Bronchiectasis in India:results from the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) and Respiratory Research Network of India Registry

BACKGROUND: Bronchiectasis is a common but neglected chronic lung disease. Most epidemiological data are limited to cohorts from Europe and the USA, with few data from low-income and middle-income countries. We therefore aimed to describe the characteristics, severity of disease, microbiology, and treatment of patients with bronchiectasis in India. METHODS: The Indian bronchiectasis registry is a multicentre, prospective, observational cohort study. Adult patients ( 6518 years) with CT-confirmed bronchiectasis were enrolled from 31 centres across India. Patients with bronchiectasis due to cystic fibrosis or traction bronchiectasis associated with another respiratory disorder were excluded. Data were collected at baseline (recruitment) with follow-up visits taking place once per year. Comprehensive clinical data were collected through the European Multicentre Bronchiectasis Audit and Research Collaboration registry platform. Underlying aetiology of bronchiectasis, as well as treatment and risk factors for bronchiectasis were analysed in the Indian bronchiectasis registry. Comparisons of demographics were made with published European and US registries, and quality of care was benchmarked against the 2017 European Respiratory Society guidelines. FINDINGS: From June 1, 2015, to Sept 1, 2017, 2195 patients were enrolled. Marked differences were observed between India, Europe, and the USA. Patients in India were younger (median age 56 years [IQR 41-66] vs the European and US registries; p<0\ub70001]) and more likely to be men (1249 [56\ub79%] of 2195). Previous tuberculosis (780 [35\ub75%] of 2195) was the most frequent underlying cause of bronchiectasis and Pseudomonas aeruginosa was the most common organism in sputum culture (301 [13\ub77%]) in India. Risk factors for exacerbations included being of the male sex (adjusted incidence rate ratio 1\ub717, 95% CI 1\ub703-1\ub732; p=0\ub7015), P aeruginosa infection (1\ub729, 1\ub710-1\ub750; p=0\ub7001), a history of pulmonary tuberculosis (1\ub720, 1\ub707-1\ub734; p=0\ub7002), modified Medical Research Council Dyspnoea score (1\ub732, 1\ub725-1\ub739; p<0\ub70001), daily sputum production (1\ub716, 1\ub703-1\ub730; p=0\ub7013), and radiological severity of disease (1\ub703, 1\ub701-1\ub704; p<0\ub70001). Low adherence to guideline-recommended care was observed; only 388 patients were tested for allergic bronchopulmonary aspergillosis and 82 patients had been tested for immunoglobulins. INTERPRETATION: Patients with bronchiectasis in India have more severe disease and have distinct characteristics from those reported in other countries. This study provides a benchmark to improve quality of care for patients with bronchiectasis in India. FUNDING: EU/European Federation of Pharmaceutical Industries and Associations Innovative Medicines Initiative inhaled Antibiotics in Bronchiectasis and Cystic Fibrosis Consortium, European Respiratory Society, and the British Lung Foundation

Endobronchial Small Cell Lung Cancer Masquerading as Carcinoid Tumour in a Young Female: A Case Report

Bronchial Carcinoid Tumours also known as BCTs, are remarkable neuroendocrine malignancies that can denature chemical compounds with biological activity. Bronchial carcinoid tumours are also known as BCTs. The phrase “bronchial adenomas” was once used to refer to BCTs; however, this nomenclature is no longer utilised because BCTs are neither glandular nor invariably benign. Instead, the term “Bronchial Cystic Tumours” is used to refer to BCTs in this context (BCTs). They are normally a neoplasm that expands slowly and displays a variety of behaviours, yet, they are also capable of expanding rapidly and being significantly more aggressive in general. Despite the fact that smoking is a significant risk factor for Small Cell Lung Cancer (SCLC), which is a more severe form of lung cancer than carcinoid. In addition, surgery is still the treatment of choice for carcinoid tumours, although chemoradiation and chemotherapy are the only options for patients with stage four SCLC. Here the authors discuss the case of 30 years old young female patient, who was erroneously diagnosed with endobronchial carcinoid turned out to be a SCLC. Because of the significant connection between smoking and SCLC, malignancies are not usually seen in young females. The relevant patient’s investigations were consistent with a small cell carcinoma of the lung. Immunohistochemistry for CD56 and synaptophysin turned out to be positive. The patient received six cycles of chemotherapy with an injection of Cisplatin and an injection of Etoposide three weekly. She was followed-up after three months and did have symptomatic relief