The coronavirus disease of 2019 (COVID-19) is an ongoing pandemic which is known to predominantly affect the respiratory system. Oxygen (O₂) therapy has a profound role in the treatment of COVID-19 patients. The pandemic has drawn special attention to ensure uninterrupted O₂ supply to all hospitals, especially those catering to COVID-19 patients. During the pandemic, a rational use of O₂ therapy is essential. This includes optimal supplemental O₂ therapy, careful monitoring of patients, and escalation as well as de-escalation of O₂ therapy when indicated. We summarize the various sources of O₂ to health-care establishments and various O₂ delivery devices which are of paramount importance to ensure seamless O₂ supply in the pandemic scenario.

Severe acute respiratory syndrome-coronavirus 2 has spread rapidly worldwide infecting ≥4 million people including ≥2.9 million deaths and overwhelming health-care systems globally. It has prompted governments to open field medical facilities to decongest hospitals and triage patients. Governments are preparing for a stage 3 surge in cases leading to a situation of “severe shortage” of mechanical ventilators due to an overwhelming number of cases. Health authorities are looking into measures for mass production of ventilators with locally available materials. However, when deploying these devices on patients, it is imperative to ascertain if they are safe and do not perpetuate a vicious circle of worsening lung injury and death. The Association for the Advancement of Medical Instrumentation and the Medicines and Healthcare Products Regulatory Agency have brought out guidelines that emergency ventilators manufactured for the current epidemic need to satisfy.

Asthma poses a serious burden and remains poorly understood and unrecognized, in lower- and middle-income countries such as India where healthcare resources are already constrained. Several misconceptions exist among Indian patients regarding asthma, including the nature of the disease. Poor adherence to maintenance treatment leads to inadequate control of underlying inflammation which, in turn, increases the chances of subsequent exacerbations. Effective management of asthma should aim to control symptoms, decrease risk of exacerbations, and minimize fixed airflow limitation and side effects. Patient education and counseling also play a key role. A control-based management of asthma is recommended with the adjustment of medications via a stepwise approach. A single inhaler for both maintenance and reliever therapy offers an approach that can provide rapid relief, simplify asthma therapy, and prevent asthma exacerbations, while decreasing the total corticosteroid dose taken over time. For this review, a literature search was conducted using PubMed and other library searches to collate data on the Indian patients’ perspectives on the level of asthma control and the associated risk of asthma exacerbations. We discuss the perceptions among Indian asthma patients regarding the disease, the gaps in asthma management, the key aspects of Global Initiative for Asthma Guidelines, and the role of single inhaler for both maintenance and reliever therapy in the management of asthma.

Despite rapidly evolving health-care systems, India continues to have a high disease burden for asthma and chronic obstructive pulmonary disease (COPD). The Asia-Pacific Asthma Insights and Management survey clearly revealed that asthma management remains very poor with worst clinical outcomes in India. Potent inhaled corticosteroids (ICS) and quick onset of long-acting beta2-agonist (LABA) are considered to be optimal dual therapy for management of asthma and COPD. Fluticasone's long-term action against inflammation and formoterol's rapid long-term bronchodilator action are vital clinical attributes for optimal asthma maintenance treatment. In an 8- and 12-week trial, dual therapy of fluticasone and formoterol (FF) reported lung function improvements and better control of asthma than its monotherapy. A large clinical study revealed mild adverse events of dual FF than other dual ICS-LABA combinations. Recent pooled analysis of asthma showed that fluticasone shares a lower risk of pneumonia in asthma. Dual ICS-LABA therapies are preferred in COPD individuals with history of exacerbations. Numerous clinical studies showed significant efficacy, dose adjustments/switching, and safety outcomes with dual FF therapy in asthma and COPD. Dual FF inhaler therapy ensures highly potent anti-inflammatory activity and sustained bronchodilation, thus making this a preferred combination in terms of efficacy, safety, and patient adherence in asthma and COPD. This present review focuses on the combination therapyof formoterol and fluticasone for managing asthma and COPD.

