Effectiveness of Telemedicine Interventions in Chronic Obstructive Pulmonary Disease (COPD) Management: A Randomized Controlled Trial Comparing Yoga Therapy and Pulmonary Rehabilitation Over Three Months.

Background Pulmonary rehabilitation (PR) is an integral part of non-pharmacological therapy in chronic obstructive pulmonary disease (COPD). Yoga therapy (YT) has been shown to be beneficial in COPD, but the lack of large well-designed trials and standardized modules restricts its acceptability. This randomized control trial compares these two modalities in COPD patients via supervised tele-intervention. Objectives The primary objective of the study is to compare a 45-minute, five-days-per-week series of tele-YT (T-YT) with tele-PR (T-PR) for three months in terms of exercise capacity (6-Minute Walk Distance (6MWD)) in COPD patients. Methods COPD patients were randomly assigned (1:1) to T-YT or T-PR groups in a parallel-arm single-blinded controlled trial. The primary outcome is 6MWD recorded at baseline and after three months and secondary outcomes were symptom scores, Forced expiratory volume in the first second (FEV1), health-related quality of life (HrQoL), and depression and anxiety scores. Assessments were conducted at baseline and at the end of the three-month study period with a sample size of 75 in each group. Results A total of 150 consecutive patients with COPD were randomly assigned to either the T-YT (n = 75) or T-PR (n = 75) group. Their mean ± SD ages was 62.5 ± 7.0 years. The T-YT group had 55.5% males and 34.47% females, whereas the T-PR group had 44.5% males and 61.53% females. The trial was completed by 123 patients; 88% in the T-YT group and 76% in the T-PR group. Pre-intervention, the median (range) of 6MWD in T-YT and T-PR groups was 240 (120-600) m and 240 (120-660) m, respectively. There was statistically significant improvement in both groups respectively (p<0.001) post intervention from baseline but no significant intergroup difference (p = 0.486). A similar trend was seen in secondary outcomes with significant intragroup improvements and non-significant inter-group differences except FEV1%, which showed neither intragroup nor intergroup significant improvement. Conclusion Using a validated module, a three-month T-YT improves exercise capacity, symptom scores, HrQoL, and depression and anxiety scores similar to T-PR. T-YT is an acceptable alternative to T-PR in the management of COPD.

Prevalence and predictors of restless legs syndrome among patients having stable chronic obstructive pulmonary disease.

BACKGROUND: Patients having COPD share some factors, e.g., chronic hypoxemia, anemia of chronic disease and nicotine use, which are also the risk factors for RLS hence predispose them to experience RLS in higher then general population. There are limited studies with methodological constraints evaluating the prevalence and/or correlates of RLS among patients with COPD. METHODS: Consecutive adult patients of either gender, having stable COPD as per GOLD guidelines 2021, were assessed for RLS using IRLSSG (2014) criteria (excluding RLS mimics) and the severity of RLS was determined in participants having RLS. Phenomenology of RLS, past medical history and laboratory parameters were gathered. Insomnia and depression were assessed using the insomnia severity index and PHQ-9, respectively. RESULTS: Participants' (N = 210) mean age was 63.02 ± 8.19 years, and 83.8% of subjects were men. 12.9% of participants were found to have RLS. Among those having RLS, nearly half (51.9%) had moderate symptoms, and 18.5% experienced severe symptoms. RLS was more prevalent among younger, females, those having severe COPD, participants having exacerbation of COPD in the previous year, lower post-bronchodilator FEV1, higher dyspnea and COPD assessment test score. Multivariate analysis showed that younger age, female gender, lower post-bronchodilator FEV1, lower FEV1/FVC ratio and higher serum creatinine increased the odds of having RLS. Depressive symptoms were more frequent in participants having RLS. CONCLUSIONS: The present study found that the prevalence of RLS among patients with stable COPD was higher than the general population. Female gender, younger age, higher airflow limitation and higher serum creatinine (though in the physiological range) increase the odds of having RLS. Stable patients with COPD having these characteristics must be screened for RLS.

Aerosol drug therapy in critically ill patients (Aero-in-ICU study): A multicentre prospective observational cohort study.

