Pakistan Journal of Chest Medicine

Comparison of Inhaler Technique between Dry Powder Inhalers and Metered Dose Inhalers among adults with Obstructive Airway Disease

2025-12-03T15:47:26+00:00

Background: Proper inhaler technique is crucial for effective management of obstructive airway diseases, yet many patients misuse it. Dry powder inhalers (DPI) and metered dose inhalers (MDI) require different handling skills, and errors in technique can lead to poor drug delivery and suboptimal disease control. Understanding the prevalence and types of errors can guide targeted patient education and improve outcomes.

Objective: To assess and compare inhaler technique performance among adult patients using dry powder inhalers (DPI) and metered dose inhalers (MDI), and to determine the prevalence of specific technique errors along with associated patient-related factors.

Methodology: This hospital-based cross-sectional study was conducted in the Department of Pulmonology, Mardan Medical Complex, Mardan from July 2023 to July 2024. Adult patients with asthma or COPD who had used DPI or MDI for at least 3 months were enrolled in this study.

Results: A total of 180 patients (90 DPI, 90 MDI) with a mean age of 58.6 ± 12.4 years were included, of whom 54.4% were female. Inhaler technique errors were highly prevalent, observed in 91.1% of DPI users and 94.4% of MDI users before instruction. Age was significantly associated with errors among MDI users, with an 8% increase in error probability per year (OR 1.08; 95% CI: 1.03–1.14).

Conclusion: Inhaler technique errors are highly prevalent among adults with obstructive airway disease using both DPI and MDI, with breathing-related and device-specific errors most common. Older age was associated with higher error rates in MDI users, highlighting the need for tailored interventions.

The Neutrophil-to-Lymphocyte Ratio as a Prognostic Marker for Disease Severity in Hospitalized Patients with Community-Acquired Pneumonia

2025-12-03T15:49:29+00:00

Background: Community-acquired pneumonia (CAP) remains a major cause of hospitalization and mortality worldwide. Early identification of patients at risk of severe disease and poor outcomes is essential for appropriate triage and management. The neutrophil-to-lymphocyte ratio (NLR), derived from routine complete blood counts, has emerged as a potential prognostic biomarker in infectious diseases, including CAP.

Objective: To evaluate the prognostic utility of the admission Neutrophil-to-Lymphocyte Ratio (NLR) for predicting disease severity and clinical outcomes in hospitalized patients with Community-Acquired Pneumonia (CAP).

Methodology: This observational, prospective study was conducted at the Department of Medicine, Saidu Sharif Teaching Hospital, Swat, from January 2023 to April 2024. The research team enrolled a total of 150 adult patients through consecutive sampling who were hospitalized with community-acquired pneumonia radiologically confirmed by X-ray or CT-scan. Data on patients' demographics, clinical findings, laboratory parameters, and X-ray features were collected at admission. The severity of the disease was measured by the CURB-65 scoring system. The admission NLR was calculated by the absolute neutrophil and lymphocyte counts. Patients were followed up for outcomes like admission to the intensive care unit (ICU), requirement for mechanical ventilation, and in-hospital death.

Results: The mean age of patients was 56.2 ± 15.7 years, with male predominance (57.3%). Severe CAP (CURB-65 ?3) was observed in 26.7% of patients. The mean NLR was significantly higher in patients with severe disease than in those with mild to moderate CAP (14.6 ± 6.1 vs. 7.9 ± 4.3; p < 0.001). Elevated NLR was strongly associated with ICU admission, mechanical ventilation, and mortality. A significant positive correlation was observed between NLR and CURB-65 score (r = 0.69, p < 0.001).

Conclusion: An elevated admission NLR is a strong predictor of disease severity and adverse clinical outcomes in hospitalized patients with community-acquired pneumonia. NLR may serve as a useful adjunct to established severity scoring systems for early risk stratification.

Hematological and Clinical Profiling of Patients with Chronic Obstructive Pulmonary Disease

2026-01-03T17:07:32+00:00

Background: Chronic obstructive pulmonary disease (COPD) is a progressive airways disease characterized by persistent airflow limitation. Apart from airflow limitation, COPD is associated with systemic inflammation, hematological alterations, recurrent exacerbations, and the presence of multiple comorbidities, each contributing to the severity of the disease. Understanding the relation between clinical presentation, spirometric severity, and hematological indices is important for the advancement of disease evaluation.

Objective: To investigate the association of hematological and inflammatory indices with disease severity, dyspnea, and frequency of acute exacerbations.

Methodology: This was a cross-sectional observational study in 180 clinically stable COPD patients, diagnosed using the Global Initiative for COPD (GOLD) guidelines. Hematological parameters that were analyzed included hemoglobin, TLC, platelets, RDW, ESR, and CRP. Comparisons across GOLD stages were done along with analysis of factors related to disease severity.

