Hypersensitivity pneumonitis was the most common new-onset ILD in India, followed by CTD-ILD and idiopathic pulmonary fibrosis; diagnoses varied between site investigators and CILD experts, emphasizing the value of MDD in ILD diagnosis. Prompted case report forms including environmental exposures in prospective registries will likely provide further insight into the etiology and management of ILD worldwide.

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ObjectiveThe objective of the sub-analysis of data from centers across urban areas in India of the Global Asthma Network (GAN) was to study the 1) prevalence of symptoms of asthma in children and adults, 2) change in prevalence of asthma and its trigger factors since the International Study of Asthma and Allergies in Childhood (ISAAC), and, 3) current asthma treatment practice.MethodsIn this cross–sectional, multicenter, school-based, and self-administered questionnaire, responses from children aged 6–7 years, 13–14 years, and their respective parents were analysed.ResultsThe GAN phase I study included 20084 children in the 6–7-year-age group, 25887 children in the 13–14-year-age group, and 81296 parents. The prevalence of wheeze in the past 12 months was 3.16%, 3.63%, and 3.30% in the three groups respectively. In comparison to the ISAAC studies, there was a significant reduction in the prevalence of current wheeze (p<0.001). Bivariate analysis revealed a significant reduction in the prevalence of trigger factors. Almost 82% of current wheezers and 70% of subjects with symptoms of severe asthma were not clinically diagnosed as having asthma. The daily use of inhaled corticosteroid (ICS) was less than 2.5% in subjects with current wheeze and those with symptoms of severe asthma but less than 1% used daily ICS when asthma remained undiagnosed.ConclusionThe prevalence of current wheeze and its causal factors showed a significant reduction compared to previous ISAAC studies. Among subjects with current wheeze and symptoms of severe asthma, the problem of under-diagnosis and under-treatment was high.

Hypersensitivity pneumonitis (HP) is an immune-mediated lung disease (ILD) caused by sensitisation to inhaled organic antigens or low molecular weight chemical compounds. Recently, there has been increased awareness of environmental factors associated with HP [1]. It has been postulated that when genetically susceptible individuals ("first hit") are exposed to an inciting antigen ("second hit") they develop HP [2]. The first hit is essential, as not all who are exposed to an inciting antigen develop disease. The second hit or the inciting antigen may be bacterial, protozoal, animal or insect protein, or rarely a chemical compound. Certain viral infections and high pesticide exposures may be risk factors for development of HP, perhaps by making the lung more susceptible to organic antigen exposure (facilitating a second hit) [3, 4].

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