Hypersensitivity pneumonitis (HP) is an immune-mediated interstitial lung disease caused by inhalation of various environmental and occupational antigens. Occupational exposure to polyurethane is an under-recognized cause, particularly in developing countries. We report a 40-year-old non-smoker employed as a supervisor in a footwear manufacturing factory who presented with recurrent episodes of acute hypoxemic respiratory failure over a period of 3 years. He had multiple hospitalizations and was repeatedly treated for presumed infective and obstructive airway disease, including a trial of antitubercular therapy based on a positive bronchoalveolar lavage (BAL) nucleic acid amplification test, without clinical improvement. On presentation to our center, detailed evaluation revealed lymphocyte-predominant BAL, fibrotic changes on transbronchial lung biopsy, and high-resolution computed tomography findings consistent with fibrotic HP. A comprehensive occupational history revealed significant exposure to polyurethane, supported by clinical findings of dental erosion and chemical stains on clothing. The patient showed marked clinical and radiological improvement following corticosteroid therapy and strict antigen avoidance. This case emphasizes the importance of meticulous occupational history in patients with recurrent or unexplained interstitial lung disease and highlights polyurethane-induced HP as a preventable cause of progressive fibrotic lung disease.
Introduction: Chronic obstructive pulmonary disease (COPD) is associated with significant morbidity and increases the risk of complications such as pulmonary hypertension (PH). Most COPD patients also have malnutrition. Considering the substantial burden of COPD in India, we conducted this study to determine the prevalence of PH in COPD and to assess malnutrition using various anthropometric parameters. Methods: In this single-center, cross-sectional study, we enrolled diagnosed COPD patients as per the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 guidelines. PH was diagnosed if pulmonary artery pressure (PAP) was >25 mm Hg on screening 2D echocardiogram. Body mass index (BMI) and other standard anthropometric measurements were taken for each patient included in the study. Results: In 120 COPD patients (mean age: 60.2 ± 10.9 years; 69.2% male), PH was diagnosed in 88.3% of patients. PH severity was associated with increasing GOLD stages (I–IV) of COPD, as indicated by significantly lower PAP in higher GOLD stages. By BMI, 34.2% were underweight, 12.5% were overweight, and 4.2% were obese. With increasing severity of COPD as per GOLD stages I to IV, the mean BMI and waist–hip ratio values were significantly declining. Conclusion: In COPD patients, the prevalence of PH is substantial, and malnutrition is not uncommon, which may be overlooked during routine clinical visits. Careful evaluation and treatment of these complications are necessary to improve outcomes in all COPD patients.
Pulmonary hypertension (PH) related to chronic lung disease (group 3 PH) frequently complicates conditions such as chronic obstructive pulmonary disease (COPD) and interstitial lung diseases. Outcomes worsen considerably once pulmonary pressures become severe, yet therapeutic options remain limited. This review examined randomized trials, observational studies, and guidelines addressing treatment strategies for Group 3 PH. Literature searches were performed in PubMed, Scopus, and Web of Science up to September 2025. Eligible publications included randomized controlled trials, large observational cohorts, and international guidelines. Outcomes of interest included 6-minute walk distance (6MWD), clinical events, and safety. The INCREASE trial demonstrated a clinically meaningful improvement in 6MWD (mean increase of 31 m at 16 weeks) and fewer respiratory hospitalizations with inhaled treprostinil in patients with PH associated with interstitial lung disease, findings that supported regulatory approval. In contrast, riociguat was associated with excess adverse events and mortality in idiopathic interstitial pneumonia and is contraindicated in this population. Evidence for phosphodiesterase-5 inhibitors in COPD-associated PH remains inconsistent, with limited benefit and potential safety concerns. Endothelin receptor antagonists have not shown reliable efficacy. As a result, supportive measures—including long-term oxygen therapy, pulmonary rehabilitation, noninvasive ventilation, and management of sleep-related breathing disorders—remain central to care. Management of Group 3 PH should priorities optimization of the underlying lung disease, correction of hypoxemia, and timely consideration of lung transplantation. At present, inhaled treprostinil is the only PH-targeted therapy supported by randomized evidence in this population. Ongoing research should focus on patient phenotyping and long-term outcome assessment.
