Severe asthma can be associated with eosinophilic or allergic phenotypes or both. Eosinophilic inflammation is associated with exacerbations and disease severity due to biological activity of interleukin-5 (IL-5). Patients with severe asthma have reported reduced lung function and poor health-related quality of life (HRQoL) and may require systemic corticosteroids for its management. Thus, treatment targeting IL-5 can help improve quality of life and reduce the use of systemic corticosteroids in severe asthma. Mepolizumab is approved for treating severe eosinophilic asthma as it helps reduce exacerbations, improve lung function and asthma control, and reduce the use of systemic glucocorticoids. This further helps in enhancing HRQoL of these patients. This case series includes four adult patients suffering from severe eosinophilic asthma who were treated with mepolizumab.

In coronavirus disease 2019 (COVID-19) patients, dysregulated release of matrix metalloproteinases occurs during the inflammatory phase of acute respiratory distress syndrome (ARDS), resulting in epithelial and endothelial injury with excessive fibroproliferation. COVID-19 resembles idiopathic pulmonary fibrosis (IPF) in several aspects. The fibrotic response in IPF is driven primarily by an abnormally activated alveolar epithelial cells (AECs) which release cytokines to activate fibroblasts. Endoplasmic reticulum (ER) stress is postulated to be one of the early triggers in both diseases. Systemic sclerosis (SSc) is a heterogeneous autoimmune rare connective tissue characterised by fibrosis of the skin and internal organs. Interstitial lung disease (ILD) is a common complication and the leading cause of SSc-related death. Several corollaries have been discussed in this paper for new drug development based on the pathogenic events in these three disorders associated with pulmonary fibrosis. A careful consideration of the similarities and differences in the pathogenic events associated with the development of lung fibrosis in post-COVID patients, IPF patients and patients with SSc-ILD may pave the way for precision medicine. Several questions need to be answered through research, which include the potential role of antifibrotics in managing IPF, SSc-ILD and post-COVID fibrosis. Many trials that are underway will ultimately shed light on their potency and place in therapy.

Background: In India, long term data regarding professional outcomes and geographical distribution of enrolled medical graduates is lacking. This adversely impacts policy for efficient healthcare delivery. Methods: A cross sectional survey of students enrolled as medical graduates in year 2001 was done at single point follow up after 17 years. Along with demographic data, gender, seat quota, post-graduate qualification, type of practice, discipline of choice and current geographic locations were collected. Logistical regression model with odds ratio was used to analyse association between variables. Results: 192/200 medical graduates were analysed. Male: female ratio was 119: 73. 109 (56%) had post-graduate degree, 35 (18%) had post-graduate diploma, while another 24 (12.8%) completed super-specialty degree.125 (65%) completed post-graduation in clinical disciplines. 103 (54%) are serving government institutes. 54 (28%) practice in metro cities, while 48 (25%) are in non-metro capital urban locations. Only 44 (23%) are serving rural Indian population, while 17 (9%) are at foreign countries. General medicine (12.5%), obstetrics (8%), paediatrics (8%) anaesthesia (7%) and general surgery (6.7%) were the most common broad clinical specialities. Females had high likelihood to pursue obstetrics/ gynaecology {OR-11.4 (95%CI-2.6-48.7)}; while males were more likely to select medical {OR-0.54 (95% CI-0.25-1.0)} and surgical disciplines {OR- 0.42 (95% CI-0.18-0.98)}. Conclusions: Majority of medical graduates complete post-graduation courses, with preference for clinical disciplines. Less than one fourth of doctors serve rural population.

Frequent coexistence and strong etiological linkage between asthma and allergic rhinitis (AR) result in higher burden with comorbid condition than individual disease. To understand attitude, perceptions, and current management practices among general practitioners (GPs) and pediatricians towards coexistent asthma-AR. A cross sectional survey was conducted in India, China, Malaysia, Vietnam, etc. Results presented here are focused on India. Physicians working in public and private sector of 10 Metropolitan cities were approached in person for this survey. A representative national sample of physicians was recruited at hospitals and clinics using a probability-based sampling methodology for a total of 200 physician in India. 98 GPs and 102 pediatricians in India were surveyed. Clinical features and family history of atopy was used by 96% and 82% physicians, respectively to form a diagnosis of asthma. 54% of physicians enquired about common triggers, 48% conducted spirometry. 25% of physicians used patient outcome questionnaires to assess control. AR was diagnosed by nasal (91% of physicians) or ocular symptoms (72% of physicians) and 32% performed skin prick test or serum Immunoglobulin E (IgE). In uncontrolled coexisting asthma-AR, 78% of physicians modified treatment, 21% of physicians referred to a specialist. 88% of physicians were concerned that treating both conditions required added medications, 59% of physicians felt managing both simultaneously was difficult, and 55% of physicians believed it was enough to manage more severe condition. Study highlights low implementation of guidelines despite awareness and need for continued medical education to encourage appropriate diagnosis and management of co-existent asthma-AR. Though the physicians are aware of the guidelines, there was poor utilization in clinical practice. This indicates a need for increase in awareness of guideline recommendations on co existent asthma-AR and improving management of patients. This also eludes to the development of an easy to use diagnostic tool for asthma- AR co-existence.

Background: Childhood asthma has emerged as an important public health issue which is often under diagnosed or undertreated, especially in underprivileged children from slum communities in India. This study aims to increase awareness and facilitate early diagnosis and treatment of childhood asthma.Methods: Americares India Foundation organized 167 asthma screening camps in the city of Bengaluru, Bhubaneswar, Cochin, Lucknow and Nagpur in India from August to November 2016. A total of 10,017 underprivileged children aged ≤16 years were screened for asthma; symptomatic treatment was provided else the children were referred for further investigations and treatment. The camps were organized in collaboration with St. Philomena’s Hospital, Bengaluru; Lourdes Hospital, Cochin; Indian Institute of Public Health, Bhubaneswar; Lata Mangeshkar Hospital, Nagpur; and St. Mary’s Polyclinic, Lucknow.Results: New and known cases of asthma were diagnosed in 199 and 166 children, respectively. The prevalence of asthma was found to be 2.7% in Bhubaneswar, 3.7% in Bengaluru and Lucknow, 3.9% in Cochin and 4.3% in Nagpur.Conclusions: Due to increase in the prevalence of childhood asthma in India, it is important to create awareness and communicate with families/caregivers about asthma and related disorders.