Can B-Type Natriuretic Peptide (BNP) be a Predictor of Severity and Outcome of Community-Acquired Pneumonia (CAP)? A Prospective Follow-Up Study.

Tropical India holds about 23% of the global pneumonia burden with case fatalities ranging between 15 to 30%, with CAP being one of the prominent causes of morbidity and mortality among adults. BNP, a hormone from ventricular myocytes during myocardial stretch or stress, causes vasodilation and natriuresis. Perhaps established as an efficient biomarker in cardiac illnesses, the possibility of it being a predictor of severity and mortality in CAP is studied. Material: 175 participants with CAP were included in the study excluding anemia and cardiac/ renal/ hepatic morbidities. Clinical history and examination, BNP, CRP, ESR, TLC, CRB-65 scores were elucidated at the time of presentation and after two weeks. Observation: At presentation, the mean values of BNP, CRP, ESR, and TLC values at presentation were 189.59, 137.29, 69.31, and 18.53* 103, whereas after two weeks of treatment, they were 94.08, 43.21, 33.01, 11.14 respectively all being significant (p <0.05). 41 participants had a CRB-65 score of one (mean BNP of 149.68), whereas rest 34 had more than one (mean BNP of 229.51). The BNP levels correlated positively with CRP, and ESR both at baseline (r=0.62, p< 0.05; r= 0.74, p< 0.05) and after treatment (r=0.39, p< 0.05; r= 0.56, p< 0.05) Conclusion: Gauging BNP levels at admission is a rapid and reliable means to triage CAP pneumonia patients into various levels of care. BNP correlates well with other biomarkers and CRB-65 scores and thus the clinical severity and outcome of CAP.

Development of an educational intervention to reduce the burden of adult chronic lung disease in rural India: Inputs from a qualitative study.

BACKGROUND: Chronic respiratory diseases (CRDs) are major causes of mortality and morbidity worldwide with a substantial burden of the disease being borne by the low and middle income countries (LMICs). Interventions to change health behaviour which aim to improve the quality of life and reduce disease burden due to CRD require knowledge of the problem and factors influencing such behaviour. Our study sought to appreciate the lived experiences of people with CRD, their understanding of the disease and its risk factors, and usual practice of health behaviour in a rural low-literate community in southern India. METHODS: Qualitative data were collected between September and December 2018 through eight focus group discussions (FGDs), five in-depth interviews and four key-informant interviews from patients and community members. Community engagement was undertaken prior to the study and all interviews and discussions were recorded with permission. Inductive coding was used to thematically analyse the results. RESULTS: Major themes included understanding of chronic lung disease, health behaviours, lived experiences with the disease and social norms, attitudes and other factors influencing health behaviour. DISCUSSION: Poor understanding of CRDs and their risk factors affect health seeking behaviour and/or health practices. Stigma associated with the disease and related health behaviours (e.g. inhaler use) creates emotional challenges and mental health problems, besides influencing health behaviour. However barriers can be circumvented by increasing community awareness; communication and connection with the community through community based health care providers can turn challenges into opportunities for better health care.