Context: Obstructive sleep apnea (OSA) poses significant health risks, with the Apnea–Hypopnea Index (AHI) from polysomnography serving as the diagnostic gold standard. Due to limited access, screening tools such as the Mallampati classification, STOP-BANG questionnaire, and Epworth Sleepiness Scale (ESS) are commonly used. Aim: This study evaluates and compares these screening tools and their correlation with AHI to determine their effectiveness in assessing OSA severity, aiming to enhance patient evaluation and guide diagnostic prioritization. Materials and Methods: A 1-year prospective observational study was conducted on 52 patients clinically suspected of OSA based on symptoms such as snoring, daytime sleepiness, witnessed apneas, and nonrestorative sleep. Each patient was evaluated using the Mallampati classification (I–IV), STOP-BANG questionnaire (0–8), and ESS (0–24), followed by a level 3 sleep study to determine the AHI. The scores of these screening tools were statistically correlated with AHI using Pearson’s and Spearman’s correlation coefficients to assess their predictive accuracy for OSA severity. Statistical Analysis: Pearson and Spearman’s coefficient, Fisher’s r-to-z transformation, multivariable linear regression analysis, and receiver operating characteristic curve analysis. Results: Among the 52 patients, Pearson’s correlation revealed a significant large positive relationship between Mallampati score and AHI (r = 0.7748, P < 0.001) and between STOP-BANG and AHI (r = 0.5866, P < 0.001). ESS showed a moderate positive correlation with AHI (r = 0.3659, P = 0.008). Neck circumference emerged as the strongest independent predictor of AHI. Conclusion: Mallampati score demonstrated the strongest association with OSA severity (especially in detecting moderate to severe OSA), followed by STOP-BANG and then ESS.
Background: Diagnosing sputum-negative pulmonary tuberculosis (PTB) remains challenging due to low bacillary load and absence of microbiological confirmation. This study evaluated the diagnostic yield of bronchoalveolar lavage (BAL) using Cartridge-Based Nucleic Acid Amplification Test (CBNAAT) and culture in sputum smear-negative, suspected PTB. Methods: This prospective observational study included 50 adults with clinical and radiological suspicion of PTB who tested negative on at least two sputum acid-fast bacilli (AFB) smears and CBNAAT. BAL fluid was analyzed using CBNAAT (GeneXpert MTB/RIF) and mycobacteria growth indicator tube (MGIT) culture. Diagnostic accuracy was calculated using culture as the reference standard. Results were expressed with 95% confidence intervals (CIs). A P-value <0.05 was considered statistically significant. Results: BAL CBNAAT detected Mycobacterium tuberculosis in 26/50 patients (52%), while BAL culture was positive in 12/50 (24%). Ten patients were positive by both modalities. Using culture as the reference standard, CBNAAT demonstrated sensitivity of 83.3% (95% CI: 51.6–97.9) and specificity of 57.9% (95% CI: 40.8–73.7). The positive predictive value was 38.5% and the negative predictive value was 91.7%. Rifampicin resistance was detected in 3/26 (11.5%) CBNAAT-positive cases. Conclusion: Bronchoscopy-guided BAL may be considered in patients with strong clinical suspicion of PTB who remain sputum-negative. It enhances microbiological confirmation and enables early detection of drug resistance.
Background: Asthma continues to impose a substantial chronic respiratory burden on the U.S. adult population, with outcomes shaped by a complex interplay of socioeconomic, demographic, and healthcare access factors. Objective: Characterizing how patterns of asthma exacerbation have shifted over time can guide targeted prevention efforts and more equitable approaches to care. Methods: This study utilized the 2019–2024 National Health Interview Survey (NHIS) adult dataset from the National Center for Health Statistics. Adults who reported a prior physician diagnosis of asthma were eligible for inclusion. Annual prevalence of asthma attacks and temporal trends were examined across a broad range of sociodemographic, clinical, and socioeconomic variables using χ2 testing; statistical significance was defined as a two-sided p<0.05. Results: Adults aged 50–64 years had the highest annual asthma attack rate (4.1%, p<0.05) and the greatest increase (+20%) during the study period. Females reported nearly twice the attacks as males (4.8% vs 2.3%, p<0.05) with an 18.2% rise since 2019. Black adults had higher attack prevalence (4.1%) compared to White (3.6%) and Asian (2.0%) adults; however, Asians experienced the largest increase (+84.6%) while Blacks declined (-15.9%). Individuals with disabilities (8.9% vs 3.1%), functional limitations (5.5% vs 2.1%), or unemployment (4.2% vs 3.3%, all p<0.05) were disproportionately affected. Among those Conclusion: Rates of asthma exacerbation are climbing among certain U.S. adult subpopulations, most notably women, middle-aged adults, Asian individuals, and those with private insurance coverage. Longstanding disparities by disability status, income level, and insurance type underscore the urgent need for targeted asthma control programs and systemic improvements in access to preventive respiratory care.
