Department of Pulmonary Medicine, PGIMER, Chandigarh

(A WHO Collaborating centre for Research & Capacity Building in Chronic Respiratory Diseases)

WHO Callaborating Centre Activities

 

The Department of Pulmonary Medicine at the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh has been designated as a WHO Collaborating Centre for Research and Capacity Building in Chronic Respiratory Diseases since 2008. This designation, which is valid for a period of four years, has been renewed twice for the Department and is currently valid till Sep 2020.

The various activities performed by the department in collaboration with the WHO over the years have been listed below:

2000s 2008-09 2009-10
2010s 2010-11 2011-12 2012-13 2013-14 2014-15

2008-2009

Activity: Assessment of contribution of indoor air pollution from solid fuel combustion and environmental tobacco smoke (ETS) to respiratory disease related morbidity and mortality

A major initiative undertaken by the department has been the completion of the Indian study on the Epidemiology of Asthma, Respiratory symptoms and Chronic bronchitis (INSEARCH) under the aegis of the Indian Council of Medical Research. In included the assessment of respiratory disease, prevalence such as of asthma and chronic bronchitis in different parts of the country using a multi-centric design with the help of uniform methodology at centers spread across India (Ahmedabad, Chennai, Mysore, Nagpur, Trivandrum, Kolkata, Berhampur, Bikaner, Mumbai, Secunderabad, Shimla and Guwahati). The study included the assessment of effect of indoor air pollution due to solid fuel combustion as well as of environmental tobacco smoke exposure on respiratory disease morbidity. The essential components of the study design were as follows:

  1. A single definition of asthma and of chronic bronchitis for field prevalence.
  2. A standardized and validated study-questionnaire (developed at the Central Coordinating Centre at Chandigarh). The questionnaire was translated in local languages and modifications done depending upon local needs.
  3. Uniform method of collecting data from the field in each region.
  4. Data analysis at the Central Coordinating Centre for area wise prevalence.

The study was conducted at 12 urban and 11 rural sites, included a total of 60764 urban and 108811 rural subjects. The Secunderabad site did not include the rural population (i.e. current residence). There were 85105 males and 84470 female individuals.

Activity: Development of educational materials for primary health care personnel on adverse effects arising from indoor air pollution due to solid fuel combustion and ETS and on their prevention

A. Participation as Resource Faculty

  1. National Course on NCD Prevention & Control (GOI – WHO Collaborating Program)
  2. WHO India supported stakeholders Workshop on Healthy workplace in Corporate Sector, India, September 30, 2008
  3. WHO –SEAR supported Inter-Country Workshop on Research Management, PGI, Chandigarh, December 8-9, 2008.
  4. Course on Non-communicable diseases for Masters of Public Health students, School of Public Health, PGI, Chandigarh. (March 30 to April 10, 2009).

B. Technical Adviser / Expert

  1. WHO Meeting on Primary Prevention of Chronic Respiratory Diseases: Asthma and COPD, Geneva, April 7-8, 2009.
  2. Temporary advisor: SEANET-NCD Meeting on Strengthening partnership for Integrated Prevention and Control of Non-communicable diseases (WHO-SEA Region), Chandigarh June 15-19, 2009.

C. Reviewing

Reviewing draft report of WHO Consultation on Severe Asthma (April 6-7, 2009): WHO definition of asthma severity, control and exacerbations.

Activity: Conduct training of personnel at primary and secondary levels of health care system in prevention and management of chronic respiratory diseases

  1. WHO-India sponsored Fellowship training in “Chronic Obstructive Lung Diseases – Prevention & Management” (17th November 2008 to 16th January, 2009) No. of trainees: Four
  2. Regional Update in Pulmonary and Critical Care Medicine, October 12, 2008
  3. Training of Private Practitioners in WHO Manual for management of asthma and COPD (April 19, 2009), Chandigarh.

Activity: Development of networking through telecommunication/telemedicine programme between various medical colleges in different regions for collaborative research and data analyses in chronic respiratory diseases

A Network of respiratory physicians and public health personnel was created. A Workshop on the development of Network was held on March 20, 2009. This was supported by WHO-India. The Network site (www.indianetred.org / www.searednet.org) was hosted and expanded. The mission and objectives of the Network are:

Mission Statement

To strengthen the evidence based integrated strategies for development, implementation and evaluation of prevention and control of respiratory diseases in India.

Objectives

  1. Development of consensus on strategy, objectives, scope and methods for sustainable cooperation in pulmonary medicine and allied fields.
  2. Facilitating intra and inter-country cooperation in order to enhance technical expertise and encourage sharing of information.
  3. Conducting periodical assessment of regional and national capacity in selected spheres.
  4. Strengthening regional capacity for diagnosis and management of chronic respiratory diseases through promotion of human resource development and mobilization and sharing of resources.
  5. Facilitating a coordinated approach by providing/adapting standardized methodology and tools for systematic collection of core data on epidemiology of chronic respiratory diseases.
  6. Contributing to development of regional databases on major chronic respiratory disorders and their risk factors.
  7. Improving availability, accessibility, and sharing regional and site-specific data on the role of indoor and outdoor air pollution in causing and worsening chronic respiratory disease.
  8. Establishing appropriate communication channels and networking between the members.
  9. Developing and periodically reviewing regional and/or country specific evidence-based guidelines and training manuals for diagnosis and management of important chronic respiratory diseases at the primary level of healthcare.
  10. Promoting action-oriented strategies and advocacy for prevention and control of major respiratory diseases in the Region.

Activity: To use tele-networking of medical colleges for training of primary health care work force in prevention and management of chronic respiratory diseases

The Centre prepared a proposal for development of a module for on-line training of health-care personnel in management of chronic respiratory diseases at primary levels of health-care, which was submitted to the WHO-India.

WHO Supported Workshops and other activities

We hosted SEANET-NCD Meeting on strengthening the partnership for Integrated Prevention and Control of Non-communicable diseases (WHO-SEA Region), Chandigarh, June 15-19, 2009. The meeting was held under the overall charge of the South East Asia Regional Office (SEARO), New Delhi. The local WHO Collaborating Centre Head (Dr S.K. Jindal) was the co-chair of the Meeting.

Interactions or collaborations with other WHO collaborating centres in the context of the implementation of the above activities

Our Centre was in close contact with the WHO Collaborating Centre for Environmental and Occupational Health, SRMU, Chennai for joint projects and training programs in respiratory disease morbidity. The centre Head had also visited the Chennai Centre for this purpose.

Back to top

2009-2010

Activity: Assessment of contribution of indoor air pollution from solid fuel combustion and environmental tobacco smoke (ETS) to respiratory disease related morbidity and mortality

The Indian Study on Epidemiology of Asthma, Respiratory symptoms and chronic bronchitis under auspices of ICMR was completed. The final report was submitted to the ICMR.

A total of 169575 individuals were surveyed across twelve centres. Both urban and rural clusters were covered at all centres, except at Secunderbad, where only urban area was surveyed. The rural:urban ratio for population surveyed ranged from 1.46 at Chennai to 4.28 at Berhampur, with an overall figure of 1.79 for the total study population. The total study population (based on ‘current residence’) of 12 urban and 11 rural samples consisted of 60764 and 108811 persons respectively. The sample included individuals of over 15 years up to over 85 years of age. The male: female ratio ranged from 0.63 at Chennai to 1.14 at Bikaner, although the gender distribution was almost equal for the total study population. In all, 85105 men (mean age 37.3±16.0 years) and 84470 women (mean age 36.9±15.8 years) were interviewed. In all, 8990 individuals (5.3%) had a first degree relative with history suggestive of bronchial asthma, more commonly in men – the male : female ratio was 1.9 for the rural and 1.2 for urban subjects.

Exposure History: Amongst men, history of ‘ever smoking’ was present in 18.5% of male (rural 20.6%, urban 14.7%) subjects. In all, 18.5% men (ranging from 4.5% at urban Mumbai to 40.7% at urban Kolkata) and 0.5% women (ranging from none at rural Nagpur to 2.2% at rural Shimla) were ever smokers. Ever exposure to household environmental tobacco smoke (ETS) was generally greater in rural areas and among women, and more than half of all women interviewed in rural areas of Ahmedabad, Bikaner, Chennai, Kolkata and Mysore had been exposed to household ETS. History of cooking at home was obtained to assess an individual’s exposure to domestic indoor combustion pollutants. About 90 percent of rural and 86 percent of urban women were engaged in current or past cooking; history of cooking amongst men was limited to about 3.5 percent

Asthma: One or more of the twelve symptoms enquired were elicited in 14479 (8.5%) respondents. There was a large variation between individual symptoms, across centres, among men and women, and between rural and urban localities. The pooled prevalence of asthma (using the questionnaire definition) across the twelve centres was 2.05% (2.28% in rural and 1.64% in urban areas). There were wide variations across the different centres. Prevalence was quite low in urban Secunderabad (0.37%) and rural Mumbai (0.74%), and relatively high at Kolkata (rural 4.52% and urban 5.52%) and rural Trivandrum (4.45%).

Chronic bronchitis: The pooled prevalence of chronic bronchitis (using the questionnaire definition) across the twelve centres was 3.49% (4.07% in rural and 2.50% in urban areas). There were wide variations across the different centres. Prevalence was quite low in urban Guwahati, Mumbai and Nagpur (0.61%, 0.91% and 0.67% respectively), and relatively high at rural Bikaner and Trivandrum (7.00% and 13.54% respectively). After pooling the entire data and additionally adjusting for between-centre differences, usual urban residence, advancing age, use of any smoking product, ETS exposure either in childhood or both in childhood and adulthood, and cooking using LPG, were associated with increased odds of chronic bronchitis. However, female gender, and medium or high socioeconomic status, was associated with reduced odds of chronic bronchitis.

Jindal SK, Aggarwal AN, Gupta D, Agarwal R, Kumar R, Kaur T, Chaudhry K, Shah B. Indian study on epidemiology of asthma, respiratory symptoms and chronic bronchitis in adults (INSEARCH). Int J Tuberc Lung Dis. 2012 Sep;16(9):1270-7.

Activity: Effect of indoor exposures of pregnant women due to solid fuel combustion and environmental tobacco smoke (ETS) on pregnancy outcome, maternal health and respiratory disease

A pilot study to study the effects of Indoor air-pollution (IAP) on maternal and fetal outcomes in pregnancy was initiated in collaborations with the departments of Obstetrics and Gynecology at our Institute and Government Medical College and Hospital, Sector 32, Chandigarh. We intended to study consecutive 2000 mothers with singleton pregnancy and study their exposures (solid fuel combustion +/-ETS) to IAP and pregnancy outcomes.

Another project to study the effects on pregnancy outcomes, maternal health and respiratory disease was planned and undertaken under auspices of Indo-US collaboration of the Indian Council of Medical Research.

Activity: Effect of solid fuel combustion and ETS exposure on respiratory symptoms and lung function in children

A Letter of Intent was submitted under the ICMR-MRC Non-Communicable Disease Research Funding for a joint proposal with the University of Aberdeen, entitled, “Clearing the air: a problem common to India and the UK. Reducing tobacco smoke levels in the home to improve chronic respiratory conditions”, which will specifically include asthmatic children exposed to ETS.

Activity: Development of educational materials for primary health care personnel on adverse effects arising from indoor air pollution due to solid fuel combustion and ETS and on their prevention.

  1. Participated as resource faculty in the ‘Course on NCD Prevention and Control’ at School of Public Health, PGIMER, Chandigarh, 8th to 19th March, 2010.
  2. Dr SK Jindal as the Chair for the National Committee for Prevention of Air borne Infection developed National Guidelines under RNTCP of Govt. of India. Dr. A. N. Aggarwal is a key member in preparing the guidelines. They also participated as resource faculty in education & implementation programs for these guidelines for state health departments.
  3. Navneet Singh and Dr. D. Behera developed and published a patient education booklet for primary care physicians and lung cancer patients in English, Hindi and Punjabi.

Activity: Conduct training of personnel at primary and secondary levels of health care system in prevention and management of chronic respiratory diseases

Dr Dheeraj Gupta participated in WHO-CDC Training programme for Prevention of Air-borne infection in New Delhi, November 4-6, 2009.

Regional Update in Pulmonary Diseases was held for general physicians at Chandigarh, 25th October, 2009

The departmental faculty participated as experts in continuing medical education activities across the country as per list given below:

  1. Jindal SK. Management of COPD in India. General Physician Forum, Patiala, Punjab, Jan 5, 2010.
  2. Jindal SK. Management of Fungal infections at the Association of Physicians of India Conference, Jaipur. Jan 7-8, 2010
  3. Jindal SK Management of COPD and Asthma. Physician Forum, Ludhiana, Jan 25, 2010.
  4. Jindal SK. Management of Extra pulmonary TB in India, Mullana, Haryana, August 27, 2010
  5. Gupta D. “Thoracoscopy for pleural effusions” at Broncocon 2010, the 15th Annual conference of the Indian Association of Bronchology, Agra, February 5-7, 2010
  6. Gupta D. “Free paper award session” Chair and judge at Broncocon 2010, the 15th Annual conference of the Indian Association of Bronchology, Agra, February 5-7, 2010
  7. Gupta D. “Medical Thoracoscopy” at CME-cum Brochoscopy Workshop, Dayanand Medical college and
  8. Hospital, Ludhiana, March 7, 2010
  9. Gupta D. “Diagnosis and treatment of tuberculosis” at Workshop for the Prison Doctors, by Punjab Health System Corporation and PGIMER, Chandigarh. February 27, 2010
  10. Gupta D. “Diagnosis and monitoring of COPD” at Evidence Translated to Practice, a workshop on COPD for General Practitioners under the aegis of ACCP (India), Baddi, March 13-14, 2010
  11. Gupta D. “HIV-TB Co-ordination: Cross referrals” at the Full Site sensitization programme regarding NACP-III, PGIMER, Chandigarh. March 17, 2010
  12. Gupta D. “Endoscopic management of benign tracheal stenosis” at Trends in Interventional Pulmonology 2010, Coimbatore, July 31-Aug 1, 2010.
  13. Gupta D. “HIV-TB Co-ordination: Cross referrals” at the Full Site sensitization programme regarding NACP-III, PGIMER, Chandigarh. July 28, 2010
  14. Gupta D. “HIV-TB Coordination” at the meeting of the North Zonal Task force for the implementation of RNTCP in Medical Colleges, Mullana, Haryana, August 27, 2010
  15. Gupta D. “Management of Chronic Stable COPD” at the CME of the Doctors Forum, Patiala (regd), Patiala, September 30, 2010.
  16. Aggarwal AN. Pleural effusion in tuberculosis: a diagnostic dilemma. At Respiratory Update 2009, Guwahati (2009)
  17. Aggarwal AN. Pathogenesis and management of acute respiratory distress syndrome. At Respiratory Update 2009, Guwahati (2009)
  18. Aggarwal AN. Bronchoscopic pearls. At Broncocon 2010: 15th Annual Conference of Indian Association for Bronchology, Agra (2010)
  19. Aggarwal AN. Transbronchial needle aspiration. At Bronchoscopy Workshop, Ludhiana (2010)
  20. Agarwal R. Lecture on “Etiological Factors and Management of Respiratory Failure” NZISACON 2009, X Annual North Zone Conference Indian Society of Anaesthesiologists, October 23-25, Banur
  21. Agarwal R. Panel Discussion “NIV in non-COPD acute respiratory failure”; Panel Discussion “APC in
  22. Severe Sepsis” Lecture on “Hospital and ICU preparedness for H1N1 influenza”
  23. Conducted the radiology quiz Annual Pulmonary & Critical Care Update, 2009, October 17, Chandigarh
  24. Agarwal R. Lecture on “Allergic broncho-pulmonary aspergillosis and AFRS” Tricity ENT forum, February 18, 2010
  25. Agarwal R. Lecture on “Respiratory Emergencies” Institute of Correctional Administration Training programme on ‘Emergency Medical Care’ for Prison Doctors of different States, March 6-7, 2010
  26. Agarwal R. Lecture on “Management of AE-COPD” and “COPD and CAD” Evidence Translated to Practice, a workshop on COPD for General Practitioners under the aegis of ACCP (India), Baddi, March 13-14, 2010
  27. Agarwal R. Lecture on “SMART approach: a paradigm shift in asthma management” Physician’s Forum, Jalandhar, June 4, 2010
  28. Agarwal R. Conducted workshop on Interventional pulmonology. Lecture on “Chemical Pleurodesis” and “Endobronchial lipoma” Trends in Interventional Pulmonology 2010, July 31-Aug 1, Coimbatore
  29. Agarwal R. Lecture on “Non-resolving pneumonia” PULMOCON 2010, September 3-4, Kolkata
  30. Agarwal R. Lecture on “Severe asthma and Aspergillus” 4th Advances Against Aspergillosis, February 4-6th, 2010, Rome, Italy

Activity: Development of networking through telecommunication/telemedicine programme between various medical colleges in different regions for collaborative research and data analyses in chronic respiratory diseases

The Indian Network on chronic Respiratory Diseases (www.indnetred.org) site was active and being further promoted for collaborative research.

Activity: To use tele-networking of medical colleges for training of primary health care work force in prevention and management of chronic respiratory diseases

Project on “Development of online module for training of physicians in management and prevention of chronic respiratory disease” was submitted to WHO-India.

