Efficacy of a Structured Yoga Intervention Integrated with Routine Care versus Exercise on Pulmonary Function and Quality of Life of Asthma Patients: A Randomized Controlled Trial.

Context: Asthma is a chronic disease and its chronicity demands therapy with minimal harm and a good impact on the quality of life of asthmatics. Objective: This study evaluates the efficacy of structured yoga intervention integrated with routine care on asthma patients in improving their pulmonary function and quality of life. Design: The study was a single-blind (outcome assessor) hospital-based randomized controlled trial. Participants: Adults between 18 to 60 years, diagnosed with mild to moderate asthma as per Global Initiative for Asthma guidelines, with no exacerbation in the past month before screening, were included in the study. Intervention: A thirty-minute structured yoga intervention was delivered daily by a qualified yoga instructor through a virtual platform. Outcome measures: Questionnaires were utilized to assess the quality of life, and Breath-o-meter equipment was used to measure peak expiratory flow rate (PEFR). It was tested at baseline and then at 15 days, 45 days, and 90 days, whereas the quality of life was evaluated once a month. Statistical analysis: Intention to treat analysis was performed to compare the mean outcome between the yoga and control groups using an independent sample t test and repeated measures analysis of variance. Results: The yoga group significantly improved their PEFR and asthma-related quality of life scores compared to the control group (P < .001). A significant difference (F = 539.72, degree of freedom = 1.1618; P < .001) was detected between PEFR values at several time intervals (baseline, day 15, day 45, day 90) in the intervention group on repeated measures analysis of variance. The difference in quality-of-life scores between yoga and control was also statistically significant (P < .001), with an improvement in the quality-of-life domain of external stimuli. Conclusion: When combined with normal asthma treatment, the findings of this study show that structured yoga intervention integrated with routine care is more beneficial than traditional breathing exercises in increasing PEFR and quality of life.

Predictors of Poor Outcome in Patients with COVID-19 associated Respiratory Failure: A Retrospective Observational Study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is majorly known to cause mild to moderate disease, but a small fraction of patients may develop respiratory failure due to diffuse lung injury, requiring management in the intensive care unit (ICU). This study attempts to identify factors that can predict unfavorable outcomes in moderate to severe COVID-19 patients. METHODS: Hospital records of 120 COVID-19 patients admitted to the ICU were retrospectively analyzed and data pertaining to demographic, clinical, and laboratory parameters were obtained. These data were then compared with outcome parameters like survival, duration of hospital stay, and various adverse events. RESULTS: Out of 120 patients, 70% were male, with a mean age of 54.44 years [standard deviation (SD) ± 14.24 years]. Presenting symptoms included breathlessness (100%), cough (94.17%), fever (82.5%), and sore throat (10.83%). Diabetes, hypertension, and chronic obstructive pulmonary disease (COPD) were the common comorbidities associated. Increased serum D-dimer, ferritin, interleukin-6 (IL-6) levels, and unvaccinated status were associated with higher mortality. Overall, 25.83% of patients survived, 24.41% of patients developed septic shock, and 10.6% of patients were discharged on oxygen. World Health Organization (WHO) clinical progression scale score ≥ 6 had 57 and 82% sensitivity and 83 and 77% specificity on days 7 and 14 after admission, respectively, for predicting mortality. A baseline National Early Warning Score 2 (NEWS 2) ≥ 9 had 48% sensitivity and 88% specificity for predicting mortality. CONCLUSION: Advanced age and associated comorbidities are linked to adverse outcomes in moderate to severe COVID-19. Persistently high D-dimer levels, despite standard treatment, may also contribute to increased mortality. WHO clinical progression scale and NEWS 2 have high specificity for predicting mortality.

Molecular characterization of lung carcinomas: A study on diagnostic, predictive, and prognostic markers using immunohistochemical analysis at a Tertiary Care Center in Uttarakhand, India.

