Socio-demographic and Clinical Profile of Children with Asthma attending Chest Clinic at B. P. Koirala Institute of Health Sciences, Nepal

Introduction: Asthma in children is one of the most common chronic diseases and little information available on factors associated with this disease in our part of the world. Objective: The present study is an attempt to find out the socio-demographic and clinical profile of children with asthma. Methodology: This was a retrospective analysis of data of asthmatic children below 14 years attending pediatric chest clinic from July 2014 till March 2016. Results: Of the 200 children, there were 142 (71%) males. The median age of presentation was 3 years and 139 (69.5%) from the age group 1-5years One third had poorly controlled asthma. Comorbidity was present in 59(29.5%) and allergic rhinitis (7%) was the most common. 90.5% had onset of wheezing before 5 years of age. Family history of asthma and/or atopy and smoking was present in 24% and 31%, respectively. 22% had exposure to pet animals. Upper respiratory tract infection (URTI) (37%) was the most common trigger for exacerbation. Cough (99%) and fast breathing (98%) were the most common symptoms. Conclusion: The majorities were males of young age with rhinitis as most common co-morbidity and many of them had a history of parental smoking at home. One third of them had poorly controlled asthma which shows the need for proper management of asthma including its comorbidity in younger children and changing certain habits like parental smoking at home.

Leprosy suspect presenting at a chest clinic

Leprosy is an ancient ailment, also known as Hansen’s disease. It primarily involves the superficial peripheral nerves, skin, upper respiratory tract mucosa, eyes, bones and testicles, but not the lungs. Although leprosy patients are not included in the study area of pulmonology, here we present an undiagnosed leprosy patient with a history of smoking, who was referred owing to upper respiratory tract symptoms and bilateral pleural effusions. From this undiagnosed case, we would like to draw specific attention of pulmonologists, since a patient with leprosy can present in this way due to hypoalbuminemia resulting from a systemic inflammatory state, which may then progress to sepsis. Collaboration of different specialists may be required to clinch extra-neurological and extra-cutaneous features of leprosy.

A Study on Recurrence Rate of Pulmonary Tuberculosis in a Tertiary Care Hospital of Pakistan.

ABSTRACT: Objective: To determine the prevalence of the recurrence rate of Pulmonary tuberculosis (TB) in successfully treated patients in a tertiary care hospital in Pakistan. Methodology: This cross-sectional study was conducted at Benazir Bhutto Hospital Rawalpindi. The study duration was from 01-January-2019 to 01-August-2020. During the study period, a total number of ten thousand nine hundred ninety-seven (10997) patients presented in the chest clinic of the hospital and were included in this study, these patients were re-treatment TB patients and presented with the first-time diagnosis of TB. The recurrence rate was the primary end-point of this study. Results: There were 10997 patients included in this study, out of these 642 (5.83%) patients presented with recurrence. Out of a total of 642 recurrence cases, 533 (83%) patients were SS positive, and the remaining 109 (17%) were SS negative. Out of 642, 341 (53.1%) patients were male and 301 (46.9%) patients were female. Regarding age, most of the patients were in the age group 16-30 (49%), 93 (23%) were in the age group 31-45 years. Regarding the timing of recurrence, 372 (58%) patients presented with in one year, 109 (17%) presented in 12-24 months, 52 (8%) presented in 24-36 months. Conclusion: Based on our study, the recurrence rate of pulmonary TB was 5.83% in the Pakistani population. The recurrence rate is high in patients having age 15-45 years and recurrence occurs in 58% of patients within first year after successful treatment of Pulmonary TB.