Collaboration with WHO in regards to the above activities of the WHO collaborating centre during the past 12 months

Participation in the meeting of WHO Collaborating Centres of the country, organized by WHO at Delhi, November 12-13, 2009.

Dr SK Jindal was selected as one of the members of the Working Group of WHO-CC Network in India.

Dr SK Jindal was invited to speak on “Role of Lung Health Professionals in Tobacco Control and Respiratory Diseases” by UICC at its World Congress in Shenzhen, China, August 18-21, 2010.

Interactions or collaborations with other WHO collaborating centres in the context of the implementation of the above activities

Dr SK Jindal invited as member of Technical Advisory Committee of PAL (Practical Approach to Lung Health), Kerala by the State Disease Control and Monitoring Cell, NRHM, Kerala.

Dr. S.K. Jindal conceptualized and was instrumental in the formation of recently published ‘Guidelines for Withdrawal of Treatment of Irreversibly Critically Ill Patients on Assisted Respiratory Supports’ for the first time in India. These guidelines are available at www.pgimer.nic.in and www.indiachest.org.

Back to top

2010-2011

Activity: Assessment of contribution of indoor air pollution from solid fuel combustion and environmental tobacco smoke (ETS) to respiratory disease related morbidity and mortality

A study on poor control of asthma and quality of life in asthmatic nonsmoker women exposed to solid-fuel combustion was completed as a post-graduation thesis. The abstract of the study has been accepted for publication in the journal Respiration. The results was planned to be presented at the Annual Conference of Asia Pacific Society of Respirology in Shanghai, China in November 2011.

A study entitled “Impact of indoor air pollution on respiratory health: A population based adult cohort study” was submitted to Indian Council of Medical Research as an Indo-US project in continuation with the ongoing Indo-US Collaboration on Environment and Health agenda. The research proposal is designed to study the health effects of indoor air pollution from solid-fuel combustion and to assess whether an effective reduction in the exposure levels of indoor air pollutants significantly improve the respiratory health outcome in adults? The proposal is planned as an interventional designed longitudinal, population-based, cohort study on 1000 adult women. Both general health parameters and respiratory symptoms and morbidity will be ascertained. Key indoor air pollutants (PM2.5, carbon-monoxide, environmental tobacco smoke, etc.) will be monitored at the participants’ homes to generate baseline exposure data. Various biomarkers will also be studied for their discriminatory value regarding exposure to indoor air pollutants. These include serum C-reactive protein (for systemic inflammation), 8-Hydroxy 2-deoxy guanosine (for DNA damage), 8-iso PGF-2a (for oxidative stress), urinary methoxyphenols (for wood smoke), urinary 1-hydroxypyrene (for polyaromatic hydrocarbons), and urinary cotinine and urinary naphthalene (for environmental tobacco smoke). A small subset of patients will also undergo detailed studies to evaluate genetic susceptibility to indoor air pollution. Investigations into genetic polymorphisms in genes related to oxidative stress (such glutathione S-transferase genes – GSTM1, GSTT1 and GSTP1), and induction of hepatic cytochrome P450 1A (CYP1A1) are proposed. Of the several different approaches to reduce the pollution levels, the study- intervention/s package will be pilot tested during the baseline phase depending upon the local practices and feasibility. The finalized package including improved stove along with education and behavioural measures will be admistered using a case-control approach for one year. The results will be analyzed with reference to the changes in the levels of pollutants and quantifiable respiratory health variables. The project has already been cleared by the Health Ministry Screening Committee, and has been approved in principle by the Indian Council of Medical Research. Formal project sanction is expected later this year.

A study entitled “Magnitude and impact of indoor air pollution on morbidity related to chronic obstructive pulmonary disease and bronchial asthma in Indian women” was submitted to Indian Council of Medical Research as an Indo-US project in continuation with the ongoing Indo-US Collaboration on Environment and Health agenda. The project will study a cohort of 200 adult women with chronic respiratory disease (COPD and asthma). Details on clinical profile, morbidity, and health related quality of life will be gathered at baseline. Key indoor air pollutants (PM2.5, carbon-monoxide, environmental tobacco smoke, etc.) will be measured in three micro-environments – kitchen, living room, and immediately outside the house, and personal monitoring will be carried out, on a cross-sectional basis. Questionnaires will be used to quantify exposure to environmental tobacco smoke, and select biomarkers will be employed to assess exposure to specific pollutants. These include serum C-reactive protein (for systemic inflammation), 8-Hydroxy 2-deoxy guanosine (for DNA damage), 8-iso PGF-2a (for oxidative stress), urinary methoxyphenols (for wood smoke), urinary 1-hydroxypyrene (for polyaromatic hydrocarbons), and urinary cotinine and urinary naphthalene (for environmental tobacco smoke). Air quality indices will be correlated with disease severity and morbidity. In the next phase, the population will be divided into two groups – an intervention group exposed to one or more interventions aimed at reducing indoor air pollution, and a control group which continues to use existing fuel and combustion devices. Indoor air pollution and disease parameters will be serially assessed over the next one year to identify the impact of these intervention(s). A small subset of patients will also undergo studies to evaluate genetic susceptibility to indoor air pollution. The project has already been cleared by the Health Ministry Screening Committee, and has been approved in principle by the Indian Council of Medical Research. Formal project sanction is expected later this year.

Gupta D, Jindal SK, Aggarwal AN, Agarwal R. Household environmental tobacco smoke exposure and bronchial asthma among nonsmoking Indian women: results from INSEARCH study. Paper presented at the ERS 2010 (19th Annual conference of the European Respiratory Society), held September 18-22, 2010 in Barcelona, Spain

Activity: Effect of indoor exposures of pregnant women due to solid fuel combustion and environmental tobacco smoke (ETS) on pregnancy outcome, maternal health and respiratory disease

The effects of Indoor air-pollution (IAP) on maternal and fetal outcomes in pregnancy were being studied in a multicentric study being conducted in collaborations with the departments of Obstetrics and Gynecology at our Institute and Government Medical College and Hospital, Sector 32, Chandigarh. The subject recruitment at GMCH was completed and data entry was on, whereas the enrollment was on at our center. We intended to study consecutive 2000 mothers with singleton pregnancy and study their exposures (solid fuel combustion +/-ETS) to IAP and pregnancy outcomes.

The department was involved in the development of project to assess impact of indoor air pollution and its reduction on maternal and child health, under the Indo-US Program on Environmental and Occupational Health. This prospective population based cohort study, to be conducted at rural Nagpur, will enroll pregnant women and follow them up till delivery. Both adverse pregnancy outcomes as well as neonatal outcomes (low birth weight, prematurity, still births, etc.) will studied and correlated with cumulative exposure to indoor air pollution. An intervention component will subsequently assess if reduction in exposures is associated with improved maternal and neonatal outcomes. The project has already been cleared by the Health Ministry Screening Committee, and has been approved in principle by the Indian Council of Medical Research. Formal project sanction is expected later this year.

Activity: Effect of solid fuel combustion and ETS exposure on respiratory symptoms and lung function in children

The department was involved in the development of project to study impact of indoor air pollution on asthma exacerbation in children, under the Indo-US Program on Environmental and Occupational Health. This project was to be carried out in Delhi on asthmatic children 4-15 years of age, and would involve assessment of indoor air pollution at homes of participants, and correlating it with the number and severity of exacerbations of asthma. The project was to be funded by the Indian Council of Medical Research.

Activity: Development of educational materials for primary health care personnel on adverse effects arising from indoor air pollution due to solid fuel combustion and ETS and on their prevention

On-line Training Module: A project was started under WHO-India sponsorship to develop the On-line self-learning, Training Module in Management of chronic respiratory diseases for health-care professionals working at the primary and secondary levels of care. The Module was to be operational by the beginning of 2012.

Fact sheet on Chronic Respiratory Diseases: The Centre contributed section on chronic Respiratory Diseases in the development of the Fact Sheets and Frequently Asked Questions and Answers, which were published and released by the WHO Country Office for India in August 2011 at the National Summit on NCDs, Ministry of Health & Family Welfare and WHO Country Office for India.

Contributed the section on chronic respiratory diseases in the National Background document on Chronic NCDs prepared by the Indian Council of Medical Research.

Participated as Faculty in the National Summit on Chronic NCDs in New Delhi (August 2011), Ministry of Health and Family Welfare and WHO-Country Office for India.

Activity: Conduct training of personnel at primary and secondary levels of health care system in prevention and management of chronic respiratory diseases

Participated in a Workshop on Multi-sectoral Partnership for Health Promotion and Non-Communicable Diseases Prevention in India (supported by WHO-GOI Collaborative Program 2010-11) held on July 15, 2011 at Chandigarh by Public Health Foundation of India.

Candidates who underwent short-term training in the department during this period

  1. Dr Prafulla Thakkar, Navi Mumbai
  2. Dr Santa Kumar Das, Nepal
  3. Dr Trinath Dash, Bhilai
  4. Dr Vishal Chopra, Patiala

The departmental faculty participated as experts in continuing medical education activities across the country as per list given below:

  1. Jindal SK. “Spectrum of chronic lung diseases”. National Conference on Lung Diseases, Jodhpur, November 26-29, 2010.
  2. Jindal SK. “Management of COPD. Doctors Forum, Patiala, December 12, 2010.
  3. Jindal SK. “Chronic Interstitial Lung Diseases”. Annual Meeting of Association of Physicians of India, Ahmedabad, Jan. 6-9, 2011.
  4. Jindal SK. “Management of pulmonary hypertension”. Bengal Chest Society Meeting, Kolkata, February 26-27, 2011.
  5. Jindal SK. “Chronic Obstructive Pulmonary Disease”. Physicians CME, Chandigarh. March 13, 2011.
  6. Jindal SK. “National Guidelines for management of COPD at primary and secondary health-care settings (25th March 2011) at NCD Course at School of Public Health, Chandigarh
  7. Jindal SK. “Bronchoscopy in clinical practice”. CME, Srinagar, June 16, 2011.
  8. 8 Jindal SK. “Masters Training Programme in Asthma and COPD”. GINA Forum, New Delhi, July 30, 2011.
  9. Gupta D. “SMART way to treat asthma”, at ICAAICON 2010 the 44th Annual Conference of Indian College of Allergy, Asthma and Applied Immunology, Udaipur, Rajasthan, October 22-24, 2010.
  10. Gupta D. “Existent criteria for diagnosis of tuberculosis”, at the Annual Conference of the Uveitis Society of India and International workshop on Intraocular Tuberculosis, Advance Eye Center, PGI, Chandigarh, 27-31 October, 2010.
  11. Gupta D. “SMART way to treat asthma”. 16th Annual Meeting of the Society of Internal Medicine (SIMON) of Nepal. Pokhra, Nepal. March 11-12, 2011
  12. Gupta D. “Interstitial Lung Diseases: Diagnosis and management”, at the Indian Chest Society Respiratory Update 2011. Guwahati, March 27, 2011
  13. Gupta D. “Evaluation and management of pneumonia in healthcare setting,” at the Indian Chest Society Respiratory Update 2011. Guwahati, March 27, 2011
  14. Gupta D. “Lung cancer in non-smokers: is it a separate entity” , at the NELCCON 2011, the 3rd National Conference of the Indian Society for Study of Lung Cancer. Indore, April 8-10, 2011
  15. Gupta D. “Interstitial Lung Diseases”, at the NELCCON 2011, the 3rd National Conference of the Indian Society for Study of Lung Cancer. Indore, April 8-10, 2011
  16. Gupta D. “Treatment of Sarcoidosis: when and how much”? 1st Pulmonary Update at the Pt. BD Sharma University of Health Sciences, Rohtak, April 24, 2011
  17. Gupta D. “Recent evidence in epidemiology of asthma from India”. Biennial conference of the Indian Academy of Allergy in collaboration of World allergy Organization, Bangalore, August 11-13, 2011
  18. Gupta D. “Pleurodesis for benign and malignant disease: A Medical Thoracoscopic approach”. Interventional Pulmonology State of the Art, Bangalore, September 9-10, 2011
  19. Gupta D. “Rigid broncoscopy: Problems and difficulties”. Interventional Pulmonology State of the Art, Bangalore, September 9-10, 2011
  20. Aggarwal AN. Indian Chest Society Oration 2010. Interpreting lung function tests: The Maths and beyond. At NAPCON 2010, Jodhpur, November 26-30, 2010
  21. Aggarwal AN. Bronchoscopy in the ICU. At NAPCON 2010, Jodhpur, November 26-30, 2010
  22. Aggarwal AN. Bronchial asthma: From just an infection to persistent inflammation and remodeling. At NAPCON 2010, Jodhpur, November 26-30, 2010
  23. Aggarwal AN. Pulmonologist’s perspective in lung cancer diagnosis: role of endoscopic techniques. At National Lung Cancer Conference 2011, Indore April 9-10, 2011
  24. Aggarwal AN. Latent tuberculosis: diagnosis and management. At Tuberculosis: A Global Challenge, Shimla, June 11-12, 2011.
  25. Agarwal R. “Systematic review and meta-analysis” at Evidence Based Nursing Practice (MOHFW sponsored), September 27-October 6, 2010
  26. Agarwal R. “Allergic bronchopulmonary aspergillosis” at AMRICON 2010, National Conference on Recent Advances in Medical Specialties, Kolkata. October 2-3
  27. Agarwal R. “SMART approach: a paradigm shift in asthma management” at Physicians Forum, Punjab Chapter, Indian Chest Society,Chandigarh. October 16, 2010
  28. 10, 44th Annual Conference of the Indian College of Allergy, Asthma & Applied Immunology, October 22-24, Udaipur
  29. Agarwal R. “Recent Advances in ARDS” at ISCCM, Jalandhar Chapter, December 17, 2010
  30. Agarwal R. “What went wrong – Management of Endobronchial lipoma” at BRONCOCON 2011, 16th Annual Conference of the Indian Association for Bronchology, Feb 4-6, Chandigarh
  31. Agarwal R “Monitoring Blood Flow, Oxygenation, Acid & Base Status” at FCCS (Fundamentals of Critical Care Support), under the aegis of SCCM, USA in Fortis Hospital, Mohali, 30th April-1st May
  32. Agarwal R “Diagnosis & Management of Acute Respiratory Failure” at FCCS (Fundamentals of Critical Care Support), under the aegis of SCCM, USA in Fortis Hospital, Mohali, 30th April-1st May
  33. Agarwal R. “Allergic bronchopulmonary aspergillosis- future directions” at Indo-German Conference on Pathogenic Fungi”. August 01-03, 2011 at Jawaharlal Nehru Centre for Advanced Scientific Research Bangalore, India
  34. Agarwal R. “Airway stents – Indian perspective” at Max Interventional Bronchoscopy Course, Hands-on training, 5-6 September, 2011, New Delhi
  35. Agarwal R. “Formulate a plan (protocol) at FHI-NIH workshop on meta-analysis, 16-18 September 2011, Lucknow
  36. Singh N. ‘HIV-Tuberculosis’ during the Link ART Centre Medical Officers (LAC-MOs) Training at Centre of Excellence in HIV/AIDS, PGIMER, Chandigarh, India from September 21-23, 2011
  37. Singh N. ‘Approach to a critically ill patient in the intensive care unit’ and ‘Arterial Blood Gas: Interpretation & Clinical Implications’ during the CME on Respiratory and Critical Care Medicine held at Assam Medical College, Dibrugarh, Assam, India from June 04-05, 2011
  38. Singh N. ‘HIV-Tuberculosis’ during the Link ART Centre Medical Officers (LAC-MOs) Training at Centre of Excellence in HIV/AIDS, PGIMER, Chandigarh, India from April 28-30, 2011
  39. Singh N. ‘Revised TNM classification of lung cancer’ during the 4th Biennial National Conference of the Indian Society for Study of Lung Cancer (NALCCON) held at Indore, Madhya Pradesh, India from April 09-10, 2011
  40. Singh N. Demonstrated medical thoracoscopic procedures during the workshop on ‘Thoracoscopy’ – a part of the 16th Annual Conference of the Indian Association for Bronchology held at Chandigarh, India from February 4-6, 2011
  41. Singh N. ‘Panel discussion on lung cancer’ during the PromOTE Lung CME of the Indian Co-operative Oncology Network (an autonomous body of the Indian Society of Medical & Pediatric Oncology) held at Chandigarh, India on September 12, 2010

Activity: Development of networking through telecommunication/telemedicine programme between various medical colleges in different regions for collaborative research and data analyses in chronic respiratory diseases.

Network was being used to develop collaborative research and training activities. The Network was being further strengthened and expanded.

Activity: To use tele-networking of medical colleges for training of primary health care work force in prevention and management of chronic respiratory diseases.

Training Workshop: One training Workshop for primary health-care professionals to manage chronic obstructive pulmonary disease and asthma was held on 21st August, 2011. The training was imparted on WHO-India Module for 42 participants. Resource Faculty from PGIMER, Chandigarh, VP Chest Institute, Delhi and St. John Medical College, Bengaluru was used for this purpose.

Collaboration with WHO in regards to the activities of the WHO collaborating centre during the past 12 months

Visits: The Centre was visited by Dr JS Thakur, Cluster Focal Point, National Professional Officer on NCDs, WHO Country Office for India, New Delhi and Dr Antonio Duran, Consultant WHO Co-India. Discussions were held on management strategies and guidelines for NCDs.

