Respiratory Diseases Clinic Research Articles

Oxidant/Antioxidant Status, C-reactive Protein and Serum Leptin in Patients with Pulmonary Tuberculosis: Effect of Vitamin E Supplemention

Objectives: To evaluate the effects of pulmonary Tuberculosis (TB) on markers of oxidative stress (malondialdehyde "MDA" and total antioxidant status "TAS"), high sensitivity C-reactive protein (hs-CRP) and serum leptin and to compare the effects of standard intensive 2 months anti-TB therapy with the standard intensive anti-TB therapy plus vitamin E supplementation on the parameters. Methods: Two group of patients with active pulmonary TB from the Advisory Clinic for Chest and Respiratory Diseases in Mosul City were included in this study.Group one consistent of 38 patients and group two consistent of 28 patients, with forty healthy age and sex matched subjects as controls. Assessment of concentrations of MDA, TAS, hs- CRP and leptin were done for both patients and controls. After two months with either the traditional intensive therapy (isoniazid "INH" 75 mg, rifampicin 150mg, pyrazinamide 400mg and ethambutol 275mg ) 4 tablets as a single dose in the morning with vitamin B6 10mg daily or , the intensive traditional therapy plus vitamin E 400 IU/day as a supplementation therapy, the same parameters were reassessed for the patients. Body mass index(BMI) were calculated by using special equation.Results: After 2 months of either the traditional therapy or the traditional therapy plus vitamin E ,there was a significant reduction inMDA and hs-CRP with significant increase in TAS ,leptin serum levels and BMI in patients with pulmonary TB in comparison to pre-therapy stage and the percentage of variation shifted towards the beneficial effect of vitamin E add- on therapy group.Conclusion: Active pulmonary TB associated with oxidative stress and an increase in the levels of hs-CRP and both traditional therapy or the traditional therapy plus vitamin E resulted in a significant improvement in oxidative stress and cause suppression of inflammatory responses with the beneficial effects shifted towards the add-on of vitamin E as a supplementation therapy.

Respiratory disease terminology: Discordance between pulmonologists and patients

Context:A number of local dialects and languages exist in India, which leads to a single disease being addressed by a number of names which may overlap with other disease names also. This creates misunderstanding and is a hindrance to effective patient–doctor communication.Aims:The paper aims to find out how effectively the name of the respiratory disease is communicated to the patient. The terminology used by patients to describe their disease was also noted at limited level.Settings and Design:The study was conducted in the form of parallel cross-sectional surveys, among pulmonologists and patients.Methods:Among the members of the Indian Chest Society and those attending the National Conference on Pulmonary Diseases (NAPCON-2015), 1028 pulmonologists participated in the online survey which was the first part of the study. The term used to address the common respiratory disease was inquired in the survey. To find the response of patients, a questionnaire was given to the patients attending four respiratory disease clinics of a city. They were inquired about the name of respiratory disease they were suffering from.Results:Pneumonia was the disease which was communicated with exact terminology by 898 (87.4%) doctors to their patients. In contrast, idiopathic pulmonary fibrosis was communicated with precise terminology by only 171 (16.6%) doctors. Pulmonary tuberculosis was exactly told by 708 (69%), asthma by 731 (71.1%), and chronic obstructive pulmonary disease by 593 (57.7%) doctors. However, only 17.6% of the 1122 patients participating in the survey had a knowledge of the name of disease they were suffering from.Conclusions:The exact terminology of the common respiratory diseases is not effectively used by many doctors and most of the patients. The study identifies an important gap in patient–doctor communication, and therefore, highlights the need of effective patient education.

P2.03b-009 Brain Metastasis and Epidermal Growth Factor Receptor Mutations in Croatian Caucasians with Lung Adenocarcinoma: Topic: Brain Meta

