Flexible bronchoscopy (FB) is commonly performed by respiratory physicians for diagnostic as well as therapeutic purposes. However, bronchoscopy practices vary widely across India and worldwide. The three major respiratory organizations of the country supported a national-level expert group that formulated a comprehensive guideline document for FB based on a detailed appraisal of available evidence. These guidelines are an attempt to provide the bronchoscopist with the most scientifically sound as well as practical approach of bronchoscopy. It involved framing appropriate questions, review and critical appraisal of the relevant literature and reaching a recommendation by the expert groups. The guidelines cover major areas in basic bronchoscopy including (but not limited to), indications for procedure, patient preparation, various sampling procedures, bronchoscopy in the ICU setting, equipment care, and training issues. The target audience is respiratory physicians working in India and well as other parts of the world. It is hoped that this document would serve as a complete reference guide for all pulmonary physicians performing or desiring to learn the technique of flexible bronchoscopy.

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Background: Asthma COPD overlap (ACO) is widely gaining recognition as separate phenotype of chronic obstructive airway disease with distinct treatment and prognosis. It is an important challenge of accurately diagnosing ACO. Aim: To estimate the prevalence of ACO among patients previously diagnosed as COPD and compare their demographical profile. Methodology: This was observational study of 351 patients with COPD visited at our center between 2018-2019. A detailed chart review including demographic, clinical, laboratory investigations, spirometry, and radiological findings were recorded in pre-structured proforma. The diagnosis of ACO was based on GINA/GOLD criteria 2019. Results: Of the total (n=351), ACO was diagnosed in 109 (31.05%) patients. Female predominance 61 (55.96%) patients were observed. There was a significantly higher incidence of wheeze, nasal symptoms, family history of atopy, as compared to obstructive airway disease. There was no significant difference in radiological findings between two groups. Conclusion: ACO represents a large proportion (31.05%) of bronchial asthma patients with female predominance, higher comorbidities. GINA/GOLD criteria 2019 are important questionnaire to differentiate ACO from COPD with limited role of chest imaging. The study results have implications for earlier identification and appropriate treatment of this distinct clinical phenotype.

Introduction: Acute febrile illness (a rapid onset of fever and symptoms such as headache, chills, muscle and joint pain) is common in topics and subtopics, caused by very diverse pathogens. Pulmonary involvement has been well reported and basic pathological process in pulmonary involvement of scrub typhus is interstitial pneumonia with or without vasculitis. Methodology: Prospective observational, analytic study performed in period of Jan-2019 to Dec-2019 to determine rates, clinic-epidemiology, pattern of respiratory system involvement, incidence, frequency and pattern of respiratory system involvement in cases of illness involvement in scrub typhus admitted in medical ward and ICU. Result: In our study of total 130 patients were included, out of which 50 were males and 80 were females. Patients above age of 16 years were included patient with Scrub typhus were admitted 46 (35.3%) in ICU and 84 (64.6%) in Ward and amongst them non smokers is more common 95 (73.07%), and Non alcoholics is common in Scrub typhus 86 (66.15%), Comorbidities In Scrub typhus DM being most common comorbidity followed by HTN (4.61%) and combination of both DM and HTN (4.61%) respectively. ABG findings In Scrub typhus 101 (77.6%) showed normal findings and 29 (22.3%) abnormal findings. In Scrub typhus most common pulmonary manifestations being productive cough 42 (32.3%) and least common being hemoptysis 1 (0.76%). Conclusion:In all the cases of scrub typhus during early stage of the disease pulmonary manifestations must be ruled out and basic radiological investigations (CXR) should be done to find out any complications of pulmonary system involvement such as ARDS, Pneumonia etc. Early detection of pulmonary manifestations can not only reduce the stay of the hospital but also improves outcome of the disease and reduces mortality and morbidity rate.