Reviewed various documents and Fact sheets from WHO-SEAR Regional Office on Antibiotic Policy, Microbial resistance, Standard treatment guidelines and other information on rational antibiotic use etc.

Interactions or collaborations with other WHO collaborating centres in the context of the implementation of the above activities

The Centre had worked in collaboration with other WHO-CCs on chronic NCDs (diabetes, stroke, cancers, ischemic heart disease) in developing the Background Paper, Fact Sheet and Frequently Asked Questions etc. on Chronic NCDs.

Back to top

2011-2012

Activity: Assessment of contribution of indoor air pollution from solid fuel combustion and environmental tobacco smoke (ETS) to respiratory disease related morbidity and mortality

We had earlier completed the INSEARCH (Indian Study on prevalence of Asthma, Respiratory symptoms and Chronic Bronchitis) at 12 different Centres (23 sites) spread in different parts of India in a population sample of 85105 men and 84470 women. The paper was published in International Journal of TB & Lung Diseases (IUTLD 2012; 16:1270-77). The paper included our results on contribution of indoor air pollution from solid fuel combustion and environmental tobacco smoke (ETS) exposures to the prevalence of chronic respiratory diseases (CRD) – asthma and chronic bronchitis (CB).  The odds of development of both asthma and CB on exposure to unclean cooking fuels as well as the ETS were higher than those amongst non-exposed individuals. This is the largest population study on prevalence and risk-factors of CRD in India. An overall burden of over 32 million adult patients as per 2011 Census of India was assessed in this study.

Activity: Effect of indoor exposures of pregnant women due to solid fuel combustion and environmental tobacco smoke (ETS) on pregnancy outcome, maternal health and respiratory disease

Partially completed:

  1. The effects of Indoor air-pollution (IAP) on maternal and fetal outcomes in pregnancy were being studied in a multicentric study being conducted in collaborations with the departments of Obstetrics and Gynecology at our Institute and Government Medical College and Hospital, Sector 32, Chandigarh. The preliminary analysis of data from 1000 mothers recruited at the GMCH showed that IAP in the form of ETS exposure and combustion of solid guels was associated with adverse pregnancy outcomes in the form of pre-maturity, low birth weight and intra-uterine growth retardation. The data from 1000 mothers at PGI was being collected.
  2. Another project to assess impact of indoor air pollution and its reduction on maternal and child health, under the Indo-US Program on Environmental and Occupational Health was in advanced stages for funding. This prospective population based cohort study, to be conducted at rural Nagpur, will enroll pregnant women and follow them up till delivery. Both adverse pregnancy outcomes as well as neonatal outcomes (low birth weight, prematurity, still births, etc.) will studied and correlated with cumulative exposure to indoor air pollution. An intervention component will subsequently assess if reduction in exposures is associated with improved maternal and neonatal outcomes. Formal project sanction was still awaited.

Activity: Development of educational materials for primary health care personnel on adverse effects arising from indoor air pollution due to solid fuel combustion and ETS and on their prevention

Completed:

We have developed an online training module for general practitioners and primary care health professionals on management of COPD and asthma. The on-line Training Module can be accessed at www.searednet.org). The modules is simple, self-administered,  has resource material and assessment tools. Upon completion of the module the participant is issued a certificate of completion if he successfully completes the assessment module.

We have also developed Guidelines for Diagnosis and Management of Community and Hospital Acquired Pneumonia in Adults: Joint ICS/ NCCP (I) Recommendations (Lung India 2012;29: S27-S62) sponsored by the ICS and NCCP and later this year we are holding similar activity  to update the National COPD guidleines.

Activity: Conduct training of personnel at primary and secondary levels of health care system in prevention and management of chronic respiratory diseases

List of short term trainees sponsored by SEAR (WHO) from Korea

  1. Dr Sung Ryong Choe
  2. Dr Myong Gon yu
  3. Dr Kon II Yang
  4. Dr Song II Pak

Other candidates who underwent short-term training in the department during this period

  1. Dr Sahebrao Toke from Purusaiwakkam, Chennai

The departmental faculty participated as experts in continuing medical education activities across the country as per list given below:

  1. Jindal S.K. “Epidemiology of asthma and Chronic obstructive pulmonary disease in India”, NAPCON 2011 (Joint Annual conference of Indian Chest Society & National College of Chest Physicians), Nov. 27-30, 2011,Delhi
  2. Jindal S.K. “Asthma control and quality of life in women exposed to solid fuel combustion”; Annual Meeting of Asia Pacific Society of Respirology, Shanghai, China, Nov 1-5, 2011
  3. Jindal S.K. “Community acquired pneumonias”; Gulf Thoracic Meeting, Dubai, UAE, March 15-17, 2012.
  4. Jindal S.K. “Management of COPD in India”, Indian Medical Association, Patiala, Punjab.
  5. Jindal S.K. “Biomass combustion as risk factor for asthma”; Indian Medical Association, Patiala, Punjab
  6. Gupta D. “Health care associated pneumonia”. 25th Annual Update on Pulmonary and Critical Care Medicine, Theme: Pulmonary Infections. PGIMER, Chandigarh, October 9, 2011
  7. Gupta D. “TB-Sarcoidosis Enigma”. NAPCON 2011 joint annual conference of the Indian Chest Society and National College of Chest Physicians (India), Delhi, November 27-30, 2011
  8. Gupta D. Training module cases 1&2. WHO-India Training Module for management of asthma and COPD at primary level of health care in India, December 18, 2011, PGI, Chandigarh
  9. Gupta D. Live operative workshop on rigid bronchoscopy. 4th Asia Pacific Congress on Bronchology, January 19-22, 2012, Jaipur
  10. Gupta D. “Oncology Pulmonology interface”. 4th Asia Pacific Congress on Bronchology, January 19- 22, 2012, Jaipur
  11. Gupta D. “Special considerations in allergic bronchopulmonary aspergillosis”. ABPA complicating asthmatics workshop. SIHAM 2012, the 9th annual conference of the Society of Indian and Human Mycologists. February 9-12, 2012, Siliguri
  12. Gupta D. “Diagnosis of CAP”. ICS-NCCP (I) Joint Workshop to formulate national guidelines for diagnosis and management of CAP and HAP. March 17-18, 2012, Chandigarh.
  13. Gupta D. “Bronchoscopy Techniques Including Lavage and Biopsies”. Workshop on Bronchoscopy and Medical Thoracoscopy. A CME organized by Centre for Respiratory Disease Jaipur Golden Hospital. April 8, 2012, New Delhi
  14. Gupta D. “COPD: diagnosis and differentiating from asthma”. Evidence Translated to Practice, a workshop for General Practitioners under the aegis of ACCP (India), May 12, 2012, Parvanoo (HP) 15.Gupta D. “COPD and CAD link”. Evidence Translated to Practice, a workshop for General Practitioners under the aegis of ACCP (India), May 12, 2012, Parvanoo (HP)
  15. Gupta D. “Non tubercular mycobacteria: Much ado about nothing”. Respiratory Update 2012, Baroda Chest Society, July 27-29, 2012, Goa, India
  16. Gupta D. “EBUS is a rich man’s TBNA: debating for the motion”. Respiratory Update 2012, Baroda Chest Society, July 27-29, 2012, Goa, India
  17. Agarwal R. Approach to a patient with respiratory failure. Physician’s Forum, December 4, 2011, Patiala
  18. Agarwal R. Training module cases 3. WHO-India Training Module for management of asthma and COPD at primary level of health care in India, December 18, 2011, PGI, Chandigarh
  19. Agarwal R. Live operative workshop on rigid bronchoscopy & Lecture on “Interventional pulmonology in massive hemoptysis”. 4th Asia Pacific Congress on Bronchology, January 19-22, 2012, Jaipur
  20. Agarwal R. Allergic bronchopulmonary aspergillosis. In: ABPA complicating asthmatics workshop. SIHAM 2012, the 9th annual conference of the Society of Indian and Human Mycologists. February 9- 12, 2012, Siliguri
  21. Agarwal R. Airway stents. Workshop on Bronchoscopy and Medical Thoracoscopy. A CME organized by Centre for Respiratory Disease Jaipur Golden Hospital. April 8, 2012, New Delhi
  22. Agarwal R. Management of HAP. ICS-NCCP (I) Joint Workshop to formulate national guidelines for diagnosis and management of CAP and HAP. March 17-18, 2012, Chandigarh.
  23. Agarwal R. Lecture on “How to choose the right appliances during NIV” and Hands-on training with NIV. SLEEPCON 2012, National Conference on Sleep Disorders, April 6-8, 2012, Chandigarh.
  24. Agarwal R. Identification of IASLC borders on x-ray and CT scan. 1st Workshop on Endoscopic Ultrasound of Lung. JR Hospitals. April 15, 2012, Meerut.
  25. Agarwal R. Bronchiectasis: which test for which patient and Panelist in Case Discussion and Meet- the-expert: Interventional Pulmonology. Respiratory Update Goa 2012 (Baroda Chest Group). July 27- 29, Goa
  26. Agarwal R. Conventional TBNA: Is it end of the road and Live workshop station of EBUS. Training course on EBUS and pleuroscopy on behalf of The Foundation for Cardiorespiratory Disorders. August 5th 2012, New Delhi
  27. Agarwal R. Management of adult ARDS. ISCCM Chandigarh Chapter, August 18th 2012, Chandigarh 29.Agarwal R. Formulation of Research Questions: Background, Hypotheses and Types of Objectives/PICO. ICMR sponsored Workshop on “BIOSTATISTICAL ASPECTS OF RANDOMIZED CLINICAL TRIALS (RCT) AND MEDICAL ETHICS”. September 21-23, 2012, GMC, Chandigarh
  28. Agarwal R. Diagnosis and treatment of allergic bronchopulmonary aspergillosis. 43rd Annual Meeting of Japanese Society of Occupational and Environmental Allergy, June 15-16, 2012, Tokyo, Japan
  29. Singh N. ‘HIV and Tuberculosis’ during the Link ART Centre Medical Officers (LAC-MOs) Training at Centre of Excellence in HIV/AIDS, PGIMER, Chandigarh from August 22-24, 2012
  30. Singh N. ‘Multidrug Resistant (MDR) and Extensively drug Resistant (XDR) Tuberculosis’ for MD (Internal Medicine) Residents at PGIMER, Chandigarh on August 21, 2012.
  31. Singh N. ‘Management of HIV-TB co-infection’ and ‘Monitoring & Evaluation Tools’ during the NACO Training Programme in HIV Care for Nurse at ART/CCC at the National institute of Nursing Education (NINE), PGIMER, Chandigarh from April 23-28, 2012
  32. Singh N. ‘Lung Cancer: Recent advances in diagnostic techniques and targeted molecular therapy’ during the CME on Recent Advances in Lung Cancer as part of the 60th Annual Conference of Indian Association of Pathologists and Microbiologists [IAPM] (APCON) held at Patiala, Punjab from December 01-04, 2011
  33. Singh N. ‘Lung Cancer: Management in resource constrained settings’ during the 13th Annual Conference of the Indian Chest Society and the National College of Chest Physicians (NAPCON) held at New Delhi from November 27-30, 2011
  34. Singh N. Chairperson for session ‘Lung Cancer: Specific Issues’ during the 13th Annual Conference of the Indian Chest Society and the National College of Chest Physicians (NAPCON) held at New Delhi from November 27-30, 2011
  35. Singh N. ‘General approach to Opportunistic infections in PLHIV’ and ‘HIV and Tuberculosis’ during the Training of Trainers (TOT) Programme for Master Trainers at Centre of Excellence in HIV/AIDS, PGIMER, Chandigarh from October 31-November 03, 2011
  36. Singh N. ‘Strategies to prevent nosocomial pneumonia’ during the 25th Update on Pulmonary and Critical Care Medicine (Pulmonary Infections) held at PGIMER, Chandigarh on October 09, 2011

Activity: Development of networking through telecommunication/telemedicine programme between various medical colleges in different regions for collaborative research and data analyses in chronic respiratory diseases

Completed:

We already have developed a web-based Network (www.indianetred.org; www.searednet.org) with membership from various Medical Colleges and Institutes on Chronic respiratory diseases. The Network is being used to develop collaborative research and training activities. The Network is being further strengthened and expanded

We for the first time brought the two National societies of Respiratory Medicine in Inida, namely the Indian Chest Society and the National College of Chest Physicians (India) together to collaborate on development of national Pneumonia Guidelines. this collaboration is committed to undertake one project very year to take up all vhronic respiratory diseases. This year we will take-up COPD.

Activity: To use tele-networking of medical colleges for training of primary health care work force in prevention and management of chronic respiratory diseases.

  1. Training workshops: the department organized two training workshops for the general practitioners on the WHO-India Training Module for management of asthma and COPD at primary level of health care in India, on December 18, and December 24, 2011, at PGI, Chandigarh. This activity was supported by WHO -India
  2. Online training module on mangement of COPD and asthma made operational.

Interactions or collaborations with other WHO collaborating centres in the context of the implementation of the above activities

  1. Participation of Dr SK Jindal in the Regional Meeting (SEARO and Govt. of India) on Multisectoral Response to Non-Communicable Diseases, New Delhi, India, November 14-16, 2011.
  2. Participation of Dr SK Jindal in the Regional Meeting (SEARO) on non-communicable Diseases including Mental Health and Neurological Disoders, Yangon, Myanmar, April 24-26, 2012.
  3. Department faculty Dr. S.K.Jindal, Dr. D. Behera and Dr. Dheeraj Gupta participated as experts in the WHO-Govt. of India Joint Monitoring Mission for the Revised National Tuberculosis Programme from August 21-31, 2012.

Back to top

2012-2013

Activity 1: Assessment of impact of indoor air pollution on respiratory health in adults and women, including pregnancy outcomes

To study the effect of household indoor air pollution (IAP), assessed by exposure to biomass fuel and/or environmental tobacco smoke on pregnancy outcome a case control study was conducted at the the department of Obstetrics and Gynecology, Govt Medical College and Hospital (GMCH), Sector-32, Chandigarh. Study included consecutive 1000 pregnant women admitted to the labour room for delivery with singleton pregnancy in GMCH-32. Following delivery, each woman was interviewed according to a pre-designed structured questionnaire to enquire if they had exposure to Biomass fuel/or exposure to passive smoke at home. Obstetric and medical details of the mothers were recorded from case notes, as also the details of the newborn baby. Comparisons were made among mother exposed and not to IAP. Out of total 1000 women recruited, 943 were included in the final analyses after excluding 57 with missing information. The prevalence of exposure to polluting fuels was 22.26% (210/943) and the prevalence of exposure to passive smoking was 23.43% (221/943). The predominant polluting fuel used for cooking was wood (11.7%) followed by kerosene (6.6%), coal (2.3%) and dung cake (1.7%). Anaemia was observed in 63.3% of patients. In this study, 4.8% patients had gestational hypertension, 8.2% had preeclampsia, 1% had eclampsia and 4.8% had cholestasis. Placenta previa was seen in 2.2% patients and 3% had abruption placentae. All the maternal complications were equally distributed in the two groups, except the patients exposed to biomass smoke had significantly increased incidence of preeclampsia (p=0.011) and eclampsia (0.016). Overall, 16.4% of patients had preterm labour, IUGR was seen in 8.4% babies and 36.5% babies weighed <2.5 kg. . On univariate analysis, exposure to IAP i.e. either polluting fuel or ETS or both in present pregnancy was significantly associated with increased incidence of preterm labour, LBW and IUGR. On multivariate analysis LBW was associated with ETS exposure (ORs 3.5-8.4 in increasing quartiles of exposure) and IUGR was associated with both ETS exposure (ORs 1.3-8.1) and use of polluting fuels in the highest quartile of exposure (OR 2.69; 95% CI 1.11-6.55). The results of this study indicate that exposure to IAP from use of poor quality of cooking fuels and /or ETS exposure leads to significant maternal and fetal morbidity.

Activity: Assessment of role of various interventional measures in reducing impact of indoor air pollution on respiratory health

Project to assess the impact of indoor air pollution and its reduction on maternal and child health, under the Indo-US Program on environmental and Occupational Health will be a cohort study, to be conducted at rural Nagpur. We propose to study the harmful effects of IAP on maternal and fetal outcomes and also beneficial effects of interventions to reduce the exposure. The project is awaiting final clearances.

Activity: Draft protocols for management and prevention of chronic respiratory diseases for health-personnel at different levels of health care

The department had held workshops for training of primary care physicians in the management    of chronic respiratory disease (COPD and asthma).

These modules are also available in an online version (www.searednet.org), where in after login the person can undertake the training in a modular fashion and also has pre- and post-training assessment tools.

We have also developed and published the guidelines for diagnosis and management of chronic obstructive pulmonary disease in India in collaboration with the Indian Chest Society (ICS)and the National College of Chest Physicians. These are published and available free online on www.lungindia.com and PubMed central

[Gupta D, Agarwal R, Aggarwal AN, Maturu VN, Dhooria S, Prasad KT, Sehgal IS, Yenge LB, Jindal A, Singh N, Ghoshal AG, Khilnani GC, Samaria JK, Gaur SN, Behera D; S. K. Jindal for the COPD Guidelines Working Group. Guidelines for diagnosis and management of chronic obstructive pulmonary disease: Joint ICS/NCCP (I) recommendations. Lung India. 2013 Jul;30(3):228-67. doi: 10.4103/0970-2113.116248. PubMed PMID: 24049265; PubMed Central PMCID: PMC3775210.]