Results: Most of the patients, 73.3%, were males aged 50 years or older, and cigarette smoking was the major identified risk factor. The patient population is largely suffering from moderate to severe disease, with a high prevalence of stages 2 (47.8%) and 3 (28.9%) according to the GOLD. The hemoglobin decreased significantly with increasing stages of GOLD (p = 0.001), while TLC, platelets, ESR, and CRP increased significantly (p = 0.01).

Conclusion: It is evident that there are serious hematological and inflammatory alterations in COPD, which tend to progress with the severity of the disease. Anemia, leukocytosis, thrombocytosis, and inflammation are highly linked with the severity of dyspnea, the number of exacerbations, and the severity of COPD stages based on the GOLD.

The Prognostic Value of Longitudinal C-Reactive Protein Trends in Complicated Parapneumonic Effusion and Empyema

2025-12-04T14:01:15+00:00

Background: Parapneumonic effusion and empyema are complications of pneumonia and are linked to significant morbidity and mortality. Yet, the early assessment of patients at risk of treatment failure has remained an area of difficulty. C-reactive protein (CRP) is a biomarker of inflammation that has widespread clinical utility. The utility of CRP trend analysis in patients suffering from pleural infections has remained unproven.

Objective: To determine the relationship between the trend of C-reactive protein levels in patients and clinical outcomes in the treatment of complicated parapneumonic effusion and empyema.

Methodology: One hundred and sixty adult patients suffering from complicated parapneumonic effusion and/or empyema were included in a prospective observational study. CRP values at admission and during treatment (on Day 3, Day 7, and discharge) were determined. Multivariate logistic regression analysis was used to differentiate independent predictors for treatment failure and mortality.

Results: A total of 95 (59.4%) patients showed a rapid decline in CRP, 50 (31.3%) showed a slow decline, while 15 (9.3%) showed persistent elevation. Multivariate analysis showed that the persistently elevated CRP levels as an independent predictor for treatment failure (OR = 6.8, 95% CI 2.4-19.2, p < 0.001) and mortality (OR = 9.1, 95% CI 2.1-39.5, p = 0.003).

Conclusion: Serum CRP dynamics within a series of patients is an independent predictor of clinical outcome for complicated parapneumonic effusion and empyema. The rapid decrease of CRP values predicts favorable outcome, while persistent elevation is a marker of patients who are at high risk for treatment failure, complications, or death.

Evaluation of Gender Differences of Inhalers Use and Training Needs among Chronic Obstructive Pulmonary Disease Patients in a Tertiary Care Hospital in Pakistan

2025-08-09T03:15:42+00:00

Background:

Correct use of metered dose inhalers (MDIs) with spacers is crucial in the management of Chronic Obstructive Pulmonary Disease (COPD). Gender-based disparities in inhaler technique may influence treatment outcomes, particularly in low-resource settings.

Objective:

To compare metered dose inhaler technique and training needs between male and female COPD patients.

Methodology:

This descriptive cross-sectional study was conducted at the Pulmonology Unit, Khyber Teaching Hospital, Peshawar. A total of 140 COPD patients using MDIs with spacers were evaluated using a 9-step checklist. Patients were classified into proper, improper, or poor technique categories. Step-wise performance and receipt of prior guidance were assessed by gender. Chi-square tests were used to evaluate associations.

Results:

Out of 78 male and 62 female patients, proper technique was observed in 17.9% males and 16.1% females. Not-Poor technique was more frequent among females (83.9%) than males (28.2%). Although 94.3% of patients reported receiving guidance, female patients missed more critical steps (especially steps 2, 3, and 4). Gender had no statistically significant association with overall technique category (p = 0.216), but significant differences were noted in specific step performances.

Conclusion:

While overall technique did not differ significantly between genders, step-wise analysis reveals areas where female patients require enhanced training. Culturally sensitive and gender-focused educational strategies are recommended to optimize inhaler use and disease outcomes.

Technique Over Technology: Rethinking Inhaler Use in Obstructive Airway Disease

2026-01-24T13:10:42+00:00

Obstructive airway diseases like asthma and chronic obstructive pulmonary disease (COPD) continue to be a global problem, causing considerable suffering and using up a lot of healthcare resources. The situation concerning these diseases in Pakistan is made worse by factors such as urban migration, poor air quality, tobacco smoking, and lack of access to well-organized respiratory care. Many patients are living near the limit of inhaled medications because there is no perfect control of their disease. It is a paradox that very good drugs exist, yet poor outcomes persist, which requires a more thorough examination of factors beyond pharmacology. One of these factors is inhaler technique, a crucial, though continuously underrated, factor in the success of the therapy.