Developed by Shawkat Jahangir NCD icddr,b © 2019                                                                         Information provided by Dr. Noshin Farzana NCD icddr,b

Theme 7:
Chronic Respiratory Diseases

Primary Care Strategies to Ensure Quality Health Services for Chronic Respiratory Patients: An Exploratory Study in Three Rural Sub-Districts of Bangladesh

Muhammad Ashique Haider Chowdhury2, Syeda Novera Anwar3, Rafiqul Islam4, A.S.M. Safiqur Rahman5, Ali Tanweer Siddiquee6, Shahed Hossain7, Aliya Naheed1

2University of Chicago, 3Swisscontact, Dhaka, Bangladesh, 1International Centre for Diarrhoeal Disease Research, Bangladesh

Background: Despite high disease burden, chronic respiratory diseases (COPD and Asthma) are largely unrecognized and undiagnosed in Bangladesh. Early detection and prevention of NCDs is a government priority in Bangladesh. It is important to explore the existing coverage and identify strategies to provide effective services for Chronic Respiratory patients at primary care settings. Method: We conducted an exploratory study using both quantitative and qualitative methods in three rural sub-districts of Bangladesh (Matlab, Chakaria, Badarganj). Study participants were purposively selected male and female chronic respiratory patients (age≥ 40years); primary care providers; district and national level policy planners. Data collection methods included facility survey at the upazilla health complexes (n=3), survey of chronic respiratory patients (n=105) and primary care provider (n=60), and key informant interviews (KII) of multiple stakeholders (n=20). We explored primary care strategies to strengthen health system in the domains of service availability, accessibility, utilization and perceived effectiveness. Result: Facility and provider survey reflected adequate availability of infrastructure and human resources. Unavailability of screening and preventive services, staff training programs, inhaler drugs and spirometry, non-functioning of x-ray machine and unavailability of ambulance were important barriers to ensure quality health services for chronic respiratory patients. Patients reported satisfactory accessibility to primary care facilities at sub district level except long waiting time at out-patient services. Service utilization was high. Most of the patients and service providers perceived existing primary care services as effective to treat chronic respiratory patients. Providers at different level supported introducing hand held spirometry to promote early detection and biweekly/monthly lifestyle clinics as preventive services at primary care settings in Bangladesh.

Frequency of Osteoporosis among Chronic Obstructive Pulmonary Disease Patients Attending Respiratory Medicine Out Patient Department, BSMMU

Dr Shish Mohammad Sarker

Respiratory Medicine Out Patient Department, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

Background: Osteoporosis is one of the systemic features of COPD. Osteoporosis is a systemic skeletal disease characterized by low bone mass and micro architectural changes that increase bone-fracture risk. The World Health Organization defines osteoporosis as bone density ≥ 2.5 standard deviations below the bone density of a normal young adult. Osteopenia, a less severe form of bone loss, is defined as a bone density between 1 and 2.5 standard deviations below that reference point. The underlying causes of osteoporosis in COPD remain unclear, but several factors significantly correspond to reduced bone density in COPD, including older age, female sex, and body mass index (BMI). However, the relationship to other factors, such as FEV1, tobacco smoking, physical inactivity, and corticosteroid therapy, are still controversial. Materials and Methods: This observational cross-sectional study was conducted on COPD patients in the Department of Respiratory Medicine, BSMMU during March 2018 to March 2019. Results: A total of 86 patients of which prevalence of osteoporosis is 29.1%, osteopenia 50% and normal BMD in 20.9%, majority of them was belong to age 51-60 years. Male were predominant with male-female ratio of 3.5:1. The frequency of osteoporosis was 32% in moderate, 64% in severe and 4% in very severe COPD patients. The frequency of osteopenia was 14% in mild, 53.5% in moderate, 20.9% in severe and 11.6% were in very severe COPD patients. The p value (p=0.018) was significant with increase in severity of COPD in prevalence of osteoporosis and osteopenia. Conclusions: There was high prevalence of osteoporosis and osteopenia in COPD patients of BSMMU. The frequency of osteoporosis and osteopenia was more with severity of COPD.