The brain is a common site of metastasis in non-small cell lung cancer (NSCLC). The aim of this study was two-fold: 1) to determine the incidence of brain metastasis (BM) in Caucasian lung adenocarcinoma patients with epidermal growth factor receptor (EGFR) mutations and 2) to evaluate the frequencies and potential relationship of the different EGFR mutations with BM. A retrospective cohort study was conducted at a Croatian tertiary hospital (Clinic for Respiratory Diseases “Jordanovac”) using data collected from medical records. Caucasian patients with primary NSCLC who were tested for EGFR mutation status between January 2014 and October 2015 were included. Of 1040 NSCLC samples tested, 122 (11.7%) patients with lung adenocarcinoma harbored EGFR mutations; six EGFR positive (+) patients (four with BM) had repeat EGFR testing. The majority of EGFR mutants were females (n= 90, 77.6%), non-smokers (including never-smokers and former-smokers; n= 95, 92.2%), diagnosed with advanced disease (stage IIIB/IV) at first presentation (n= 75, 68.8%), and median age at initial diagnosis of primary lung cancer was 65 years (35 - 90). Twenty-three (19.8%) of 116 EGFR+ patients were diagnosed with BM; for six EGFR+ patients, data about BM was missing. Most were 64 years of age or younger (n= 15, 65.2%) at diagnosis of BM (median age: 62 years, 48 - 72). Synchronous BM disease at initial diagnosis of lung cancer was found in 43.5% of EGFR+ patients with BM (n= 10). There were more EGFR+ women with BM (n= 20, 87%) than men. Single exon 19 deletion and exon 21 L858R mutations were the most common subtypes in both EGFR+ patients without BM (n= 44, 47.3% and n= 27, 27.8%, respectively) and with BM (n= 13, 56.5% and n= 5, 21.7%, respectively). One BM patient (4.3%) had a double mutation (exon 19 and 21), while six non-BM patients (6.2%) had simultaneous pairings, most commonly between exon 19 and 20 (n=3, 3.1%). Although exon 18 mutations were seen in six patients without BM (6.2%), none were found in BM+EGFR+ patients. Exon 20 T790M mutation occurred in 17.4% of BM patients (n= 4) versus 15.3% of non-BM patients (n= 15). Rare EGFR double mutations (exon 18 and 20) were found in two non-BM patients (2.2%). Larger long-term prospective studies to explore and confirm these results in BM+EGFR+ patients are warranted. In the era of precision oncology, molecular testing of EGFR mutations may further clarify the pathogenesis of lung cancer-associated BM.

Investigation of Lipid Peroxidation and Antioxidant Enzyme Activity in Sleep Apnea Patients

Aim: The goal of this study was to investigate the activities of malondialdehyde (MDA), a product of lipid peroxidation, and glutathione peroxidase (GPx), anantioxidant enzyme, in sleep apnea patients. Method: The study involved 40 healthy control patients and 40 sleep apnea patients. Participants in the experimental group were between the ages of 18 and 65, were diagnosed and treated in the Respiratory Diseases Clinic of Yuzuncu Yil University Medical Faculty. Malondialdehyde (MDA) and glutathione peroxidase (GPx) levelsin blood samples were measured using spectrophotometry. Findings: According to our results, the difference in the enzyme activity of glutathione peroxidase (GPx) between the experimental group (0.03 ± 0.04U/ml) and the control group (0.06 ± 0.03 U/ ml) was significant (p<0.001).MDA levels were determined to be3.292 U/L (± 0.724U/L) in the experimental groupand 0.882 U/L (± 0.226) in the control group (p<0.001). Conclusion: Based on our results, we can conclude that sleep apnea causes a decrease in the GPx enzyme, by means of the body’s antioxidant defense system,and an increase in malondialdehyde, a symptom of oxidative stress.

Editorial introductions

Editorial introductions

Role of the private health sector in detection of cases of tuberculosis in Missan Governorate

Background: As tuberculosis (TB) is still endemic disease in Iraq, efforts in detection, diagnosis, treatment, and prevention are of utmost importance to decrease the prevalence and negative impacts of this disease on people. In this study we aim to find out the extent of contribution of the private health sector in, Missan governorate to the detection of cases of tuberculosis and referring them to the Chest and Respiratory Disease Clinic in Missan for further management. Collaboration between the private and public health sectors is crucial for early detection, treatment, and cure of tuberculosis and consequently decrease in its prevalence and transmission to other people. Patients and methods: Records of patients managed by the Chest and Respiratory Disease Clinic in Missan, for the period between 2012-2014 were reviewed. The above mentioned clinic deals with all cases any different types of tuberculosis. All cases, and of different types of tuberculosis, were enrolled in the study. Particular concern to the source of referral of these cases was considered. Other parameters such as, type of tuberculosis, whether it is newly or previously diagnosed, and the results of the sputum test for acid-fast bacilli. (AFB) were considered. Results: 752 patients with tuberculosis were diagnosed and managed by the Chest and Respiratory Disease Clinic in Missan for the period between 2012-2014, considerable number of these patients (44.4%) was detected and referred to the TB Center by the physicians in the private health sector. Private health sector had more contribution to detection of extrapulmonary tuberculosis than the public health centers. Conclusion: The private health sector in Missan governorate has an important role in detection of cases, mostly newly diagnosed cases, of tuberculosis. So collaboration between governmental health faculties and private health sector is essential for effective detection and management of cases of tuberculosis to decrease its prevalence and negative impacts on the public health.

