ABSTRACT
Background: Bronchiectasis is common in patients with Chronic Obstructive Pulmonary Disease (COPD). COPD with bronchiectasis has been considered a phenotype with worse lung function and more severe exacerbations. There is scarce literature on the characteristics and optimal management of such patients.Methods:Patients with COPD reporting within the one-year study period were subjected to High Resolution Computed Tomography (HRCT) scan of the thorax. Sputum was sent for Gram-stain and culture/sensitivity for patients found to have bronchiectasis. Bronchiectasis Severity Index (BSI) was calculated using the online BSI calculator. Association between presence of bronchiectasis and gender, lung function and frequency of exacerbations was statistically analysed.Results: Total 62 patients with COPD were enrolled. Bronchiectasis was present in 11 (17.7%) patients. The most common bacterial isolate from sputum of patients with bronchiectasis was Haemophilus influenza (54.54%). The prevalence of bronchiectasis was more in females (19.45% compared to 15.4% in males), but this association was not found to be statistically significant(p=0.748). Forced Expiratory volume in 1st second (FEV1) was found to be significantly lower in patients with bronchiectasis (p<0.05). There was increased frequency of exacerbations among patients with bronchiectasis. This association was however not found to be statistically significant (p=0.765), 1 (9.1%) patient had low BSI score (0-4), 3 (27.3%) patients had intermediate BSI score (5-8) and 7 (63.3%) patients had high BSI score (?9).Conclusions:The presence of bronchiectasis in COPD is a phenotype associated with a poor clinical course. The characteristics of this co-existence are largely unknown. More studies are required to properly characterize and manage patients with this coexistence.
ABSTRACT
Aim and Objective: To study the clinical, pathological andradiological profile of lung cancer in non-smokers in a tertiarycare center.Methods: 53 non-smokers diagnosed with lung cancerattending the Department of Respiratory Medicine, KingGeorge’s Medical College from September 2015 to August2017 were enrolled. Record of all diagnostic investigations andprocedures performed namely transthoracic fine needleaspiration cytology (FNAC) and biopsy, bronchoscopy,thoracoscopy, closed pleural biopsy, lymph-node FNAC andbiopsy, routine blood and sputum examinations and a detailedhistory were obtained. Data was analysed retrospectively.Results: The mean age of presentation was 53.8±11.6 years.Majority were females (60.4%). Most common presentingsymptom was cough (84.9%). Mean duration of symptoms was6.9 months. Pallor was the most common clinical examinationfinding (41.5%). Mass with effusion was the most commonradiological lesion (45.3%). 22.6% masses were centrallylocated. Transthoracic biopsy could diagnose 32 (60.4%)cases. Adenocarcinoma was the most common type in bothmales (76.2%) and females (78.1%). Epidermal growth factorreceptor (EGFR) mutation was positive in 46.3% ofadenocarcinoma. Exon 19 deletion was the more commonmutation.Conclusion: Lung cancer among never smokers is a distinctclass with risk factors and genetic features discrete from thoseassociated with tobacco smoke. Indoor air pollutants as well asETS are definitely implicated risk factors. Targetable mutationsare commoner in non-smokers and hence mutation testingshould always be done in such patients. It is important toconduct studies about the diverse characteristics of this entityto consolidate our knowledge of this growing group of cancer.