Background: Treatment for acute hypoxemic respiratory failure (AHRF) includes treating the underlying disease, conventional oxygen therapy (COT), noninvasive ventilation (NIV), high-flow nasal oxygen (HFNO), and invasive mechanical ventilation. Aim: The aim of this study was to compare the use of HFNO and NIV in patients with moderate-to-severe AHRF to the tertiary level intensive care unit (ICU) of a teaching hospital. Methods: All adult patients admitted to the ICU with AHRF and failed COT were included. Administration of HFNO or NIV was protocol-based and targeted improvement in oxygen saturation, respiratory rate, PaO₂, and PaCO₂. Demographic data, clinical details, vital parameters, and laboratory findings were noted at prespecified intervals. Acute Physiology and Chronic Health Evaluation II at 24 h of ICU admission and daily Sequential Organ Failure Assessment were noted. The primary outcome was failure of treatment modalities defined as need for intubation and invasive ventilation. The secondary outcomes measured at 28 days were differences in ventilator-free days, ICU and hospital length of stay, patient comfort, and mortality. Results: A total of 35 patients were included in the study. Treatment failure was 20.8% (5/24) in the NIV group and 36% (4/11) in the HFNO group (P = 0.32). The number of ventilator-free days at day 28 was 22.67 ± 9.92 and 19.36 ± 12.45 (P = 0.44) in the NIV and HFNO groups, respectively. Mortality at 28 days was 12.5% (3/24) and 27.2% (3/11) in the NIV and HFNO groups, respectively (P = 0.282). Conclusion: Treatment with HFNO is associated with nonsignificant increase in the need for intubation and 28-day mortality compared to NIV. Larger studies are required to assess the utility of HFNO in moderate-to-severe AHRF.

Background: As COVID-19 continues to spread globally, a safe workforce reentry for people with elevated individual and occupational risk from COVID-19 is essential. Risk stratification may help to identify individuals with COVID-19 risk levels and take appropriate measures. Objectives: (a) To reduce the burden of (COVID-19 among) corporate health-care ecosystem by multiple layers of screening of employees and their families through Nurse Education Health Assistants (NEHA) mobile application and using VIEW (COVID-19 Early Warning System) scores. (b) To offer teleconsultation services to individuals with the assistance of doctors and NEHA coaches (c) To assess accuracy/efficacy of VIEW system. Materials and Methods: A cross-sectional survey using NEHA mobile application was conducted among 2424 employees and their families of a leading multinational company. The human resource staff of the company collected data using NEHA application and uploaded it through a web portal. Further investigation was carried out by NEHA coaches through telephonic consultation using VIEW data. Results: More than half of the participants received the same VIEW scores by system and doctor zone, i.e., A VIEW score (58.54%), B VIEW score (59.63%), and C VIEW score (66.67%). System zone of VIEW system was compatible to categorize participants depending upon the level of risk probability toward COVID-19. Furthermore, NEHA coach and doctor gave the same VIEW scores under A (81.74%), B (67.63%), and C (38.46%). Conclusion: VIEW system is useful to detect risk probability toward COVID-19 infection and stratify patients under different VIEW zones to prioritize medical care, identify isolation needs, identify hospitalization needs at a scale.

Introduction: Severe acute respiratory syndrome coronavirus 2 has caused a worldwide pandemic. This study was aimed to describe the clinico-demographic, hematological, and comorbidity profile in a group of coronavirus disease 2019 (COVID-19) patients at a tertiary care center in north India. Materials and Methods: We conducted a prospective, single-center collection of data regarding clinico-epidemiological, hematological parameters, and comorbidity profile of COVID-19 patients admitted at a tertiary care facility. Results: Data from 200 patients with COVID-19 were collected and analyzed. The median age of the patients was 48 years, with 63% males, and 78% patients were from urban area. Ten patients were smokers while 11 patients were alcoholic. The occupation of 20.6% of patients was related directly or indirectly with medical or allied professions. The most common mode of transmission of COVID-19 was direct close contact with microbiologically confirmed patients. Fever (n = 93; 46.5%) was the most common presenting symptom and the median duration of onset of symptoms before admission were 3.5 days (range 2–6 days). In hematological profile, lymphopenia (n = 48; 24%) had been the most common documented finding. Comorbidities were present in 39 (19.5%) patients, of which diabetes mellitus (n = 25; 12.5%) was the most common. Furthermore, the case fatality rate in our study was 1.5%. Conclusion: Among all patients of COVID-19 at our center, the characteristic findings included high proportion of male patients with younger to middle-age group, diabetes as most common comorbidity and people who were directly or indirectly in contact with the health-care system were more prone for developing the disease.