Pulmonary alveolar proteinosis (PAP) is a rare lung disease, and this case series describes three patients with heterogeneous clinical presentations, management strategies, and outcomes. Whole lung lavage is indicated for symptomatic patients with significant functional and gas exchange impairment. In contrast, asymptomatic patients with no functional deficit may be kept under close observation with radiologic and pulmonary function follow-up. Although outcomes of PAP treatment are usually favorable and spontaneous resolution may occur in a subset of patients, the evolution of disease and response to therapy can be unpredictable. Some patients may develop progressive disease or complications despite optimal management. This case series highlights the marked heterogeneity of PAP and underscores the need for individualized, patient-centered decision-making rather than a uniform therapeutic approach.
Respiratory diseases impose a substantial global health burden, with preventive pulmonology strategies offering critical opportunities to reduce morbidity and mortality through early detection, risk factor modification, and disease progression prevention. Digital health technologies enable a paradigm shift in respiratory disease prevention through remote monitoring, early exacerbation detection, personalized interventions, and enhanced patient engagement. This narrative review examines digital health applications in preventive pulmonology from clinical and public health perspectives, analyzing evidence across chronic obstructive pulmonary disease, asthma, tuberculosis, lung cancer screening, and occupational lung disease prevention. Key technologies include smartphone-based spirometry, wearable sensors, artificial intelligence–driven risk prediction, telemedicine platforms, and mobile health applications. Evidence indicates digital interventions can improve disease detection, reduce exacerbations, and enhance quality of life in selected populations, though significant challenges persist, including device accuracy concerns, data security issues, implementation barriers, and equity considerations. We synthesize evidence on validation requirements, implementation frameworks, cost-effectiveness, and patient-centered approaches essential for clinical translation. Understanding how to effectively deploy, validate, and sustain these technologies is critical for chest physicians and pulmonary disease prevention specialists.
Background: Ventilator-associated pneumonia (VAP) is a major cause of morbidity and mortality in critically ill patients requiring mechanical ventilation. The increasing burden of multidrug-resistant (MDR) organisms has complicated treatment and outcomes. This study aimed to determine the bacteriological profile, antimicrobial resistance patterns, and clinical outcomes in patients with VAP in a tertiary-care intensive care unit (ICU) in Eastern India. Methods: This prospective observational study (February 2020–January 2022) included adults undergoing invasive mechanical ventilation for >48 hours who developed clinical suspicion of VAP, defined as new or progressive radiographic infiltrates plus ≥2 clinical features (fever/hypothermia, leukocytosis/leukopenia, purulent secretions, or worsening oxygenation). VAP was microbiologically confirmed by quantitative endotracheal aspirate culture ≥105 CFU/mL. Bacterial identification used standard biochemical methods, and antimicrobial susceptibility testing followed CLSI 2023 guidelines. Colistin minimum inhibitory concentrations were determined by broth microdilution. MDR was defined as nonsusceptibility to ≥1 agent in ≥3 antimicrobial classes. Results: Of 200 clinically suspected VAP cases, 76 (38%) were microbiologically confirmed. Early-onset VAP constituted 38.15% and late-onset VAP 61.85%. A total of 100 isolates were recovered; 91% were gram-negative bacilli, predominantly Klebsiella spp. (36%), Acinetobacter spp. (25%), and Pseudomonas spp. (24%). Over 90% of gram-negative isolates were resistant to third-generation cephalosporins and fluoroquinolones. Colistin resistance was identified in 5.49% of isolates. MDR prevalence was 73% overall, and was highest in late-onset VAP (76.5%). Mortality among culture-confirmed VAP patients was 48.68%. Conclusion: MDR gram-negative organisms remain the predominant etiological agents of VAP in this ICU setting, with emerging colistin resistance posing additional therapeutic challenges. These findings reinforce the need for ongoing surveillance, local antibiograms, and strengthened antimicrobial stewardship to optimize therapy and improve clinical outcomes.
