Effect of Home-Based Pulmonary Rehabilitation on Pulmonary Fibrosis.

BACKGROUND: Pulmonary fibrosis is a chronic, progressive lung condition that involves lung tissue scarring and thickening. The effects of home-based pulmonary rehabilitation (PR) in post-covid pulmonary fibrosis (PCPF) and other forms of fibrosis together have not been evaluated. This study aims to evaluate the effectiveness of home-based pulmonary rehabilitation on pulmonary function, functional capacity, and health-related quality of life in people with pulmonary fibrosis (post-COVID pulmonary fibrosis, pulmonary fibrosis secondary to pulmonary tuberculosis (TB), pulmonary fibrosis secondary to interstitial lung disease (ILD), pulmonary fibrosis secondary to bronchiectasis). METHODS: A single-group pretest-posttest experimental study was performed after recruiting 98 pulmonary fibrosis subjects from K.M.C hospitals. After being screened for the inclusion and exclusion criteria, 45 subjects were analyzed, and 6 subjects were lost to follow-up.  A home-based pulmonary rehabilitation program was carried out for 8 weeks (warm-up, stretching exercises, aerobic exercise, strength training for upper limb and lower limb, breathing exercises mainly involved; others: energy saving techniques, controlled coughing techniques, dyspnea relieving positions). The program was supervised via weekly phone calls. Pulmonary function (Pulmonary function test), exercise capacity (6-minute walk test), dyspnea (modified Borg scale), and health-related quality of life (SF-36) were evaluated before and after the intervention. During the enrollment and after the 6-minute walk test, saturation of peripheral oxygen (SPO2) level was also evaluated pre-intervention and after the 8-weeks program. RESULTS: Pulmonary function [FVC(L) t = -12.52, p<0.05; FEV1(L) t = -2.56, p<0.05; FEV1/FVC t = 7.98, p<0.05 and DLCO (ml/min/mmHg) t = -5.13, p<0.05], 6MWD [MD 88.66; p<0.05] and HRQOL measured by SF-36 scores (p<0.05) were improved significantly. Both the baseline SPO2 level before the 6MWT [MD 1.07, p<0.05] and the SPO2 level after the 6MWT [MD 1.16, p<0.05] showed a significant improvement. The rating of perceived exertion(dyspnea) [MD 1.30, p<0.05] was reduced significantly after the 8-week program. CONCLUSION: Our study shows that home-based pulmonary rehabilitation is an effective option for improving lung function and physical functional capacity by reducing dyspnea perception and improving the saturation of peripheral oxygen (SPO2) level, and enhancing the quality of life in people with pulmonary fibrosis.

Clinical usefulness of nebulized dexmedetomidine for conscious sedation in daycare flexible bronchoscopy in Southern India.

BACKGROUND: Sedative agents used in bronchoscopy require trained personnel to administer and monitor the patient. This increases the procedure cost, duration, and inpatient stay. Inhalational administration of sedative agents can be a practical solution to the issue. Dexmedetomidine in the inhalational form could give results similar to the intravenous form without significant adverse events. MATERIALS AND METHODS: The study is prospective, randomized, and double-blinded study. Patients needing bronchoscopy were randomized to receive the nebulized form of either dexmedetomidine or saline (0.9%) before bronchoscopy. The study parameters are assessed and recorded before, during, and after bronchoscopy. Data collected are analyzed using the SPSS software. DISCUSSION: The side effects limit using commonly administered sedation agents in bronchoscopy, such as midazolam, fentanyl, and dexmedetomidine. The nebulized dexmedetomidine is safe with proven efficacy when compared to the placebo. Proceduralist-administered conscious sedation reduces the overall cost and shortens inpatient stays. Attenuation of hemodynamic parameters by dexmedetomidine could be an advantage for the physician in reducing an untoward cardiac event. CONCLUSION: Dexmedetomidine in the nebulized form improves the comfort of patients during the procedure. It blunts the pressure response during bronchoscopy and could be a safer and cost-effective agent in its nebulized form for conscious sedation in bronchoscopy. The study is approved by the institutional ethics committee (IEC KMC MLR 10-2021-310).

COVID-19 Pandemic: Need of the Hour - A Course Correction, Restructuring & Review of our Policies - An Indian Perspective.

The world stunned by a pandemic of such cataclysmic scale is reeling under the joint burden of health impact unleashed by the diseases and the strain on the economy. Glaring shortfalls and inconsistencies in strategies to combat the pandemic have surfaced worldwide irrespective of the country's economic and health care status. The responses have vacillated from mute to drastic. Gaps in health preparedness coupled with administrative tardiness, lack of co-ordination and foresight has heightened the impact of pandemic. Coordinated holistic approach with structured policies in place is the need of the hour. Surveillance and epidemiological models to predict the unpredictable and preempt the backlash will dictate our future successes and failures in this protracted fight against the pandemic. This article attempts to review the present status of health policy on COVID in general and with specific reference to India and their outcome thus far. We also propose a simple and practical framework on which a decisive, well-knit, reliable and acceptable policy can be framed.

Perils with Pirfenidone and "the tuberculosis link".

We report a case of idiopathic pulmonary fibrosis (IPF) treated with pirfenidone who developed tuberculosis (TB) and later had exfoliative dermatitis secondary to an interaction between pirfenidone and rifampicin. This case report highlights the possible risk of developing TB in patients diagnosed with IPF and on antifibrotic therapy like pirfenidone. Furthermore, this case report documents a previously unreported adverse reaction due to the interaction of rifampicin with pirfenidone.

Utility of Various Bronchoscopic Modalities in Lung Cancer Diagnosis

Background: Bronchoscopy and different techniques to obtain tissue sample form the cornerstone of lung cancer diagnostics. The utility, specificity and sensitivity of various techniques are compared against each other and also in relation to the tumour type, location and morphology. Aim: To assess and compare the utility of various bronchoscopic procedures in lung malignancies. Study also compares the utility of these techniques on tumour site, morphology and cell type. Methods: One hundred and fifty six patients with suspected malignancies in whom bronchoscopy was deemed as the primary diagnostic procedure were selected. These patients underwent bronchoscopic lavage, brushings and biopsy. Samples were assessed by microbiological, cytology and histopathological analysis. Results: Bronchoscopic procedures have a high diagnostic accuracy of 81.25% in confirming lung malignancies in central tumours and also in non-accessible peripheral tumours. Bronchial brushings had the highest yield in central tumours (55.9%) and a reasonably good yield even in perpipheral tumours (40.8%). When all the modalities were compared against each other, brushings was the single most decisive technique as it alone yielded a diagnosis in a significant 33% of cases, whereas the comparative diagnosis by biopsy alone was in a minority 7.6% of cases.