BACKGROUND: In recent years, a significant understanding of delivering optimal aerosol therapy and the availability of various drugs and devices have led to an increase in its use in clinical practice. There are only a few studies available regarding their use in critically ill patients from a few parts of the world. We aimed to study the practice pattern of aerosol therapy in critically ill patients from Indian intensive care units (ICUs). METHODS: After ethical approval, this multi-centric prospective observational study was performed over a study period of four weeks. Newly admitted adult patients considered who had an artificial airway and/or ventilation (including non-invasive). Patients were followed up for the next 14 days or until ICU discharge/death (whichever came first) for details of each aerosol therapy, including ongoing respiratory support, drug type, and aerosol-generating device. RESULTS: From the nine participating centers across India, 218 patients were enrolled. Of 218 enrolled patients, 72.48% received 4884 aerosols with 30.91 ± 27.15 (95%CI: 26.6-35.1) aerosols per patient over 1108 patient days. Approximately 62.7% during IMV, 30.2% during NIV, 2.3% in spontaneously breathing patients with an artificial airway during weaning, and 4.7% were given without an artificial airway after weaning or decannulation. In 59%, a single drug was used, and bronchodilators were the most frequent. The jet nebulizer was the most common, followed by the ultrasonic and vibrating mesh aerosol generator. The ventilator setting was changed in only 6.6% of the aerosol sessions with IMV and none with NIV. CONCLUSION: Aerosol therapy is frequently used with a wide variation in practices; bronchodilators are the most commonly used drugs, and jet nebulizers are the most widely used.

A Lung Cancer Patient Presenting With Gynecomastia: An Uncommon Paraneoplastic Syndrome.

Lung cancer is the most common neoplastic disorder associated with paraneoplastic syndromes. The most common paraneoplastic syndromes are the syndrome of inappropriate release of antidiuretic hormone (SIADH), hypercalcemia of malignancy, ectopic Cushing's syndrome, and various other neurological syndromes. A few case reports have reported gynecomastia as a paraneoplastic syndrome. Recognition of this uncommon presentation can aid in the early detection of associated malignancies, thus potentially improving outcomes. In this article, we are presenting the case of a male patient in his late sixties who, on presentation, had gynecomastia and was eventually diagnosed with non-small-cell lung cancer (NSCLC).

The Role of Yoga in Hospitalized COVID-19 Patients: An Exploratory Randomized Controlled Trial.

Introduction The unpredictable course and sheer magnitude of coronavirus disease 2019 (COVID-19) have sparked a search for novel and repurposed pharmacological interventions. Non-pharmacological interventions may also play a role in the management of this multifaceted disease. This study aimed to evaluate the safety, feasibility, and effect of yoga in hospitalized patients with moderate COVID-19. Methods Twenty patients satisfying the inclusion criterion were randomized (1:1 ratio) into Intervention and Control groups. Patients in the intervention arm performed a one-hour yoga session that included pranayama and Gayatri mantra (GM) chant for up to 14 days. Sessions were fully supervised by a trained yoga trainer via an online platform. Patients in both groups received the normal treatment as per national guidelines. Outcome parameters were recorded on the 14th day/end of the hospital stay. Results Yoga is safe and feasible in hospitalized patients with COVID-19. The decline of high-sensitivity C-reactive protein (hs-CRP) levels was significantly greater in the Intervention Group. Quality of life (QOL), depression, anxiety, and fatigue severity scale (FSS) showed a decline in both groups with a significant decline observed in FSS scores of the Intervention Group. Median chest X-ray score values, duration of hospital stay, and reverse transcription-polymerase chain reaction (RT-PCR) conversion days were observed to be lower in the Intervention Group but were not significant (p>0.05). Conclusion The study found that incorporating pranayama and GM practices in hospitalized patients with moderate COVID-19 pneumonia was safe and feasible. It showed a notable reduction in hs-CRP levels and FSS scores in the Intervention Group, but the study was not powered to detect statistically significant results. Further research with larger sample sizes is needed for conclusive findings.

Post-COVID pulmonary fungal infections: An unanticipated predicament or a ticking time bomb? Clinico-microbiological profile of cases encountered during the second wave of COVID-19 pandemic at a teaching hospital in the Himalayas with a brief literature review.