Lung oscillometry test (LOT) is an emerging, noninvasive tool that assesses airway resistance and reactance during tidal breathing. Unlike spirometry, which depends on patient effort, LOT provides objective insights into small airway function and has shown potential utility in conditions where spirometry may fall short, such as interstitial lung diseases (ILDs). The study aims to summarize current evidence on the role of LOT in ILDs and discuss its clinical applications in diagnosis and disease monitoring. A narrative review of published literature was conducted to evaluate the diagnostic accuracy, reproducibility, and clinical utility of LOT in ILDs. Comparative studies with spirometry and other functional measures were included to highlight strengths and limitations. LOT demonstrates high sensitivity in detecting early small airway dysfunction, with evidence suggesting it may complement or even outperform spirometry in certain ILD cohorts. Its ability to monitor disease progression and treatment response without requiring maximal effort enhances its applicability in clinical practice. However, standardization of protocols and larger multicenter validation studies are needed before widespread adoption. It is a promising addition to the respiratory physician’s toolkit for ILD evaluation. Future studies should focus on establishing normative values, defining ILD-specific thresholds, and integrating LOT into clinical algorithms.
Antitubercular drug (ATD)-induced hypovitaminosis D3 and secondary hyperparathyroidism are less reported phenomena compared to other antitubercular therapy–induced adverse events. Rifampicin and isoniazid are often identified as the culprits in causing secondary hyperparathyroidism. The mechanism involved is CYP3A4 induction by rifampicin and isoniazid, which leads to hypovitaminosis D and hypocalcemia. In response, there is an increase in parathyroid hormone (PTH) secretion, leading to secondary hyperparathyroidism, which can cause bone decay, nephrolithiasis, and other complications. We report a case of a 43-year-old female who developed a nonhealing coccyx fracture following trivial trauma. She had been on antitubercular treatment for the past 5 months after being diagnosed with isoniazid monoresistant pulmonary tuberculosis. Her blood report showed increased PTH levels and decreased calcium and vitamin D3 levels. Rifampicin was stopped, replaced it with linezolid, and the modified regimen was continued for a total of 9 months. The patient showed clinicoradiological improvement. Calcium, vitamin D3, and PTH levels were repeated and gradually normalized after stopping rifampicin. We conclude that regular monitoring of calcium and PTH levels during antitubercular treatment is important for early identification and management of potential vitamin D deficiency and secondary hyperparathyroidism.
Introduction Respiratory tract infection is a common precipitating factor of acute exacerbation of chronic obstructive pulmonary disease (AE-COPD). Early diagnosis and prompt treatment, with knowledge of the local bacteriological profile and antibiogram, are likely to reduce the case fatality rate during empirical treatment of AE-COPD. Aims and objectives: The present study aimed to determine the influence of respiratory tract bacterial infection on the treatment outcomes of infective exacerbations of COPD. This study is likely to provide local data from Eastern India regarding clinical, radiological, and microbiological presentation of patients with AE-COPD. Materials and methods: A cross-sectional observational study was conducted over a period of 12 months on 50 admitted AE-COPD patients. Clinical examination, followed by laboratory investigations, including blood tests, chest radiology, electrocardiogram, arterial blood gas analysis, and sputum and blood bacteriology, was done. Results: Sputum culture was positive in 41 (82%) patients, while blood culture was positive in only 12 (24%) patients. In sputum, gram-negative bacteria were more common (63.41%), of which the most common was Pseudomonas aeruginosa (13 cases, 26%). The association between sputum C/S and outcome was not significant, whereas the association between blood C/S and outcome was significant (41.7%). All-cause mortality was 10%. Conclusion: A previous severe episode of AE-COPD appears to predict a high probability of respiratory failure in subsequent episodes. Gram-negative bacteria, such as Pseudomonas and Escherichia coli, were the most common bacterial isolates in sputum and blood, respectively. The presence of invasive pneumonia and chest infiltrates showed a significant association with outcome. Polymyxin B was sensitive to most organisms, including Pseudomonas.