Patterns of prescribing and utilization of asthma medications in a tertiary hospital in Dubai, United Arab Emirates

Purpose: To assess the prescribing patterns of asthma medications in a hospital in Dubai, United Arab Emirates (UAE) with regard to the demographic pattern of the population.Methods: One hundred fifty four patients, 83 male and 71 female, were randomly selected from the outpatient respiratory diseases clinic of a tertiary hospital in Dubai, UAE over a 3-month period. Patients were asked to complete a structured questionnaire and data were analyzed using STATA 12 software.Results: Most of the patients were within the age range of 0 – 10 years. About 86 % of the patients were overweight. Half of the patients were non-smokers while 51 % of them had a family history of asthma. About 54 % of the patients received multiple drug therapy of which two-drug combinations were widely prescribed (31 %). The most utilized drug classes were short acting β-agonists (42 %), xanthine drugs (16 %), leukotriene modifiers (14 %) and oral and intravenous corticosteroids (13 %). Statistical significant differences among the age groups (F = 2.33, p = 0.0275) were found.Conclusion: Primary prevention to reduce the level of exposure to common risk factors for asthma would be a vital step to control the disease. More resources should be channeled into educating physicians and patients on rational drug utilization to improve the quality of patients’ care.Keywords: Asthma, utilization of medicines, β-agonists, Xanthines, Leukotriene modifiers, Rational drug utilization

A pilot study-is there a role for mitoxantrone pleurodesis in the management of pleural effusion due to lung cancer?

Lung cancer is the leading cause of malignant pleural effusion (MPE). Management of MPEs remains a clinical challenge due to recurrence and poor quality of life. An ideal sclerosing agent has yet to be found. The aim of this cohort pilot study was to evaluate the role of mitoxantrone pleurodesis (MP) as an alternative to talc sclerotherapy for managing MPEs in lung cancer patients. A retrospective chart review was conducted on consecutively admitted patients with MPE to the Department of Post-Intensive Care at the Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, in Croatia. Of 34 patients with MPE, twenty-one (64.8±9.46 years; 47-84 years) with primary lung carcinoma who received MP (30 mg of mitoxantrone) between December 2003 and February 2009 were included in this study. Chest radiographs taken prior to sclerotherapy and at 1-, 2-, and 3-month follow-up were compared. At the post-sclerotherapy evaluation periods, overall success (OS) rates of MP were 88.2% [17.6%, complete response (CR); 70.6%, partial response (PR)], 53.9% (7.7% CR; 46.2% PR), and 45.5% (PR), respectively. Kaplan-Meier median survival from MP until death was 5.2 months, while that from diagnosis of primary lung cancer was 12.3 months. MP may be a safe and effective method of managing MPE due to lung cancer. Future randomized controlled studies comparing mitoxantrone and talc pleurodesis in lung cancer patients are warranted to elucidate whether a significant difference exists between these agents. Factors affecting success, survival probability, and quality of life also require further investigation.

Editorial introductions

Editorial introductions

Editorial introductions

Editorial introductions

Editorial introductions

Editorial introductions

M7 Poor control of asthma in Uyo, South-Eastern Nigeria

Background The prevalence of asthma is increasing in the developing world. Asthma, management guidelines have been instituted to provide recommendations for the optimal control of asthma. This study evaluated the current level of asthma control as reported by the patients which may be a reflection of adherence to guidelines. Methods Asthma patients referred to a respiratory diseases clinic were recruited for the study. The asthma control test (ACT) was administered on the patients. Data was also obtained for medication use and disease monitoring. A total ACT score of less than 20 signified poor control. Results Seventy out of 78 patients completed the survey (89.7%). The average age of patients was 46 ± 18 years. The average ACT score was 14.4 ± 4.8 (mean ± SD). 82.9% of patients had poor control. 57.1% of patients who perceived their asthma to be well or totally controlled were objectively assessed to be poorly controlled. More than half of the patients used short acting β2 agonist (SABA) alone and only 20% used inhaled corticosteroids (ICS) for maintenance therapy. Thirty eight patients made unscheduled emergency room visits in the past 12 months and 68.8% could not use their inhaler devises well. Emergency room visits (OR 9.5) and poor inhaler technique (OR 18.9) was independent predictors of poor asthma control. Conclusion The current level of asthma control among patients in Uyo is below guideline recommendations. Management of patients did not appear to follow guideline recommendations and patients tend to over-estimate their disease control.