Background: Asthma and bronchiectasis are critical diseases for public health. In some patients, asthma and bronchiectasis exist together, and bronchiectasis negatively affects asthma control. This study aimed to evaluate the clinical impacts of coexisting asthma and bronchiectasis on patients. Methods: This was a retrospective single-center study on data collected from electronic medical records between January 2014 and January 2017. Patients were divided into three groups, wherein asthma (n = 33), bronchiectasis (n = 33), and coexisting asthma and bronchiectasis (n = 33) were compared. Asthma diagnosis was made according to the guidelines of Global Initiative for Asthma. Confirmation of bronchiectasis diagnosis was made by high-resolution computed tomography. Patients with cystic fibrosis and those who have asthma–chronic obstructive pulmonary disease overlap syndrome were excluded from the study. Results: Medical records of 1467 patients were analyzed. Among them, well-matching 99 patients in terms of gender and comorbid diseases were taken (33 of them had only asthma, 33 had only bronchiectasis, and 33 had coexisting asthma and bronchiectasis). Forty (40.5%) men and 59 (59.5%) women with a mean age of 45.0 ± 5.2 were included in the study. Asthma and bronchiectasis coexistence had lower forced expiratory volume in 1 s (FEV1) (%), forced vital capacity (FVC) (%), FEV1/FVC (%), and FEV1 (L) ratios (P = 0.0001). Moreover, total immunoglobulin E levels were the highest in this group (P = 0.0001). The most frequently observed microorganism in the culture tests was Pseudomonas aeruginosa in the bronchiectasis-only as well as in asthma + bronchiectasis groups. Conclusions: Asthmatic patients who have bronchiectasis revealed lower asthma control levels and worse respiratory function test results than other groups.

Introduction: Patients with obstructive sleep apnoea syndrome (OSAS) are often prescribed the use of continuous positive airway pressure (CPAP) devices to overcome obstruction during sleep. We aimed at assessing the adherence rates to CPAP therapy in two clinical subtypes of OSAS. Patients and Methods: Patients diagnosed with positional or rapid eye movement related OSAS using polysomnography were included. Patients were contacted by telephone calls to collect data. Inclusion criteria were age >18 years, a total apnea-hypopnea index (AHI) >5, and a physician recommendation to initiate therapy with a CPAP device. Patients were excluded if they had known neurological disorders, were unwilling to answer all questions and had no recommendation to use CPAP therapy. Results: A total of 286 patients, 99 females (34.6%) and 187 males (65.4%), with a mean age of 56.5 ± 11.3 years were included. There were 134 (46.9%) CPAP users and 152 (53.1%) CPAP nonusers. Reasons for not using the CPAP device included unwillingness to use the device (n = 73, 48%), reduced patient comfort due to noise, hose, or air pressure (n = 31, 20.3%), reimbursement problems (n = 38, 25%), and reasons such as recovery or operation (n = 10, 6.5%). Age, duration of use/months, number of nights per week during which the device was used and the mean number of hours per night were not significantly different between OSAS types (P > 0.05), while the mean AHI and body mass index were significantly different between OSAS types (P < 0.05). Conclusion: A significant proportion of OSAS patients do not use CPAP devices due to various reasons. Adherence to CPAP therapy was not significantly different between groups.

Video-assisted thoracoscopic surgery (VATS) is a less invasive approach for thoracoscopic surgery providing better visualization through minimal access. In addition, it offers less postoperative pain, fewer operative complications, and shortened hospital stay. These advantages make VATS ideal for the pediatric age group. Various societies recommend the use of VATS for Stage 2 pulmonary empyema and also in some cases of early Stage 3 where the plane of cleavage exists between the pleura and the exudate. A well-executed one-lung ventilation (OLV) is necessary for a successful VATS; however, performance of OLV and postoperative pain management in children poses a challenging task for an anesthesiologist.

Aspergillus species, especially Aspergillus fumigatus, can cause varied pulmonary manifestations depending on the host immune status and duration of infection. Chronic pulmonary aspergillosis (CPA) is an under-reported entity, and its diagnosis remains a diagnostic challenge for clinicians. CPA can have varied presentations including chronic cavitary pulmonary aspergillosis (CCPA), subacute invasive pulmonary aspergillosis, and chronic fibrosing pulmonary aspergillosis. Underlying lung diseases such as chronic obstructive pulmonary disease and sequelae of pulmonary tuberculosis predisposes these individuals to CPA. These cases can present as chronic cough with hemoptysis even requiring emergency bronchial artery embolization. Here, we present a series of four CCPA cases who were diagnosed on the basis of clinico-radiological features and the Aspergillus-specific IgG antibody levels. A review of case series published in India is also presented.

This case illustrates a potential complication of mechanical ventilation in COVID patients, which can mimic as a pneumothorax on chest X-rays. Recognizing this complication in critically ventilated patients is important to avoid unnecessary surgical intervention, which can further add to the patient's morbidity and increase the duration of hospital stay.