Background: Extrapulmonary tuberculosis poses a great challenge in the diagnosis and management due to the paucibacillary nature of the disease and limited tests available for early diagnosis. Tuberculous lymphadenopathy is the most common extrapulmonary manifestation of tuberculosis (TB). The Xpert mycobacterium tuberculosis/rifampicin (MTB/RIF) assay or cartridge-based nucleic acid amplification test (CBNAAT) for Mycobacterium is a rapid, automated, molecular assay, along with bedside fine needle aspiration cytology (FNAC) of the lymph nodes, together can form an excellent early screening tool for diagnosis and treatment initiation for TB. Aim: To assess the early and rapid diagnostic accuracy of CBNAAT in the diagnosis of TB lymphadenitis by bedside FNAC procedure at a rural center.Methodology: This prospective observational diagnostic accuracy study [FNAC-Fine needle Aspiration Smear for Tuberculosis (FAST)] was conducted from January 2024 to June 2025 among 61 patients clinically suspected of lymph node TB. Bedside FNAC was performed on lymph nodes from the neck, axilla, or inguinal regions. Samples were tested using CBNAAT, liquid culture via BACTEC MGIT 960, and acid-fast bacilli (AFB) staining with Ziehl-Neelsen and Auramine methods. Mycobacterial culture served as the reference standard for comparison. Results: Most patients were young adults (20–40 years, 65.6%) with a female predominance (67.2%). CBNAAT was positive in 62.3% of cases, while culture confirmed TB in 47.5% of cases. Granulomatous lymphadenitis was observed in 83.6% of cases, with 72.5% CBNAAT positivity and 6.5% rifampicin resistance among these. Reactive lymphadenitis cases were mostly negative on culture and CBNAAT. AFB staining detected only 20% of cases. Conclusion: CBNAAT performed on FNAC samples shows excellent sensitivity and provides rapid results for diagnosing tuberculous lymphadenitis, while also identifying rifampicin resistance. This makes it an ideal point-of-care test for early treatment initiation, especially in resource-limited settings.
Introduction: Pleural effusion is a frequent presentation in pulmonary medicine, with 25% to 40% of exudative effusions remaining undiagnosed despite pleural fluid cytology and closed biopsy. Medical thoracoscopy (MT) enables direct pleural visualization and targeted biopsy under local anesthesia, providing a higher diagnostic yield with minimal morbidity. Aim: To evaluate the diagnostic yield and safety profile of rigid MT in patients with undiagnosed exudative pleural effusion. Materials and Methods: This descriptive cross-sectional study was conducted at the Institute of Respiratory Diseases, SMS Medical College, Jaipur, Rajasthan, India, from September 2023 to January 2025, after obtaining ethical approval. Patients aged >18 years with exudative pleural effusion requiring thoracoscopy were included. A total of 75 met the inclusion criteria. All underwent baseline hematological, biochemical, and radiological evaluation, followed by rigid thoracoscopy under local anesthesia and conscious sedation. Multiple pleural biopsies were obtained and analyzed using histopathology, immunohistochemistry, cartridge-based nucleic acid amplification test, and culture. Data were analyzed with descriptive statistics and the chi-square test, with P < 0.05 considered significant. Results: The mean ± standard deviation age was 50.8 ± 15.3 years; 57 (76%) were male and 18 (24%) were female (M:F = 3.2:1). Right-sided effusion occurred in 46 (61.3%) patients and left-sided in 28 (37.3%). The most common fluid appearance was straw-colored in 47 (62.7%), followed by hemorrhagic in 25 (33.3%) and purulent in 3 (4%). Histopathology revealed malignancy in 35 (46.7%), tuberculosis (TB) in 28 (37.3%), inflammatory conditions in 8 (10.7%), and inconclusive findings in 4 (5.3%). Adenocarcinoma was the predominant malignant subtype (20 cases; 26.7%). The overall diagnostic yield was 94.7% (71/75). The most common complication was chest pain in 47 (62.7%); no mortality was recorded. Pleurodesis was performed in 15 (20%) patients, predominantly using bleomycin (73.3%). Conclusion: Rigid MT is a safe and minimally invasive procedure with excellent diagnostic accuracy (94.7%) for undiagnosed exudative pleural effusion. It offers simultaneous therapeutic benefits with minimal complications, making it an important tool, particularly in high TB-burden areas where differentiation between infectious and neoplastic etiologies is clinically challenging.
Isoniazid (INH) acetylating status and its variability among different regions and parts of the world are well known; however, they are never elaborated much in day-to-day tuberculosis (TB) guidelines. Hence, we discuss three cases of pulmonary TB presenting with drug-induced hepatitis. Workup and evaluation demonstrated slow acetylation of INH, which caused drug-induced hepatitis. The clinical adverse event resolved by transiently stopping anti-TB therapy (ATT) to normalize liver function tests. Following reintroduction of ATT, INH was replaced with levofloxacin in the regimen, taking care to ensure sensitivity to levofloxacin, as an individualized decision-making under expert supervision. We highlight the role of INH acetylating status as a major cause for the same and its management as needed for the treating clinician.