INTRODUCTION: Focused studies in different geographic regions would delineate the underlying biological differences and molecular alterations in non-small cell lung cancer (NSCLC) worldwide. Previous studies in literature have documented limited characterization by studying a minimal number of biological markers. This study was done to evaluate expression of multiple immunomarkers including diagnostic, prognostic, and predictive markers in NSCLC for its characterization. MATERIALS AND METHODS: This was an observational study conducted on 60 consecutive cases of NSCLC. Immunomarkers comprising of p63, p40, TTF-1, napsin A, B-Raf, c-Met, phospho-AKT (P-AKT), PTEN, anaplastic lymphoma kinase (ALK), epidermal growth factor receptor (EGFR) and K-Ras, synaptophysin, chromogranin and pan-cytokeratin were evaluated on paraffin-embedded tissue sections of NSCLC. RESULTS: Age of patients with NSCLC in our study ranged from 35 to 90 years, and 93.3% of them were chronic smokers. 93.3% of cases presented in late stages (Stages III and IV) and 78% of cases were squamous cell carcinoma (SCC). EGFR positivity was noted in 83.3% of cases. ALK was positive in one case while C-Met and PTEN immunopositivity was noted in only two cases. Ten cases showed positivity for K-Ras and 90% of these were SCC. Ten cases were positive for B-Raf and 80% of these were SCC. 30% of cases showed immunopositivity for P-AKT. None of the molecular markers was found to have statistically significant correlation with clinicopathological parameters. CONCLUSION: SCC is the predominant histological subtype of NSCLC in the region of Uttarakhand, India, with a high proportion of cases harboring EGFR mutation. Variable expression of K-Ras, P-AKT, ALK 1, and PTEN in NSCLC signifies that molecular profile of every case is individualistic and independent. We attribute this to ethnicity, influence of implicated substance or metabolite in tobacco, and variable mutations incurred in tumor cells over a period of time.

Bronchoscopic Cryotherapy for Acute Hypoxemic Respiratory Failure in Three Mechanically Ventilated Patients: A Case Series.

Endobronchial blood clots or mucus plugs can present with minimal symptoms or acute airway obstruction in the intensive care unit (ICU) patients. Acute airway obstruction can lead to rapid worsening of dyspnea owing to poor oxygenation due to collapse of the lung. Prompt recognition and treatment of this condition can translate into a successful outcome by decreasing morbidity and mortality and facilitating successful weaning of these patients. When conventional methods fail to relieve the obstruction, cryoextraction a novel technique, may prove to be a useful alternative for the removal of these clots and mucus plugs. Cryoextraction is best performed with rigid bronchoscopic intubation. However, in certain conditions, it may be used with a flexible fiberoptic bronchoscope (FOB) through an endotracheal tube, especially when bedside procedure is required in ICU patients. In this series, three cases are being discussed where bedside flexible bronchoscopy-guided cryoextraction was done leading to a successful resolution of acute hypoxemic respiratory failure. How to cite this article: Tale S, Meitei SP, Prakash V, Negi A, Mishra M, Sindhwani G. Bronchoscopic Cryotherapy for Acute Hypoxemic Respiratory Failure in Three Mechanically Ventilated Patients: A Case Series. Indian J Crit Care Med 2021;25(1):94-96.

Application of lipoarabinomannan antigen in tuberculosis diagnostics: current evidence.

Tests based on the detection of mycobacterial lipoarabinomannan (LAM) antigen in urine have emerged as potential point-of-care tests for tuberculosis (TB). We aimed to assimilate the current evidence regarding the diagnostic performance of LAM assays and to ascertain their clinical indication in settings with high and low prevalence of HIV-TB co-infection. Owing to suboptimal sensitivity, the urinary LAM assays are unsuitable as general screening tests for TB. However, unlike traditional diagnostic methods, they demonstrate improved sensitivity in HIV-TB co-infection which further increases with low CD4 counts. Accordingly, these assays are indicated as rule-in tests for TB in patients with advanced HIV-induced immunosuppression, and facilitate the early initiation of antituberculous treatment in them. They also offer incremental sensitivity and specificity when used as adjunct tests to smear microscopy and chest radiography in HIV-TB co-infection. They obviate the biohazards associated with sputum samples and provide an alternative diagnostic tool in sputum-scarce patients. Notwithstanding these advantages, the specificity of these assays is variable, which is mostly attributable to misclassification bias and cross-reactivity with non-tuberculous mycobacteria or other commensal flora. Furthermore, the inability to detect low titres of antigen in HIV-uninfected patients makes these assays unsuitable for use in settings with a low HIV prevalence. Future research targeted towards inclusion of specific monoclonal antibodies and more sensitive immunoassay platforms might help to improve the diagnostic performance of these assays and extend their applicability to the general population of patients with TB.

Idiopathic central sleep apnoea: an Indian case with polysomnographic findings.

