BACKGROUND:Allergic Broncho Pulmonary Aspergillosis (ABPA) is a rare disease characterized by an allergic inflammatory response to the colonization by aspergillus or other fungi in the airways. The aim was to study the clinical, radiological, and serological characteristics of patients of ABPA.MATERIALS AND METHODS:A prospective observational study of patients with breathlessness, chronic cough, blood eosinophilia, and infiltrates on chest X-ray were evaluated with serologic and allergic skin fungal tests using 15 common fungal antigens. Total of 24 patients were diagnosed as ABPA.RESULTS:Total 24 patients, 15 males (62%), 9 females (38%). Age range: 14-70 years, mean 49.13, standard deviation (SD) 14.12. Central bronchiectasis — sixteen patients, bronchocoele — one patient, consolidation — five patients, collapse with mucous plugging with areas of consolidation — three patients, one patient had bronchiectasis, consolidation with hemorrhagic pleural effusion. Fifty-eight percent of patients had received anti-tuberculosis medications prior to diagnosis. Serum total IgE varied from 340 to 18100 IU/mL. Two patients had IgE levels below 1,000 IU/mL. The mean decrease in Serum total IgE levels at the end of 1 month was 26.1% (range: 0.7-71.9%) and at the end of 2 months was 58.9% (range: 11.11-93.26%) (P value of 0.004). Two patients had skin sensitivity to fungal antigens other than aspergillus species.CONCLUSION:ABPA is a disease with varied clinical, radiological, and serological patterns. Serum IgE monitoring may be done at the end of 2 and 6 months. Further studies are required to simplify the diagnosis and treatment algorithms in resource-limited countries.

OBJECTIVES:Idiopathic pulmonary fibrosis (IPF) is the most common form of interstitial lung disease (ILD) diagnosed all over the world as well as in India. The objective was to study the clinical presentations, treatment options, and survival of patients diagnosed with IPF. MATERIALS AND METHODS:This was a 6-year retrospective observational study. All patients diagnosed with ILD underwent a comprehensive evaluation to confirm the diagnosis of IPF and were subsequently included in the study. Clinical data and laboratory data were recorded. Patients were treated as per current guidelines. RESULTS:Out of the total number of patients (n=123) diagnosed with ILD, 46 (37.4%) patients were included in the study [Males, n=19 (41%) and females, n=27 (59%)]. Sixty-seven percent (n=31) of the patients were in the age group of 61-80 years. The mean age of males and females was 68.36 and 66.25 years, respectively. Clubbing was observed in 67% (n=29) of the patients. The mean forced vital capacity (FVC) was 52%. High-resolution computed tomography (HRCT) of the chest showed a definite usual interstitial pneumonia (UIP) pattern of honeycombing in 60% (n=28) of the patients. Desaturation on a 6 min walk distance was noted in 60% (n=28) of the patients. Ten patients wrongly received-anti tuberculosis treatment (21%) before they were diagnosed with IPF. The median delay in diagnosis was 20 months. The 5-year survival rate was 25%; the average survival was 39 months. Patients receiving pirfenidone showed a survival benefit compared with those having received triple therapy. Survival in IPF was significantly low compared with that in other ILDs. Twenty-four (52%) patients died during the study. CONCLUSION:IPF is a disease which affects the fourth to seventh decade of the Indian population with low survival. KEYWORDS: Idiopathic pulmonary fibrosis, survival, pirfenidone INTRODUCTIONInterstitial lung diseases (ILD) are a group of disorders characterized by varying degrees of fibrosis and inflammation of the lung parenchyma or interstitium [1]. Combining clinical, radiological, and pathological information is pivotal to accurate diagnosis in interstitial lung diseases. Idiopathic pulmonary fibrosis (IPF) is the most common form of ILD diagnosed worldwide as well as in India. IPF portends a poor prognosis as well as increased morbidity and poor quality of life. In India where lung transplantation is in a nascent stage, patients presenting with IPF have a poor prognosis. We present the analysis of our data from the western Indian population.The objective was to study the clinical presentations, treatment options, and survival of patients diagnosed with IPF. MATERIAL AND METHODS Design and setting:This was a retrospective observational study of patients presented to our specialty respiratory clinics in the period from January 2008 to March 2014. Data analysis was performed subsequently.Eligibility: All patients presented to the outpatients department with a history and examination suggesting interstitial lung disease were confirmed with...

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Background. Non-specific interstitial pneumonia (NSIP) has now been accepted to be a distinct clinical entity. However, very limited data is available in western Indian population regarding its clinical presentation, treatment options and survival of patients diagnosed with idiopathic NSIP.Methods. A retrospective, observational analysis of clincial, radiological, treatment and survival of patients data collected from hospital records who were diagnosed with idiopathic NSIP over the six years was carried out.Results. Out of a total of 146 patients of interstitial lung disease (ILD), 46 (31.5%) patients diagnosed with idiopathic non-specific interstitial pneumonia were included in the study. There were 12 male patients. Mean age of female was 60.6 years and 60.5 years for male patients. Clubbing was seen in 12 (26%) patients. Fifteen (32.6%) patients were on anti-tuberculosis medications prior to the diagnosis of idiopathic NSIP. The mean forced vital capacity (FVC) in the present study was 56%. High resolution computed tomography (HRCT) of the chest revealed reticulation with basal predominance in 35 (76%) patients and ground-glass opacities in 9 (19%). Median survival from initial visit was 29.6 months; while that from symptom onset was 46.2 months (p=0.03). Stabilisation of disease was seen in 26 (56.5%). Twenty patients died during the study period.Conclusions. Idiopathic NSIP is a disease of the elderly with female predominance with a five-year mortality of 25%. Late presentation worsened the prognosis.

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