To Study the Effectiveness of Inhalation Technique Training in Patients with COPD and Asthma.

INTRODUCTION: Asthma and chronic obstructive pulmonary disease (COPD) are characterized by chronic airway inflammation. Lack of knowledge about the correct inhalation techniques leads to poor control of both diseases. This study aimed to study the effectiveness of inhalation technique training in patients with COPD and asthma. MATERIALS AND METHODS: A total of 132 patients fulfilling the inclusion criteria were trained with the correct technique of inhalation on day 0 and at the end of 1 and 6 months. Evaluation of technique training was done on these three occasions posttraining. The mean score of devices was obtained, and the mean inhalation technique score of various devices was compared. RESULTS: Out of 132 patients, 65.1% (86/132) patients were using a dry powdered inhaler (DPIs), 26.5% (35/132) patients used metered dose inhalers (MDIs), and 8.4% (11/132) patients used MDI with spacer. The mean scores of patients using MDI at baseline were 5.68 ± 0.83, and after 1 month, 6.68 ± 0.58 (p < 0.000). The inhalation technique mean score of MDI improved after 6 months, 7.02 ± 0.56 as compared to baseline (p < 0.008) mean score of the patients using DPIs improved after 1 month, 5.53 ± 0.58 as compared to baseline 4.37 ± 5.53 (p < 0.000). There was no statistical improvement in the device mean score of DPIs after 6 months, 5.62 ± 0.55 when compared with 1 month, 5.53 ± 0.58 (p < 0.117). Patients who used pressurized metered-dose inhalers (pMDI) with spacers improved their inhalation score after 1 month by 6.90 ± 0.94 as compared to the baseline score of 6.90 ± 0.94 (p < 0.001). The mean score decreased marginally after 6 months, 7.818 ± 0.60, as compared to the score at the end of 1 month of 8.27 ± 0.64 (p < 0.053). DISCUSSION: Patients showed improvement in the technique of inhalation after educational training, reinstructions, and a standard checklist.

A 54-Year-Old Woman With Rheumatoid Arthritis, Low-Grade Fever, and Cough.

CASE PRESENTATION: A 54-year-old Indian woman presented with low-grade fever and cough with expectoration for 1 month. Fever was not associated with any chills or night sweats. Expectoration was minimal in amount and mucoid in nature. Her appetite was decreased, without any significant weight loss. She denied any history of dyspnea or hemoptysis. The patient was diagnosed with rheumatoid arthritis 1 year previously and was initially started on methotrexate and short-term glucocorticoids. At the time of presentation, she was taking methotrexate 15 mg weekly and hydroxychloroquine 200 mg daily. Her joint disease was controlled on immunomodulators. She had no other comorbid condition, and she was a never smoker. She neither traveled within or outside India in the past nor came in contact with patients with pulmonary TB. A chest radiograph was done because a prior workup showed an ill-defined solitary nodular lesion in the right lower zone. She took a course of amoxicillin-clavulanate, but that was of no benefit.

ROS1 positive non-small cell lung cancer with pulmonary embolism in a 22-year woman.

ROS1-rearrangement occurs in 1-2% of non-small cell lung cancer (NSCLC). This mutation is predominantly seen in relatively young, non-smoker, female with adenocarcinoma. Association of pulmonary embolism with ROS1-rearranged NSCLC has been suggested. We report a case of a 22-year-old woman with ROS1-positive NSCLC and pulmonary embolism. This case possibly represents the youngest patient in the literature.