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. MethodsThe Indian bronchiectasis registry is a multicentre, prospective, observational cohort study. Adult patients (≥18 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.

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IntroductionIdentifying risk factors for poor outcomes can help with risk stratification and targeting of treatment. Risk factors for mortality and exacerbations have been identified in bronchiectasis but have been almost exclusively studied in European and North American populations. This study investigated the risk factors for poor outcome in a large population of bronchiectasis patients enrolled in India.MethodsThe EMBARC-India registry is a prospective observational study of adults with CT confirmed bronchiectasis enrolled at 31 sites across India. Baseline characteristics of patients were used to investigate associations with key clinical outcomes: Mortality, severe exacerbations requiring hospital admission, overall exacerbation frequency and FEV1decline.Results1018 patients with at least 12 months follow-up data were enrolled in the follow-up study. Frequent exacerbations (3 or more per year) at baseline were associated with an increased risk of mortality (hazard ratio(HR) 3.23 95%CI 1.39–7.50), severe exacerbations (HR 2.71 95%CI 1.92–3.83), future exacerbations (rate ratio(RR) 3.08 95%CI 2.36–4.01) and lung function decline. Co-existing COPD, dyspnoea and current cigarette smoking were similarly associated with a worse outcome across all endpoints studied. Additional predictors of mortality and severe exacerbations were increasing age and cardiovascular co-morbidity. Infection with Gram-negative pathogens (predominantly Klebsiella pneumoniae) was independently associated with increased mortality (HR 3.13 95%CI 1.62–6.06), whilePseudomonas aeruginosainfection was associated with severe exacerbations (HR 1.41 95%CI 1.01–1.97) and overall exacerbation rate (RR 1.47 95%CI 1.13–1.91).ConclusionThis study identifies risk factors for morbidity and mortality among bronchiectasis patients in India. Identification of these risk factors may support treatment approaches optimised to an Asian setting.FundingEU/European Federation of Pharmaceutical Industries and Associations Innovative Medicines Initiative inhaled Antibiotics in Bronchiectasis and Cystic Fibrosis Consortium, European Respiratory Society, and Asthma and Lung UK.

PURPOSE: India has been implementing Revised National Tuberculosis Control Programme (RNTCP), WHO-recommended Directly Observed Treatment Short Course (DOTS) to control tuberculosis (TB). The present study was undertaken to analyze outcome of Category III treatment in RNTCP received by patients having tuberculous cervical lymphadenopathy. METHODS: 65, FNAC proven cases having tuberculous cervical lymphadenopathy received Category III regimen under RNTCP i.e. 2(HRZ) 3 / 4(HR) 3. The clinical response was noted at the end of treatment. Patients having no response or persistent lymphadenopathy underwent lymph node aspirate or lymph node tissue homogenate for Mycobacterial culture and sensitivity before receiving a re treatment regimen i.e. 2(SHERZ) 3 / 1(HER) 3 / 5(HR) 3, (Category II).RESULTS: 41 out of 65 patients (63%) responded to Category III treatment, however, 24 patients (36.9%) did not showed response at the end of treatment.16 patients (24.6%) showing no response with initial regimen, responded to re treatment regimen (Category II), while 5 patients (7.6%) turned out to be having drug resistant disease and responded with reserved drugs. Three patient required surgical resection of glands after completing the re treatment regimen.CONCLUSION: Six months, thrice weekly, Category III regimen with three drugs in initial intensive phase seems insufficient treatment for patients having tuberculous cervical lymphadenopathy (only 63% response rate with about one fourth patients requiring re treatment regimen). CLINICAL IMPLICATIONS:There is need for conducting large operational research, considering the number of drugs and duration of therapy in patients receiving Category III treatment for tuberculous cervical lymphadenopathy under RNTCP, especially in areas with primary drug resistance > 4%. Review and timely revision should be the essential component of any Tuberculosis Control Programme.

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