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

CAN FEF 25-75% BE USED AS A VALID ALTERNATIVE TO FEV1% IN COPD DIAGNOSIS?

BACKGROUND According to American Thoracic Society criteria FEV1% is the gold standard test in the diagnosis of COPD. The prospect of detecting lung disease, at an early stage has led to widespread measurement of FEF 25-75%. This study will provide an alternative to FEV1% in the diagnosis of COPD, so that the difficulties faced by the patients and the technicians in the measurement of FVC and FEV1% can be minimised. MATERIALS AND METHODS The study was conducted on 304 patients (194 COPD patients and 110 normal individuals) in the Pulmonary Function Test (PFT) Laboratory of Govt. Medical College; Kottayam. The instrument used was ‘Compact Vitalograph’. The results obtained were analysed using SPSS software and the sensitivity and specificity of FEF 25-75% was calculated using 2x2 tables. The positive predictive value (PPV) and negative predictive value (NPV) was also calculated. RESULTS Out of the total 304 subjects, 221 (72.70%) are males and 83 (27.30%) are females. 273 subjects (89.8%) came under ‘COPD’ category and 31 subjects (10.2%) came under ‘normal’ category based on FEF 25 -75. As per our study, FEF 25-75% had a sensitivity of 100%, specificity 28.20% PPV 71.06% and NPV 100%. CONCLUSION As per our study, we found that FEF 25-75% has a high sensitivity and low specificity. 71.06% of subjects who test positive will have COPD and 100% of subjects who test negative do not have the disease, hence its validity in COPD diagnosis is very less compared to FEV1%