Background: Incorrect use of pressurized metered-dose inhalers (MDIs) compromises drug delivery in asthma and chronic obstructive pulmonary disease (COPD) management, with global error rates up to 94%. This cross-sectional study evaluated MDI technique correctness and predictors among patients in a respiratory outpatient department in Eastern India, addressing a local research gap. Methods: Purposively sampled 115 patients aged >12 years using MDIs were assessed over 1 month, excluding severely ill cases, active tuberculosis, or interfering comorbidities. Observational checklists based on National Heart, Lung, and Blood Institute 2021 guidelines and Newman critical steps (shaking inhaler, full exhalation, actuation–inhalation coordination, ≥10-second breath-hold) were used during interviews with dummy inhalers. Sociodemographics, disease, and MDI variables were analyzed via SPSS v20 (means ± standard deviation, percentages, Mann–Whitney U, Fisher’s exact; P < 0.05 significant). Results: Mean age was 50 ± 14.5 years; 50.4% male, 67% rural, 51.3% secondary-educated, 34.8% socioeconomic status (SES) class V. Patients were diagnosed with asthma in 46.9%, COPD in 36.5%, and others 16.5%. Only 14.8% had no critical errors (85.2% had ≥1); key errors: 59.2% inadequate breath-holding, 53.9% incomplete exhalation, 29.6% poor coordination. Shorter MDI duration predicted errors (median 5.5 vs. 36 months, P = 0.043); no associations with age, sex, education, and residence (P > 0.05). Conclusion: With an 85.2% critical error rate, routine reinforcement of key MDI steps, especially for short-term users, rural, and low-SES patients, is essential to enhance respiratory outcomes.
Linezolid is widely used in the treatment of drug-resistant tuberculosis (TB), despite being associated with severe adverse effects, including lactic acidosis, which remains underreported in the literature and is fatal in many cases. This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered in PROSPERO (CRD42024552225). We conducted comprehensive searches across PubMed, Scopus, Embase, and Google Scholar, covering case reports and case series without language restrictions. Data were extracted on demographics, clinical presentation, linezolid dosage, laboratory findings, treatment regimens, and outcomes. Lactic acidosis was defined as a serum pH <7.35 and lactate >4 mmol/L. Quality assessment followed the protocol of Murad et al. Data were synthesized narratively and statistically analyzed using Microsoft Excel. Seven case reports were identified. The average patient age was 49.33 years (range: 20–81 years), with a near-equal distribution between males and females. Most cases were reported from India (3/7). Respiratory symptoms predominated, and gastrointestinal and central nervous system involvement was also noted. Linezolid dosing varied between 600 and 1200 mg daily. Arterial blood gas analysis showed significant acidosis, with pH values ranging from 6.09 to 7.32. Lactate levels were elevated (range: 10.2–20 mmol/L). Symptoms emerged from within 7 days to over 1 month after starting linezolid, except for one patient who developed symptoms immediately. Four patients died, and three survived after treatment modification. Linezolid-induced lactic acidosis is a rare but serious complication in drug-resistant TB, emphasizing the need for close monitoring and individualized treatment.
Background: Non-invasive ventilation (NIV) with bi-level positive airway pressure (BiPAP) is commonly used to treat patients admitted to the hospital with acute hypercapnic respiratory failure (AHRF) secondary to an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Aims: Evaluation of the outcome of NIV with BiPAP in the management of hypercapnic respiratory failure (HRF) patients in AECOPD with respect to success rate and treatment failure in a tertiary care hospital. Methods: A single-centred, prospective observational study was conducted for a period from April 2021 to September 2022 in the Department of Respiratory Medicine of a tertiary care hospital to evaluate the outcome of NIV with BiPAP in the management of HRF patients in AECOPD. Fifty-three patients were included in this study. Patients were divided into two groups as follows: NIV success group (Group I) and NIV failure group (Group II). Evaluation was based on clinical parameters and arterial blood gas analysis (ABG) parameters. Clinical parameters include heart rate (HR), respiratory rate (RR), systolic blood pressure, diastolic blood pressure at the time of admission. ABG was analysed at the time of admission and after 2 hours of initiation of NIV. Results: In our study, 44 (83.0%) patients improved with NIV (Group I: NIV success group) and 7 (17%) patients failed NIV and were intubated (Group II: NIV failure group). Only three clinical parameters, i.e., level of consciousness, HR and RR at the admission time, showed statistical significance between the two groups to predict treatment outcome. pH and PaCO 2 revealed significant improvement after 2 hours in the success group. Conclusion: Only three clinical parameters at the time of admission, i.e., level of consciousness, HR, and RR, predict the success of NIV in patients with AECOPD. pH and PaCO 2 both can be used as predictors for treatment outcome.