Activity: Provide training to trainers, medical teachers, specialists and research personnel sponsored from SEAR countries (in management and prevention of chronic respiratory diseases) at the department as well as conduct on-line training

List of short term trainees sponsored by SEAR (WHO) from Korea

  1. Dr Ryong Guk Hong
  2. Dr Chang Gol Run
  3. Dr UN Hi Kim
  4. Dr Son Hwa Ri

Other candidates who underwent short-term training in the department during this period

  1. Dr Jennifer Trevor from University of Alabama, Alabama, USA – completed review project on Biomass fuel combustion and asthma.
  2. Dr. Sheetu sponsored by the SMS Medical College, Jaipur

The departmental faculty participated as experts in continuing medical education activities across the country as per list given below:

  1. Jindal SK. “Promotion of Standard Treatment Guidelines for NCDs’  for students of School of Public Health in the NCD course (1st April to 12th April, 2013)
  2. Gupta D. “Sarcoidosis and tuberculosis: a continuing enigma”. NCCP(I) German Remedies Oration delivered at NAPCON 2012, Bhubneshwar, November 17-19, 2012
  3. Gupta D. “Role of bronchoscopy in diagnosis of sarcoidosis” at Broncocon 2013 the 18th Annual Conference of the Indian association for Bronchology, Vadodra, February 7-9, 2013
  4. Gupta D. “COPD: definition and risk factors” At workshop to formulate Guidelines for diagnosis and management of COPD in India. Chandigarh, February 23-24, 2013
  5. Gupta D. “Difficulties in diagnosis and management of sarcoidosis in India” at An Evening with Prof. R. B. Baughman, by Indian Chest Society. Delhi March 24, 2013
  6. Gupta D. “Difficulties in diagnosis and management of sarcoidosis in India” at An Evening with Prof. R. B. Baughman, by Indian Chest Society. Chandigarh, March 25, 2013
  7. Gupta D. “National guidelines for management of COPD at primary and secondary health care settings” at the Non Communicable disease (NCD) course for MPH students,  School of Public Health, PGIMER. Chandigarh, April 1-12, 2013.
  8. Gupta D. “Challenges in diagnosis of mediastinal lymphadenopathy” at 7th CME on Interventional Pulmonology (Interventional Pulmonology League 2013 – IPL 2013), Mumbai, April 13-14, 2013.
  9. Gupta D. “Classification and management of Interstitial lung diseases: The Indian perspective” at 19th National conference of Environment and Pulmonary diseases (19th NESCON 2013). Mumbai, May 3-5, 2013
  10. Gupta D. “Smoking, Tobacco and Lung cancer problem” at the Lung cancer Awareness programme by the Indian Clinical Oncology Network. Chandigarh, May 26, 2013
  11. Gupta D. “Assessment and management of dyspnoea” at the National workshop on Pulmonary Rehabilitation. Delhi, June 2, 2013
  12. Gupta D. participated as faculty in the Medical Thoracoscopy Workshop organized by the Indian Association for Bronchology in association with Lancashire Hospitals, Preston UK. Delhi, August 11, 2013
  13. Gupta D. “Rheumatology-Pulmonology interface: a pulmonologists view” at the  Rheumatology-Respiratory Update, Vadodara, September 8, 2013
  14. Gupta D. “Management of acute severe asthma” at the Recent Trends in Medical Emergencies, Command Hospital, Chandigarh, September 15, 2013
  15. Gupta D. “Sarcoidosis: difficulties in India” at the CME organized by the Indian Chest Society and Govt. Medical College, Jammu, September 22, 2013
  16. Gupta D. “Diagnosis and Management of Comorbidities in current health system- service delivery issues”, at the Expert Group meeting to address Co-morbidities, WHO/GOI, New Delhi, September 26-27, 2013
  17. Gupta D. “Treatment issues in sarcoidosis, when and how to treat with treatment of relapses.” At PULMOCON 2013, 11th Annual Conference of Pulmonary Diseases, Kolkata, September 28-29, 2013
  18. Gupta D. “Management of non IPF IIPs.” At PULMOCON 2013, 11th Annual Conference of Pulmonary Diseases, Kolkata, September 28-29, 2013
  19. Agarwal R. Pharmacological management of acute exacerbations of COPD; Pulmonary Quiz. Annual Pulmonary & Critical Care Update, October 14, 2012, Chandigarh
  20. Agarwal R. Flexi vs. Flexirigid vs. rigid thoracoscopy & Hands on (including veterinary) training for thoracoscopy. EABIP endorsed Max Interventional Bronchoscopy Course, Hands-on training, 20-21 October, 2012, New Delhi
  21. Agarwal R. Primer on Research Methodology: Framing a research question. 37th Annual Conference of the Indian Psychiatric Society (North Zone). 27-28 October 2012, Sri Ganganagar
  22. Agarwal R. Airway stenting and complications; Balloon Bronchoplasty; Hands on workshop: airway stenting. AMALA INTERVENTIONAL PULMONOLOGY CONGRESS 2013, 18th-19th January 2013, Thrissur, Kerala, India
  23. Agarwal R. Foreign body removal by Flexible bronchoscopy. Broncocon 2013, the annual congress of the Indian Association for Bronchology, February 8-10 2013, Vadodara, Gujarat, India
  24. Agarwal R. Clinical approach to nonresolving pneumonia. Pulmonary Pathology CME. 2013, February 15-17, PGIMER Chandigarh, India
  25. Agarwal R. Clinical trial data management. PGI-ICMR training on Clinical trial methodology (as per GCP guidelines). 2013, February 15-17, PGIMER Chandigarh, India
  26. Agarwal R. Acute exacerbations of COPD. ICS-NCCP (I) Joint Workshop to formulate national guidelines for diagnosis and management of COPD. February 23-24, 2013, PGIMER Chandigarh
  27. Agarwal R. Making sense of the forest plot. Singapore Indian Government Network Empowerment Training (SIGNET) Workshop: Evidence-based Decision-making in Health-Care. March 8-10, 2013, GMCH Chandigarh
  28. Agarwal R. Conducted live workshop on flexible bronchoscopy and endobronchial ultrasound; lecture on “Role of flexible bronchoscopy in diagnosis of sarcoidosis”. BRONCO-CME, March 15-16, 2013, Jaipur.
  29. Agarwal R. High-risk bronchoscopy; Rigid bronchoscopy; Interesting case: spigot insertion in post-pneumonectomy stump fistula. Interventional Pulmonary League 2013, April 13-14, Mumbai
  30. Agarwal R. Clinical trial data management. 2nd PGI-ICMR training program in Clinical trial methodology (as per GCP guidelines) with emphasis on investigator initiated trials. 2013, July 29 to August 2, PGIMER Chandigarh, India
  31. Agarwal R. Difficult to treat asthma: a therapeutic challenge. CME conducted by Apollo Hospitals, Bengaluru. August 18, 2013
  32. Agarwal R. EBUS in non-malignant disorders & Live workshop on EBUS. CME conducted by Continental Hospitals, Hyderabad. September 15 2013
  33. Aggarwal AN. Debate: Lung function testing is necessary for diagnosis of COPD. At 26th Annual Pulmonary and Critical Care Update, Chandigarh (October 14, 2012)
  34. Aggarwal AN. Complications of interventional pulmonology. At Broncocon 2013: 17th Annual Conference of Indian Association for Bronchology, Vadodra (February 8-10, 2013)
  35. Aggarwal AN. Hemoptysis: clinical perspectives. At CME on Emergency and Trauma Radiology, Chandigarh (May 4-5, 2013)
  36. Aggarwal AN. Cross sectional survey methodology. At PGI-ICMR Training Programme on Clinical Trial Methodology, Chandigarh (July 29-August 2, 2013)
  37. Singh N. ‘Early stage/locally advanced lung cancer : Focus on management in non-small cell lung cancer’ during the PromOTE Lung CME of the Indian Co-operative Oncology Network (ICON) held at Chandigarh, India on May 26, 2013
  38. Singh N.  ‘HIV and Tuberculosis’ during the Specialists Training at Centre of Excellence in HIV/AIDS, PGIMER, Chandigarh, India from May 06-09, 2013
  39. Singh N.  ‘Choosing the optimal chemotherapeutic regimen in resource constrained setting: More than just histology directed’ during the 5th Biennial National Conference of the Indian Society for Study of Lung Cancer (NALCCON) held at Srinagar, Jammu & Kashmir, India from April 21-22, 2013
  40. Singh N.  Panel Discussion on ‘Is there a role for mediastinoscopy in the era of PET-CT Scan in non-small cell lung cancer?’ during the 28th Indian Cooperative Oncology Network (ICON)Meeting held at Mumbai, Maharashtra, India from April 05-07, 2013
  41. Singh N.  ‘Demographic profile of lung cancer in India’ during the Eleventh Annual Meeting on Evidence Based Management of Common Cancers in India held at Tata Memorial Centre, Mumbai, Maharashtra, India from March 01-03, 2013
  42. Singh N.  ‘Personalized therapy for lung cancer: Potential & Pitfalls’ and ‘Recent staging system of lung tumours-clinician’s perspective’ during the Workshop-cum-CME in Pulmonary Pathology held at PGIMER, Chandigarh, India from February 15-17, 2013
  43. Singh N.  ‘Targeted therapy for lung cancer’ during the Update in Pulmonary, Critical Care & Sleep Medicine (AIIMS Pulmocrit 2012) held at AIIMS, New Delhi, India from December 15-16, 2012
  44. Singh N.  ‘COPD – CAD linkage’ during the 26th Update on Pulmonary and Critical Care Medicine (COPD) held at PGIMER, Chandigarh, India on October 14, 2012

Activity: Develop Fact sheets, Leaflets, Booklets and other materials for advocacy to sensitize policy makers and health-planners

  1. Developed Indian COPD guidelines (see above)
  2. Dr Dheeraj Gupta prepared the background technical paper for inclusion of household air pollution as an additional indicator in the SEAR Regional Action Plan
  3. Dr. Dheeraj Gupta also briefed the media about the newly proposed regional  target on household air pollution at the Media Workshop pre-HMM/RC, WHO-SEARO, New Delhi,  4 September 2013
  4. Dr. Dheeraj Gupta has been nominated as a member (Pulmonary Diseases) of the National Steering Committee for Non-communicable Diseases (NCD) Surveillance and Monitoring, Ministry of Health and Family Welfare, Govt. of India, September, 2013

Papers published in National/International peer-reviewed journals during the period

  1. Yadav R, Sethi S, Dhatwalia SK, et al. Molecular characterisation of drug resistance in Mycobacterium tuberculosis isolates from North India. Int J Tuberc Lung Dis 2013; 17:251-257
  2. Vishwanath G, Madan K, Bal A, et al. Rigid bronchoscopy and mechanical debulking in the management of central airway tumors: an Indian experience. J Bronchology Interv Pulmonol 2013; 20:127-133
  3. Srinivasan A, Agarwal R, Gupta N, et al. Initial experience with real time endobronchial ultrasound guided transbronchial needle aspiration from a tertiary care hospital in north India. Indian J Med Res 2013; 137:803-807
  4. Singh N, Mootha VK, Madan K, et al. Tumor cavitation among lung cancer patients receiving first-line chemotherapy at a tertiary care centre in India: association with histology and overall survival. Med Oncol 2013; 30:602
  5. Singh N, Madan K, Bhattacharya A, et al. Malignant pleural mesothelioma in a patient with systemic sclerosis: the first report. Respiration 2013; 85:66-71
  6. Singh N, Madan K, Aggarwal AN, et al. Symptomatic large bilateral adrenal metastases at presentation in small-cell lung cancer: a case report and review of the literature. J Thorac Dis 2013; 5:E83-86
  7. Singh N, Goyal A. Lack of improvement in overall survival with gemcitabine/ erlotinib maintenance and its relationship with pemetrexed use in the second-line setting. J Clin Oncol 2013; 31:1250-1251
  8. Sharma SK, Mohan A, Chauhan LS, et al. Contribution of medical colleges to tuberculosis control in India under the Revised National Tuberculosis Control Programme (RNTCP): lessons learnt & challenges ahead. Indian J Med Res 2013; 137:283-294
  9. Sharma S, Madan K, Singh N. Fatal re-expansion pulmonary edema in a young adult following tube thoracostomy for spontaneous pneumothorax. BMJ Case Rep 2013; 2013
  10. Sehgal IS, Agarwal R. Unusually High Incidence of Pulmonary Hypertension in MOPETT Trial. Am J Cardiol 2013; 111:1831
  11. Savardekar A, Gyurmey T, Agarwal R, et al. Incidence, risk factors, and outcome of postoperative pneumonia after microsurgical clipping of ruptured intracranial aneurysms. Surg Neurol Int 2013; 4:24
  12. Porwal C, Kaushik A, Makkar N, et al. Incidence and risk factors for extensively drug-resistant tuberculosis in Delhi region. PLoS One 2013; 8:e55299
  13. Mehta S, Chhetra R, Srinivasan R, et al. Potential importance of Maackia amurensis agglutinin in non-small cell lung cancer. Biol Chem 2013; 394:889-900
  14. Maturu VN, Agarwal R. Endobronchial Ultrasound-guided Transbronchial Needle Aspiration for Diagnosing and Subtyping Lung Cancer: Is It Required in All Patients? Am J Respir Crit Care Med 2013; 187:450
  15. Maskey D, Agarwal R. Oxygen Therapy in Chronic Obstructive Pulmonary Disease. World Clin Pulm Crit Care Med 2013; 2:134-153
  16. Madan K, Singh N, Jain V, et al. Spontaneous pneumothorax following caesarean section under spinal anaesthesia. BMJ Case Rep 2013; 2013
  17. Madan K, Singh N, Das A, et al. Pleural tuberculosis following lung cancer chemotherapy: a report of two cases proven pathologically by pleural biopsy. BMJ Case Rep 2013; 2013
  18. Madan K, Singh N. Massive compensatory hyperinflation. BMJ Case Rep 2013; 2013
  19. Madan K, Aggarwal AN, Bhagat H, et al. Acute respiratory failure following traumatic tooth aspiration. BMJ Case Rep 2013; 2013
  20. Kang M, Deoghuria D, Varma S, et al. Role of HRCT in detection and characterization of pulmonary abnormalities in patients with febrile neutropenia. Lung India 2013; 30:124-130
  21. Jindal SK, Aggarwal AN, Gupta D, et al. Tuberculous lymphadenopathy: a multicentre operational study of 6-month thrice weekly directly observed treatment. Int J Tuberc Lung Dis 2013; 17:234-239
  22. Jindal SK. Silicosis in India: past and present. Curr Opin Pulm Med 2013; 19:163-168
  23. Jindal SK. Burden of asthma in India. Int J Tuberc Lung Dis 2013; 17:145
  24. Jindal A, Madan K, Nijhawan R, et al. Incidental pathologically proven pulmonary hamartoma in a patient with carcinoma tongue. BMJ Case Rep 2013; 2013
  25. Irwin RS, Augustyn N, French CT, et al. Spread the word about the journal in 2013: from citation manipulation to invalidation of patient-reported outcomes measures to renaming the Clara cell to new journal features. Chest 2013; 143:1-4
  26. Goyal A, Singh N, Bal A, et al. Gynaecomastia, galactorrhoea, and lung cancer in a man. Lancet 2013; 381:1332
  27. Ghosh S, Choudhary NS, Sharma AK, et al. Noradrenaline vs terlipressin in the treatment of type 2 hepatorenal syndrome: a randomized pilot study. Liver Int 2013
  28. Dhooria S, Agarwal R, Behera D. Linezolid for extensively drug-resistant tuberculosis. N Engl J Med 2013; 368:290-291
  29. Birbian N, Singh J, Jindal SK. Protective role of IL-18 -137G/C polymorphism in a North Indian population with asthma: a pilot study. Cytokine 2013; 61:188-193
  30. Birbian N, Singh J, Jindal SK. High risk association of IL-1 receptor antagonist (IL-1RN) VNTR polymorphism with asthma in a North Indian population: a pilot study. Cytokine 2013; 62:389-394
  31. Aggarwal AN, Gupta D, Janmeja AK, et al. Assessment of health-related quality of life in patients with pulmonary tuberculosis under programme conditions. Int J Tuberc Lung Dis 2013; 17:947-953
  32. Agarwal R, Vishwanath G, Aggarwal AN, et al. Itraconazole in chronic cavitary pulmonary aspergillosis: a randomised controlled trial and systematic review of literature. Mycoses 2013
  33. Agarwal R, Srinivasan A, Aggarwal AN, et al. Adaptive support ventilation for complete ventilatory support in ARDS: a pilot randomized controlled trial. Respirology 2013
  34. Agarwal R, Maskey D, Aggarwal AN, et al. Diagnostic Performance of Various Tests and Criteria Employed in Allergic Bronchopulmonary Aspergillosis: A Latent Class Analysis. PLoS One 2013; 8:e61105
  35. Agarwal R, Aggarwal AN, Gupta D. Efficacy and safety of conventional transbronchial needle aspiration in sarcoidosis: a systematic review and meta-analysis. Respir Care 2013; 58:683-693
  36. Agarwal R, Aggarwal AN, Gupta D. Efficacy and Safety of Conventional TBNA in Sarcoidosis: A Systematic Review and Meta-Analysis. Respir Care 2013; 58:683-693
  37. Yadav R, Sethi S, Mewara A, et al. Rapid detection of rifampicin, isoniazid and streptomycin resistance in Mycobacterium tuberculosis clinical isolates by high-resolution melting curve analysis. J Appl Microbiol 2012; 113:856-862
  38. Visalakshi P, Meharwal SK, Arora J, et al. Fate of sputum samples transported in bottles containing cetylpyridinium chloride and sodium chloride: a national reference laboratory study. Indian J Tuberc 2012; 59:112-115
  39. Verma VK, Taneja V, Jaiswal A, et al. Prevalence, distribution and functional significance of the -237C to T polymorphism in the IL-12Rbeta2 promoter in Indian tuberculosis patients. PLoS One 2012; 7:e34355
  40. Taneja S, Dhiman RK, Khatri A, et al. Inhibitory Control Test for the Detection of Minimal Hepatic   Encephalopathy in Patients with Cirrhosis of Liver. Journal of Clinical & Experimental Hepatology 2012; 2:306-314
  41. Singla R, Caminero JA, Jaiswal A, et al. Linezolid: an effective, safe and cheap drug for patients failing multidrug-resistant tuberculosis treatment in India. Eur Respir J 2012; 39:956-962
  42. Singla N, Gupta D, Joshi A, et al. Association of mannose-binding lectin gene polymorphism with tuberculosis susceptibility and sputum conversion time. International journal of immunogenetics 2012; 39:10-14
  43. Singla N, Gupta D, Joshi A, et al. Genetic polymorphisms in the P2X7 gene and its association with susceptibility to tuberculosis. Int J Tuberc Lung Dis 2012; 16:224-229
  44. Singhal R, Arora J, Lal P, et al. Comparison of line probe assay with liquid culture for rapid detection of multi-drug resistance in Mycobacterium tuberculosis. Indian J Med Res 2012; 136:1044-1047
  45. Singhal R, Arora J, Bhalla M, et al. Presumptive identification of Mycobacterium tuberculosis complex based on cord formation in BACTEC MGIT 960 medium. Indian J Med Microbiol 2012; 30:218-221