Role of Radiology and Imaging in Diagnosis, Assessment and Management of COPD

Dr Jalal Mohsin Uddin

National Institute of diseases of Chest and Hospital, Dhaka, Bangladesh

Chronic obstructive pulmonary disease (COPD) is a pathologic pulmonary condition characterized by expiratory airflow obstruction due to emphysematous destruction of the lung parenchyma and remodeling of the small airways. For diagnosis of COPD we mainly depends on history taking  and lung function test . But they are the part of subjective evaluation. Radiology and imaging may play a great role in diagnosis and detection of phenotype of COPD (chronic bronchitis predominant or emphysema predominant etc. We can also  assess severity and complications of COPD with the help of X-ray chest and other radiological means .   Chest x-ray is almost universally available, But it lacks sensitivity in detecting both early airway disease and mild emphysema, and is not generally  enough for objective analysis. Rather Computed tomography has become the standard modality used for objective assessment of disease. It can provide useful measures for emphysema, airway disease, and more recently pulmonary vascular disease for clinical correlation. Newer techniques such as OCT (Optical Coherence Tomography)  and MRI describe special features of lung structure and function that was previously available only in autopsy specimens and respiratory labs. Due to limited availability of these techniques, they are at present used as adjuncts to CT imaging.  Despite ongoing refinements in the spirometric classification of disease, marked phenotypic variation  exists in both subject symptoms and response to therapeutic intervention. This inconsistent association between lung function and disease manifestations has led to increasing interest in image based methods for the diagnosis and classification of COPD.  Lung volume reduction (LVR) and endoscopic lung volume reduction (ELVR) are the current therapeutic options  in cases of severe emphysema. Nowadays imaging is one of the key factors for the success of these therapies. Especially quantitative computed tomography (CT) with its increasing possibilities has become a viable tool, providing detailed information about distribution and heterogeneity of emphysema. Other imaging techniques like dual-energy CT (DECT) and functional magnetic resonance (MR) have shown to add functional information.

Insight into The Uses of Non-Invasive Ventilation for Management of COPD Exacerbation over One Year

Md. Mamunur Rashid, Md. Shahedur Rahman Khan, Md. Bashir Ahmed, Md. Khairul Islam Jessy, KC Ganguly

Professor, National Institute of diseases of Chest and Hospital, Dhaka, Bangladesh

Background: Non-invasive ventilation is an important tool for the management of COPD exacerbation especially in type-2 respiratory failure. In this study, an attempt was done to observe the outcomes and factors influence its use in the management of COPD exacerbation. Method: It’s a prospective observational study done in intensive care unit of NIDCH from January 2013 to December 2013. Patient who had COPD exacerbations with PCO2 >60 mm of Hg and PH <7.35 and who were conscious and could tolerate NIV were included and treated with bi-level positive airway pressure (BiPAP) along with a standard medical regime. Result: Total 143 patients were enrolled. They had age 52 (SD, ± 13) with Male: Female 1.56. Total COPD sufferings were 76 (SD, ± 21) months with duration of Exacerbations 92 (SD,± 28) yrs. Complete recovery was seen in 28% and recovered from exacerbation, but dependant to NIV was seen in 46%. Failure or intolerant to NIV was seen in 26% cases.  Failed patients had mean PCO2 92 mm of Hg and PH < 7.18. Pressure support needed > 6 mm of Hg 18.4%; >8 mm of Hg in 38.8% and > 10 mm of Hg 46.6%. Rate of Nosocomial infection was only 18% and of them, Acinatobacter spp. (34%) and Pseudomonas spp. (52%) were commonly seen. Nasal sore was seen in 32% patients; but no patient had pneumothorax or barotraumas. Hospital stay was 12 (SD, +/- 09) days. Conclusion: Non-invasive ventilation was an effective tool of management COPD exacerbation to clear CO2 and reduces PH. Side-effects of NIV use was minimal.

Pattern of Bacterial Infection in Acute Exacerbation of COPD in A Tertiary Care Hospital.

