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Introduction: Pneumococcal diseases pose a significant public health concern in India, with substantial morbidity and mortality, with the elderly and those with coexisting medical conditions being most at risk. Pneumococcus was also seen to be one of the main reasons for co‑infection, pneumonia and complications in COVID. Current guidelines recommend vaccination for specific adult populations, but there is a lack of uniformity and guidance on risk stratification, prioritisation and optimal timing. Methods: Nation Against Pneumococcal Infections – Expert Panel Opinion (NAP‑EXPO) is a panel convened to review and update recommendations for adult pneumococcal vaccination in India. The panel of 23 experts from various medical specialties engaged in discussions and evidence‑based reviews, discussed appropriate age for vaccination, risk stratification for COPD and asthma patients, vaccination strategies for post‑COVID patients, smokers and diabetics, as well as methods to improve vaccine awareness and uptake. Outcome: The NAP‑EXPO recommends the following for adults: All healthy individuals 60 years of age and above should receive the pneumococcal vaccine; all COPD patients, regardless of severity, high‑risk asthma patients, post‑COVID cases with lung fibrosis or significant lung damage, should be vaccinated with the pneumococcal vaccine; all current smokers and passive smokers should be educated and offered the pneumococcal vaccine, regardless of their age or health condition; all diabetic individuals should receive the pneumococcal vaccine, irrespective of their diabetes control. Strategies to improve vaccine awareness and uptake should involve general practitioners (GPs), primary health physicians (PHPs) and physicians treating patients at high risk of pneumococcal disease. Advocacy campaigns should involve media, including social media platforms. Conclusion: These recommendations aim to enhance pneumococcal vaccination coverage among high‑risk populations in India in order to ensure a reduction in the burden of pneumococcal diseases, in the post‑COVID era. There is a need to create more evidence and data to support the recommendations that the vaccine will be useful to a wider range of populations, as suggested in our consensus. [ABSTRACT FROM AUTHOR]

Household air pollution (HAP) from biomass fuels, coal, and kerosene burned in open fires, primitive stoves, and lamps causes at least 2 million deaths per year. Many of these deaths occur in children

The author discusses the genetic basis of asthma. He says that asthma is a chronic inflammatory disease which impact individuals of all age groups. He adds that about half of the patients of asthma have genetic susceptibility. He mentions that the presence of a family history of asthma and/or other atopies in a huge population of patients accounts for an essential evidence in favor of genetic basis of asthma.

The article presents the author's views on chronic obstructive pulmonary disease (COPD) in non-smokers. Topics discussed here include COPD phenotypes, Chronic cor pulmonale due to chronic lung disease, and asthma-COPD overlap. Also being discussed is chronic bronchitis incorporated in COPD, and the criterion of clinical phenotypes.

The article discusses guidelines for bronchial asthma diagnosis and management, the joint recommendations from the Indian Chest Society (ICS) and the National College of Chest Physicians (NCCP). Topics include the definition of asthma, factors to consider when diagnosing asthma, the role of chest readiography in the disease, and recommendation for occupational asthma.

BACKGROUND: Although the statistically derived lower limit of normal (LLN) for the ratio of FEV1 to FVC is considered superior to a fixed cutoff value (such as 0.70) for diagnosing airway obstruction, the fixed-cutoff method continues to be used and advocated. OBJECTIVE: To evaluate the misclassification of spirometrically determined airway obstruction arising from the use of the fixed-percent method, in comparison to the LLN method for FEV1/FVC. METHODS: We reviewed 27,307 spirometry records from adult men, and diagnosed airway obstruction based on the LLN (predicted value minus 1.645 times the standard error of estimate from a north Indian reference equation for FEV1/FVC) and based on a fixed cutoff of 0.70. We computed agreement and discordance between the two methods, and determined the sensitivity, specificity, and predictive values of the fixed-percent method in identifying true obstruction. RESULTS: The results were discordant in 1,622 subjects (6%). Overall agreement between the two methods was good (kappa estimate 0.869), but worsened considerably with advancing age. 1,290 subjects (5%) who were deemed normal with the LLN method were diagnosed as having airway obstruction with the fixed-percentage method. Overall the sensitivity, specificity, and positive predictive value of the fixed-percentage method were 0.963, 0.929, and 0.871, respectively. Specificity and positive predictive value decreased sharply with advancing age. CONCLUSIONS: The negative age-dependence of FEV1/FVC results in over-diagnosis of airway obstruction in middle-aged and elderly men, and under-diagnosis in young men, with the fixed-percentage method. Airway obstruction should be assessed with the LLN of FEV1/ FVC, with the LLN derived from appropriate reference equations. [ABSTRACT FROM AUTHOR]