Collaboration with WHO in regards to the above activities of the WHO collaborating centre during the past 12 months

  1. Dr Dheeraj Gupta participated as expert at the WHO Regional Consultation to develop a Regional Strategic Action Plan with Indicators and Targets for Prevention and Control of NCDs in SEA Region, New Delhi, 25-27 February 2013
  2. Dr SK Jindal participated in the WHO World Health Day 2013, New Delhi, April 7, 2013
  3. Dr. Dheeraj Gupta participated as a expert at WHO SEARO Technical Working Group meeting to finalize Regional Action Plan with Indicators and Targets, Bangkok, 11-13 June 2013
  4. Dr. Dheeraj Gupta participated as a technical expert for briefing the media about the newly proposed regional  target on household air pollution at the Media Workshop pre-HMM/RC, WHO-SEARO, New Delhi,  4 September 2013
  5. Dr. Dheeraj Gupta participated as expert at the expert group meeting to address co-morbidities hosted by  WHO and Govt. of India, New Delhi, September 26-27, 2013

Interactions or collaborations with other WHO collaborating centres in the context of the implementation of the above activities

Dr SK Jindal and Dr Ashutosh N. Aggarwal visited the WHO Collaborating Centre in Environmental and Occupational Health at SR University, Chennai, India to discuss the standardization of pulmonary function tests for study of health effects of indoor air pollution.

The two Centers are actively working to develop collaborative study on the impact of pollution due to biomass fuel combustion on human health.

Technical, programmatic, advisory or other support received from WHO during this period

Dr. Renu Garg, MD, MPH, Regional Advisor, Non-communicable Diseases, Department of Sustainable Development and Healthy Environments, WHO Regional Office for South-East Asia, Delhi was actively supported our effort to include Household Air Pollution as an extra target at the regional level in the post MDG agenda for control of NCDs. She helped by provided active technical/advisory support and peer review for the background technical paper on HAP and COPD prepared by Dr. Gupta for the technical working group meeting.

Back to top

2013-2014

Activity: Assessment of impact of indoor air pollution on respiratory health in adults and women, including pregnancy outcomes

To study the effect of household indoor air pollution (IAP), assessed by exposure to biomass fuel and/or environmental tobacco smoke (ETS) on pregnancy outcome a case control study was conducted at the department of Obstetrics and Gynecology, Govt. Medical College and Hospital (GMCH), Sector-32, Chandigarh. On univariate analysis, exposure to IAP i.e. either polluting fuel or ETS or both in present pregnancy was significantly associated with increased incidence of preterm labour, LBW and IUGR. On multivariate analysis, LBW was associated with ETS exposure (ORs 3.5-8.4 in increasing quartiles of exposure) and IUGR was associated with both ETS exposure (ORs 1.3-8.1) and use of polluting fuels in the highest quartile of exposure (OR 2.69; 95% CI 1.11-6.55).

Activity: Assessment of role of various interventional measures in reducing impact of indoor air pollution on respiratory health

Initiated a research project “Magnitude and impact of indoor air pollution on morbidity related to chronic obstructive pulmonary disease and bronchial asthma in Indian women” sponsored by the Indian Council of Medical Research. The project will study a cohort of adult women with chronic respiratory disease (COPD and asthma). Details on clinical profile, morbidity, and health related quality of life will be gathered at baseline. In addition, indoor air pollution will be measured in three micro-environments – kitchen, living room, and immediately outside the house, and personal monitoring will be carried out, on a cross-sectional basis. A proportion of households will be followed up with serial air quality and personal assessments. Questionnaires will be used to quantify exposure to environmental tobacco smoke, and select biomarkers will be employed to assess exposure to specific pollutants. Air quality indices will be correlated with disease severity and morbidity. In the next phase, the population will be divided into two groups – an intervention group exposed to one or more interventions aimed at reducing indoor air pollution, and a control group which continues to use existing fuel and combustion devices. Indoor air pollution and disease parameters will be serially assessed over the next one year to identify the impact of these intervention(s). A small subset of patients will also undergo studies to evaluate genetic susceptibility to indoor air pollution.

Another research project “Impact of indoor air pollution on respiratory health: A population based adult cohort study” was sanctioned for funding by the Indian Council of Medical Research, and we are awaiting disbursement of funds to start project work. The proposal is planned as an interventional designed longitudinal, population-based, cohort study. The cohort will comprise of married rural women over 18 years of age (who are exposed to combustion of solid-fuels at home). We will study the health effects of indoor air pollution from solid-fuel combustion and assess whether an effective reduction in the exposure levels of indoor air pollutants significantly improve the respiratory health outcomes in apparently healthy women?

Activity: Draft protocols for management and prevention of chronic respiratory diseases for health-personnel at different levels of health care

We developed modules for training primary care physicians in the management of chronic respiratory disease (COPD and asthma).  These modules are also available in an online version (www.searednet.org), where in after login the person can undertake the training in a modular fashion and also has pre- and post-training assessment tools. Regular workshops are held for training primary care physicians using these modules

We have also developed the guidelines for diagnosis and management of Asthma in India in collaboration with the Indian Chest Society (ICS) and the National College of Chest Physicians. These will have been published and are available free online on www.lungindia.com and PubMed central.

Agarwal R, Dhooria S, Aggarwal AN, Maturu VN, Sehgal IS, Muthu V, Prasad KT, Yenge LB, Singh N, Behera D, Jindal SK, Gupta D, Balamugesh T, Bhalla A, Chaudhry D, Chhabra SK, Chokhani R, Chopra V, Dadhwal DS, D’Souza G, Garg M, Gaur SN, Gopal B, Ghoshal AG, Guleria R, Gupta KB, Haldar I, Jain S, Jain NK, Jain VK, Janmeja AK, Kant S, Kashyap S, Khilnani GC, Kishan J, Kumar R, Koul P, Mahashur A, Mandal AK, Malhotra S, Mohammed S, Mohapatra PR, Patel D, Prasad R, Samaria JK, Sarat P, Sawhney H, Shafiq N, Sidhu UPS, Singla R, Suri JC, Talwar D, Varma S. GUIDELINES FOR DIAGNOSIS AND MANAGEMENT OF BRONCHIAL ASTHMA: JOINT ICS/NCCP (I) RECOMMENDATIONS. Lung India. 2015 Apr;32(Suppl 1):S3-S42.

Activity: Provide training to trainers, medical teachers, specialists and research personnel sponsored from SEAR countries (in management and prevention of chronic respiratory diseases) at the department as well as conduct on-line training

List of short term trainees sponsored by SEAR (WHO) from Korea

  1. Ryong Guk Hong
  2. Chang Gol Run
  3. UN Hi Kim
  4. Son Hwa Ri

Other candidates who underwent short-term training in the department during this period

  1. Sahele Rao Kondika, Pune
  2. Ankit A Gupta, Chandigarh
  3. Sanchit Kumar, Chandigarh
  4. Sarat Kumar Behera, Odisha
  5. Rajesh Raju, Panchkula
  6. Aditya Aggarwal, Mumbai

The departmental faculty participated as experts in continuing medical education activities across the country as per list given below:

  1. Behera D. Management of Pulmonary disease in India, a perspective. PULMOCRIT, AIIMS, New Delhi. February 1-2, 2014.
  2. Behera D, Occupational asthma, CME of VP chest Institute, New Delhi , March 22, 2013.
  3. Behera D, Clinical Approach to lung cancer in Indian setting. PULMOCRIT, AIIMS, New Delhi. February 1-2, 2014.
  4. Behera D., Management of Interstitial lung diseases.   API, Lucknow
  5. Behera D. Air pollution, climate change and respiratory health in India, Dept Science and Technology, IIT, New Delhi. January 9, 2014.
  6. Behera D. Chair a session at Dissemination Workshop to communicate the findings of all the Operation Research studies conducted under the umbrella of the USAID/WHO-supported Model DOTS project held at Chennai. September 2-3, 2014.
  7. Gupta D. “Immunotherapy in adult asthma: is there a role?” at the 27th Annual Update on Pulmonary and Critical Care Medicine, PGIMER, Chandigarh. October 20, 2013.
  8. Gupta D, Maturu VN, Aggarwal AN, Agarwal R, Mittal BR,  Bal A,  Dual Time Point 18F-FDG PET/CT in Undiagnosed Mediastinal Lymphadenopathy: A Comparative Study of Sarcoidosis and Tuberculosis at AASOG 2014 the Annual Conference of American Association of Sarcoidosis and other granulomatous Disorders, Columbus, OH, USA. September 19- 20, 2014.
  9. Aggarwal AN. What’s new in GINA 2014 guidelines? Tricity Chest Forum Meeting, Chandigarh. July 27, 2014.
  10. Aggarwal AN. All that wheezes is not asthma. Respiratory Update 2014 of North East Pulmonary and Critical Care Society, Guwahati. May 3-4, 2014.
  11. Aggarwal AN. Indications and contraindications of fibreoptic bronchoscopy. Respiratory Update 2014 of North East Pulmonary and Critical Care Society, Guwahati. May 3-4, 2014.
  12. Aggarwal AN. Severe sepsis – Key steps in saving lives. Respiratory Update 2014 of North East Pulmonary and Critical Care Society, Guwahati. May 3-4, 2014.
  13. Aggarwal AN. Debate: Daily DOTS is better than intermittent. Pulmonary and Critical Care CME 2014, Rohtak. April 27, 2014.
  14. Aggarwal AN. Endobronchial sonographic characterization of lymph node appearance. Workshop on ultrasonography of mediastinal lesions, Meerut. April 12, 2014.
  15. Aggarwal AN. How do I approach a patient with hemoptysis. AIIMS PULMOCRIT 2014, New Delhi. February 1-2, 2014.
  16. Agarwal R. Medical thoracoscopy: Step by Step, Understanding the Equipment & How to do it. 3rd Max Interventional Bronchoscopy Course (Endorsed by EABIP). October 5-6, 2013
  17. Agarwal R. Recognizing tropical infections in ICU. ISCCM Chandigarh Chapter. October 9, 2013.
  18. Agarwal R. Ventilatory management of severe acute asthma; Allergic bronchopulmonary aspergillosis. Annual Pulmonary & Critical Care Update, Chandigarh. October 20, 2013.
  19. Agarwal R. Rigid bronchoscopy- step by step; Allergic bronchopulmonary aspergillosis; Mediastinal lymphadenopathy- TB or not TB. National Pulmonary Conference (NAPCON 2013) , Chennai. November 27-30, 2013.
  20. Agarwal R. Allergic bronchopulmonary aspergillosis. 7th National Update in Respiratory Medicine at Hinduja Hospital, Mumbai. December 6-8, 2013.
  21. Agarwal R. Allergic bronchopulmonary aspergillosis. 10th Congress of the Society of Indian Human and Animal Mycology, SIHAM, Coimbatore. January 9-12, 2014.
  22. Agarwal R. Allergic bronchopulmonary aspergillosis in India. Indo-French workshop on filamentous fungal pathogens: current trends and future perspectives, Aravind Research Foundation (CEFIPRA), Madurai. January 19-22, 2014,
  23. Agarwal R. Identification of IASLC borders by EBUS. The second conference on Lung Ultrasound. Jaswant Rai Hospital. Meerut. April 12-13, 2014.
  24. Agarwal R. All about ABPA: let’s hear from the expert. First Meeting of the Coimbatore Respiratory Society. Coimbatore. August 10, 2014.
  25. Agarwal R. Medical thoracoscopy: indication, technique and complication; live operative workshop on thoracoscopy. Interventional pulmonology CME cum workshop. Institute of Respiratory Diseases, SMS Medical College, Jaipur. August 13-14, 2014.
  26. Agarwal R. Basic diagnostic procedures in fiberoptic bronchoscopy- how do I do it. Bronchoscopy CME and Workshop, Conducted jointly by Chest Superspecialty Hospital & National Chest Forum. Patna. August 24, 2014.
  27. Agarwal R. Faculty involvement in procurement: is it necessary? Workshop conducted by the Procurement Division of PGI, Chandigarh. Chandigarh. September 20, 2014.
  28. Agarwal R. Basic procedures in flexible bronchoscopy: BAL, Endobronchial biopsy, TBLB, TBNA. Thoracoscopy and Bronchoscopy Training Course under the aegis of Tricity Chest Forum conducted by State Institute of Health and Family Welfare, Haryana. September 21, 2014.
  29. Agarwal R. Epidemiology of allergic bronchopulmonary aspergillosis. 50th Annual Meeting of the British Society of Medical Mycology, Manchester, United Kingdom. April 27-29.
  30. Agarwal R, Aggarwal AN, Gupta D, Chakrabarti A. Diagnostic Value of Serum Galactomannan in Allergic Bronchopulmonary Aspergillosis. At ICAAC 2014, the Interscience conference on antimicrobial agents and chemotherapy, Washington, USA. September 5-9
  31. Singh N. ‘Clinical Presentation and Management of Lung Cancer’ at ESI Hospital, Baddi, Himachal Pradesh, India on August 22, 2014.
  32. Singh N. Chairperson for session on ‘Lung Cancer’ during the Best of ASCO Annual Meeting 2014 held at Hyderabad, India from June 27-29, 2014
  33. Singh N. ‘Current TNM Staging of Lung Cancer’ and Coordinator for sessions on ‘Metastatic NSCLC’ during the First ASCO-ISSLC-PGIMER-TMC Multidisciplinary Lung Cancer Management Course held at PGIMER, Chandigarh, India from April 05-06, 2014
  34. Singh N. ‘Understanding Lung Cancer Genetics: A Simplified Approach’ during the 68th NATCON 2013 held at New Delhi, India from February 23-26, 2014
  35. Singh N. ‘Clinical Presentation and Management of Lung Cancer’ in the Tricity Chest Forum held at Chandigarh, India on February 08, 2014
  36. Singh N. ‘Rationalizing Targeted Therapy of Lung Cancer’ during the Update in Pulmonary, Critical Care & Sleep Medicine (AIIMS Pulmocrit 2014) held at AIIMS, New Delhi, India from February 01-02, 2014
  37. Singh N. ‘Current Status and Challenges faced in practice of pulmonary oncology in India’ during the Pulmonary Oncology Meet held at New Delhi, India on January 18, 2014
  38. Dhooria S. Organizer and session moderator in ASCO-ISSLC-PGIMER-TMC Multidisciplinary Cancer Management Course PGIMER, Chandigarh on April 5-6, 2014
  39. Dhooria S. Expert at live workshop on rigid and semirigid thoracoscopy and endobronchial ultrasound held at Institute of Respiratory Disease, SMS Medical College, Jaipur on August 13-14, 2014
  40. Dhooria S. “Indications, contraindications and complications of bronchoscopy, whether it can be done in district hospitals” at the First Thoracoscopy and Bronchoscopy Training Course held on September 21, 2014 under the aegis of Tricity Chest Forum organized by State Institute of Health & Family Welfare, Haryana

Activity: Develop Fact sheets, Leaflets, Booklets and other materials for advocacy to sensitize policy makers and health-planners.