Introduction: This study attempts to generate preliminary data regarding post-COVID pulmonary fungal infections, namely, COVID-19-associated pulmonary aspergillosis (CAPA), COVID-19-associated pulmonary mucormycosis (CAPM), and mixed infections from the Himalayas and compares the micro-radio-clinical profile and outcomes of the affected patients. Materials and Methods: A retrospective data analysis was conducted, where clinical profiles, microbiological and radiological reports, and outcomes of n = 16 patients of post-COVID pulmonary infections were compared. Results: Of n = 16 patients, n = 7 had CAPA (n = 5 Aspergillus fumigatus, n = 1 Aspergillus flavus, and n = 1 Aspergillus niger), n = 5 CAPM (Rhizopus arrhizus), and n = 4 with mixed infections (n = 3 infected with Aspergillus fumigatus and Rhizopus spp. and n = 1 with Aspergillus flavus and Rhizopus arrhizus). Thick-walled cavitary lesions, air-fluid levels, and multiple centrilobular nodules were some of the common radiological findings reported among these patients. Conclusion: The immuno-compromised state following COVID-19 infection and treatment might be responsible for the progression of regular exposure to the dense Himalayan vegetation into an invasive pulmonary fungal infection. Suspecting post-COVID pulmonary fungal infection is necessary for primary care physicians to ensure timely referral to higher centers. Mixed pulmonary fungal infections (coinfection with Aspergillus spp. and Rhizopus spp.) are also emerging as important sequelae of COVID-19.

Exercise Capacity in Patients With Chronic Obstructive Pulmonary Disease Treated With Tele-Yoga Versus Tele-Pulmonary Rehabilitation: A Pilot Validation Study.

Background In chronic obstructive pulmonary disease (COPD), pulmonary rehabilitation (PR) is an integral component of the non-pharmacological management of COPD. Yoga has proven to be beneficial in COPD, although well-designed comparative studies between the two modalities are lacking. This pilot study aims to compare these two modalities delivered as supervised tele-intervention. Methods The outpatient department (OPD) of a tertiary hospital recruited consenting, consecutive, inclusion-eligible COPD participants who were randomly assigned to intervention and control arms of 30 patients each. The intervention arm received a 45-minute tele-yoga therapy module (T-YT) validated by content validity ratio (CVR), computed using Lawshe's methodology and responses from 24 yoga specialists. The control arm received a 45-minute standardized tele-pulmonary rehabilitation session (T-PR). T-YT and T-PR were both managed through an online portal. Exercise capacity as measured by the six-minute walk distance (6MWD), symptom score (COPD assessment test [CAT], modified medical research council [mMRC]), forced expiratory volume in one second (FEV1%), quality of life (QoL) scores, St. George respiratory questionnaire (SGRQ), depression and anxiety scores (patient health questionnaire [PHQ-9] and generalized anxiety disorder scale [GAD-7] scores), were recorded at baseline and at the end of three months. Results 6MWD, symptom scores, SGRQ, PHQ-9, and GAD-7 all improved significantly from baseline within each group, but there was no statistically significant difference between the groups. FEV1% did not differ significantly between or among groups. This study shows T-YT module can be a reasonable substitute for T-PR in patients with COPD. Conclusions T-YT is beneficial in patients of COPD in terms of exercise capacity, symptom scores, and depression and anxiety scores and can be a reasonable alternative to T-PR.

Rare case of high amylase pleural effusion without pancreatitis, oesophageal rupture or malignancy.

High amylase pleural effusion remains an entity which includes a wide variety of differentials, with pancreatitis, oesophageal rupture or malignant pleural effusion being most commonly encountered in clinical practice. Keeping the clinical picture (suggestive of pain in abdomen preceding any respiratory complaints) and differentials at hand, the case was evaluated with contrast-enhanced CT of the thorax and abdomen which revealed normal pancreatic architecture and no abnormal communication was noted between the pancreas and pleural space. A contrast oesophagogram, done when pancreatitis was ruled out, showed no evidence of any leak. The patient underwent upper gastrointestinal endoscopy which was suggestive of an ulcer with fistulous communication with the pleural space. Following nasojejunal feeding and clipping of the fistulous tract the patient's symptoms improved.

Chemotherapy Associated Bilateral Secondary Spontaneous Pneumothorax.

