Beena Thomas

Abstract

Introduction: Triple therapy (Long Acting Muscarinic Antagonist (LAMA), Long Acting b 2 Agonist (LABA), Inhaled Corticosteroid (ICS)) for Chronic Obstructive Pulmonary Disease (COPD) is available as single or separate inhalers. There is a dearth of studies in real-world scenario comparing them. Materials and Methods: We followed up 33 moderate to severe COPD patients each on single inhaler (Tiotropium-Formoterol-Ciclesonide) and two separate inhalers (Tiotropium; Formoterol-Budesonide) for triple therapy for a period of three months.We compared socio-demography, Test of Adherence to Inhalers (TAI) score, baseline and improvement in FEV1, FEV1/FEV, St George Respiratory Questionnaire score (SGRQ) and Euro Qol 5 Dimension Scale score (EQ-5D) by independent t-test or Mann Whitney U test. The change in each group was compared with their baseline by paired t-test or Wilcoxon Signed Rank test. Results: The groups were comparable at the baseline with respect to age, gender, smoking, FEV1/FEV, SGRQ, EQ-5D; TAI but, separate inhaler group was worser than single inhaler group with respect to baseline FEV1 (Severe COPD - 61% Vs. 30%) and spacer use (70% Vs. 100%) (p improved significantly on FEV1, FEV1/FEV, SGRQ and EQ-5D (p separate inhalers was significantly (p 5% Vs. 1%), FEV1/FEV (median 0.04 Vs. 0.02), SGRQ (mean -50.1 Vs. -25.5) and EQ-5D (median -3 Vs. -1). Conclusion: Triple therapy improves patients by single or separate inhalers. Patients on separate inhalers had more improvement than patients on single inhaler without considering the confounding factors. Keywords: COPD, Inhalers.

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Abstract

Background: Metered dose inhalers (MDI) are preferred treatment for asthma and chronic obstructive pulmonary disease. The used MDI canisters are to be disposed off in appropriate manner to prevent environmental pollution. In this study, the disposal methods followed by the patients were investigated. Methodology: This study was conducted in out-patient setting in departments of pulmonary medicine of a tertiary care teaching hospital in south Kerala. The Any patient who was using MDI for at least past one year was enrolled into the study. Exhaustive sampling was done over a period of six months to obtain interviews of 883 patients. Age, gender and educational status of participants, disposal methods they followed for MDI canisters and the source of information for the disposal methods were enquired. Results: Among the 883 patients who were interviewed, 46% were females and 54% were males and 57% were older persons (age above 60 years). All of them were using MDI for at least past one year. None of them were informed about the correct methods of disposal of used MDI canisters (recycle or incineration or plasma pyrolysis). Majority (79%) of the participants disposed them in the waste bins or into the general waste heaps, 13.7% of the participants burned them in their courtyard and 7 (0.8%) participants stored them and 3 (0.4%) used to flush down them in the toilet. Conclusions: MDI canister disposal is an unaddressed environmental hazard. Take back programs need to be initiated to recycle them or at least to incinerate them safely according to Biomedical Waste Management and Handling Rules. ‘Complete the Cycle’ scheme in United Kingdom can be a model for a recycling project venture. Incineration is currently possible through IMAGE project (IMA Goes Eco-friendly) which is currently run in Kerala. Keywords: Biomedical waste management; Metered dose inhaler; Inhalational therapy; Recycle, Take back program.

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Abstract

Background: Acinetobacter baumannii has evolved as a common Multi Drug Resistant (MDR) microbe. This study was conducted to find the profile of antimicrobial resistance and mortality and their associated factors in A. baumannii infection of lower respiratory tract. Materials and Methods: This was a record based cross sectional study done in a tertiary care teaching hospital in Kerala. Records of all the 63, A. baumannii lower respiratory infection in 2017, were retrieved and analyzed. MDR was defined as resistance to at least one agent of three or more antimicrobial classes. Proportion of MDR, carbapenam resistance and resistance to other major antimicrobials were calculated. Determinants of carbapenam resistance and its associated antimicrobial resistance were explored. Proportion of mortality and the associated factors were explored. Student’s t-test, chi-square test or fisher exact test were used appropriately. Results: Proportions of MDR and carbapenam resistance were 85.7% and 41.3% respectively. Highest proportion (90.5%) was resistant to piperazillin-tazobactam. Carbapenam resistance was associated with MDR (p-value95% CI: 63.9% to 85.3%). Older age and ICU stay prior to infection were associated with mortality (p-value Conclusions: Rates of antimicrobial resistance in Acinetobacter baumannii and the mortality were high in the setting, comparable to reports from other parts of India. The drug resistance increases hospital care burden. There is an urgent need to implement stringent infection control measures. Keywords: Acinetobacter baumannii; Nosocomial infection; Antimicrobial resistance; Multi Drug Resistance; ESKAPE.

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