                                                                Md Rowshan Arif

Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

Background: Acute exacerbation of COPD is one of the important problems during management of COPD. Acute exacerbations of COPD (AECOPD) have considerable impact on morbidity, mortality and quality of life. In COPD acute exacerbation can occur due to bacterial or viral infection and non-infectious causes. Only bacterial infections are benefitted from antibiotic. There are multiple bacteria responsible for acute exacerbation of COPD. Sputum culture and real-time PCR can identify the pattern of bacterial infection. Sputum culture and real-time PCR test can also identify the common pathogenic bacteria responsible for acute exacerbation according to the severity of AECOPD. Rational use of antibiotic can reduce the cost of treatment and possibility of antibiotic resistance. Objective: The present study was conducted with an objective to observe the pattern of bacterial infection in acute exacerbation of COPD. This study can also identify the common pathogenic bacteria responsible for acute exacerbation. Material and Method: This cross sectional study was conducted on hospital admitted and outdoor attended acute exacerbation of COPD patients using sputum Gram stain and culture and Real time PCR. Data were collected on smoking habits, complete blood count with ESR, Chest X-ray. Result: The mean age of the respondents was 60.02±10.55 years, range 38-96 years. Maximum patients (79.0%) age above 50 years followed by 21.0% below 50 years. Maximum patients (87.1%) were male and rest 12.9% patients were female. Male: female ratio 6.8:1. Among the respondents 43.5% were farmer, 32.3% were businessman and 12.9% patients were housewife. Maximum patients had dyspnea (87.1%) followed by increased sputum volume 48.4%, increased wheezing or cough 37.1%, increased sputum purulence 29.0%, Upper respiratory infection (within past 5 days) was observed in 14.5% cases, fever without other cause 9.7%. Acute exacerbation type -3 was found in maximum cases (48.4%) followed by 41.9%  type 2 and 9.7% patients had type 1. Maximum patients (59.7%) were smoker followed by 29.0% patients were ex-smoker and 11.3% patients were non-smoker. Considering sputum culture and RT-PCR, 29(46.8%) patients was positive. Among 29 positive cases, gram positive was 4(13.8%), gram negative was 24(82.8%), 1(3.4%) case was atypical and mixed 1 case. Klebsiella was isolated most frequently 10(34.5%) followed by Haemophilus 7(24.1%). Conclusion: In conclusion, Gram negative bacteria were the most common isolates and Klebsiella was the most commonly recovered bacteria from AECOPD patients.

Frequency of Secondary Adrenal Insufficiency in Patients with Bronchial Asthma and COPD on Long Term Inhaled Corticosteroid

Md Shohidul Islam

Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh


Background: For many decades inhaled corticosteroids (ICS) have been used as first line treatment of asthma. Inhaled corticosteroids are a form of exogenous glucocorticosteroids that can suppress the endogenous production of glucocorticosteroids, a condition known as adrenal suppression (AS). As a result, cessation, decreasing the dose as well as changing the type of ICS may trigger features of adrenal insufficiency (AI). AI may cause a spectrum of presentations from vague symptoms of fatigue to potentially life threatening acute adrenal crisis. There is an association between ICS and AI particularly patients using high doses.  However, low to moderate doses of ICS can also causes AI. Screening for AI in selected patient groups with an initial early morning serum cortisol is essential. If results are abnormal, more definite test such as the low dose short synacthen test (LDSST) should be done to confirm the diagnosis. Objective: The present study was conducted with an objective to determine the frequency of secondary adrenal insufficiency in patients with asthma and COPD on long term treatment with inhaled corticosteroid. Materials and Method: This cross sectional study was conducted in the Department of Respiratory Medicine of BSMMU for a period of one year from May 2018 to April 2019.This study included 48 participants who fulfilled inclusion and exclusion criteria and the age over 18 years who were diagnosed as bronchial asthma or COPD and treated with inhaled corticosteroid for at least six months. Before obtaining the consent all patients were explained about the duration of the study, details study procedure, the benefits and potential risk.  Basal serum cortisol, ACTH and serum cortisol 30 minutes after the low dose ACTH (0.5–1.0 µg) stimulation test were done by Chemiluminescent assay in the Department of Microbiology of BSMMU. Statistical analysis was performed using Statistical Package for Social Science (SPSS) version 22. Only p values <0.05 was considered as significant. Result: The mean age of the respondents was 36.7±13.5 years, range 18-70 years. Maximum patients age within 21-30 years (35.4%) followed by 41-50 years (25.0%).  Among the study population 20 patients were male (41.7%) and 28 patients were female (58.3%). Male: female ratio was 1:1.4.  Out of 48 cases, 17 (35.4%) cases were suspected adrenal insufficiency on the basis of basal serum cortisol. Among 43 bronchial asthma patients, 15(34.9%) were suspected adrenal insufficiency and among 5 COPD patients, 2(40.0%) were suspected adrenal insufficiency on the basis of basal serum cortisol. Out of 17 suspected cases, 3(17.6%) had adrenal insufficiency on the basis of post ACTH serum cortisol which were patients with bronchial asthma and had no adrenal insufficiency in COPD patients. Out of 17 suspected cases, 3(17.6%) patients had adrenal insufficiency on the basis of post ACTH serum cortisol with duration of ICS 18-24 months. Adrenal insufficiency significantly related to increased duration of inhaled corticosteroid. Out of 48 cases, 3(6.3%) patients had adrenal insufficiency and rest of the patients 45(93.7%) were normal and ACTH value was also within normal range in all cases. Conclusion: Adrenal suppression due to ICS treatment is not uncommon. A basal serum cortisol concentration has utility to determine which patients should undergo dynamic assessment of adrenal function. ICS is associated with adrenal suppression in a minority of patients who were on ICS for their respiratory conditions. More researches need to be undertaken to evaluate the AI who are using ICS for asthma and COPD management.

