A cross sectional observational study on uncontrolled bronchial asthma and inhaler technique among out patients in a tertiary care centre in Western Maharashtra.

Background: The 2014 Asia Pacific - Asthma Insight and Management (AP-AIM) study showed that none of the Indian asthmatics had controlled asthma when evaluated objectively. Our study aims to detect through objective measurements, uncontrolled asthma in OPD patients, the adequacy of their inhaler technique, and their awareness regarding the importance of inhaler technique. Method: The asthma Control Test (ACT) score was used to screen for uncontrolled asthma. A validated objective questionnaire and scoring were used to objectively assess the correctness and awareness of the inhalation technique. Result: The study was carried out over 2 month period and 80 patients meeting the inclusion criteria were enrolled. Out of 80 patients; 47 (58.75%) had well-controlled asthma and 33 (41.25%) had uncontrolled asthma. 64 (80%) patients had good, and 16 (20%) had poor inhalation techniques. Among the 64 patients with good inhalation technique 43 (67.18%) had well-controlled asthma and 21 (32.82%) had uncontrolled asthma. Among the 16 patients with poor inhalation technique 4 (25%) had well-controlled asthma and 12 (75%) had uncontrolled asthma. There was a statistically significant association between asthma control and inhaler technique (P value 0.002). In the study population 56 (70%) patients were aware of the inhalation technique and 24 (30%) were unaware of the inhalation technique. Out of the 56 patients who were aware of the inhalation technique 53 (94.64%) had good inhaler technique and 3 (5.36%) had poor inhalation technique. Among the 24 patients who were unaware of the inhaler technique 11 (45.83%) had good inhaler technique and 13 (54.17%) had poor inhaler technique. There was a statistically significant association between awareness of inhaler technique and good inhaler technique (P value 0.001). Conclusion: There is a statistically significant association between asthma control and inhaler technique and between inhaler technique and inhaler awareness. Improving the awareness regarding inhaler technique among bronchial asthma patients is the way forward to improve asthma control in our country.

Case Report: Autoimmune Pulmonary Alveolar Proteinosis after COVID-19: A Report of Two Cases.

Autoimmunity has been extensively established as a characteristic feature of the post-COVID-19 syndrome. There is evolving evidence of immune system dysregulation leading to the development of autoimmune phenomena in patients with COVID-19. This immune dysregulation may range from the production of autoantibodies to the new onset of rheumatic autoimmune diseases. An extensive literature search in databases from December 2019 to date revealed that no cases of autoimmune pulmonary alveolar proteinosis (PAP) were reported in post-COVID patients. In this context, we report a novel case series of two cases of new-onset autoimmune PAP in post-COVID patients, an entity that has not been described before. We recommend further studies to better understand this association between new-onset autoimmune PAP and SARS-CoV-2.