  1. Developed Indian Asthma guidelines (see above)
  2. Behera is Chairman of The National Task Force for involving Medical Colleges in the Revised National Tuberculosis Control Program (RNTCP) and participated in The Zonal Task Force workshops across the country in Tanda, Himachal Pradesh; Dibrugrarh,  Assam and Raipur, Chhattisgarh.
  3. Dr Dheeraj Gupta prepared the background technical paper for inclusion of household air pollution as an additional indicator in the SEAR Regional Action Plan, which was successfully completed during the year under review
  4. Dheeraj Gupta has been nominated as a member (Pulmonary Diseases) of the National Steering Committee for Non-communicable Diseases (NCD) Surveillance and Monitoring, Ministry of Health and Family Welfare, Govt. of India, September, 2013
  5. Dheeraj Gupta and Dr. SK Jindal have been nominated to the high powered steering committee on “Health related issues pertaining to Air Pollution” under MOH, Govt. of India
  6. Dheeraj Gupta has been constantly working to support SEARO office’s efforts to take the agenda of HAP and respiratory forward he held informal meetings with Dr. Renu Garg, at WHO SEARO, Dr. Damodar Bachani, NCD Dy Director and Dr. Kirk Smith
  7. Dheeraj Gupta presented a talk on Health Hazards of Air Pollution at the symposium hosted at Nirman Bhavan on July 5, 2014 on behalf of WHO India . The meeting was presided over by Hon’ble Health Minister of India

Papers published in National/International peer-reviewed journals during the period

  1. Agarwal R, Aggarwal AN, Gupta D. Diagnostic Accuracy and Safety of Semirigid Thoracoscopy in Exudative Pleural Effusions: A Meta-analysis. Chest. 2013;144(6):1857-1867.
  2. Agarwal R, Chakrabarti A. Allergic bronchopulmonary aspergillosis. In: Chakrabarti A, ed. Fungal Infections in Asia: the Eastern frontier of Mycology. New Delhi: Elsevier; 2013:173-193.
  3. Agarwal R, Chakrabarti A. Allergic bronchopulmonary aspergillosis in asthma: epidemiological, clinical and therapeutic issues. Future Microbiol. 2013;8(11):1463-1474.
  4. Agarwal R, Chakrabarti A, Shah A, et al. Allergic bronchopulmonary aspergillosis: review of literature and proposal of new diagnostic and classification criteria. Clin. Exp. Allergy. 2013;43(8):850-873.
  5. Aggarwal AN, Chakrabarti A. Does climate mould the influence of mold on asthma? Lung India. 2013;30(4):273-276.
  6. Agrawal K, Bhattacharya A, Singh N, Harisankar CN, Mittal BR. Skeletal muscle metastases as the initial manifestation of an unknown primary lung cancer detected on F-18 fluorodeoxyglucose positron emission tomography/computed tomography. Indian J. Nucl. Med. 2013;28(1):34-35.
  7. Arora J, Sidiq Z, Visalakshi P, Bhalla M, Behera D, Myneedu VP. Pyrazinamide resistance among drug-resistant Mycobacterium tuberculosis isolates at a referral hospital. Diagn. Microbiol. Infect. Dis. 2013;77(4):380-381.
  8. Behera D. Issues in the management of drug resistant tuberculosis in India. Lung India. 2013;30(4):269-272.
  9. Bhagat P, Bal A, Das A, Singh N, Singh H. Pulmonary inflammatory myofibroblastic tumor and IgG4-related inflammatory pseudotumor: a diagnostic dilemma. Virchows Arch. 2013;463(6):743-747.
  10. Dhooria S, Agarwal R, Gupta D. Intensive lifestyle intervention in type 2 diabetes. N. Engl. J. Med. 2013;369(24):2356-2357.
  11. Goyal A, Madan K, Singh N. Erasmus syndrome with pulmonary tuberculosis. BMJ Case Rep. 2013;2013.
  12. Gupta D, Agarwal R, Aggarwal AN. Seasonality of Sarcoidosis: the ‘heat’ is on. Sarcoidosis. Vasc. Diffuse Lung Dis. 2013;30(3):241-243.
  13. Gupta D, Agarwal R, Aggarwal AN, et al. Guidelines for diagnosis and management of chronic obstructive pulmonary disease: Joint ICS/NCCP (I) recommendations. Lung India. 2013;30(3):228-267.
  14. Gupta D, Vinay N, Agarwal R, Agarwal AN. Socio-demographic profile of patients with sarcoidosis vis-a-vis tuberculosis. Sarcoidosis. Vasc. Diffuse Lung Dis. 2013;30(3):186-193.
  15. Jindal SK. Challenges of training in pulmonary medicine in India. Indian J. Chest Dis. Allied Sci. 2013;55(2):73-74.
  16. Panda A, Kurapati S, Samantaray JC, et al. Rapid identification of clinical mycobacterial isolates by protein profiling using matrix assisted laser desorption ionization-time of flight mass spectrometry. Indian J. Med. Microbiol. 2013;31(2):117-122.
  17. Sethi S, Mewara A, Dhatwalia SK, et al. Prevalence of multidrug resistance in Mycobacterium tuberculosis isolates from HIV seropositive and seronegative patients with pulmonary tuberculosis in north India. BMC Infect. Dis. 2013;13:137.
  18. Sharma S, Lal V, Prabhakar S, Agarwal R. Clinical profile and outcome of myasthenic crisis in a tertiary care hospital: A prospective study. Ann. Indian Acad. Neurol. 2013;16(2):203-207.
  19. Shweta K, Kumar S, Gupta AK, Jindal SK, Kumar A. Economic analysis of costs associated with a Respiratory Intensive Care Unit in a tertiary care teaching hospital in Northern India. Indian J. Crit. Care Med. 2013;17(2):76-81.
  20. Singh N, Behera D. Lung cancer epidemiology and clinical profile in North India: Similarities and differences with other geographical regions of India. Indian J. Cancer. 2013;50(4):291.
  21. Singh N, Goyal A. Lack of improvement in overall survival with gemcitabine/ erlotinib maintenance and its relationship with pemetrexed use in the second-line setting. J. Clin. Oncol. 2013;31(9):1250-1251.
  22. Sinha S, Raghunandan P, Chandrashekhar R, et al. Nevirapine versus efavirenz-based antiretroviral therapy regimens in antiretroviral-naive patients with HIV and tuberculosis infections in India: a pilot study. BMC Infect. Dis. 2013;13:482.
  23. Srinivasan A, Agarwal R, Gupta N, Aggarwal AN, Gupta D. Initial experience with real time endobronchial ultrasound guided transbronchial needle aspiration from a tertiary care hospital in north India. Indian J. Med. Res. 2013;137(4):803-807.
  24. Srinivasan A, Syal K, Banerjee D, et al. Low plasma levels of cholecalciferol and 13-cis-retinoic acid in tuberculosis: implications in host-based chemotherapy. Nutrition. 2013;29(10):1245-1251.
  25. Vishwanath G, Madan K, Bal A, Aggarwal AN, Gupta D, Agarwal R. Rigid bronchoscopy and mechanical debulking in the management of central airway tumors: an Indian experience. J Bronchology Interv Pulmonol. 2013;20(2):127-133.
  26. Yadav R, Sethi S, Dhatwalia SK, Gupta D, Mewara A, Sharma M. Molecular characterisation of drug resistance in Mycobacterium tuberculosis isolates from North India. Int. J. Tuberc. Lung Dis. 2013;17(2):251-257.
  27. Agarwal R, Aggarwal AN, Garg M, Saikia B, Chakrabarti A. Cut-off values of serum IgE (total and A. fumigatus -specific) and eosinophil count in differentiating allergic bronchopulmonary aspergillosis from asthma. Mycoses. 2014;57(11):659-663.
  28. Agarwal R, Aggarwal AN, Gupta D. Response. Chest. 2014;146(3):e97-98.
  29. Agarwal R, Devi D, Gupta D, Chakrabarti A. A questionnaire-based study on the role of environmental factors in allergic bronchopulmonary aspergillosis. Lung India. 2014;31(3):232-236.
  30. Agarwal R, Gupta D. Endobronchial Ultrasound-guided Transbronchial Needle Aspiration: Indian Perspective. J Bronchology Interv Pulmonol. 2014;21(4):284-287.
  31. Aggarwal AN, Agarwal R, Gupta D. Abbreviated World Health Organization Quality of Life questionnaire (WHOQOL-Bref) in north Indian patients with bronchial asthma: an evaluation using Rasch analysis. NPJ Prim Care Respir Med. 2014;24:14001.
  32. Aggarwal AN, Umasankar K, Gupta D. Health-related quality of life in women exposed to wood smoke while cooking. Int. J. Tuberc. Lung Dis. 2014;18(8):992-994.
  33. Bhoil A, Singh B, Singh N, et al. Can 3′-deoxy-3′-(18)F-fluorothymidine or 2′-deoxy-2′-(18)F-fluoro-d-glucose PET/CT better assess response after 3-weeks treatment by epidermal growth factor receptor kinase inhibitor, in non-small lung cancer patients? Preliminary results. Hell. J. Nucl. Med. 2014;17(2):90-96.
  34. Birbian N, Singh J, Jindal SK. Highly Protective Association of MMP-2-1306C/T Promoter Polymorphism With Asthma in a North Indian Population: A Pilot Study. Allergy Asthma Immunol. Res. 2014;6(3):234-241.
  35. Birbian N, Singh J, Jindal SK, Sobti RC. High risk association of IL-4 VNTR polymorphism with asthma in a North Indian population. Cytokine. 2014;66(1):87-94.
  36. Dhooria S, Agarwal R. External fixation of a subglottic tracheal silicone stent. Ann Am Thorac Soc. 2014;11(3):467-468.
  37. Dhooria S, Agarwal R, Aggarwal AN, Bal A, Gupta N, Gupta D. Differentiating tuberculosis from sarcoidosis by sonographic characteristics of lymph nodes on endobronchial ultrasonography: A study of 165 patients. J. Thorac. Cardiovasc. Surg. 2014;148(2):662-667.
  38. Dhooria S, Kumar P, Saikia B, et al. Prevalence of Aspergillus sensitisation in pulmonary tuberculosis-related fibrocavitary disease. Int. J. Tuberc. Lung Dis. 2014;18(7):850-855.
  39. Dhooria S, Singh N, Aggarwal AN, Gupta D, Agarwal R. A randomized trial comparing the diagnostic yield of rigid and semirigid thoracoscopy in undiagnosed pleural effusions. Respir. Care. 2014;59(5):756-764.
  40. Gonzalez JM, Francis B, Burda S, et al. Development of a POC Test for TB Based on Multiple Immunodominant Epitopes of M. tuberculosis Specific Cell-Wall Proteins. PLoS One. 2014;9(9):e106279.
  41. Goyal A, Gupta D, Agarwal R, Bal A, Nijhawan R, Aggarwal AN. Value of different bronchoscopic sampling techniques in diagnosis of sarcoidosis: a prospective study of 151 patients. J Bronchology Interv Pulmonol. 2014;21(3):220-226.
  42. Goyal B, Kumar K, Gupta D, et al. Utility of B-cell epitopes based peptides of RD1 and RD2 antigens for immunodiagnosis of pulmonary tuberculosis. Diagn. Microbiol. Infect. Dis. 2014;78(4):391-397.
  43. Gupta D, Agarwal R, Aggarwal AN, et al. Guidelines for diagnosis and management of chronic obstructive pulmonary disease: joint recommendations of Indian Chest Society and National College of Chest Physicians (India). Indian J. Chest Dis. Allied Sci. 2014;56 Spec No:5-54.
  44. Gupta D, Agarwal R, Aggarwal AN, et al. Guidelines for diagnosis and management of chronic obstructive pulmonary disease: joint recommendations of Indian Chest Society and National College of Chest Physicians (India). Indian J. Chest Dis. Allied Sci. 2014;56 Spec No:5-54.
  45. Gupta D, Dadhwal DS, Agarwal R, Gupta N, Bal A, Aggarwal AN. Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration vs Conventional Transbronchial Needle Aspiration in the Diagnosis of Sarcoidosis. Chest. 2014;146(3):547-556.
  46. Gupta N, Agarwal R, Rajwanshi A. Liquid-based cytology sample showing leishmaniasis in bronchoalveolar lavage fluid. Cytopathology. 2014.
  47. Jindal A, Agarwal R. Novel treatment of a persistent bronchopleural fistula using a customized spigot. J Bronchology Interv Pulmonol. 2014;21(2):173-176.
  48. Jindal SK. Relationship of household air pollution from solid fuel combustion with tuberculosis? Indian J. Med. Res. 2014;140(2):167-170.
  49. Jindal SK. Leadership in medicine. Indian J. Chest Dis. Allied Sci. 2014;56(2):69-70.
  50. Jung RS, Mittal BR, Maturu NV, Kumar R, Bhattacharya A, Gupta D. Ocular sarcoidosis: does (18)F-FDG PET/CT have any role? Clin. Nucl. Med. 2014;39(5):464-466.
  51. Kumar P, Pandya D, Singh N, Behera D, Aggarwal P, Singh S. Loop-mediated isothermal amplification assay for rapid and sensitive diagnosis of tuberculosis. J. Infect. 2014.
  52. Kumar S, Agarwal R, Aggarwal AN, Gupta D, Jindal SK. Role of ultrasonography in the diagnosis and management of pneumothorax following transbronchial lung biopsy. J Bronchology Interv Pulmonol. 2014.
  53. Kumar S, Agarwal R, Bal A, et al. Utility of ADA, PCR and thoracoscopy in differentiating tuberculous and non-tuberculous pleural effusion complicating chronic kidney disease. Indian J. Med. Res. 2014.
  54. Kumar V, Kumar V, Yadav AK, et al. Scrub Typhus Is an Under-recognized Cause of Acute Febrile Illness with Acute Kidney Injury in India. PLoS Negl. Trop. Dis. 2014;8(1):e2605.
  55. Madan K, Agarwal R, Aggarwal AN, Gupta D. Therapeutic rigid bronchoscopy at a tertiary care center in North India: Initial experience and systematic review of Indian literature. Lung India. 2014;31(1):9-15.
  56. Madan K, Bal A, Agarwal R, Das A. Malignant Extra Renal Rhabdoid Tumour Presenting as Central Airway Obstruction. Case Rep Pulmonol. 2014;2014:950869.
  57. Maskey D, Agarwal R. Noninvasive ventilation in lung injury secondary to malaria. In: AM E, ed. Noninvasive Ventilation in High-Risk Infections and Mass Casualty Events. New York: Springer; 2014:109-128.
  58. Maturu VN, Agarwal R. Reversed Halo Sign: A Systematic Review. Respir. Care. 2014;59(9):1440-1449.
  59. Maturu VN, Agarwal R, Aggarwal AN, et al. Dual time point 18F-FDG PET/CT in undiagnosed mediastinal lymphadenopathy: A comparative study of sarcoidosis and tuberculosis. Chest. 2014;In Press.
  60. Maturu VN, Dhooria S, Bal A, et al. Role of medical thoracoscopy and closed pleural biopsy in undiagnosed exudative pleural effusions: A single centre experience of 348 patients. J Bronchology Interv Pulmonol. 2014;In Press.
  61. Maturu VN, Singh N, Bansal P, et al. Combination of intravitreal bevacizumab and systemic therapy for choroidal metastases from lung cancer: report of two cases and a systematic review of literature. Med. Oncol. 2014;31(4):901.
  62. Muthu V, Das A, Bal A, Agarwal R. Severe cholestasis and hepatic dysfunction in a case of fatal paraquat poisoning. Clin Res Hepatol Gastroenterol. 2014;In press.
  63. Muthu V, Sehgal IS, Agarwal R. Childhood ILD: Don’t forget lymphocytic interstitial pneumonitis. Early Hum. Dev. 2014;90(3):161-162.
  64. Myneedu VP, Behera D, Verma AK, et al. Xpert((R)) MTB/RIF assay for tuberculosis diagnosis: evaluation in an Indian setting. Int. J. Tuberc. Lung Dis. 2014;18(8):958-960.
  65. Sehgal IS, Agarwal R. Role of inhaled amphotericin in allergic bronchopulmonary aspergillosis. J. Postgrad. Med. 2014;60(1):41-45.
  66. Sehgal IS, Agarwal R. Oxygen therapy in Elderly. In: Sanchetee P, ed. Textbook of Geriatric Medicine. New Delhi: Paras Medical Publisher; 2014:191-196.
  67. Sehgal IS, Agarwal R, Aggarwal AN, Jindal SK. A randomized trial of Mycobacterium w in severe sepsis. J. Crit. Care. 2014.
  68. Sethi S, Kaur J, Yadav R, et al. Combination of adenosine-deaminase and nucleic acid amplification assays for diagnosing tuberculous pleural effusion. J. Infect. 2014;69(1):99-101.
  69. Singh N, Aggarwal AN, Kaur J, Behera D. Association of Graded Folic Acid Supplementation and Total Plasma Homocysteine Levels With Hematological Toxicity During First-line Treatment of Nonsquamous NSCLC Patients With Pemetrexed-based Chemotherapy. Am. J. Clin. Oncol. 2014.
  70. Singh Sehgal I, Agarwal R. Pulse methylprednisolone in allergic bronchopulmonary aspergillosis exacerbations. Eur. Respir. Rev. 2014;23(131):149-152.
  71. Singla N, Gupta D, Birbian N, Singh J. Association of NAT2, GST and CYP2E1 polymorphisms and anti-tuberculosis drug-induced hepatotoxicity. Tuberculosis (Edinb). 2014;94(3):293-298.
  72. Singla N, Satyanarayana S, Sachdeva KS, et al. Impact of introducing the line probe assay on time to treatment initiation of MDR-TB in Delhi, India. PLoS One. 2014;9(7):e102989.
  73. Sinha S, Singh J, Jindal SK, Birbian N, Singla N. Association of 24 bp Duplication of Human CHIT1 Gene with Asthma in a Heterozygous Population of North India: A Case-Control Study. Lung. 2014;192(5):685-691.
  74. Trevor J, Antony V, Jindal SK. The effect of biomass fuel exposure on the prevalence of asthma in adults in India – review of current evidence. J. Asthma. 2014;51(2):136-141.
  75. Vir P, Gupta D, Agarwal R, Verma I. Immunomodulation of alveolar epithelial cells by Mycobacterium tuberculosis phosphatidylinositol mannosides results in apoptosis. APMIS. 2014;122(4):268-282.