Assessment of Lipid Profile Parameters among Chronic Obstructive Pulmonary Disease Patients Attending Department of Respiratory Medicine, BSMMU

Gopal Chandra Sarker

Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

Background: Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease which is characterized by progressive and not completely reversible airflow limitation due to inflammatory response of the lungs to noxious particles or gases. The status of serum lipid profiles among these patients is very crucial for the outcome of the disease. Objective: The purpose of the present study was to assess the serum lipid profiles of COPD patients with their different grading. Methodology: This cross-sectional study was carried out in the Department of Respiratory Medicine at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from February  2019 to September 2019 for a period of Eight (08) Months. Patients with the age group of more or equal to 40 years in both sexes who were presented with COPD who were attended at OPD or IPD of Department of Respiratory Medicine at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh were selected as study population.Laboratory Measurement of fasting serum lipid profiles was measured. Result: A total number of 100 patients presented with COPD were recruited for this study after fulfilling the inclusion and exclusion criteria. The mean age of the patients was 59.19±10.826 years (range40 to 85years).The ratio of male and female was 19:1.The mean ± SD of total cholesterol was 166.8±41.05 mg/dl (range 106 to 295 mg/dl).The mean ± SD of serum triglyceride level was 122.12±55.949 mg/dl (range 52 to 393 mg/dl).The mean ± SD of serum LDL level was 102.5±34.87mg/dl (range 41 to 212 mg/dl). In 21 cases of high Cholesterol2 cases were in group the stage I; 12 cases were in the stage II; 7 cases were in the stage III and no cases were in the stage IV (p=0.549).In 16 cases of high triglyceride 4 cases were in group the stage I; 7 cases were in the stage II; 4 cases were in the stage III and only 1 cases were in the stage IV (p=0.172).In 21 cases of high LDL 2 cases were in group the stage I; 11 cases were in the stage II; 6 cases were in the stage III and only 2 cases were in the stage IV (p=0.784).In 48 cases of low HDL 4 cases were in group the stage I; 22 cases were in the stage II; 19 cases were in the stage III and only 3 cases were in the stage IV (p=0.877).The correlation coefficient (r) between serum cholesterol and stage I of COPD was found -0.125 (p=0.731).The correlation coefficient (r) between serum cholesterol and stage II of COPD was found 0.038 (p=0.801).The correlation coefficient (r) between serum cholesterol and stage III of COPD was found -0.159 (p=0.356).The correlation coefficient (r) between serum cholesterol and stage IV of COPD was found 0.192 (p=0.680). Conclusion: In conclusion there is no significant relationship between COPD and abnormal serum level of HDL, LDL, triglycerides and total cholesterol. Furthermore there is no statistically significant association between different severity of COPD and lipid profiles parameters.