Pre-polysomnographic assessment using the Pittsburgh Sleep Quality Index questionnaire is not useful in identifying people at higher risk for obstructive sleep apnea

Polysomnography remains the diagnostic gold standard for obstructive sleep apnea syndrome (OSAS), but it is time consuming and requires dedicated personnel and setting. It may be more useful to plan a polysomnogram based on a preliminary screening. To verify whether a questionnaire of general quality of sleep, the Pittsburgh Sleep Quality Index (PSQI), could outperform a dedicated questionnaire (Epworth Sleep Scale: ESS) in targeting OSAS patients in an at risk population. 254 consecutive subjects attending the outpatient clinic for respiratory diseases were clinically evaluated for sleep apnea and referred to a 12 channel night-time polysomnography. All patients were administered the ESS and the PSQI before the procedure. The correlation between the Apnoea/Hypopnoea Index (AHI) and the global score of the PSQI was calculated; Sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively), Diagnostic accuracy and the area under the receiver operating characteristic curve (AUC) were calculated. ESS performance was used as a control reference. The mean age was 65.8 (standard deviation: 12.1) and the study group was 68.4% male. The mean BMI was 38.5; SD 7.7. Prevalence of OSAS in the study population was 55.5%; OSAS was severe in 60.5% of OSAS patients. ESS was significantly, but weakly, correlated with the AHI (AHI vs ESS: R = 0.308; p < 0.001), whereas PSQI was not (R = 0.037; p = 0.581). Both PSQI and ESS, however, performed unsatisfactorily: sensitivity 37.8% and 69.7%; Specificity 76.1% and 31.0%; Diagnostic Accuracy 57.5% and 49.8%; PPV 60% and 48.7%; NPV 56.3% and 52.2%; AUC 0.589 and 0.509, respectively. The PSQI score is not helpful in the pre-polysomnographic assessment of people with suspected OSAS. Further studies are required to provide reliable pre-clinical instruments targeting patients amenable to polysomnography.

Vitamin D Deficiency in Patients With Neuromuscular Diseases With Chronic Respiratory Failure

The prevalence and clinical implications of vitamin D deficiency have never been studied in patients with underlying neuromuscular diseases complicated with chronic respiratory failure. The aim of this study is to demonstrate the prevalence of vitamin D deficiency, its relationship with other bone markers, and mode of nutrition. Serum 25-hydroxyvitamin D (25[OH]D) levels along with calcium, serum albumin, and phosphorus levels were obtained from 57 patients with chronic respiratory failure due to underlying neuromuscular diseases. These levels were obtained during their first visit to a chronic respiratory diseases clinic. Data with regard to nutrition, respiratory muscle function, and level of mobility were also obtained at the same time. Seventy-five percent of patients had serum 25(OH)D levels ≤ 30 ng/mL. There is a negative correlation between parathyroid hormone and 25(OH)D levels (P = .006) and corrected calcium levels (P = .066). Serum 25(OH)D levels varied with the mode of nutrition. Patients on enteral nutrition had the highest serum levels of 25(OH)D, whereas combined oral and tube feeds had the lowest 25(OH)D levels (P = .006). Low serum 25(OH)D levels are highly prevalent in patients with neuromuscular disease and chronic respiratory failure. The route of nutrition has an impact on these levels.