Chemotherapy-associated pneumothorax is a rarely encountered oncological emergency. Herein, we present a rare chemotherapy-associated bilateral secondary spontaneous pneumothorax case of a man in his 60s with invasive breast carcinoma after four cycles of chemotherapy. He presented to our emergency department with acute onset dyspnea and left-sided pleuritic chest pain. A chest X-ray showed a left-sided pneumothorax, and an intercostal chest tube (ICT) was inserted with underwater seal drainage. After three days, he complained of sudden onset right-sided chest pain and increased dyspnea. A repeat chest X-ray revealed right-sided pneumothorax, which was managed with ICT again. Bilateral pleurodesis was done after a repeat chest x-ray showed complete lung re-expansion. The patient was doing well with no recurrence of pneumothorax after three months of follow-up. Male breast cancer is uncommon, and presentation with bilateral secondary spontaneous pneumothorax is rare. This case is reported as a rare complication of chemotherapy-associated bilateral spontaneous pneumothorax.

Clinical Profile, Risk Factors, and Therapeutic Outcome of Cavitating Fungal Pneumonia Coinfection in COVID-19 Patients: A Retrospective Analysis.

BACKGROUND: An end to the novel coronavirus disease 2019 (COVID-19) pandemic appears to be a distant dream. To make matters worse, there has been an alarming upsurge in the incidence of cavitating invasive fungal pneumonia associated with COVID-19, reported from various parts of the world including India. Therefore, it remains important to identify the clinical profile, risk factors, and outcome of this group of patients. METHODS: Out of 50 moderate to severe COVID-19 inpatients with thoracic computed tomographic (CT) evidence of lung cavitation, we retrospectively collected demographic and clinical data of those diagnosed with fungal pneumonia for further investigation. We determined the association between risk factors related to 30-day and 60-day mortality. RESULTS: Of the 50 COVID-19 patients with cavitating lung lesions, 22 (44 %) were identified to have fungal pneumonia. Most of these patients (n = 16, 72.7 %) were male, with a median (range) age of 56 (38-64) years. On chest CT imaging, the most frequent findings were multiple cavities (n = 13, 59.1 %) and consolidation (n = 14, 63.6 %). Mucormycosis (n = 10, 45.5 %) followed by Aspergillus fumigatus (n = 9, 40.9 %) were the common fungi identified. 30-day and 60-day mortalities were seen in 12 (54.5 %) and 16 (72.7 %) patients, respectively. On subgroup analysis, high cumulative prednisolone dose was an independent risk factor associated with 30-day mortality (p = 0.024). CONCLUSION: High cumulative prednisolone dose, baseline neutropenia, hypoalbuminemia, multiple cavities on CT chest, leukopenia, lymphopenia and raised inflammatory markers were associated with poor prognosis in severe COVID-19 patients with cavitating fungal pneumonia.

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.

Flexible bronchoscopy during the COVID-19 pandemic: A concise clinical review and practical recommendations.

Bronchoscopy is an extremely useful diagnostic and therapeutic procedure that finds an invaluable place in Pulmonology practice. Due to aerosol generation, bronchoscopy carries a high risk of infection transmission to health care workers and other patients. This fact is even more important in the present times of COVID-19 pandemic owing to its droplet- (and possibly aerosol-) mediated spread. With this background, a working group extracted literature through electronic search of PubMed and Google Scholar databases. All relevant documents were comprehensively reviewed and consensus recommendations formulated based on the level of available evidence. Where evidence was insufficient, Usual Practice Points were formulated based on expert opinion. This resultant document attempts to present clinical recommendations for performing flexible bronchoscopy in COVID-19 suspect/confirmed patients. It outlines important general considerations for bronchoscopy in these cases, provides an algorithmic approach to patient selection for bronchoscopy during these extraordinary times, and enlists critical do's and don'ts that should be followed before, during, and after the procedure. To conclude, flexible bronchoscopy must be cautiously performed amid the COVID-19 crisis. Judicious case selection and meticulous contact and airborne precautions are important to minimise infection transmission.

Prevalence and characteristics of venous thromboembolism in severe exacerbation of chronic obstructive pulmonary disease in a tertiary care hospital in India.