Patients with idiopathic central sleep apnoea (ICSA) usually complain of poor quality sleep; yet many of them do not receive appropriate treatment because of poor recognition of ICSA by health professionals. We report the case of a patient with ICSA who was misdiagnosed and received treatment for seizures, depression or anxiety for a number of years and discuss the differential diagnosis and treatment options for ICSA.

Effect of adjuvant yoga therapy for asthma control: A randomized controlled trial.

BACKGROUND: Asthma is a chronic respiratory disease with symptoms of attacks of wheezing, shortness of breath, & tightness in the chest. Even with pre-existing treatment exacerbations go uncontrolled. OBJECTIVE: This study compared asthma control in yoga intervention versus non-yoga intervention group using Asthma Control Test. METHODS: In this randomized controlled trial, participants were allocated into two groups in 1:1 ratio - yoga intervention versus non-yoga intervention. Only outcome assessor was blinded. Sample size of 200 was calculated. Individuals between 18 and 60 years of age, diagnosed with mild to moderate asthma with no exacerbation in past one month were screened and enrolled. Per-protocol analysis was done to assess the outcomes of Asthma Control Test and expenditure.(CTRI/2020/02/023534) RESULTS: A total of 192 participants enrolled, 165 completed this study who were considered for final analysis. A significant difference (p < 0.001) was found between yoga and non-yoga exercise group at 13 weeks. Expenses were more in non-yoga exercise group. CONCLUSION: Our findings confirm that yoga exercise with routine medical care reduces exacerbations and improves asthma control.

Comparison of Patient's Procedural Tolerance of EBUS-TBNA Performed Through Nasal Versus Oral Route: The NO-EBUS Randomized Clinical Trial.

BACKGROUND: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a commonly performed procedure by the bronchoscopist for the evaluation of mediastinal lesions. However, evidence directly comparing the nasal and oral routes to guide the choice of an optimal insertion approach is scanty. METHODS: In this prospective, parallel-group, open-label randomized clinical trial, adults posted for a linear EBUS-TBNA examination under conscious sedation were randomized to undergo the procedure via the nasal or oral route. The primary objective was to assess the equivalence of subject-rated tolerance of EBUS-TBNA procedure in the 2 groups. Key secondary objectives were to assess the equivalence of subject-rated overall experience, willingness for a repeat procedure, operator-rated subject's tolerance, and operator-rated ease of performing the procedure. RESULTS: One hundred and eighty subjects were randomized in a 1:1 ratio to the nasal (n=98) or oral (n=82) group. Outcome measures were assessed by both per-protocol (PP) and intention-to-treat (ITT) analysis. Subject-rated procedural tolerance, overall satisfaction and operator's ease of performing the procedure were found to be equivalent in the 2 groups ( P <0.05 in all cases for PP and ITT analysis). The operator-rated subject's tolerance was, however, nonequivalent ( P =0.0596, 0.1286 for PP and ITT, respectively). Subject's willingness to undergo a repeat procedure was similar in both groups [90% CI of difference in proportions: (-0.023, 0.121) in PP and (-0.028, 0.115) in ITT analysis]. CONCLUSION: Nasal route for EBUS-TBNA could be considered where it is feasible and preferable for the patient as well as the operator.

NCCP-ICS joint consensus-based clinical practice guidelines on medical thoracoscopy.

ABSTRACT: Medical Thoracoscopy (MT) is commonly performed by respiratory physicians for diagnostic as well as therapeutic purposes. The aim of the study was to provide evidence-based information regarding all aspects of MT, both as a diagnostic tool and therapeutic aid for pulmonologists across India. The consensus-based guidelines were formulated based on a multistep process using a set of 31 questions. A systematic search of published randomized controlled clinical trials, open labelled studies, case reports and guidelines from electronic databases, like PubMed, EmBase and Cochrane, was performed. The modified grade system was used (1, 2, 3 or usual practice point) to classify the quality of available evidence. Then, a multitude of factors were taken into account, such as volume of evidence, applicability and practicality for implementation to the target population and then strength of recommendation was finalized. MT helps to improve diagnosis and patient management, with reduced risk of post procedure complications. Trainees should perform at least 20 medical thoracoscopy procedures. The diagnostic yield of both rigid and semirigid techniques is comparable. Sterile-graded talc is the ideal agent for chemical pleurodesis. The consensus statement will help pulmonologists to adopt best evidence-based practices during MT for diagnostic and therapeutic purposes.