We report here a case of a large emphysematous bulla with a fluid level that was managed successfully by percutaneous catheter drainage in a 50 year-old man with chronic obstructive airway disease. [ABSTRACT FROM AUTHOR]

Lung function in 1686 adult patients was measured before, and 15 minutes after, salbutamol inhalation. Bronchodilator responsiveness (BDR) was defined as a 12% improvement over baseline in either FEV1 or FVC, along with an absolute volume increment of 200ml. Peak expiratory flow (PEF) change, both absolute and relative to baseline, was also calculated (ΔPEF and ΔPEF%, respectively). Change in PEF significantly correlated with change in FEV1. However, ΔPEF and ΔPEF% had poor discrimination in identifying BDR, with all specific cutoff values for ΔPEF and ΔPEF% having low or moderate sensitivity, specificity and predictive values. [ABSTRACT FROM AUTHOR]

Presents an abstract of the article "Performance of Standard Severity Scoring Systems for Outcome Prediction in Patients Admitted to a Respiratory Intensive Care Unit in North India," by Ashutosh N. Agrawal, Parlay Sarkar, Dheeraj Gupta and Surinder K. Jindal.

Background: Interstitial lung disease (ILD) is a complex and heterogeneous group of acute and chronic lung diseases of several known and unknown causes. While clinical practice guidelines (CPG) for idiopathic pulmonary fibrosis (IPF) have been recently updated, CPG for ILD other than IPF are needed., Methods: A working group of multidisciplinary clinicians familiar with clinical management of ILD (pulmonologists, radiologist, pathologist, and rheumatologist) and three epidemiologists selected by the leaderships of Indian Chest Society and National College of Chest Physicians, India, posed questions to address the clinically relevant situation. A systematic search was performed on PubMed, Embase, and Cochrane databases. A modified GRADE approach was used to grade the evidence. The working group discussed the evidence and reached a consensus of opinions for each question following face-to-face discussions., Results: Statements have been made for each specific question and the grade of evidence has been provided after performing a systematic review of literature. For most of the questions addressed, the available evidence was insufficient and of low to very low quality. The consensus of the opinions of the working group has been presented as statements for the questions and not as an evidence-based CPG for the management of ILD., Conclusion: This document provides the guidelines made by consensus of opinions among experts following discussion of systematic review of evidence pertaining to the specific questions for management of ILD other than IPF. It is hoped that this document will help the clinician understand the accumulated evidence and help better management of idiopathic and nonidiopathic interstitial pneumonias., Competing Interests: None

Background: Bronchoscopic lung cryobiopsy (BLC) is a novel technique for obtaining lung tissue for the diagnosis of diffuse parenchymal lung diseases. The procedure is performed using several different variations of technique, resulting in an inconsistent diagnostic yield and a variable risk of complications. There is an unmet need for standardization of the technical aspects of BLC., Methodology: This is a position statement framed by a group comprising experts from the fields of pulmonary medicine, thoracic surgery, pathology, and radiology under the aegis of the Indian Association for Bronchology. Sixteen questions on various technical aspects of BLC were framed. A literature search was conducted using PubMed and EMBASE databases. The expert group discussed the available evidence relevant to each question through e-mail and a face-to-face meeting, and arrived at a consensus., Results: The experts agreed that patients should be carefully selected for BLC after weighing the risks and benefits of the procedure. Where appropriate, consideration should be given to perform alternate procedures such as conventional transbronchial biopsy or subject the patient directly to a surgical lung biopsy. The procedure is best performed after placement of an artificial airway under sedation/general anesthesia. Fluoroscopic guidance and occlusion balloon should be utilized for positioning the cryoprobe to reduce the risk of pneumothorax and bleeding, respectively. At least four tissue specimens (with at least two of adequate size, i.e., ≥5 mm) should be obtained during the procedure from different lobes or different segments of a lobe. The histopathological findings of BLC should be interpreted by an experienced pulmonary pathologist. The final diagnosis should be made after a multidisciplinary discussion. Finally, there is a need for structured training for performing BLC., Conclusion: This position statement is an attempt to provide practical recommendations for the performance of BLC in DPLDs., Competing Interests: None