Collaboration with WHO in regards to the above activities of the WHO collaborating centre during the past 12 months

  1. Nominated as a member of the National Steering Committee on Health related issues on Air Pollution, Ministry of Health and Family Welfare, Govt. of India, January, 2014
  2. Nominated as a member (Pulmonary Diseases) of the National Steering Committee for Non-communicable Diseases (NCD) Surveillance and Monitoring, Ministry of Health and Family Welfare, Govt. of India, September, 2013
  3. Dheeraj Gupta has been constantly working to support SEARO office’s efforts to take the agenda of HAP and respiratory forward he held informal meetings with Dr. Renu Garg, at WHO SEARO, Dr. Damodar Bachani, NCD Dy Director and Dr. Kirk Smith
  4. Dheeraj Gupta presented a talk on Health Hazards of Air Pollution at the symposium hosted at Nirman Bhavan on July 5, 2014 on behalf of WHO India . The meeting was presided over by Hon’ble Health Minister of India

Interactions or collaborations with other WHO collaborating centres in the context of the implementation of the above activities

  1. Dr Ashutosh N. Aggarwal visited the WHO Collaborating Centre in Environmental and Occupational Health at Shri Ramachandra University, Chennai to discuss and share experiences in assessment of lung function and quantification of indoor air pollution in field setting. The two Centers are actively collaborating in research studies related to indoor air pollution.
  2. Dr Ashutosh N. Aggarwal initiated a research project in collaboration with the WHO Collaborating Centre on Reference and Research on Fungi of Medical Importance at PGIMER, Chandigarh. This project, entitled “Effect of seasonal variation in airborne fungal spore load on bronchial asthma and its control: a longitudinal study in north Indian adults” and sponsored by the Department of Science and Technology of Government of India, will also collect data on indoor load of fungal spores in the households of asthamatics.

Technical, programmatic, advisory or other support received from WHO during this period

Dr. Renu Garg, MD, MPH, Regional Advisor, Non-communicable Diseases, Department of Sustainable Development and Healthy Environments, WHO Regional Office for South-East Asia, Delhi was actively involved in our effort to include Household Air Pollution as an extra target at the regional level in the post MDG agenda for control of NCDs. Having achieved the this, she was also instrumental in our efforts to get COPD included in the National Programme for control of NCDs.

Back to top

2014-2015

Activity: Assessment of impact of indoor air pollution on respiratory health in adults and women, including pregnancy outcomes

A research project entitled “Magnitude and impact of indoor air pollution on morbidity related to chronic obstructive pulmonary disease and bronchial asthma in Indian women“, funded by the Indian Council of Medical Research, was in progress. Among other things, the project aimed to assess the magnitude of indoor air pollution in households through indoor and ambient air quality monitoring in households using biomass fuel for cooking, as well as assessment of prevalence and morbidity related to women with asthma and COPD in these households. Further details are provided below.

Activity: Assessment of role of various interventional measures in reducing impact of indoor air pollution on respiratory health

A research project entitled “Magnitude and impact of indoor air pollution on morbidity related to chronic obstructive pulmonary disease and bronchial asthma in Indian women“, funded by the Indian Council of Medical Research, had been initiated more than a year back. The study hypothesis was that, effective reduction in level of exposure to smoke from solid fuel combustion will significantly improve selected health outcomes in adult women with chronic respiratory disease (chronic obstructive pulmonary disease [COPD] and bronchial asthma). The study has cross-sectional, longitudinal, as well as interventional components to address the study hypothesis through specific objectives that include:

  1. Quantifying exposure to various indoor air pollutants from solid fuel combustion smoke, both gaseous and particulate, among women with COPD and asthma.
  2. Studying the magnitude of association of such exposure with selected health outcomes, both general and chronic respiratory disease-specific, in these women.
  3. Identification of potentially useful biomarkers relating degree of exposure and health outcomes in women with COPD and asthma.
  4. Determining if effective reduction in amount of exposure to solid fuel smoke, resulting from accompanying interventions, is associated with improvement in specified health outcomes in women with COPD and asthma.
  5. Examining behavioural factors that can modify disease severity and morbidity among women with COPD and asthma.
  6. Assessing role of gene-environment interactions in women with COPD and asthma exposed to solid fuel smoke.

The field area for this project had been identified as two clusters, with total of 25 villages, in Fatehgarh Sahib District of Punjab. A baseline population survey, along with development of study modules was in progress. The project aimed to study a cohort of adult women with chronic respiratory disease (COPD and asthma). Details on clinical profile, morbidity, and health related quality of life were to be gathered at baseline. In addition, indoor air pollution was to be measured in three micro-environments – kitchen, living room, and immediately outside the house, and personal monitoring was to be carried out, on a cross-sectional basis. A proportion of households will be followed up with serial air quality and personal assessments. Questionnaires will be used to quantify exposure to environmental tobacco smoke, and select biomarkers will be employed to assess exposure to specific pollutants. Air quality indices will be correlated with disease severity and morbidity. In the next phase, the population will be divided into two groups – an intervention group exposed to one or more interventions aimed at reducing indoor air pollution, and a control group which continues to use existing fuel and combustion devices. Indoor air pollution and disease parameters will be serially assessed over the next one year to identify the impact of these intervention(s). A small subset of patients will also undergo studies to evaluate genetic susceptibility to indoor air pollution. As of now the baseline population survey, along with development of study modules, is in progress.

Another research project “Impact of indoor air pollution on respiratory health: A population based adult cohort study” had been sanctioned for funding by the Indian Council of Medical Research, and we were awaiting disbursement of funds to start project work. The proposal was planned as an interventional designed longitudinal, population-based, cohort study. The cohort was to comprise of married rural women over 18 years of age (who are exposed to combustion of solid-fuels at home). We aimed to study the health effects of indoor air pollution from solid-fuel combustion and assess whether an effective reduction in the exposure levels of indoor air pollutants significantly improve the respiratory health outcomes in apparently healthy women?

Activity 3: Draft protocols for management and prevention of chronic respiratory diseases for health-personnel at different levels of health care

We had earlier developed modules for training primary care physicians in the management of chronic respiratory disease (COPD and asthma) and are holding regular workshops are held for training primary care physicians using these modules. This year we have updated the information contained in the slideset to better reflect the recent advances in management of chronic respiratory disorders.

We also developed the guidelines for diagnosis and management of bronchial asthma in India in collaboration with the Indian Chest Society (ICS) and the National College of Chest Physicians. These were published as a special supplement the Lung India (official journal of the ICS) and are freely available in public domain through the journal website (www.lungindia.com) as well as and PubMed central.

Agarwal R, Dhooria S, Aggarwal AN, Maturu VN, Sehgal IS, Muthu V, Prasad KT, Yenge LB, Singh N, Behera D, Jindal SK, Gupta D, Balamugesh T, Bhalla A, Chaudhry D, Chhabra SK, Chokhani R, Chopra V, Dadhwal DS, D’Souza G, Garg M, Gaur SN, Gopal B, Ghoshal AG, Guleria R, Gupta KB, Haldar I, Jain S, Jain NK, Jain VK, Janmeja AK, Kant S, Kashyap S, Khilnani GC, Kishan J, Kumar R, Koul PA, Mahashur A, Mandal AK, Malhotra S, Mohammed S, Mohapatra PR, Patel D, Prasad R, Ray P, Samaria JK, Singh PS, Sawhney H, Shafiq N, Sharma N, Sidhu US, Singla R, Suri JC, Talwar D, Varma S. Guidelines for diagnosis and management of bronchial asthma: Joint ICS/NCCP (I) recommendations. Lung India 2015;32, Suppl S1:3 -42.

Activity: Provide training to trainers, medical teachers, specialists and research personnel sponsored from SEAR countries (in management and prevention of chronic respiratory diseases) at the department as well as conduct on-line training

Candidates who underwent short-term training in the department during this period

  1. Chakradhar P.
  2. M. Anand
  3. Raja Thilakam N. K.
  4. Anup Singh

The following CMEs and Workshops were organized by the department:

  1. 28th Annual Update on Pulmonary and Critical Care Medicine at Chandigarh on October 12, 2014. The theme topic was ‘Current Concepts and Controversies in Pulmonary Medicine’ with a special focus on non-communicable respiratory disorders. Nearly 150 delegates from Chandigarh and neighbouring states (mostly resident doctors and general practitioners) attended the meeting.
  2. Refresher course on Asthma and COPD in adults (Chandigarh, August 30, 2015). The objective of this course was to provide a simple framework to internists and general practitioners for evaluating a patient presenting with common symptoms of cough, breathlessness and wheezing in order to diagnose asthma and COPD.
  3. Thoracic Endoscopy workshop (Chandigarh, July 12). The workshop provided hands-on training to a small group of early career pulmonologists in basic bronchoscopic and thoracoscopic techniques.

The departmental faculty participated as experts in continuing medical education activities across the country as per list given below:

A N Aggarwal:

  1. Daily DOTS is better than thrice-weekly. At Annual Pulmonary & Critical Care Update, Chandigarh (2014)
  2. Respiratory Health effects of outdoor air pollution. At Environmental Training Programme on Impact of Air Quality on Human Health (2014)
  3. Non-tuberculous Mycobacteria: Rare, Or Rarely Diagnosed, In India. At Update in Pulmonary, Critical Care & Sleep Medicine (AIIMS Pulmocrit 2015), New Delhi (2015)
  4. Building research capacities of health professionals in non-communicable diseases. National Course on Public Health Approaches to Non-Communicable Diseases, Chandigarh (March 16-27, 2015)
  5. Management of massive hemoptysis. At 21st Annual Conference of the Indian Society of Critical Care Medicine, Bengaluru (2015)
  6. Pleural tuberculosis. Indo-US CME-symposium on Diagnostic challenges in TB and HIV-TB co-infection, Chandigarh (2015)

Ritesh Agarwal:

  1. Basic procedures in flexible bronchoscopy: BAL, Endobronchial biopsy, TBLB, TBNA. At Thoracoscopy and Bronchoscopy Training Course, Chandigarh (2014)
  2. ISCCM and PGI Guidelines on End of Life Care. At ISCCM Chandigarh Chapter CME on “We must know when to stop”, Chandigarh (2014)
  3. What works in IPF? At Annual Pulmonary & Critical Care Update, Chandigarh (2015)
  4. Poorly resolving pneumonia; Pneumonia in the Elderly: peculiarities. At PULMOCON 2014, Kolkata (2014)
  5. Rigid bronchoscopy: indications, anesthesia, methodology. At NAPCON 2014, Agra (2014)
  6. COPD management: problems and solutions. At Symposium on COPD, Chandigarh (2014)
  7. All asthmatics should be screened for ABPA: procon debate. At AIIMS Pulmocrit 2015, New Delhi (2015)
  8. Framing research question. At PGIMER Research Methodology Workshop, Chandigarh (2015)
  9. Overview of management of lung cancer. At APICON 2015, Gurgaon (2015)
  10. Ventilation strategy and therapy for COPD. At CRITICARE 2015, Bengaluru (2015).
  11. When it is not safe to give biologics in the context of pulmonary infections. At Dermatopathology workshop and Dermatology CME, Chandigarh (2015)
  12. Oration: mediastinal granulomatous adenopathy; airway stents; recurrent spontaneous pneumothorax. At Interventional Pulmonology League 2015, Mumbai (2015)
  13. EBUS-TBNA. At Thoracic Endoscopy Workshop 2015, Chandigarh (2015)
  14. Mechanical ventilation, Arterial Blood Gases. At 21st Comprehensive Critical Care Course (4C) of the Indian Society of Critical Care Medicine, Mohali (2015)
  15. Is EBUS-TBNA necessary; Interventional Rigid Bronchoscopy. At Visakhapatnam Interventional Pulmonology Update-2015, Visakhapatnam (2015)

Navneet Singh:

  1. Maintenance treatment in advanced NSCLC, At CME on nonsmall cell lung cancer, Ludhiana (2015)
  2. Recipient and donor selection for lung transplantation, At Lung Transplant CME, Chandigarh (2015)
  3. Clinician’s perspective and expectations: focus on lung cancer. At Indian College of Pathologists National CME, Chandigarh (2015)
  4. Normal Airway Anatomy, At Thoracic Endoscopy Workshop, Chandigarh (2015)
  5. EGFR Targeted Therapy for NSCLC in Era of Personalized Medicine, At Tricity Chest Forum, Chandigarh (2015)
  6. Role of PET scan in Pulmonary Medicine At PGI DM Pulmonary Update 2015, New Delhi (2015)
  7. HIV and Tuberculosis. At Specialists Training at Centre of Excellence in HIV/AIDS, PGIMER, Chandigarh (2015)
  8. Sampling in lung cancer: Pulmonologist’s view. At Update in Pulmonary, Critical Care & Sleep Medicine (AIIMS Pulmocrit 2015), New Delhi, (2015)
  9. How do I stage lung cancer? At International Pulmonary Oncology Meet, Jaipur (2015)
  10. Chemotherapy of Lung Cancer. At 16th Annual Conference of the National College of Chest Physicians and the Indian Chest Society (NAPCON), Agra (2014)
  11. Epidemiology of lung cancer in India and Importance of Lung Cancer Staging. At CME on Lung Cancer, Vadodara (2014)
  12. Mutation testing in lung adenocarcinoma. At 28th Annual Update on Pulmonary and Critical Care Medicine, Chandigarh (2014)

Sahajal Dhooria:

  1. Indications, contraindications and complications of bronchoscopy, whether it can be done in district hospitals. At First Thoracoscopy and Bronchoscopy Training Course, Chandigarh (2014)
  2. Maintenance chemotherapy for non-small cell cancers. At 28th Annual Update on Pulmonary and Critical Care Medicine, Chandigarh (2014)
  3. Ultrasound evaluation of the Lung and Pleura. At First Basic Echo course, Chandigarh (2014)
  4. How to assess fluid status? How I do it, At APICON 2015, Gurgaon (2015)
  5. Year in review 2014: Sleep Medicine. At PGI-DM Pulmonary Update 2015 on Pulmonary, Critical Care and Sleep Medicine, Delhi (2015)
  6. Sedation and anesthesia during diagnostic bronchoscopy. At BRONCOCON 2015, Udaipur (2015)
  7. Airway diseases: clinical perspectives. At PGI-AIRP (American Institute for Radiologic Pathology) categorical course series first course on chest and cardiac imaging, Chandigarh (2015)
  8. Management of bronchial asthma. At Refresher course on asthma and COPD in Adults, Chandigarh (2015)

Activity: Develop Fact sheets, Leaflets, Booklets and other materials for advocacy to sensitize policy makers and health-planners.

  1. Published evidence-based guidelines for diagnosis and management of bronchial asthma in Indian patients (see above).
  2. D. Behera is Chairman of The National Task Force for involving Medical Colleges in the Revised National Tuberculosis Control Program (RNTCP) and participated in The Zonal Task Force workshops across the country.
  3. D. Behera, Dr. Ritesh Agarwal, Dr. Sahajal Dhooria and Dr. Inderpaul Singh .are members of the INDEX-TB guidelines, an initiative of the Ministry of Health and Family Welfare (MOHFW) to frame national guidelines for the management of extrapulmonary tuberculosis
  4. Ashutosh N. Aggarwal was nominated to the Governing Council of World Non-Communicable Disease Federation, an international body working towards sensitization and education of healthcare personnel at primary and secondary levels of health care, as well as interaction with policy makers and health administrators. Dr. Aggarwal was also nominated as the managing Editor of the upcoming official journal being planned for this society.