Cardiac Involvement in Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss Disease)

Eosinophilic granulomatosis with polyangiitis (EGPA), previously known as Churg-Strauss disease, is a rare vasculitis that affects small- to medium-sized vessels and has a propensity to involve the heart. Patients with cardiac involvement have a poor prognosis and usually require immunosuppressive treatment along with corticosteroids. Cardiovascular magnetic resonance (CMR) is a noninvasive diagnostic tool that can detect cardiac involvement and guide the management plan. Herein, we present the case of a 39-year-old man with a known history of bronchial asthma who was referred to the chest clinic at the Royal Hospital for further assessment of persistent lung parenchymal changes on chest computed tomography. Given the clinical context of the patient and the radiological findings, EGPA was suspected. Lung biopsy confirmed the diagnosis of EGPA. CMR was performed for further assessment, which confirmed cardiac involvement. The patient was started on prednisolone and azathioprine and showed significant radiological and clinical improvement. Keywords: Eosinophilic Granulomatosis with Polyangiitis, Vasculitis, Eosinophils, Vascular Diseases, ANCA-associated Vasculiti

P045 Nothing is too 'cagey' for the rheumatologist

Background/Aims Rheumatological conditions can present with a number of non-specific features like arthralgia, fever, fatigue, weight loss along with raised inflammatory markers and positive antibodies. Due to this, when similar symptoms are referred for input it is very important to consider other ‘mimics’. We report a case of Pigeon fancier’s lung presenting with these symptoms which was referred as likely connective tissue disease. Methods A 52-year-old lady of South Asian origin was referred by her GP with six month history of 3kg weight loss, arthralgia, fatigue, low grade fever and persistently raised inflammatory markers (ESR ranging from 50-64 mm/hr, CRP 10-14 mg/L, normal BMI). On further questioning there was history of mouth ulcers, non-specific rash, occasional cough but no Raynaud’s or joint swelling. Blood investigations showed weakly positive ANA and RF but negative ENA, DNA, antiCCP , CK, C3,C4. C-ANCA was positive but PR3 negative. CXR was clear and tests for chronic infections including TB were negative. Due to lack of objective CTD signs, plan was to take a careful monitoring approach to see if clinical features evolved. A month later due to worsening cough, a CT chest/abdomen arranged by GP showed ground-glass changes consistent with pneumonitis and hence her rheumatology appointment was expedited to see if there was an autoimmune unifying diagnosis. She was also referred by her GP to the chest clinic in view of CT report and mild shortness of breath. Results On further review, again there were no objective CTD signs. On direct questioning there was history of travelling before worsening chest symptoms to South Asia. Also around a year before her symptoms started she was given an African grey parrot. Based on this, serology for Avian precipitin was checked which showed strongly positive IgG antibodies to avian antigens (Budgerigar droppings and feathers, Pigeon feathers IgG Abs) confirming the diagnosis of pigeon fanciers lung. She fulfilled the diagnostic criteria and was asked to avoid the trigger. Urgent respiratory input was arranged where diagnosis was agreed with and disease was deemed sub-acute in presentation. Due to PFTs showing low transfer factor of 38%, Prednisolone was started with significant improvement within few days. Review of CT chest only showed inflammatory changes and no established fibrosis predicting excellent prognosis as delay in treatment can cause irreversible pulmonary fibrosis. Conclusion A number of conditions can mimic rheumatological conditions which usually turn out to be either infectious or malignant in origin. This case highlights the importance of considering other differentials and along with taking a travel history also asking for other possible triggers like pets. In similar scenarios the diagnosis may be ‘cagey’ but as rheumatologists we are expected to answers questions which others can’t. Disclosure M.F. Kazmi: None.

Awareness of Long-Term Prednisolone Use Among Patients Attending a Respiratory Clinic in Sri Lanka: A Clinical Audit

