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.
Blood Eosinophils and Response to Maintenance Chronic Obstructive Pulmonary Disease Treatment. Data from the FLAME Trial.
indacaterol/glycopyrronium provides superior or similar benefits over salmeterol/fluticasone regardless of blood eosinophil levels in patients with COPD
The incidence of pneumonia was higher in patients receiving salmeterol/fluticasone than indacaterol/glycopyrronium in both the <2% and ≥2% subgroups
Indacaterol/glycopyrronium was significantly superior to salmeterol/fluticasone for the prevention of exacerbations
Practical Recommendations for COPD: Evidence-Based Care
The treatment of patients with chronic obstructive pulmonary disease (COPD) depends on symptoms and history of exacerbation. These elements define the treatment strategies within the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Guidelines' ABCD assessment tool
• Although not taken into account in the ABCD tool, spirometry remains important for the diagnosis and assessment of airflow limitation.
Bronchodilators are first-line treatment, either as a single or dual bronchodilator treatment.
• The recently available combination of a long-acting beta agonist (LABA) and a long-acting muscarinic receptor antagonist (LAMA) into a single inhaler has demonstrated improvement in lung function, either in combination or with monotherapy.
In the SPARK study evaluating indacaterol/glycopyrrolate vs glycopyrronium and tiotropium (LABA/LAMA vs LAMA alone) for the prevention of exacerbation in patients with COPD, the combination therapy was superior to a single bronchodilator as measured by the reduction of exacerbations.
• LABA/LAMA was also shown to be superior in the ILLUMINATE study, which compared the patient-reported outcomes and the transition dyspnea index (TDI) for patients on LABA/LAMA with patients on LABA/ICS (inhaled corticosteroid).
Data from multiple studies show that ICS-containing regimens can also effectively reduce exacerbation rates.
Data from post-hoc analyses of clinical trials suggest that patients with high levels of blood eosinophils may respond better to ICS therapy, whereas patients with very low levels of eosinophils may not respond.
ICS therapy is associated with serious side effects, such as pneumonia.
In the WISDOM trial, patients who discontinued ICS experienced approximately 40 mL in forced expiratory volume over 1 second (FEV1), indicating that ICS should be withdrawn very carefully in some patients.
As exacerbations are more frequent and often more severe in winter months, it is recommended to not withdraw steroids during that period
Current evidence suggests that the combination of LABA/LAMA with ICS into a single inhaler will improve lung function, exacerbations, and symptoms
Other treatment options besides triple therapy exist for patients who still experience exacerbations after LABA/LAMA treatment.
• Roflumilast may be considered in patients with chronic bronchitis.
• The use of long-term macrolides is possible in a particular profile subset of patients who have frequent exacerbations with bronchiectasis, bronchial colonization, and frequent bacterial infections.
1. Size short axis : less or more than 1cm
2. Shape : Oval or round ; when ratio of short axis vs . long axis of lymph node is smaller than 1.5cm , the lymph node defined as round. If ration more than 1..5cm it is oval.
3. Margin indistinct or distinct : if more than 50% is clearly visible with a high echoic border they are distinct . If less than 50% and margin unclear determined indistinct.
4.Echogenecity; Homogenous or heterogenous.
5. Presence or absence of central hilar structure CHS
CHS defined as linear flat hyperechoic area in the center of lymph node which indicate prediction of metastatic L node