Background: The spitting of blood derived from the lungs or bronchial tree owing to pulmonary or bronchial hemorrhage is defined as hemotypsis. Blood expectoration even in small volume gives rise to a worrying symptom, and huge hemoptysis might be a life-threatening event. Hence, hemoptysis of any grade requires detailed examination. Hemoptysis is a broad-spectrum symptom and can be observed in various clinical conditions. Objective: To evaluate the various etiological possibilities in patients of hemoptysis. Material and Methods: We conducted a study on 462 patients attending the Department of Pulmonary Medicine, at a tertiary care center in central India, with complain of hemoptysis. The study was done during the period of June 2011 to December 2014. Patients were then categorized according to their etiologies of hemoptysis after further investigations and follow-ups. Result: Of 462 patients of hemoptysis evaluated, 344 were male and 118 female subjects. From our study, we concluded that sputum AFB-negative posttubercular sequelae (110, 24%) was the leading cause. Similarly, bronchiectasis was found in 92 (20%) subjects; sputum-positive pulmonary tuberculosis, 73 (16%) subjects; chronic obstructive pulmonary disease/ emphysema, 46 (10%); chronic bronchitis, 27 (6%); pneumonia, 27 (6%); aspergilloma, 23 (5%); and lung carcinoma, 11 (2.5%). Conclusion: It is clear from the study that pulmonary tuberculosis and its sequelae still holds the leading cause of hemoptysis in our region of study with bronchiectasis being the second most common. Many patients of bronchiectasis are being misdiagnosed as tuberculosis and put on antitubercular treatment. Hence, raising awareness among general physicians is the point of discussion here.

Background: C-reactive protein (CRP) is an acute phase protein synthesized in response to tissue damage or inflammation and reflects total systemic burden of inflammation in individuals. Objective: To assess the levels of serum CRP in acute exacerbations of chronic obstructive pulmonary disease (COPD) and wherever possible compare it with their stable state and to evaluate clinical severity of exacerbations viz a viz rise in serum CRP. Materials and Methods: It was a prospective study in which cases (76) were patients with acute exacerbation of COPD and control group (30) comprised of patients with acute exacerbation of other respiratory diseases such as pneumonia (15 patients), acute exacerbation of asthma (10 patients), and 5 patients of acute respiratory distress syndrome (ARDS). CRP measurement was done by Nephlometry. CRP levels were measured at time of exacerbation and at time of recovery of the patients, which were compared with the overall prognosis of the patients and with the duration and stage of COPD and also the prognosis of patients in each group is correlated to CRP levels. To achieve this objective, receiver operating characteristic curve analysis has been used with the help of MedCalc software and logistic regression analysis has been used to study the role of different stages of COPD and role of comorbidity in the final outcome of the patients using SPSS software version 22. Result: The serum CRP was significantly elevated in patients with COPD with acute exacerbation (mean value 14.78 mg/dL). There was significant elevation of CRP values in control group such as in asthma (mean value 2.71 mg/dL), pneumonia (mean value 20.28 mg/dL), and ARDS (mean value 27.02 mg/dL). Conclusion: CRP is a good discriminator and it predicts poor outcome and also predicts admission in intensive care unit (ICU) or in ward for the patients of acute exacerbation of COPD. CRP value higher than 17.5 mg/dL and above had the poor final outcome of treatment. Positive correlation was found between CRP value and admission in ICU.

Background: Chronic obstructive pulmonary disease (COPD) is a leading respiratory illness affecting the quality of lives around the world. The present study aims to compare the efficacy and safety of combination of inhaled corticosteroid (ICS) and long acting β2 agonist (LABA) with long acting β2 agonist and long acting muscarinic antagonist (LAMA) in treatment of mild to moderate COPD in a tertiary care hospital.Methods: Total 132 patients with COPD were recruited on the basis of inclusion and exclusion criteria for 8 weeks study from outpatient clinic. A complete pulmonary examination including spirometry examination was done to rule out severe and very severe forms of COPD. Spirometry was performed at the time of recruitment for evaluation of forced expiratory volume in one second (FEV1) and measurement of SpO2 at the time of recruitment at 2 weeks and 8 weeks. Appropriate statistical methods were used to compare the qualitative and quantitative primary and secondary efficacy end points, p value <0.05 was considered significant.Results: On analysis, there was a significant difference (p<0.05) was observed in FEV1 and SpO2 from baseline in ICS plus LABA group (n=66). A similarly significant difference (p<0.05) was observed in LABA and LAMA group (n=66). On comparison between ICS plus LABA and LABA plus LAMA no significant difference in FEV1 and SpO2 was observed between the two groups.  More adverse drug reactions were observed in ICS plus LABA group than LAMA plus LABA group.Conclusions: Combination of ICS and LABA combination is as effective as combination of LABA and LAMA in patients having mild to moderate COPD. However, LABA and LAMA combination is preferable because it is associated with fewer side effects.

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Background: Chronic obstructive pulmonary disease COPD is a more complex systemic disease that has significant extra pulmonary effects along with pulmonary involvement. Complexity and mortality of COPD is increased by its co-morbidities and exacerbations. Depression is One of the commonest co-morbidity that occurs in patient with COPD and is associated with poor quality of life therefore we planned to assess depression among COPD patients.Methods: This was a cross-sectional study done in the respiratory medicine department of tertiary care centre, during the period from January 2015 to June 2016. A total of 200 patients of COPD of either sex having age more than 40 years included in the study. Patients who were critically ill and uncooperative excluded from the study. Patients who did not give consent and having previous history of any psychiatric illness also excluded from the study. The diagnosis of COPD was made on the basis of the clinical history, examination, X-ray chest and spirometry. Further, depression was evaluated with the validated Hindi version of nine items PHQ-9 (a subset of patient health questionnaire).Results: The data of all 200 COPD patients were analysed and it was observed that- prevalence of depression in COPD was found to be 49%. Prevalence was higher in male patients 147 (73.5%) as compared to female 53 (26.5%) patients in the present study. Minimal depression was found in 14.28 % COPD patients and mild depression in 25.51 % moderate depression in 39.79 % cases and severe depression in 20.40% cases.Conclusions: Symptoms of depression are common in patients with COPD and its presence may have significant impact on the quality of life of such patients and may be associated with a higher mortality rate.