Prevalence of Respiratory Symptoms among Cotton Mill Workers in Bangladesh

Dr Dibanur Rashid

Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

Background: The cotton textile mill is one of the largest sectors providing a prominent source of growth in the rapidly developing economy of Bangladesh. This sector employs about 5 million workers of whom the majority (80%) are women. During the processing from fiber to fabric the workers are constantly at risk of suffering from various respiratory problems. This study was initiated and conducted to assess the effect of exposure to cotton dust on respiratory symptoms of workers in a Bangladeshi cotton spinning mill. Objective: The study was carried out with an objective to evaluate the effect of long term exposure to organic cotton dust on different respiratory symptoms in the workers. On the basis of the results, the study may provide information on respiratory health risks and finally the data can be used to help the policy makers in executing appropriate strategy regarding the work environment. Materials and Method: This cross sectional study was conducted in a cotton mill at Gazipur, Dhaka, Bangladesh for 1 year. Three hundred and eighty four workers had participated in this study. Enquiry was made regarding respiratory symptoms with the help of a pretested questionnaire. An air quality monitor was used to measure the amount of dust (PM 2.5) in the work place. The collected data were organized and analyzed using Statistical Package for the Social Sciences (SPSS) version 23. Chi square test, unpaired student’s t test and Fisher’s exact test were used for statistical analysis. A p value of < 0.05 was considered as significant and < 0.001 was considered as very significant. Result: 73.18% workers had one or more respiratory symptoms, 54.2% had cough, 31.8% had phlegm production. Breathlessness was complained by 27.9%, chest tightness by 24.2% and wheezing by 14.3%. Only one upper respiratory tract symptom was considered which was runny nose; 47.1% of workers reported about it. During the subgroup analysis, no statistically significant difference was found between different age groups and sex. The blow room workers were more significantly affected (p< 0.05). Using of biomass fuel came out as a potential confounding factor.Most importantly, we demonstrated that, the level of PM 2.5 varied in different working section based on activities of processing of cotton, and it significantly had a greater impact on respiratory symptoms. Conclusion: In summary, we found that the prevalence of respiratory symptoms was higher among the workers exposed to cotton dust. Working section, level of PM 2.5 and use of biomass fuel in some respondents are some of the significant risk factors for the presence of symptoms.

Observation of Pulmonary Function among Cotton Mill Workers in Bangladesh with Spirometric Assessment

Dr Anita Rubaiya Husain

Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangaldesh

Background: Cotton, one of the world’s leading agricultural crops, is plentiful and economically produced, making cotton products relatively inexpensive. Cotton is a group of organic fibres predominantly used for manufacturing material for clothing or soft furnishings. Over 60 million people are employed in the textile or clothing industry worldwide. Cotton industry workers are exposed to various hazards in the different departments of textile factories. The major health problems associated with cotton dust are respiratory problems, byssinosis, bronchitis, asthma etc. Objective: The purpose of the study is to observe pulmonary function among cotton mill workers in Bangladesh with spirometric assessment. Method: This study was conducted in Gazipur, Dhaka in a cotton spinning mill. Among 100 workers pulmonary function was assessed with spirometer in different working section. Pollution of air of different working sections were measured with air quality monitor. Result: There was a significant association of pulmonary function FEV1,FVC,PEF with cotton dust exposure. A significant association was found of FEV1 in blow room. A significant reduction of FEV1 and PEF were found among female workers. No significant association  of pulmonary function was found with duration of exposure. Conclusion: We conclude that there is significant association of  pulmonary function in both long-term and short-term cotton exposed workers. There is also significant association of Pulmonary function parameters (FEV1 and PEF) among female workers. It is justified to tell that solely cotton dust exposure has the effect on pulmonary function impairment.

Dual Bronchodilator Therapy in COPD: A Step Forward

Md. Safiul Islam

National Institute of diseases of Chest and Hospital, Dhaka, Bangladesh

Chronic obstructive pulmonary disease (COPD) is a preventable and treatable condition characterized by persistent airflow limitation that is not fully reversible. The disease has a progressively worsening course with exacerbations, exertional dyspnea, and deterioration of health status each of which contributes to the disease severity. Both the stable COPD and its exacerbations are associated with significant morbidity, mortality, and increased health care costs. Hence, the treatment as well as prevention of stable COPD and its exacerbations is of prime importance

