AR Advanced Respiratory HUBDr. Ranjit Singh is a Pulmonologist with specialized expertise in Sleep Apnea, NIV and ILD procedures and has an experience of 18 years in this field. Having laid the foundation of his career in 2001, Dr. Singh has come a long way in terms of professional experience. His present centres of consultation are RTIICS (Kolkata) and Advanced Respiratory Centre (Jharkhand) where one may visit with a prior appointment.. He completed MBBS from Ranchi University in 1996, DM - Pulmonary Medicine from SMS Medical College, Jaipur in 2001 and MRCP from Royal Colleges of Physicians, Uk in 2008. Faculty at CMC Vellore. Trained in interventional Bronchology from France Marsille. MRCP examiner since 2012. Some of the services provided by the doctor are Video Bronchoscopy, Endobronchial Ultrasound (EBUS) and Thoracoscopy, Cryo biopsy in ILD, Debulking of the Tumor, Management of central airways Tumor, Ultrasound chest etc. Diseases like Interstitial lung diseases, Lung cancer, severe COPD, Severe Uncontrolled Asthma.
An Update on Lymphocyte Subtypes in Asthma and Airway Disease
Inflammation is a hallmark of many airway diseases. Improved understanding of the cellular and molecular mechanisms of airway disease will facilitate the transition in our understanding from phenotypes to endotypes, thereby improving our ability to target treatments based on pathophysiologic characteristics. For example, allergic asthma has long been considered to be driven by an allergen-specific T helper 2 response. However, clinical and mechanistic studies have begun to shed light on the role of other cell subsets in the pathogenesis and regulation of lung inflammation.
COPD-OSA Overlap Syndrome
The recognition of co-existing OSA in COPD patients has important clinical relevance as the management of patients with overlap syndrome is different from COPDalone, and the survival of overlap patients not treated with nocturnal positive airway
pressure is significantly inferior to those overlap patients appropriately treated.
What is a chest infection and what causes it?
This is an infection of the large airways in the lungs (bronchi). Acute bronchitis is common and is often due to a viral infection. Infection with a germ (bacterium) is a less common cause.
This is a serious infection of the lung. Treatment with medicines called antibiotics is usually needed.
How common are chest infections?
Chest infections are very common, especially during the autumn and winter. They often occur after a cold or flu. Anyone can get a chest infection but they are more common in:
Young children and the elderly.
People who smoke.
People with long-term chest problems such as asthma.
What are the symptoms of a chest infection?
The main symptoms are a chesty cough, breathing difficulties and chest pain. You may also have headaches and have a high temperature (fever). The symptoms of an infection of the large airways (bronchi) in the lungs (acute bronchitis) and a serious lung infection (pneumonia) may be similar; however, pneumonia symptoms are usually more severe
Diagnosis of asthma–COPD overlap: the five commandments
1) A patient with asthma may develop non-fully reversible airflow obstruction but this is not COPD, not even ACO; it is obstructive asthma.
2) A patient with asthma who smokes may also develop non-fully reversible airflow obstruction, which differs from obstructive asthma and from “pure” COPD. This is the most frequent type of patient with ACO.
3) Some patients who smoke and develop COPD may have a genetic Th2 background (even in the absence of a previous history of asthma) and can be identified by high eosinophil counts in peripheral blood.These individuals could be included under the umbrella term of ACO.
4) A patient with COPD and a positive bronchodilator test (>200 mL and >12% FEV1 change) has reversible COPD but is not an asthmatic, or even ACO.
5) A patient with COPD and a very positive bronchodilator test (>400 mL FEV1 change) is more likely to have some features of asthma and could also be classified as ACO.
Personalised Medicine for Asthma and Chronic Obstructive Pulmonary Disease
Asthma and chronic obstructive pulmonary disease (COPD)
are prevalent condition sboth significant heterogeneity
within each of these conditions and additionally significant
overlap in many of the clinical and inflammatory features useful clinical and immunological biomarkers which
inform about prognosis and response to therapy have
emerged in both asthma and COPD.
These biomarkers will allow both better targeting of existing treatments and the identification of those patients who will respond to novel therapies which are now becoming available Delivery of precision medicine
in airways disease is now feasible and is a core component
of a personalised healthcare delivery in asthma and COPD
COPD patients significant effects on survival have been shown for several interventions , including. high-frequency neuromuscular electrical stimulation should initiated as the main training modality during his Pulmonary rehabilitation programme, weight gain in underweight patients , non-invasive positive pressure ventilation in chronic hypercapnic patients and lung volume reduction surgery or endobronchial valve treatment in patients with upper-lobe predominant emphysema and poor exercise capacity
An Official American Thoracic Society/European Society of Intensive
Care Medicine/Society of Critical Care Medicine Clinical Practice
Guideline: Mechanical Ventilation in Adult Patients with Acute
Respiratory Distress Syndrome
For all patients with ARDS, the recommendation is strong for
mechanical ventilation using lower tidal volumes (4–8 ml/kg predicted
body weight) and lower inspiratory pressures (plateau pressure , 30 cm
H2O) (moderate confidence in effect estimates). For patients with severe
ARDS, the recommendation is strong for prone positioning for more
than 12 h/d (moderate confidence in effect estimates). For patients with
moderate or severeARDS, the recommendation is strong against routine
use of high-frequency oscillatory ventilation (high confidence in effect
estimates) and conditional for higher positive end-expiratory pressure
(moderate confidence in effect estimates) and recruitment maneuvers
(low confidence in effect estimates). Additional evidence is necessary to
make a definitive recommendation for or against the use of
extracorporeal membrane oxygenation in patients with severe ARDS.
Severe eosinophilic asthma: a roadmap to consensus
Adult-onset asthma patients with a high blood eosinophil count (⩾0.3×109 per L) have been found to have a distinct phenotype of severe asthma with frequent exacerbations and poor prognosis Persistent airflow limitation and distal inflammation with air trapping are common in these patients, as is upper airway pathology such as chronic rhinosinusitis with nasal polyposis .