Sleep-stage-independent obstructive sleep apnea: an unidentified group?

Our clinical experience suggested existence of a third group, stage-independent-OSA besides two known groups: REM-dependent-OSA and NREM-dependent-OSA. This study was planned to compare the characteristics of this group with the other two. All the subjects undergoing diagnostic video-polysomnographies with AHI >5/h were included in this study. Based upon the ratio of AHI during REM and NREM sleep, various groups were formed. REM-dependent-OSA was defined as AHI-REM/AHI-NREM >2; all other subjects were included in Not-REM-dependent-OSA (A-1 analysis). This group was further bifurcated into two groups: Non-REM-dependent OSA (NREM-dependent-OSA) where AHI-NREM/AHI-REM >2 and remaining subjects were included in the sleep-stage-independent-OSA group (A-2 analysis). SPSS v 17.0 was used to calculate independent sample t test (A-1 analysis) and Kruskall-Wallis test (A-2 analysis). Using A-1 approach, REM-dependent-OSA group was found to be suffering from mild-moderate OSA (90 %). REM-dependent OSA group had lower AHI-NREM (P < 0.001; 95 % CI 22.11-36.81) and lower AHI-total (P < 0.001; 95 % CI 15.39-30.73). Surprisingly, AHI-REM and DI-REM were not significantly different between these groups. A-2 analysis showed that overall, REM-dependent-OSA had lowest AHI-total while the stage-independent group had highest (P < 0.001). However, on analysis of REM-dependent-OSA, it was found that few of the subjects from this group had severe OSA (AHI-total > 30/h). The NREM-AHI increased linearly as we moved from REM-dependent-OSA to stage-independent-OSA with a significant difference across groups (P < 0.001). However, similar trend was not observed for AHI-REM. This study showed that a third group, sleep-stage-independent-OSA also exists when OSA is classified according to the proportion of apnea across sleep stages. This classification partially corresponds with the severity of illness.

Haemoptysis after four years of lobectomy for aspergilloma.

We present a case of a 26-year-old male who underwent lobectomy for life-threatening haemoptysis due to aspergilloma in an old tuberculosis left upper lobe cavity who presented with recurrence of haemoptysis four years after the surgery. Fibreoptic bronchoscopy revealed Aspergillus colonisation in the ectatic residual bronchus which is an uncommon complication of lobectomy. The patient was successfully managed with antifungal agents.

Transbronchial needle aspiration with rapid on-site evaluation: a prospective study on efficacy, feasibility and cost effectiveness.

BACKGROUND: Transbronchial needle aspiration (TBNA) has an established role in diagnosis of hilar and mediastinal lesions. Rapid on-site evaluation (ROSE) of TBNA smears can determine the adequacy of TBNA smears that can obviate the need for repeat procedures, thus avoiding added cost. There is paucity of data from India showing efficacy and cost-effectiveness of ROSE. Hence, this study was carried out to assess the efficacy, feasibility and cost implications of ROSE assisted TBNA. METHODS: Forty consecutive patients undergoing TBNA were enrolled and ROSE was performed on TBNA smears. The results were analysed using a comparative study design. RESULTS: It was found that 45% of patients would have required a repeat bronchoscopy due to inadequacy of material, if ROSE was not used. Inadequate smears were more common in benign aetiologies than malignant ones. TBNA of mass lesions and lesions with endoluminal bulge give better results than TBNA of lymph nodes and without endoluminal bulge. CONCLUSIONS: ROSE was found to increase the yield of TBNA and help to prevent repeat procedures. It proved to be simple, cost-effective and feasible in Indian settings.

Management of post-traumatic tracheal stenosis with silicone stent placement.

Benign airway stenosis often poses a therapeutic challenge and requires a multidisciplinary approach involving interventional pulmonologists and thoracic surgeons. We report the case of a man who presented with thoracic trauma following a road traffic accident. His chest X-ray showed complete collapse of the right lung, while screening flexible bronchoscopy revealed pooled secretions and asymmetric mid-to-lower tracheal stenosis. After thorough clinicoradiological evaluation and multidisciplinary discussion, we proceeded with therapeutic rigid bronchoscopy and silicone stenting of the tracheal stenotic lesion. Post-procedure, the patient improved clinically and also showed radiological improvement. Subsequently, he underwent stent removal and remains in follow-up. While surgery is a definitive modality for management of benign tracheal stenosis, most patients with advanced disease, pneumonia or with poor general condition are unfit to tolerate general anaesthesia or surgery. In such patients, minimally invasive bronchoscopic techniques that are generally safe to perform have led to substantial improvement in symptoms and long-term quality of life.