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) carries a high risk of venous thromboembolism (VTE). Pulmonary embolism (PE) and AECOPD increase the mortality and morbidity risk associated with each other. Racial and ethnic differences in VTE risk have been documented in multiple studies. However, there is a dearth of reliable Indian data on the same. This study was planned to find the prevalence of VTE in the setting of severe AECOPD in a tertiary care hospital in India and to identify the clinical, laboratory and radiological characteristics of VTE in severe AECOPD. A total of 156 consecutive patients admitted with severe AECOPD and meeting the specified inclusion and exclusion criteria were recruited. Thorough workup of all patients was done including ABG, serum D dimer, ECG, compression ultrasound of lower limbs and 2-D echocardiography. Patients with high pre-test probability score, or intermediate pre-test probability score at presentation with serum D dimer above the age adjusted cut-off underwent computerised tomography pulmonary angiography (CTPA).  Results were analysed using SPSS version 23.  Sixteen (10.3%) patients had VTE, 15 (93.75%) of them being cases of isolated PE. Female gender, higher cumulative past exposure to corticosteroid, higher alveolar-arterial gradient, right ventricular dysfunction, and higher mean pulmonary artery pressure were associated with increased risk for VTE. The prevalence of VTE in AECOPD in this study among an Indian population is higher than among other Asians, but lower than among the Blacks, the Caucasians and the Middle-East ethnicities. Since a vast majority of VTE presents as PE without DVT in the setting of AECOPD, the absence of deep vein thrombosis of lower limbs does not rule PE in the setting.

Bronchial artery embolization. What further we can offer?

INTRODUCTION: Massive hemoptysis is the most feared of all respiratory emergencies, with many underlying causes. In 90% of cases, the source of hemoptysis is the bronchial circulation. Despite high recurrence rates, bronchial artery embolization (BAE) remains the first-line treatment in management of hemoptysis. AIM: To establish pre-procedure and procedural protocols for BAE. MATERIAL AND METHODS: The study included a total of 50 patients referred to the Department of Radiology for complaints of hemoptysis. Pre-procedure computed tomography (CT) angiography for determination of responsible circulation was performed as a regular protocol except in cases presenting with life-threatening hemoptysis. Polyvinyl alcohol (PVA size, 300-500 µm and 500-700 µm) particles combined with gel foam embolization was performed. Successful catheterization and embolization of the targeted vessel was considered technical success and the cessation of hemoptysis to minimal levels was labeled clinical success. RESULTS: Thirty-two (64%) male and 18 (36%) female subjects comprised the study group. Forty (80%) patients had moderate to severe hemoptysis. Tuberculosis (80%) was the most common etiology. Five patients had severe AV shunting and were embolized with decremental particle size (500-700 µm followed by 300-500 µm) to occlude the bed and then embolize the artery. Technical success was achieved in all the patients, but clinical success was achieved in 40 (80%) patients. CONCLUSIONS: Bronchial artery embolization is a minimally invasive procedure recognized for primary management of hemoptysis. Preprocedure evaluation with CT angiography can add incremental value in management. Usage of decremental particle size is helpful to embolize large AV shunts.

Translation, cultural adaptation, and validation of the duke activity status index in the hindi language.

Background: The Duke Activity Status Index (DASI) is a validated questionnaire in English to assess the functional capacity (FC) of patients with cardiovascular disease (CVD). Aim: The aim of the study is to translate, cross-culturally adapt, and validate the DASI in Hindi. Settings and Study Design: Observational validation study. Methodology: Different translators translated the DASI into Hindi and then back-translated it into English. Validation for feasibility and psychometric properties of translated questionnaire was done on 200 adults, Hindi-speaking patients with CVD, who were advised exercise testing by a cardiologist. Statistical Analysis: Internal consistency (Cronbach's α) and test-retest reliability (Pearson's correlation coefficient) were calculated. Construct (correlation with the Canadian Cardiovascular Society Classification [CCSC] for angina and exercise capacity with treadmill testing [TMT]) and content validity (time taken to fill the questionnaire, ease of understanding the questionnaire items, and comprehensibility) were calculated.P < 0.05 was considered significant. Results: The Cronbach's α for internal consistency was 0.78, which indicates adequate relatedness among the items of questionnaire, and the test-retest reliability was 0.65 (P < 0.05). A significant correlation between CCSC (r = -0.60) and TMT (r = 0.56) was found. The median time taken by the respondents to fill the questionnaire was 4 min. Of all the respondents, 95.74% of the respondents agreed that the Hindi questionnaire was easy to comprehend and 97.87% patients correlated the translated items to their daily physical activity. Conclusions: The Hindi translated and culturally adapted version of the DASI is reliable, valid, and feasible to assess the FC in the Hindi-speaking CVD patients.