Bronchodilators are the mainstay of symptomatic management of COPD. Current guidelines recommend one or more long-acting bronchodilators for patients with moderate-to-very-severe COPD. Combination of a long-acting β2 -agonist (LABA) and inhaled corticosteroids (ICSs) or a long-acting muscarinic antagonist (LAMA) monotherapy has been recommended by most guidelines as the first choice for patients with higher risk of exacerbation. However, LABA/ICS combination therapy is associated with an increased risk of pneumonia, along with other steroid-related adverse effects. Both the LABA (indacaterol) and the LAMA (glycopyrronium) are approved as single agents for the treatment of moderate-to-severe COPD, and their efficacy and safety has been validated in large, randomised phase III studies. Glycopyrronium (NVA237) is a recently launched once-daily LAMA for the treatment of moderate-to severe COPD, and has been shown to provide rapid and sustained improvements in lung function, dyspnoea, health status, exercise endurance and exacerbation risk similar to tiotropium with a safety profile similar to placebo.

QVA149 is a novel dual bronchodilator containing an inhaled, once-daily (OD) fixed-dose dual bronchodilator, combining the LABA indacaterol (IND) 110 μg and the LAMA glycopyrronium (GLY) 50 μg, delivered by the Breezhaler device. In patients with COPD, QVA149 has demonstrated rapid and sustained bronchodilation, which is significantly superior to that observed with indacaterol alone or glycopyrronium alone and it is well tolerated with an adverse event profile similar to that of placebo. Prospective exploratory analyses showed for the first time in the LANTERN study that a fixed dose combination of IND (a LABA) and GLY (a LAMA) was more effective in reducing exacerbations compared with SFC (a LABA/ICS) in patients with moderate-to-severe COPD. As dyspnoea is not always adequately controlled by bronchodilator monotherapy, and there are risks of pneumonias along with other steroid-related adverse effects of LABA/ICS combination, dual bronchodilators with different mechanisms of action in a fixed dose combination as maintenance therapy is a further step forward in the management of patients with COPD.

Inhaled Mannitol in Patients with Bronchiectasis Effect on Lung Function and Health Status

Kazi Fawzia Afreen

National Institute of Diseases of the Chest and Hospital, Dhaka, Bangladesh

Background: Bronchiectasis patients have chronic cough and viscid sputum production.This study was carried out to see whether inhaled mannitol as a hyperosmolar agent induces expectoration of sputum and thereby improves lung function and quality of life. Method: This single blind randomized controlled trial (RCT) was done in indoor patients of National Institute of Diseases of The Chest and Hospital, Dhaka from January to November, 2010. 50 adult stable bronchiectasis patients aged above 12 years were randomly allocated into mannitol (N=25) and placebo (N=25) group after mannitol challenge test. Baseline vital parameters along with 24 hours sputum volume, dyspnea, spirometry (FEV1, FVC and FEF25,FEF50,FEF75)and health status were documented through ST.George’s Respiratory Questionnaire (SGRQ).  Mannitol group was treated with 400 mg (10 capsules, each containing 40 mg mannitol) of rotacapsule through rotahaler once daily and placebo group was treated with similar amount of empty capsules for 12 consecutive days. Spirometry and sputum volume were evaluated on 6th and 12th day (1st 2 hours and 24 hours of postmannitol inhalation). Dyspnea scale and health status were evaluated again on 12th day. Result: In Mannitol group, sputum volume was reduced faster than placebo though result was not significant. FVC (p < 0.039) and FEF25-75 (p < 0.045) were significant on 12th day and the percentage of total SGRQ reduction and improvement in dyspnea scale was much higher in the mannitol group than placebo (p <0.001). Side effects noted with mannitol were dry mouth in two patients and headache, fatigue, chest pain in four patients. Conclusion: This study concludes that, inhaled Mannitol in bronchiectasis patients improves dyspnea and health status significantly with partial improvement of lung function (FVC and FEF25-75, not FEV1) and reduces sputum volume greater than placebo though result was not significant.