Globally, millions of people have been impacted with COVID-19. A fraction of these people develop severe respiratory distress and require prolonged intensive care unit stay. With this, and with the improving recovery rate, the numbers of post-COVID survivors are steeply increasing. This demands an early, effective, inexpensive, and safe post-COVID pulmonary rehabilitation (PR) in a low available resource setting. A 56-year-old female diagnosed to have COVID-19 pneumonitis with acute respiratory distress syndrome developed severe exercise limitation after discharge, and a supervised low resource home-based PR program was initiated. The PR was followed as per the American Thoracic society/European Respiratory Society guidelines for 6 weeks with supplemental oxygen with a progressive metabolic equivalent of task level training. By the end of 6 weeks, the patient was independent in most of her self-care activities and was ambulatory in and around the house. We conclude with this case report that, by maintaining necessary precautions as recommended by the World Health Organization, PR can be delivered to remotest places with minimal resources and the outcome of this can make an individual independent in the self-care activities at the least.

Miliary tuberculosis (TB) is an uncommon cause of acute respiratory distress syndrome (ARDS) with a high mortality. Early diagnosis and timely initiation of treatment are important for good outcome. We report the case of a 23-year-old female who needed admission to intensive care unit (ICU) due to ARDS. On routine investigations, the cause of ARDS could not be ascertained. Finally, high-resolution computed tomography of the chest and bronchoscopic-guided lung biopsy were done which confirmed the etiology to be miliary TB. The patient showed an improvement after starting antitubercular therapy with steroids. One week later, the patient's condition was stabilized and was shifted out of ICU. This case report emphasizes that miliary TB, though difficult to diagnose, should always be considered a differential diagnosis in patients with ARDS, as early initiation of treatment can prove to be lifesaving.

Presented here is a case of 46-year-old Hindu male with a complaint of progressive shortness of breath, chest discomfort, fever, generalized weakness, and malaise over 6 months. He had a past history of diabetes mellitus (on oral antihyperglycemic agents) and pulmonary tuberculosis, for which he took DOTS category-1 antitubercular treatment for 9 months about 10 years back. On examination, he was febrile with stable vitals; breath sounds diminished over the right side of chest with stony dull percussion note. A provisional diagnosis of right-sided pleural effusion was made, and chest X-ray posteroanterior (PA) view confirmed the same. Diagnostic thoracentesis was done, which showed that the fluid was exudative in nature. The microscopy of centrifuged fluid debris strikingly showed microfilariae of Wuchereria bancrofti. Eosinophils and macrophages were in plenty without any evidence of malignancy or lymphoma. The complete blood count confirmed eosinophil >30% with absolute eosinophil count to be 2400 cells. A diagnosis of filarial pleural effusion was made, and he was started on antihelminthic medication. There was a remarkable improvement in his symptoms over 14 days of starting the therapy. He was maintained on drugs for 6–8 months. There was complete resolution of his effusion and respiratory symptoms.

Chylothorax is a rare complication after total thyroidectomy with radical neck dissection, and isolated right side chylothorax is even rarer. Treatment may be conservative or surgical. Besides being helpful in making a diagnosis, thoracic duct lymphangiography (TDL) may be therapeutic in some cases. However, its application in high output chylous leak is not fully explored. Here, we present a rare case of right-sided high output chylothorax, secondary to total thyroidectomy, successfully treated with TDL.

Lymphangioleiomyomatosis (LAM) is a cystic lung disease frequently associated with reduced exercise capacity, mostly affecting young women. The disease is characterized by progressive pulmonary cystic change, recurrent pneumothorax, chylous pleural collections, and in most cases, progressive respiratory failure. Diagnosis is made by a combination of clinical features and computed tomography scanning or, with lung biopsy. We present a case report of a young woman who suspected of LAM and diagnosed with cystic lung disease, admitted to the intensive care unit in view of worsening hypoxia associated with pneumothorax. She was on ventilator support and placement of repeated intercostal drains and had a tracheostomy to step down to bilevel positive airway pressure support, after the medical stabilization. She was referred for pulmonary rehabilitation, in which she showed good outcomes and recovered well.

We report a case of broncho-esophageal fistula associated with tuberculosis. A 29-year-old female diagnosed with smear-positive pulmonary tuberculosis on anti-tuberculosis treatment for 2 months presented with complaints of cough on food intake with food particles present in the expectorant. Radiological examination revealed mediastinal lymphadenopathy and upper gastrointestinal endoscopy revealed multiple fistulous tracts in the esophagus. Small fistulae were treated by clipping and large fistulae were treated with self-expandable metallic stents which resulted in the alleviation of symptoms.

Bilateral whole lung lavage (WLL), a complex procedure involving large volume saline washes of both lungs is a standard treatment for pulmonary alveolar proteinosis. Uncommonly, following large volume oil aspiration, the ensuing fulminant lipoid pneumonia (“oil drowning”) can be fatal, and therapeutic WLL can be lifesaving. In this report, we describe an oil drowning situation salvaged with high-risk WLL and highlight procedural and critical care aspects from a respiratory therapist's perspective.