New combined assessment of chronic obstructive pulmonary disease: Utilization, pitfalls, and association with spirometry.

INTRODUCTION: Classification of chronic obstructive pulmonary (COPD) disease has changed from being solely based on spirometric variables to combined assessment including symptom scores and history of exacerbations/ hospitalizations. There is both lack of awareness regarding change in its assessment as well as underutilization due to time constraints and seeming complexity. Moreover, treatment of COPD needs to be tailored according to the new combined assessment. AIMS: Current study was planned to look at current stratification of patients according to new revised combined assessment (Global Initiative for Chronic Obstructive Lung Disease GOLD 2017) in comparison to old(GOLD 2011) as well as its incorporation in clinical practice. Co-relation between revised combined assessment and spirometric staging was also assessed. METHODS: 418 consecutive COPD patients were enrolled, their dyspnea scores in terms of modified medical research council scale (mMRC), preceding history of hospitalization/ exacerbation over preceding one year and spirometric variables were recorded. Their stratification according to old and new classification recorded. Their past treatment records were reviewed and combined assessment if done recorded. RESULTS: Substantial shift of categories is seen from C and D respectively to stage A and B on applying the new classification compared to old i.e more severe to less severe. Secondly, revised combined assessment is still highly underutilized. Revised combined assessment has positive co-relation with spirometry and post bronchodilator forced expiratory volume in 1 second(FEV1). CONCLUSIONS: Management of substantial number of stable COPD patients may need to be stepped down in accordance with revised combined assessment. There is a need to disseminate information regarding change in COPD classification and stress on its incorporation in our day-to day clinical practice. Revised combined assessment has positive co-relation with spirometry, stressing its utility even in peripheral centers without spirometry facilities.

Eosinophilia in Advanced HIV Infection with Hyperinfection Syndrome: A Case Report.

Strongyloides stercoralis is a soil-transmitted helminth that occurs almost worldwide, yet estimates about its prevalence are not well documented. The spectrum of clinical manifestations of strongyloidiasis is wide, ranging from asymptomatic disease to hyperinfection or dissemination of larvae involving multiple organ systems. Immunosuppression can increase the risk of hyperinfection syndrome in patients with strongyloidiasis. Strongyloidiasis continues to remain a neglected tropical disease, the diagnosis of which is often overlooked by clinicians and diagnosticians alike. The paucity of published literature from India further accentuates this problem. We hereby present a case report with the aim of elucidating this relatively underreported infection.

Association of comorbid anxiety and depression with chronic obstructive pulmonary disease.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a disease with known systemic manifestations including psychiatric comorbidities most commonly being depression and/or anxiety. Studies regarding the association of these psychiatric comorbidities in terms of symptom scores, spirometric variables, and hospitalizations among patients of COPD are lacking, especially in India. MATERIALS AND METHODS: One hundred and twenty-eight patients of COPD attending the Outpatient Department of AIIMS Rishikesh, and fulfilling inclusion criteria were screened by Hospital Anxiety and Depression Scale, and those who scored above the cutoff underwent psychiatric evaluation using the International Classification of Diseases, Tenth Edition Diagnostic Criteria for Research for confirmation of their diagnosis. All patients were then evaluated by physician-administered questionnaire for symptom scores by Modified Medical Research Council Scale (mMRC) for dyspnea, Hindi-validated Clinical COPD Questionnaire (CCQ), and for functional capacity by 6-min walk distance (6MWD) according to the American Thoracic Society Guidelines. All patients also underwent spirometric evaluation, and postbronchodilator forced expiratory volume in 1 s (FEV1), BODE index (body mass index [BMI], postbronchodilator FEV1, mMRC for dyspnea, 6MWD) and a history of hospitalization/exacerbations over the past 1 year was also obtained. Comparison of symptom scores, functional capacity in terms of 6MWD, history of exacerbations or hospitalizations over preceding 1 year and BODE index between patients of COPD with or without anxiety and/or depression was done. RESULTS: COPD patients with comorbid anxiety and/or depression had higher dyspnea scores and CCQ scores though the proportion of current smokers, BMI, history of hospitalization over the past 1 year, FEV1, and BODE index was not statistically significant between the two groups. CONCLUSIONS: Depression is a common comorbidity and leads to higher symptom scores as well as poorer quality of life among COPD patients.