A 60-year-old male who was being worked up for surgical management of cholelithiasis was advised medical consultation for his respiratory complaints. He was a chronic smoker and had a history of long standing cough with dyspnoea on exertion with periodic exacerbations. There was a definitive change in pattern of cough for the last 3 months and he was expectorating mucopurulent sputum. He however ignored it as a seasonal event, that was not very unusual for him. There was no history of fever, haemoptysis, chest pain or increased shortness of breath from baseline. Routine investigations including haemogram, electrocardiogram, liver function test, renal function test, serum electrolytes, fasting blood sugar, coagulogram and urine complete examination were normal. Sputum was negative for acid fast bacillus. Chest radiograph showed paracardiac opacity in right lower zone [Table/ Fig-1]. Computed Tomography (CT) of chest showed collapse consolidation of right lower lobe of lung . Keeping in view prolonged smoking history, age, change in character of cough as reported by the patient, paracardiac opacity and CT findings, malignancy was suspected and patient was taken up for bronchoscopy and during the procedure a suspected mass was seen in the right main bronchus , it was cauliflower like, whitish yellow in colour causing almost complete occlusion of the right main bronchus. Multiple endobronchial biopsies were taken using an alligator jaws type biopsy forceps. As the third biopsy was being taken the mass came up along with the biopsy forceps. At this point it was realised that probably it was a foreign body. An attempt was made to take it out by pulling out the bronchoscope along with the foreign body attached to the biopsy forceps. But during the process, the patient coughed violently and got very restless. As the bronchoscope was taken out, it was observed that the foreign body had got dislodged. The patient suddenly became dyspnoeic and his oxygen saturation began to fall to around 70%. He was given high flow oxygen by a mask and bronchoscope was reintroduced once saturation improved to around 90%. Now the foreign body was seen lying in the left main bronchus. Patient's head end was lowered and attempt was made to take out the foreign body with a grasping forceps. After a few failed attempts, it was possible to hold it with the grasping forceps. However, again as bronchoscope was negotiating the vocal cords, the patient coughed violently and got up pulling out the bronchoscope. It was noticed that the foreign body AbSTRACTForeign body aspiration mostly presents as acute emergency with cough, choking and dyspnoea. Rarely aspiration of foreign body may be the underlying cause in patients presenting with long term symptomatologies. Here is a case of 60-year-old male who came for surgical management of cholelithiasis. During his workup, X-ray chest revealed right paracardiac opacity. Fibre-optic bronchoscopy showed a mass lesion in right main bronchus. It was taken out of the airways by flexible bronchoscope but could ...

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Background: Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airway and the lung to noxious particles or gases. Sputum production is a cardinal feature in COPD. Airway clearance techniques have been the mainstay of management. Oscillating positive expiratory pressure (OPEP) devices are handheld devices that provide a combination of positive expiratory pressure (PEP) with high frequency oscillations which involve exhaling against a resistance that is fluctuating. It encourages airflow within secretions, whereas oscillations induce vibrations within airway wall to displace secretions into airway lumen and help in expectoration. Methods: A randomized control trial was conducted at the department of pulmonary medicine, Government Medical College & Hospital, Chandigarh, in which 50 patients with stable COPD were enrolled for one- and- half years. After taking proper history, they were subjected to spirometry, six- minute walk test, and were asked to fill the St. George’s Respiratory Questionnaire (SGRQ) and COPD Assessment Test (CAT). These patients were randomized into group A (intervention group) and group B (control group), where group A was prescribed Aerobika OPEP device for daily use for a period of three months. After three months of use of device, the patients were again subjected to assessment parameters and inquired about any exacerbation within the three- month period. Results: At the end of three months were compared with baseline results. The median change in FEV1, FVC, 6MWD from baseline in group A was significantly more as compared to group B (FEV1: P < 0.001; FVC: P < 0.001; 6MWD: P = 0.08), whereas SGRQ score showed a significant improvement in both the intervention and control groups ( P < 0.001) and CAT score showed significant improvement in comparison to the control group ( P < 0.001). The median change in 6MWD and CAT from baseline in group A was significantly more as compared to group B (SGRQ: P < 0.001; CAT: P < 0.001), whereas it was not significant in case of SGRQ ( P = 0.233). There was no significant difference in the incidence of exacerbation in the two groups ( P = 0.19). The device did not help in controlling the rate of exacerbation in the present study at three months. Conclusion: Stable COPD patients who were given OPEP therapy as an adjunct to the standard drug therapy showed improvement in the spirometry parameters, exercise capacity and symptom burden in comparison to the drug only group.

A 26 year old female presented with complaints of high grade fever and cough for 10 days. Nasopharyngeal swab tested for COVID-19 RT-PCR at admission was negative. Clinical examination suggested a patch of bronchial breathing in left infrascapular region and bilateral diffuse rhonchi. Chest X-ray was suggestive of left lower zone consolidation. HRCT showed a large patch of consolidation with GGO along with a cavitary lesion involving left lower lobe. Sputum for RT-PCR COVID 19 was positive. Patient was managed as per covid-19 protocol, subsequently showing clinical and radiological improvement.