Features of severe asthma in young children from Romania

Asthma is the most frequent chronic disease of childhood. In spite of significant improvement of treatment options and diagnostic tools, asthma remains in many patients uncontrolled. The term of "severe asthma" seems to be rather a large umbrella for a heterogeneous group of diseases. This paper is presenting our experience in two respiratory disease clinics that evaluate asthmatic children. Current study was designed to test an algorithm for daily practice in a special group of patients: children with previously diagnosed asthma or recurrent-wheezing, evaluated by family physician or pediatrician as severe disease ("Asthma Decalogue in Children"). Out of 313 referrals (during a six months inclusion time) we had 202 children completing study per-protocol. 49 (22.69%) had severe disease, but only 8 had severe asthma (3.7% of total patients and 18.6% of severe patients). They were older, with less male predominance and with more frequent rhino-conjunctivitis and D vitamin deficiency than other asthmatic children with less severe disease. Asthma Decalogue in Children seems to be an efficient tool to differentiate severe asthma from the rest of children with reactive airway diseases.

Asthma control among patients in Uyo South-Eastern Nigeria

Background: The prevalence of asthma is increasing in the developing world. Asthma, management guidelines have been instituted to provide recommendations for the optimal control of asthma. This study evaluated the current level of asthma control as reported by the patients, which may be a reflection of adherence to guidelines. Materials and Methods: Asthma patients referred to a respiratory diseases clinic were recruited for the study. The asthma control test (ACT) was administered on the patients and data were also obtained for medication use and disease monitoring. A total ACT score of Results: Out of 78 patients, 70 completed the survey (89.7%). The average age of patients was 46 ± 18 years (mean ± standard deviation). The average ACT score was 14.4 ± 4.8 82.9% of patients had poor control. 57.1% of patients who perceived their asthma to be well or totally controlled were objectively assessed to be poorly controlled. More than half of the patients used short acting β2 agonist alone and only 20% used inhaled corticosteroids for maintenance therapy. Thirty eight patients made unscheduled emergency room visits in the past 12 months and 68.8% could not use their inhaler devises well. Emergency room visits (odds ratio [OR] 9.5) and poor inhaler technique (OR 18.9) was independent predictors of poor asthma control. Conclusion: The current level of asthma control among patients in Uyo is below guideline recommendations. Management of patients did not appear to follow guideline recommendations and patients tend to over-estimate their disease control.

Role of Transbronchial Needle Aspiration in Patients with Thoracic Lymphadenopathy on CT Scan

Context: Transbronchial needle aspiration (TBNA) is a method in which an aspirating needle is used to obtain diagnostic samples from a peribronchial or submucosal lesion through a rigid [1] or flexible bronchoscope [2]. Though it is a very useful bronchoscopic technique it still remains underutilized [3]. Aims: This study was done to evaluate the sensitivity, complication rates and factors affecting the outcome of TBNA. Settings and Design: Prospective trial of fifty two patients with mediastinal lymphadenopathy on CT scan attending Respiratory Diseases Clinic of Jawaharlal Nehru Medical College Hospital. Methods and Material: We analyzed the outcome of TBNA in fifty two patients who underwent TBNA between 2010 and 2012. Sensitivity of TBNA was calculated and factors affecting the TBNA results were analyzed. Statistical analysis used:Chi square test was used for analyzing the factors affecting TBNA results. SPSS Statistics 17.0 was used for analysis. Results: The overall sensitivity of TBNA was found to be 59.6% and it was the only diagnostic technique in 47.6% of the patients. Factors associated with diagnostic acquisition of samples were lymph node size more than 1.5 cm and the presence of indirect signs on bronchoscopy. Conclusions: The sensitivity of TBNA is high in malignant mediastinal lymphadenopathy. Complications occurred in four patients who had self limited bleeding at the site of puncture which healed spontaneously. Important factors predicting the outcome of TBNA are lymph node size and the presence of indirect signs on bronchoscopy. We would recommend this procedure for detection of metastatic lymph nodes in patients with lung cancer and also for mediastinal tubercular lymphadenopathy where diagnosis could not be achieved by less invasive methods.

