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Purpose The aim of the survey was to evaluate attitudes and perceptions toward nebulization therapy for the management of chronic obstructive pulmonary disease (COPD) in Indian population. Patients and methods A cross-sectional, multicenter, quantitative survey was conducted from July to August 2019 among 103 COPD patients [>40 years, either gender, belonging to socio-economic class (SEC) A or SEC B] and their family caregivers. One-on-one interviews were conducted telephonically via an online survey platform (KoBo data collection tool) using a structured questionnaire. Patients receiving home nebulization were included, and the usage of nebulizers, satisfaction, and benefits and concerns with nebulizers were assessed. Results Overall, 47% patients were on handheld inhalers + nebulizer, 54% used nebulizer for >8 weeks, and 27% used nebulizers daily for home maintenance. Majority of the patients (77%) were satisfied with nebulization therapy. Around 70% family caregivers opined that the quality of life of COPD patients improved post-nebulization therapy. The benefits of nebulizers perceived by patients were easier breathing (89%), feeling of well-being (86%), and ease of use (86%), while family caregivers reported reduced hospitalization (76%) and easier breathing (75%). Among those with prior experience with inhalers, 72% felt nebulizers gave long-term relief, while 65% perceived having immediate relief compared to inhaler. Overall, 61% opined that benefits with nebulizers outweighed the inconvenience associated with its use. Key concerns regarding nebulizers cited by patients were time-consuming procedure (50%), feeling of dependency (49%), and social embarrassment (48%), while family caregivers highlighted social embarrassment (45%) and multiple daily use (45%) as major concerns. Majority of the patients (73%) were compliant with their recommended frequency of the nebulizer. Conclusion This first-of-its-kind survey highlights that the majority of patients and family caregivers were satisfied with nebulizers and reported improvements in symptoms and reduced hospitalizations with nebulizer therapy. The patients preferred nebulized therapy to inhalers.

Background: High-flow nasal cannula (HFNC) oxygen therapy is carried out using an air/oxygen blender, active humidifier, single heated tube, and nasal cannula. It is an oxygen delivery system which uses air blender to deliver accurate oxygen concentration to the patient from 21% to 100% at desired temperature. It can be administered via wide bore nasal cannula or to the tracheostomy tube via connector. It can give upto 60L/min flow hence can generate positive end expiratory pressure between 2 to 7 cmH20. By providing humidified oxygen along with the high flow rates it satisfies air hunger and reduces work of breathing for the patient.Methods: This is a retrospective observational study. Patients with persistent hypoxia in spite of conventional oxygen therapy were treated with HFNC. Patients with possible need for immediate invasive ventilator support were excluded. Clinical respiratory parameters and oxygenation were compared under conventional and HFNC oxygen therapy.Results: Thirty patients, aged more than 18 years admitted in intensive respiratory care unit with acute hypoxemic respiratory failure from June 2017 to January 2018 were included in the study. Study period was of 6 months. Etiology of acute respiratory failure (ARF) was mainly pneumonia (n = 17), interstitial lung disease (n = 5), bronchial asthma (n=3) and others (n = 5). There was statistically significant reduction in respiratory rate (29.40 before Vs 23.50 after; P- <0.0001) and significant improvement in comfort level of the patient after HFNC therapy. Median duration of HFNC was 48 hrs (24-360) hours. Five patients were intubated later on and 4 died in the intensive care unit.Conclusions: Use of HFNC in patients with persistent ARF was associated with significant and sustained improvement of clinical parameters (respiratory rate). It can be used comfortably for prolonged periods.

Background: Electrolyte disorders are common in patients in the emergency department and intensive care unit, and have been associated with increased morbidity and mortality. In this respect sodium and potassium are the most important cations, whose improper adjustment may cause severe neuromuscular disorders. This study was designed to compare values obtained by laboratory and point-of-care testing and also to find most frequent electrolyte abnormalities.Methods: Observational Study was done on 51 patients presenting to Tertiary care Hospital emergency department with altered sensorium between 1st January 2016 to 31st May 2017 fulfilling the inclusion criteria and willing for participation by giving written informed consent. Electrolytes were tested in patients with GCS 14 or less by both point of care system and in the laboratory.Results: The distribution of mean sodium and potassium levels did not differ significantly between two techniques (P-value>0.05). The sodium and potassium levels by POC and laboratory techniques are significantly and positively correlated (P-value<0.001). The distribution of mean along with 95% CI of mean of amount of bias in the estimation of Sodium and Potassium levels by POC against Laboratory method is 3.50 [2.79-4.20] mEq/L and 0.83 [0.55-1.11] mEq/L respectively. The most common electrolyte abnormality was hyponatremia.Conclusions: We concluded that it is advisable to do a point-of-care electrolyte in Emergency department and Intensive care unit. By use of point-of-care testing, we can identify electrolytes imbalance early in emergency department. Point-of-care electrolyte levels had a near comparable value with laboratory electrolyte levels.

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