinophil counts and elevated IgE had more frequent and severe exacerbations, lower mean FEV₁%, and a higher prevalence of advanced COPD (GOLD stage E). Conclusion: Our findings suggest that elevated blood eosinophil counts and serum IgE levels are associated with increased frequency and severity of COPD exacerbations. Routine assessment of these biomarkers could aid in identifying high-risk patients and tailoring pharmacological interventions.

: Introduction: Respiratory tract infections are commonly encountered in clinical practice and are often complicated by the presence of underlying comorbidities such as Chronic Obstructive Pulmonary Disease, Bronchial asthma, and Diabetes Mellitus. These can alter the respiratory microbiological profile. Moraxella catarrhalis, considered a commensal organism of human upper respiratory tract, has emerged as a notable pathogen in lower respiratory tract infections, particularly in individuals with chronic respiratory diseases. Understanding the relationship between specific comorbidities and the isolation of Moraxella catarrhalis can help improve clinical management and targeted therapy. Objectives: This study aimed (1) To establish the pathogenicity of Moraxella catarrhalis through microbiological identification using microscopy, culture, and biochemical reactions (2) To assess the incidence of Moraxella catarrhalis and to analyse the association between comorbidities like Chronic Obstructive Pulmonary Disease & Bronchial Asthma (3) To determine its antibiotic susceptibility profile to various antibiotic classes. Methodology: A cross-sectional study was conducted involving 250 bacteriologically significant respiratory samples. Participants were categorized based on the presence of no comorbidity, with Chronic Obstructive Pulmonary Disease, Bronchial Asthma, or Diabetes Mellitus. The isolates were identified conventionally and antibiotic susceptibility testing done with various classes of antibiotics. Results: Out of the 250 bacteriologically significant respiratory sample, 38 clinically significant Moraxella catarrhalis were isolated and accounted for 15.2% of total isolates. Antibiotic susceptibility testing showed 100% resistance to ampicillin and 100% sensitivity to amoxicillin -clavulanic acid correlating with the production of beta-lactamase enzyme by the isolates. Moraxella catarrhalis was isolated predominantly among Chronic Obstructive Pulmonary Disease patients (26.8%) followed by, Bronchial Asthma patients (17.1%). The Chi-square test showed a significant association between comorbid conditions and bacterial isolates (χ² = 14.92, p = 0.002). Conclusion: Moraxella catarrhalis should be considered as a lower respiratory tract pathogen especially in elderly patient with underlying comorbidity like Chronic Obstructive Pulmonary Disease & Bronchial Asthma.

Background: To study the impact of ultrasound-assessed Diaphragmatic impairment on predicting the need for invasive mechanical ventilation in patients with Acute Exacerbations of Chronic Obstructive Pulmonary disease (AECOPD) and also, its impact on duration of invasive mechanical ventilation, length of ICU stay and outcome. Methodology: A total 95 patients with AECOPD requiring NIV support in the Intensive care unit (ICU) were included in the study in our hospital from April 2023 to November 2024. This was a prospective observational study. Ultrasound-assessed Diaphragm Thickness Fraction (DTF) was done to assess the Diaphragmatic Impairment (DI). Either the patient was weaned off from NIV or put on IMV based on clinical condition and ABG analysis. Results: Receiver operating characteristic (ROC) curve analysis of diaphragmatic thickness fraction on the Right & Left-side gives a cut off <31.88% and <28.2% with 100% sensitivity and 20.9% specificity for the need of Invasive mechanical ventilation (IMV). Out of 43 patients that were put on IMV, 34 were below and 9 were above this cut-off. Mean Duration of IMV was significantly higher in deceased patients compared to patients who survived. (8.56+/-2.11 vs 2.78+/-0.83 days). Mean Duration of ICU stay was also significantly higher in deceased patients compared to survived patients. (9.95+/-2.46 vs 5.37+/-1.17 days). Conclusion: we conclude that ultrasound-assessed Diaphragmatic thickness fraction is a good indicator in determining the diaphragmatic impairment and predicting the need for invasive mechanical ventilation in AECOPD patients with 100% sensitivity and 20.9% specificity. DI as assessed by DTF can be used as a prognostic factor for determining Invasive Mechanical Ventilator days, ICU stay and Outcome of the patient.

Background: Chronic obstructive pulmonary disease (COPD) is characterized by persistent airway obstruction caused by chronic inflammation. It is a significant contributor to early mortality and morbidity among adults. Anemia is recognized as a common comorbidity in COPD, similar to other chronic conditions. This retrospective hospital-based study aimed to evaluate the prevalence of anemia among a cohort of individuals diagnosed with COPD. Materials and Methods: The study included 567 COPD patients clinically diagnosed at a teaching hospital affiliated with an Indian medical college. Of these, 234 patients who met the inclusion criteria were analyzed. Anemia was defined using the World Health Organization (WHO) criteria: hemoglobin (Hb) levels <13 g/dL in males and <12 g/dL in females, with hematocrit (Hct) levels <39% in males and <36% in females. Statistical analysis was conducted using SPSS version 21.0.   Results: The mean age of male COPD patients was 67.28 years, while that of females was 66.35 years. Among the 234 participants, 60 males (25.64%) had Hb levels below 13 g/dL, and 79 females (33.76%) had Hb levels below 12 g/dL. Hematocrit values below 39% were observed in 59 males (25.21%), while levels below 36% were found in 79 females (33.76%). Conclusion: Based on Hb levels, the prevalence of anemia was 25.64% in males and 33.76% in females. When assessed using Hct values, anemia was observed in 25.21% of males and 33.76% of females. The occurrence of anemia was higher among older age groups in both genders.