Bone mineral density among Chronic Obstructive Pulmonary Disease patients admitted in a tertiary level hospital

Dr. Muhammad Ali Ashraf1, Dr. F. M. Mofakharul Islam2

Background: Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and mortality throughout the world. It is a preventable and treatable disease with significant extra pulmonary menifestations that may contribute to the severity in individual patients. Osteoporosis is an important systemic feature of COPD and causes significant morbidity. Osteoporosis gradually worsens as the COPD progresses. This study is undertaken to investigate the relationship between BMD and disease severity of COPD patients. Objective: To evaluate the status of BMD among patients with COPD. Method: This was an observational descriptive cross-sectional study carried out in Departments of Medicine of Sir Salimullah Medical College and Mitford Hospital, from July 2017 to December 2017. According to inclusion and exclusion criteria, a total of 50 COPD patients were selected and their BMD was done. Result: Of the 50 patients, on the basis of BMD femoral neck t- score, 100% of very severe and severe COPD patient had osteoporosis, 15% of moderate COPD patients had osteoporosis, while mild COPD patients had no osteoporosis. And also, on the basis of lumber spine t-score, osteoporotic changes were highest among very severe COPD patients (100.0%) which reduced with the reduction of severity of COPD while osteopenia was highest among mild and moderate COPD patients. Mean of BMD femoral neck t-test was lowest among very sever COPD patients (-3.21± 0.16) and highest among mild COPD patients (-1.37± 0.83). ANOVA test revealed that this mean difference was significantly associated (p=<0.001, F= 29.07). Mean of BMD lumber neck t-test was lowest among very sever COPD patients (-3.53± 0.69) and highest among mild COPD patients (-1.16± 0.51). ANOVA test revealed that this mean difference was significantly associated (p=0.012, F= 4.04). Conclusion: BMD alterations are common in COPD patients. A high proportion of patients with COPD experience a significant bone loss which is associated with increased morbidity and mortality. Such patients should be provided with adequate preventive and curative therapy of osteoporosis for better survival.

Histopathological Pattern of Bronchial Carcinoma Among Women in Bangabandhu Sheikh Mujib Medical University

Dr. Abdullah Al Masud

Bangabandhu Sheikh Mujib Medical University

Background: Bronchial carcinoma is the number one cause of cancer-related death in the Western world. Bronchial carcinomas arise from the bronchial epithelium or mucous glands and carcinoma tissue material can be obtained by Computed Tomography (CT) guided biopsy or Fibreoptic Bronchoscopy (FOB) with needle biopsy. Till now treatment of bronchial carcinoma is directed according to histological diagnosis. Objective: To observe histopathological pattern of Bronchial carcinoma and current clinico-pathological status of Bronchial Carcinoma among women in Bangabandhu Sheikh Mujib Medical University. Material and Method: This observational study was conducted on cases of suspected bronchial carcinoma patients and also previously diagnosed cases of bronchial carcinoma on management process using pre-designed data collection sheet. Information about clinical profile, routine laboratory parameters, sputum for malignant cell, X-ray chest PA view, CT scan of chest and CT-guided biopsy, FOB with needle biopsy etc were documented.  Lung biopsy was done under CT guidance in Department of Radiology, BSMMU and other centers or FOB with needle biopsy from lesion in Respiratory Medicine, BSMMU and biopsy material was sent for histopathological study for confirmation of diagnosis in Department of Pathology, BSMMU and also other centers in case of diagnosed patients. Data were analyzed by computer with the help of SPSS version 23. Statistical significance was set at 0.05 level and confidence interval at 95% level. Result: In this study the mean age of patient was 64.1±8.0 years for females. Maximum patients (57.9%) had age group 60-70 years followed by 23.7% patient’s age 71-80 years. Most common clinical presentation was cough (55.5%), followed by weight loss (67.4%), anorexia dyspnea (55.3%), SOB (47.4%), fever (34.2%), chest pain (34.), Hemoptysis (18.4%), hoarseness (13.2%), dysphasia (13.2%). Clinical examination findings were observed maximum patients had anaemia (36.8%) followed by lymphadenopathy (21.1%), clubbing (15.8%) and jaundice (10.5%). Considering histopathological findings, maximum patients had adenocarcinoma (39.5%), small cell carcinoma (21.1%), squamous cell carcinoma (13.2%) and others types (26.3%). Conclusion: Adenocarcinoma now seems to be the most common histological subtype of lung cancer in this study. The worldwide epidemic of lung cancer in women continues to trouble clinicians and researchers alike. An in-depth understanding of the detrimental effects of various environmental exposures when combined with a comprehensive analysis of the molecular basis of lung cancer will lead to the establishment of new and efficacious strategies for the prevention and treatment of this devastating disease.