The effect of yoga on pulmonary function in patients with asthma: A meta-analysis.

BACKGROUND: Asthma is one of the most common non-communicable diseases. Yoga with physical postures, breathing exercises, meditation, and relaxation may play an essential role in the complementary management of lower respiratory diseases. The study aimed to evaluate the impact of yoga (posture, breathing exercises, and meditation) on pulmonary function tests, asthma control tests, and health-related quality of adult asthmatic patients. METHODS: MEDLINE, PubMed, Embase, Cochrane, Scopus, Google Scholar, ResearchGate, Clinical Key, and Academia electronic search engines were explored to search the relevant literature. The present study included adult asthmatic patients (age -18 and 60 years) with mild to moderate asthma, per GINA (Global Initiative for Asthma) guidelines. The effect of yoga was assessed on the following outcomes; pulmonary function tests, including FeV1 (Forced expiratory volume 1 s), FVC (Forced vital capacity), FeV1/FVC, peak expiratory flow rate (PEFR), health-related quality of life, and asthma control test. A fixed-effect model was applied to compute significance for statistical heterogeneity. P-value <0.05 was considered for statistical significance. RESULTS: Finally, fifteen articles were included for meta-analysis. The forest plot for overall effect of yoga intervention and usual care favors the yoga intervention for improvement in pulmonary function as FeV1 (SMD = 0.96, CI = 0.77-1.14, I2 = 54%), FVC (SMD = 0.35, CI = 0.14-0.55, p = 0.11, I2 = 50%), Fev1/FVC (SMD = 0.18, CI = -0.38-0.02, p = 0.02, I2 = 50%), PEFR (SMD = 0.38, CI = 0.18-0.58, p = 0.0003, I2 = 0%), asthma control test (SMD = 0.16, CI = 0.15-0.48, p = 0.31, I2 = 86%) and health-related quality of life (SMD = 0.26, CI = 0.18-0.34, p = 0.02, I2 = 51%) of asthmatic patients. CONCLUSION: This meta-analysis provides a moderate level of evidence regarding yoga as a complementary therapy in managing mild to moderate asthmatic patients. It also adds to the current knowledge of the same.

Five Versus 10 Pharyngeal Sprays of 10% Lignocaine for Topical Anesthesia During Flexible Bronchoscopy: A Multicenter, Randomized Controlled Trial.

BACKGROUND: Ensuring adequate patient comfort is crucial during bronchoscopy. Although lidocaine spray is recommended for topical pharyngeal anesthesia, the optimum dose of sprays is unclear. We compared 5 versus 10 sprays of 10% lidocaine for topical anesthesia during bronchoscopy. METHODS: In this investigator-initiated, prospective, multicenter, randomized clinical trial, subjects were randomized to receive 5 (group A) or 10 sprays (group B) of 10% lidocaine. The primary objective was to compare the operator-rated overall procedure satisfaction between the groups. RESULTS: Two hundred eighty-four subjects were randomized (143 group A and 141 group B). The operator-rated overall procedure satisfaction, VAS [mean (SD)] was similar between the groups [group A, 74.1 (19.9) and group B, 74.3 (18.5), P =0.93]. The VAS scores of patient-rated cough [group A, 32.5 (22.9) and group B, 32.3 (22.2), P =0.93], and operator-rated cough [group A, 29.8 (22.3) and group B, 26.9 (21.5), P =0.26] were also similar. The time to reach vocal cords, overall procedure duration, mean doses of sedatives, the proportion of subjects willing to return for a repeat procedure (if required), and complications were not significantly different. Subjects in group A received significantly less cumulative lidocaine (mg) [group A, 293.9 (11.6) and group B, 343.5 (10.6), P <0.001]. CONCLUSION: During bronchoscopy, topical anesthesia with 5 sprays of 10% lidocaine is preferred as it is associated with a similar operator-rated overall procedure satisfaction at a lower cumulative lidocaine dose compared with 10 sprays.

Role of endobronchial electrocautery in management of neoplastic central airway obstruction: initial experience with seven cases.

