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Although a simple and useful pulmonary function test, spirometry remains underutilized in India. The Indian Chest Society and National College of Chest Physicians (India) jointly supported an expert group to provide recommendations for spirometry in India. Based on a scientific grading of available published evidence, as well as other international recommendations, we propose a consensus statement for planning, performing and interpreting spirometry in a systematic manner across all levels of healthcare in India. We stress the use of standard equipment, and the need for quality control, to optimize testing. Important technical requirements for patient selection, and proper conduct of the vital capacity maneuver, are outlined. A brief algorithm to interpret and report spirometric data using minimal and most important variables is presented. The use of statistically valid lower limits of normality during interpretation is emphasized, and a listing of Indian reference equations is provided for this purpose. Other important issues such as peak expiratory flow, bronchodilator reversibility testing, and technician training are also discussed. We hope that this document will improve use of spirometry in a standardized fashion across diverse settings in India.

Pulmonary alveolar microlithiasis (PAM) is a rare, chronic lung disease with bilateral intra-alveolar calcium and phosphate deposition throughout the lung parenchyma with predominance to lower and midzone. Although, etiology and pathogenesis of PAM is not fully understood, the mutation in SLC34A2 gene that encodes a sodium-phosphate co-transporter in alveolar type II cells resulting in the accumulation and forming of microliths rich in calcium phosphate (due to impaired clearance) are considered to be the cause of the disease. Chest radiograph and high-resolution CT of thorax are nearly pathognomonic for diagnosing PAM. HRCT demonstrates diffuse micronodules showing slight perilobular predominance resulting in calcification of interlobular septa. Patients with PAM are asymptomatic till development of hypoxemia and cor-pulmonale. No therapy has been proven to be beneficial except lung transplantation.

We present a case of severe H1N1 influenza with hypoxemic acute respiratory failure necessitating mechanical ventilation benefited from noninvasive positive pressure ventilation (NIPPV). The NIPPV may be of great use in treating patients with H1N1-related acute respiratory distress syndrome in a resource poor setting or when invasive ventilator is unavailable.

We report a case of middle-aged female presenting with mediastinal widening on chest radiograph owing to pleural effusion. The pleural effusion presenting as mediastinal widening on chest radiograph is rarely reported.

Background: Several studies have demonstrated considerable impairment of quality of life (QOL) in obstructive sleep apnea (OSA) patients, but its relation with severity of OSA is yet unclear. Study Objectives: To investigate the effects of OSA on the QOL and its association with the disease severity. Design and Setting: Observational, prospective case-control study. Materials and Methods: QOL of 69 OSA patients and 41 healthy controls were assessed using the Calgary sleep apnea quality of life index (SAQLI) on the morning following the polysomnography (PSG) study. Statistics: All statistical analyses were performed using the SPSS 17.0 (SPSS Inc., Chicago). Differences between sleep-related symptoms and SAQLI subscales scores were assessed with the Chi-square test and the Student t-test. Due to non-normal distribution, differences between SAQLI scores of controls and OSA patients were evaluated using a non-parametric Mann-Whitney test. Spearman correlation and backward multiple regression analysis were used to analyze the association between SAQLI scores and sleep indices and anthropometric variables and PSG variables. Results: Study included 69 cases (57 male and 12 females) with a mean age, weight, height, neck circumference, and body mass index 48.45 ± 10.12 years, 83.03 ± 16.48 kg, 159.75 ± 28.29 cm, 44.01 ± 3.23 cm and 30.77 ± 6.71 kg/m 2 . Mean apnea-hypopnea index was 26.39 ± 16.62. The median score of four SAQLI domains daily function, social interaction, emotional, symptoms and total mean SAQLI score were 3.64 (3.46-3.90), 3.77 (3.51-3.88), 3.64 (3.53-3.83), 4.80 (4.68-5.11), 4.09 (3.88-4.09) ,and 1.36 (1.29-1.71), 1.38 (1.24-1.62), 1.45 (1.23-1.62), 2.00 (1.78-2.26), 1.55 (1.46-1.73) for patients and controls respectively. All the individual domain scores and the mean SAQLI scores of patients were significantly higher than the controls. Conclusion: OSA causes significant impairment of QOL, but the severity of impairment is not directly proportional to the severity of OSA.

Aluminium phosphide (ALP) is a common agrochemical pesticide poisoning with high mortality rate. Primary manifestations are due to myocardial and gastrointestinal involvement. Pleural effusion in ALP poisoning is occasionally reported. We report a case of pleural effusion that developed after ALP ingestion and resolved along with recovery from poisoning.

Bronchoesophageal fistula in an adult is rarely encountered in clinical practice. Most commonly, they have malignant origin. We report a case of bronchoesophageal fistula secondary to trauma caused by upper gastrointestinal endoscopy. The patient presented with recurrent chest infections and dysphagia since he underwent endoscopic procedure for obstructed denture. Barium swallow study revealed fistulous connection between right lower lobe bronchus and esophagus.

A middle aged male presented to us with right side pneumothorax. Two hours after insertion of intercostals tube he felt discomfort and increased breathlessness. His chest examination showed crepitations. Chest radiograph showed partial expansion of right lung with opacity in right lower zone consistent with unilateral pulmonary edema. He was managed conservatively and improved with complete resolution on chest radiograph. Reexpansion pulmonary edema is an uncommon complication of the treatment of lung atelectasis, pleural effusion or pneumothorax and patho­genesis is unclear.

Objectives: This study, using a questionnaire and pulmonary function tests (PFTs), was aimed at assessing the prevalence of respiratory diseases and the impact of environmental factors on these diseases. Materials and Methods: 201 schoolteachers, residing in an urban area at moderate altitude (2200m), were administered a standardized questionnaire and subjected to PFTs. The data obtained was statistically analyzed. Results: 28.35% subjects had one or more chronic symptoms. Shortness of breath was present in 16.41%; wheeze in 14.43%; cough in 8.46%; sputum production in 8.46%; and wheeze with shortness of breath in 6.97%. The frequency of symptoms increased with age and smoking. Pulmonary functions were lower in subjects with symptom(s) as compared to those who were asymptomatic; forced expiratory vol­ume in one second (FEV1) showed the greatest reduction amongst the parameters studied. Functions were significantly lower in smokers and those using hydrocar­bon fuels. 3.98% had bronchial asthma; the prevalence was higher in females at 4.48%. The overall prevalence of chronic bronchitis was 8.46%; however among smokers this was 29.16% and in non-smokers 5.65%.