Papers published in National/International peer-reviewed journals during the period

  1. Agarwal R, Aggarwal AN, Garg M, Saikia B, Chakrabarti A. Cut-off values of serum IgE (total and A. fumigatus -specific) and eosinophil count in differentiating allergic bronchopulmonary aspergillosis from asthma. Mycoses. 2014;57(11):659-63.
  2. Agarwal R, Aggarwal AN, Gupta D. Response. Chest. 2014;146(3):e97-8.
  3. Agarwal R, Aggarwal AN, Sehgal IS, Dhooria S, Chakrabarti A. Performance of serum galactomannan in patients with allergic bronchopulmonary aspergillosis. Mycoses. 2015;58:408-12.
  4. Agarwal R, Denning DW, Chakrabarti A. Estimation of the Burden of Chronic and Allergic Pulmonary Aspergillosis in India. PLoS One. 2014;9(12):e114745.
  5. Agarwal R, Dhooria S, Aggarwal AN, Maturu VN, Sehgal IS, Muthu V, et al. Guidelines for diagnosis and management of bronchial asthma: Joint ICS/NCCP (I) recommendations. Lung India. 2015;32(Suppl 1):S3 -S42.
  6. Agarwal R, Gupta D. Endobronchial ultrasound-guided transbronchial needle aspiration: indian perspective. J Bronchology Interv Pulmonol. 2014;21(4):284-7.
  7. Agarwal R. Burden and distinctive character of allergic bronchopulmonary aspergillosis in India. Mycopathologia. 2014;178(5-6):447-56.
  8. Aggarwal AN, Agarwal R, Gupta D, Dhooria S, Behera D. Interferon-gamma release assays for diagnosis of pleural tuberculosis: a systematic review and meta-analysis. J Clin Microbiol. 2015;53(8):2451-9.
  9. Aggarwal AN, Gupta D, Agarwal R, Sethi S, Thakur JS, Anjinappa SM, et al. Prevalence of Pulmonary Tuberculosis among Adults in a North Indian District. PLoS One. 2015;10(2):e0117363.
  10. Baldi M, Dhooria S, Aggarwal AN, Agarwal R. Correlation of Pulmonary Artery Dimensions Between Endobronchial Ultrasound and CT Scan. Chest. 2015;147(3):e113-4.
  11. Behera D, Sehgal IS. Bronchial asthma – Issues for the developing world. Indian J Med Res. 2015;141:380      -2.
  12. Behera D. (Book Review). Atlas of Fiberoptic Bronchoscopy. Indian J Chest Dis Allied Sci 2014;56:197.
  13. Dhooria S, Agarwal R, Aggarwal AN, Gupta N, Gupta D, Behera D. Agreement of mediastinal lymph node size between computed tomography and endobronchial ultrasound: A study of 617 patients. Annals of Thoracic Surgery 2015;99(6):1894-1898.
  14. Dhooria S, Agarwal R, Gupta D. Conventional bronchoscopic techniques in sarcoidosis: not too far behind. Thorax. 2015;70(6):587.
  15. Dhooria S, Agarwal R, Gupta D. Is pirfenidone ready for use in non-idiopathic pulmonary fibrosis interstitial lung diseases? Lung India. 2015;32(1):4-5.
  16. Dhooria S, Agarwal R. “Early goal directed therapy” versus “Early” and “goal directed” therapy for seve sepsis and septic shock: time to rationalize. Lung India. 2015;32(5):521-3.
  17. Dhooria S, Agarwal R. Controlling asthma by breathing techniques: role of anxiety. Chest. 2015;147(3):e130.
  18. Dhooria S, Agarwal R. Diagnosis of allergic bronchopulmonary aspergillosis: a case-based approach. Future Microbiol. 2014;9:1195-208.
  19. Dhooria S, Aggarwal AN, Gupta D, Behera D, Agarwal R. Utility and Safety of Endoscopic Ultrasound With Bronchoscope-Guided Fine-Needle Aspiration in Mediastinal Lymph Node Sampling: Systematic Review and Meta-Analysis. Respir Care. 2015;60(7):1040-50.
  20. Dhooria S, Aggarwal AN, Singh N, Gupta D, Behera D, Gupta N, et al. Endoscopic ultrasound-guided fine-needle aspiration with an echobronchoscope in undiagnosed mediastinal lymphadenopathy: First experience from India. Lung India. 2015;32(1):6-10.
  21. Dhooria S, Behera D, Agarwal R. Amitraz: a mimicker of organophosphate poisoning. BMJ Case Rep. 2015 Oct 1;2015
  22. Dhooria S, Dadhwal DS, Agarwal R, Aggarwal AN. Difficult Removal of Montgomery T-tube. J Bronchology Interv Pulmonol. 2015;22(1):e2-4.
  23. Dhooria S, Muthu V, Agarwal R, Behera D. An unusual cause of posterior mediastinal cyst. Lung India. 2015;32(6):209-10.
  24. Dhooria S, Sehgal IS, Agarwal R. Driving Pressure as a Key Ventilation Variable. N Engl J Med. 2015;372(21):2071-2.
  25. Dhooria S, Sehgal IS, Aggarwal AN, Agarwal R. Whither, Not Wither: Endoscopic Ultrasound-Guided Fine -Needle Aspiration by an Interventional Pulmonologist Using an Echobronchoscope? Chest. 2015;148(3):e99 -e100.
  26. Garg MK, Gupta P, Agarwal R, Sodhi KS, Khandelwal N. MRI: A New Paradigm in Imaging Evaluation of Allergic Bronchopulmonary Aspergillosis? Chest. 2015;147(2):e58-9.
  27. Gonzalez JM, Francis B, Burda S, Hess K, Behera D, Gupta D, Agarwal AN, Verma I, Verma A, Myneedu VP, Niedbala S, Laal S. Development of a POC Test for TB Based on Multiple Immunodominant Epitopes of M. tuberculosis Specific Cell-Wall Proteins. PLoS One. 2014 Sep 23;9(9):e106279.
  28. Gupta AA, Sehgal IS, Dhooria S, Singh N, Aggarwal AN, Gupta D, et al. Indications for performing flexible bronchoscopy: Trends over 34 years at a tertiary care hospital. Lung India. 2015;32(3):211-5.
  29. Gupta D, Dadhwal DS, Agarwal R, Gupta N, Bal A, Aggarwal AN. Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration vs Conventional Transbronchial Needle Aspiration in the Diagnosis of Sarcoidosis. Chest. 2014;146(3):547-56.
  30. Gupta N, Agarwal R, Rajwanshi A. Liquid-based cytology sample showing leishmaniasis in bronchoalveolar lavage fluid. Cytopathology. 2015;26(1):59-60.
  31. Jindal A, Bal A, Agarwal R. Inflammatory myofibroblastic tumor of the trachea in the pediatric age group: case report and systematic review of the literature. J Bronchology Interv Pulmonol. 2015;22(1):58-65.
  32. Kamath A, Joseph AM, Gupta K, Behera D, Jaiswal A, Dewan R, Rajala MS. Proteomic analysis of HEK293 cells expressing non small cell lung carcinoma associated epidermal growth factor receptor variants reveals induction of heat shock response. Exp Hematol Oncol. 2015 Jun 12;4:16.
  33. Kapoor R, Bhattacharyya T, Bahl A, Agarwal R, Bal A, Gulati A. Primary amyloidoma of lung treated with radiation: A rare case report. Lung India. 2014;31(4):404-6.
  34. Kaur H, Dhooria S, Aggarwal AN, Gupta D, Behera D, Agarwal R. A randomized trial of 1% vs. 2% lignocaine by the spray-as-you-go technique for topical anesthesia during flexible bronchoscopy. Chest 2015;148(3):739-745.
  35. Kumar P, Pandya D, Singh N, Behera D, Aggarwal P, Singh S. Loop-mediated isothermal amplification assay for rapid and sensitive diagnosis of tuberculosis. J Infect. 20142014;69:607-15.
  36. Kumar S, Agarwal R, Aggarwal AN, Gupta D, Jindal SK. Role of ultrasonography in the diagnosis and management of pneumothorax following transbronchial lung biopsy. J Bronchology Interv Pulmonol. 2015;22(1):14-9.
  37. Kumar S, Agarwal R, Bal A, Sharma K, Singh N, Aggarwal AN, Verma I, Rana SV, Jha V. Utility of adenosine deaminase (ADA), PCR & thoracoscopy in differentiating tuberculous & non-tuberculous pleural effusion complicating chronic kidney disease. Indian J Med Res 2015; 141(3): 308-314.
  38. Maturu VN, Agarwal R. Acute Invasive Pulmonary Aspergillosis Complicating Allergic Bronchopulmonary Aspergillosis: Case Report and Systematic Review. Mycopathologia. 2015;180(3-4):209-15.
  39. Maturu VN, Agarwal R. Itraconazole in chronic pulmonary aspergillosis: In whom, for how long, and at what dose? Lung India. 2015;32(4):309-12.
  40. Maturu VN, Dhooria S, Agarwal R. Efficacy and safety of transbronchial needle aspiration in diagnosis and treatment of mediastinal bronchogenic cysts: a systematic review of case reports. J Bronchology Interv Pulmonol 2015;22(3):195-203.
  41. Maturu VN, Dhooria S, Bal A, Singh N, Aggarwal AN, Gupta D, Behera D, Agarwal R. Role of medical thoracoscopy and closed pleural biopsy in undiagnosed exudative pleural effusions: A single centre experience of 348 patients. J Bronchology Interv Pulmonol 2015; 22: 121-9
  42. Maturu VN, Dhooria S, Bal A, Singh N, Aggarwal AN, Gupta D, et al. Role of medical thoracoscopy and closed-blind pleural biopsy in undiagnosed exudative pleural effusions: a single-center experience of 348 patients. J Bronchology Interv Pulmonol. 2015;22(2):121-9.
  43. Maturu VN, Sehgal IS, Dhooria S, Bal A, Aggarwal AN, Behera D, et al. Pleuroscopic Cryobiopsy: Case Series and Systematic Review. J Bronchology Interv Pulmonol. 2015;22(3):e11-3.
  44. Muthu V, Agarwal R. A report of a successfully treated case of ABPA in an HIV-infected individual. BMJ Case Rep. 2014;2014(nov09 1):pii: bcr2014206236.
  45. Muthu V, Behera D, Agarwal R. ABPA or TB: a case of mistaken identity? Lung India. 2015;32(5):529-30.
  46. Muthu V, Das A, Bal A, Agarwal R. Severe cholestasis and hepatic dysfunction in a case of fatal paraquat poisoning. Clin Res Hepatol Gastroenterol. 2015;39(1):e7-9.
  47. Sehgal IS, Agarwal R, Aggarwal AN, Jindal SK. A randomized trial of Mycobacterium w in severe sepsis. J Crit Care. 2015;30(1):85-9.
  48. Sehgal IS, Agarwal R. Are CHEST Guidelines Global in Coverage?: Probably Not. Chest. 2015;147(5):e190.
  49. Sehgal IS, Agarwal R. New Classification of Acute Respiratory Distress Syndrome: Not So Convincing. Crit Care Med. 2015;43(6):e214.
  50. Sehgal IS, Agarwal R. Performing Pulmonary Interventions: Pulmonologist or Pulmonary Interventionist. Chest. 2015;148(2):e59-60.
  51. Sehgal IS, Agarwal R. Specific IgE Is Better Than Skin Testing for Detecting Aspergillus Sensitization and Allergic Bronchopulmonary Aspergillosis in Asthma. Chest. 2015;147(5):e194.
  52. Sehgal IS, Dhooria S, Agarwal R, Behera D. Use of flexible cryoprobe for removal of tracheobronchial blood clot. Respir Care. 2015;60:e128-31.
  53. Sehgal IS, Dhooria S, Agarwal R. High-Flow Nasal Cannula Oxygen in Respiratory Failure. N Engl J Med. 2015;373(14):1374.
  54. Sehgal IS, Dhooria S, Bal A, Agarwal R. Allergic bronchopulmonary aspergillosis in an adult with Kartagener syndrome. BMJ Case Rep. 2015;2015(aug06):pii. bcr-2015-211493.
  55. Sehgal IS, Dhooria S, Ram B, Singh N, Aggarwal AN, Gupta D, Behera D, Agarwal R. Foreign body inhalation in adult population: experience of 25,998 bronchoscopies and systematic review of literature. Respir Care 2015
  56. Sharma SK, Katoch VM, Mohan A, Kadhiravan T, Elavarasi A, Ragesh R, Nischal N, Sethi P, Behera D, Bhatia M, Ghoshal AG, Gothi D, Joshi J, Kanwar MS, Kharbanda OP, Kumar S, Mohapatra PR, Mallick BN, Mehta R, Prasad R, Sharma SC, Sikka K, Aggarwal S, Shukla G, Suri JC, Vengamma B, Grover A, Vijayan VK, Ramakrishnan N, Gupta R, Consensus & Evidence-based INOSA Guidelines 2014 (First edition). Apnoea INOSA Guidelines Working Group FI. Indian J Med Res. 2014 ;140:451-68.
  57. Singh N, Behera D. Lung cancer with cavitation – a distinct subgroup of NSCLC associated with worse overall survival. Respir Investig 2015; 53(3): 133-134.
  58. Singh N, Behera D. Palliation in metastatic non-small cell lung cancer: Early integration with standard oncological care is the key. Lung India 2014; 31(4): 317-319.
  59. Singh N, Jindal A, Behera D. Erlotinib usage after prior treatment with gefitinib in advanced non-small cell lung cancer: A clinical perspective and review of published literature. World J Clin Oncol 2014; 5(5): 858-864
  60. Singh N, Maturu VN, Behera D. Total Plasma Homocysteine Level Assessment and Timing of Folate/B12 Supplementation Prior to Initiation of Pemetrexed Based Chemotherapy for Non-Squamous NSCLC Patients – an Irrelevant Investigation or Unnecessary Delay or Both? Oncologist 2015: 20: e21.
  61. Singh N, Vishwanath G, Aggarwal AN, Behera D. Clinical experience on use of oral EGFR-TKIs as first-line treatment of advanced NSCLC from a tertiary care centre in North India and implications of skin rash. Indian J Chest Dis Allied Sci 2014; 56(3): 149-152.
  62. Sodhi KK, Bahl C, Singh N, Behera D, Sharma S. Functional Genetic Variants in pre-miR-146a and 196a2 genes are associated with risk of lung cancer in North Indians. Future Oncol 2015; 11(15): 2159-2173.
  63. Sodhi KS, Saxena AK, Chandrashekhar G, Bhatia A, Singhi S, Agarwal R, et al. Vascular air embolism after contrast administration on 64 row multiple detector computed tomography: A prospective analysis. Lung India. 2015;32(3):216-9.
  64. Vir P, Gupta D, Agarwal R, Verma I. Immunomodulation of alveolar epithelial cells by Mycobacterium tuberculosis phosphatidylinositol mannosides results in apoptosis. APMIS. 2014;122(4):268-82.

Collaboration with WHO in regards to the above activities of the WHO collaborating centre during the past 12 months

Dr. D. Behera has been invited to attend the Strategic Technical Meeting on Management of Chronic Respiratory Diseases at Geneva, Switzerland in October 2015.

Dr. D. Behera participated in the Dissemination Workshop to communicate the findings of all the Operational Research studies conducted under the umbrella of the USAID/WHO-supported Model DOTS project to be held at NIRT, Chennai from 2nd to 3rd September 2014.

Interactions or collaborations with other WHO collaborating centres in the context of the implementation of the above activities

Dr. Ashutosh N. Aggarwal held discussions with Prof. Kalpana Balakrishnan at the WHO Collaborating Centre in Environmental and Occupational Health at Shri Ramachandra University, Chennai to discuss and share experiences in assessment of lung function and quantification of indoor air pollution in field setting. The two Centers are actively collaborating in research studies related to indoor air pollution, specifically with respect to the ongoing research project “Magnitude and impact of indoor air pollution on morbidity related to chronic obstructive pulmonary disease and bronchial asthma in Indian women” funder by the Indian Council of Medical Research. Dr. Balakrishnan will provide manpower, technical and logistic support with respect to air quality monitoring in this project.

Dr. Ashutosh N. Aggarwal is carrying out a research project in collaboration with the WHO Collaborating Centre on Reference and Research on Fungi of Medical Importance at PGIMER, Chandigarh. This project, entitled “Effect of seasonal variation in airborne fungal spore load on bronchial asthma and its control: a longitudinal study in north Indian adults” and sponsored by the Department of Science and Technology of Government of India, will also collect data on indoor load of fungal spores in the households of asthmatics.

Dr. Ritesh Agarwal is a collaborator with Prof. A. Chakrabarti (WHO Collaborating Centre on Reference and Research on Fungi of Medical Importance at PGIMER, Chandigarh) on several research projects on allergic bronchopulmonary aspergillosis. The current extramural projects include:

  1. ABPA complicating asthmatics working group
  2. A randomized controlled trial of voriconazole in allergic bronchopulmonary aspergillosis
  3. Multi-laboratory evaluation of a synthetic peptide based ELISA for detection of A. fumigatus specific antibodies in asthma and pulmonary tuberculosis
  4. Relationship of baseline vitamin D levels with lung function, immunological and radiological parameters and outcome in patients with allergic bronchopulmonary aspergillosis

Dr. D. Behera is working on a project in collaboration with AIIMS, New Delhi and SVIMS, Tirupathi to study the effects of mobile phone on wellbeing, sleep and cognitive function (co-investigator) funded by the Science and Engineering Research Board, Dept. of Science and Technology, Govt. of India.

Back to top

 

Developed and Maintained by Ajay Grover
1035