BACKGROUND: Central airway obstruction (CAO) due to malignant and benign conditions is common. Tumour ablation by various techniques helps effective palliation of symptoms in such patients. Tumour ablation using endobronchial electrocautery (EBEC) with flexible bronchoscope (FB) is an established procedure. However, there is paucity of data from India on this topic. METHODS: EBEC was performed in seven patients with CAO; six of these patients had malignant (non-small cell carcinoma) and one had benign aetiology (tracheal fibro-epithelial polyp) as the cause of CAO. Pre- and post-procedure assessment was done with the help of Speiser's symptomatic scoring. RESULTS: Mean age of the patients was 52.9 +/- 7.0 years; there were five males. All the patients had symptomatic relief after the procedure; in five of them the improvement in symptom scores was significant. No major complication was encountered in any patient. CONCLUSIONS: EBEC can be a safe, effective and cost-effective tool for palliation in patients with benign or malignant CAO. It is especially beneficial for centres where cost of bronchoscopic laser and cryotherapy is prohibitive.

Tracheal polyp treated with endobronchial electrocautery.

Fibroepithelial polyps of trachea are extremely rare. Here, we report a case of tracheal polyp in a 40-year-old woman that was managed successfully with endobronchial electrocautery with a review of the relevant literature.

Effects of ergoreflex on respiration and other efferent effects in adult male patients with chronic obstructive pulmonary disease.

In COPD, overactivation of ergoreceptors may be a link between peripheral changes, sympathetic over activation and increased hemodynamic and ventilatory responses to exercise. The current study was undertaken to test the hypothesis that, ergoreflex in COPD patients is hyperactive and contributes to breathlessness and exercise limitation. The aim of study was to (1) demonstrate its hyperactivity in COPD (2). To record other efferent effects. Twenty stable COPD male patients aged 50 +/- 2.5 years and twenty healthy male subjects aged 48 +/- 3.5 years were studied under experimental and control groups. The ergoreflex contribution to cardio respiratory parameters was assessed by post-handgrip regional circulatory occlusion method (PH-RCO) and computed as the difference in heart rate and respiratory rate response between PH-RCO and control run without PH-RCO. Results were analyzed for significance between two groups by repeated measures ANOVA. COPD patients showed over activation of ergoreflex as compared to control subjects in terms of heart rate during sustained hand grip (SHG) exercise (117 +/- 1.22 versus 89 +/- 0.89) beats/min, recovery heart rate (p < 0.001), and respiratory rate during SHG (24 +/- 0.54 versus 19 +/- 03.24) breaths/min and recovery respiratory rate (p < 0.001). Degree of overactivation of ergoreflex was significant in COPD patients (p < 0.001). In COPD, overactivity of ergoreflex is associated with abnormal cardio respiratory reflex control. COPD patients showed overactivation of sympathetic nervous system as evidenced by heart rate changes during exercise and delayed recovery.

Novel use of metallic stent to control post-debulking bleeding in a patient with central airway obstruction.

Bronchoscopy-related bleeding is often encountered and is usually self-limiting or controllable by conservative measures. However, major bleeds can be life threatening for the patient as well as challenging for the physician to manage. There are several methods to achieve adequate haemostasis should a significant airway bleed occur. In this context, we describe a patient who had a post-bronchoscopic debulking bleed which persisted despite use of all available measures, and we deployed a self-expanding metallic stent in an attempt to control it. To the best of our knowledge, this is the first instance of a metallic airway stent being used to control bronchoscopy associated bleeding, though reports of its usage in management of intractable haemoptysis exist in the literature.

Management of chronic respiratory diseases during viral pandemics: A concise review of guidance and recommendations.

Coronavirus disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is an acute respiratory disease that can lead to respiratory failure and death. Although anticipated that patients with chronic respiratory diseases would be at increased risk of SARS-CoV-2 infection and more severe presentations of COVID-19, it is striking that these diseases appear to be underrepresented in the comorbidities reported for patients with COVID-19. The first wave of COVID-19 has taught us important lessons concerning the enormous burden on the hospitals, shortage of beds, cross infections and transmissions, which we coped together. However, with the subsequent waves of COVID-19 or any other viral pandemic, to ensure that patients with respiratory illnesses receive adequate management for their diseases while minimizing their hospital visits for their own safety. Hence, we prepared an evidence-based summary to manage outpatients and inpatients suspected or diagnosed with COPD, asthma and ILD based on the experience of the first wave of COVID-19 and recommendations by expert societies and organizations.