Editorial introductions

Current Opinion in Allergy and Clinical Immunology was launched in 2001. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The fields of allergy and clinical immunology are divided into 14 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Amos EtzioniAmos EtzioniAmos Etzioni, MD is a Professor of Pediatrics and Immunology at the Faculty of Medicine, Technion in Haifa, Israel and is the Director of the Children's hospital at the Rambam Health Campus in Haifa, Israel. After finishing a residency in pediatrics in Haifa, he did a fellowship in immunology in Philadelphia, USA and upon his return in 1982 opened the first center for primary immunodeficiency in Israel. His main interest in the field of primary immunodeficiency (PID) is in the leukocyte adhesion molecules defects, in which he described two new conditions LAD II and III. He has published more than 200 papers and has written many reviews and chapters in books. He was invited as a speaker to numerous international meetings in the field of immunodeficiency. He is currently the President of the Israeli Immunology Society as well as the President of the European Society for Immunodeficiency (ESID). Ramsay L. FuleihanRamsay L. FuleihanRamsay L. Fuleihan, MD, is Associate Professor at Northwestern University Feinberg School of Medicine, USA and an Attending Physician at the Ann & Robert H. Lurie Children's Hospital of Chicago, Illinois, USA, where he is also Director of Primary Immunodeficiency Clinical Services and Director of the Jeffrey Modell Foundation Diagnostic Center for Primary Immunodeficiencies. In addition, Dr Fuleihan is Associate Director of the Allergy and Clinical Immunology Training Program at the Northwestern University Feinberg School of Medicine. Dr Fuleihan received his medical degree at the American University of Beirut in Lebanon. He then trained in pediatrics at Duke University Medical Center in Durham, North Carolina, USA and in allergy and immunology at the Children's Hospital Boston at Harvard Medical School in Massachusetts, USA. A Diplomate of the American Board of Allergy and Immunology, Dr Fuleihan is a member of several professional societies, including the American Academy of Allergy, Asthma and Immunology, the European Society for Immunodeficiencies, the Clinical Immunology Society, and the Society for Pediatric Research. He is a member of the steering committee of the US Immunodeficiency Network and a member of the Medical Advisory Committee of the Immune Deficiency Foundation. Giovanni PassalacquaGiovanni PassalacquaDr Passalacqua was born in Genoa in 1964. He graduated in 1990 from the Genoa University Medical School, Italy, and received specialty degrees in Allergy and in Respiratory Medicine in 1994 and 2002. Under the chairmanship of Prof. Giorgio Walter Canonica, he contributed to investigation into the mechanisms of allergic inflammation, the treatment of respiratory allergy and developed sublingual immunotherapy. Currently he is Professor of Respiratory Medicine and Allergy at the Respiratory Diseases Clinic of the University of Genoa. Dr Passalacqua has coauthored more than 200 publications in peer reviewed journals. He serves on the board of experts of Allergic Rhinitis and its Impact on Asthma (ARIA), and is co-Chairman of the immunotherapy committee of the World Allergy Organization. Robert BushRobert BushDr Robert Bush received his MD degree from West Virginia University, USA. After completing his residency in internal medicine and fellowship in allergy and immunology at the University of Wisconsin – Madison, USA, he joined the faculty. He is currently Professor (Emeritus) of Medicine and was the former Chief of Allergy at the William S Middleton VA Hospital, Madison, Wisconsin, USA. His research interests include sublingual immunotherapy, allergen characterization, fungal allergy, food allergy, and occupational asthma.

Psychiatric morbidity in chronic respiratory disorders in an Indian service using GMHAT/PC

ObjectiveThe study aimed to assess psychiatric morbidity in stable chronic respiratory disorders and to examine the pattern of psychiatric illness in specific respiratory disorders in Northern India. MethodsAll consecutive patients with stable chronic respiratory illnesses who attended the respiratory disease clinic were recruited in the study. Their healthy attendants were interviewed as a control group. The research clinician, trained in the use of the Global Mental Health Assessment Tool, Primary Care Version (GMHAT/PC), interviewed all the participants. The respiratory consultant made the respiratory illness diagnosis. The data were analyzed comparing the patient and the control group by using relative risk and adjusted odds ratios. ResultsOf 391 patients with respiratory illness, 44.8% had a mental illness identified by GMHAT/PC interview compared with 24.3% of 177 attendants (controls). Anxiety (20.6%), depression (13.2%) and obsessive compulsive disorders (4.6%) were the most frequently identified mental disorders in the respiratory disease group. Chronic obstructive pulmonary disease and bronchial asthma when combined with rhinitis had a significantly higher prevalence of comorbid mental illness than those illnesses alone. ConclusionPatients with chronic respiratory illness have high mental health comorbidity. Physicians and practitioners can be trained to identify mental illness using computer-assisted tools such as GMHAT/PC (which is easy to use by clinicians and well accepted by patients). A holistic approach of providing care to such patients may improve their overall outcome and quality of life.

Editorial introductions

Editorial introductions