Background: Prednisolone is recognized as one of the most commonly used, highly effective anti-inflammatory agent. It plays a pivotal role in the management of various disease conditions in pulmonology, such as interstitial lung diseases, sarcoidosis, bronchial asthma, chronic obstructive airway disease, allergic bronchopulmonary aspergillosis and even in some forms of extrapulmonary tuberculosis. However, this medication with great therapeutic importance is not free of risks. Long-term use and use in higher doses are known to cause various systemic adverse effects. Therefore, complying with recommended precautionary strategies is of paramount importance. Objectives: To assess awareness of correct use of prednisolone particularly among long-term, outpatient users. Methodology: A structured interviewer-based questionnaire was used to assess awareness of prednisolone usage in patients attending Central chest clinic, Colombo. Forty-one consecutive patients on long term prednisolone were selected from the clinic. The questionnaire was prepared based on recommendations and guidelines related to proper use of corticosteroids. Data were collected by the principal investigator. Results: This clinical audit highlighted the inadequacy of awareness about side effects and safety practices among patients on prolonged courses of prednisolone. Conclusion: Patients need to be educated more on adverse effects, safety measures and correct use to improve risk/ benefit ratio. Designing a steroid treatment card was identified as a potential method to optimize patient education, monitoring and adverse outcome prevention in long-term steroid therapy. Intended quality improvement will be evaluated by re-auditing the implemented protocol.

Awareness of Long-Term Prednisolone Use Among Patients Attending a Respiratory Clinic in Sri Lanka: A Clinical Audit

Background: Prednisolone is recognized as one of the most commonly used, highly effective anti-inflammatory agent. It plays a pivotal role in the management of various disease conditions in pulmonology, such as interstitial lung diseases, sarcoidosis, bronchial asthma, chronic obstructive airway disease, allergic bronchopulmonary aspergillosis and even in some forms of extrapulmonary tuberculosis. However, this medication with great therapeutic importance is not free of risks. Long-term use and use in higher doses are known to cause various systemic adverse effects. Therefore, complying with recommended precautionary strategies is of paramount importance. Objectives: To assess awareness of correct use of prednisolone particularly among long-term, outpatient users. Methodology: A structured interviewer-based questionnaire was used to assess awareness of prednisolone usage in patients attending Central chest clinic, Colombo. Forty-one consecutive patients on long term prednisolone were selected from the clinic. The questionnaire was prepared based on recommendations and guidelines related to proper use of corticosteroids. Data were collected by the principal investigator. Results: This clinical audit highlighted the inadequacy of awareness about side effects and safety practices among patients on prolonged courses of prednisolone. Conclusion: Patients need to be educated more on adverse effects, safety measures and correct use to improve risk/ benefit ratio. Designing a steroid treatment card was identified as a potential method to optimize patient education, monitoring and adverse outcome prevention in long-term steroid therapy. Intended quality improvement will be evaluated by re-auditing the implemented protocol.

Awareness of Long-Term Prednisolone Use Among Patients Attending a Respiratory Clinic in Sri Lanka: A Clinical Audit

Background: Prednisolone is recognized as one of the most commonly used, highly effective anti-inflammatory agent. It plays a pivotal role in the management of various disease conditions in pulmonology, such as interstitial lung diseases, sarcoidosis, bronchial asthma, chronic obstructive airway disease, allergic bronchopulmonary aspergillosis and even in some forms of extrapulmonary tuberculosis. However, this medication with great therapeutic importance is not free of risks. Long-term use and use in higher doses are known to cause various systemic adverse effects. Therefore, complying with recommended precautionary strategies is of paramount importance. Objectives: To assess awareness of correct use of prednisolone particularly among long-term, outpatient users. Methodology: A structured interviewer-based questionnaire was used to assess awareness of prednisolone usage in patients attending Central chest clinic, Colombo. Forty-one consecutive patients on long term prednisolone were selected from the clinic. The questionnaire was prepared based on recommendations and guidelines related to proper use of corticosteroids. Data were collected by the principal investigator. Results: This clinical audit highlighted the inadequacy of awareness about side effects and safety practices among patients on prolonged courses of prednisolone. Conclusion: Patients need to be educated more on adverse effects, safety measures and correct use to improve risk/ benefit ratio. Designing a steroid treatment card was identified as a potential method to optimize patient education, monitoring and adverse outcome prevention in long-term steroid therapy. Intended quality improvement will be evaluated by re-auditing the implemented protocol.