Journal Issue: Volume: 4, No. 1 (2025)
Loading...
Volume
Number
Issue Date
2025
Journal Title
Journal ISSN
ISSN 2822-1893 eISSN 2822-2016
Journal Volume
Articles
Pulmonary Rehabilitation: Reclaiming Respiratory Health through Multidimensional Care
(Nepalese Respiratory Society, 2025) Shrestha, Sanjeet Krishna
NA
Outcome of Pulmonary Rehabilitation on Post-Covid Pneumonia Survivors with Residual Lung Fibrosis
(Nepalese Respiratory Society, 2025) Suvedi, Rashmi; Gyawali, Manju; Shahi, Reema; Shrestha, Asmita; Thapa, Anisha; Adhikari, Shradha; Tarmakar, Suraj; Chaudhary, Deepak; Karthak, Ashish; Gurung, Naresh; Shrestha, Sanjeet Krishna
Abstract:
Background: A significant proportion of COVID-19 survivors develop residual pulmonary fibrosis, leading to persistent dyspnea, reduced exercise capacity, and impaired quality of life. Pulmonary rehabilitation (PR) may help address these sequelae, but evidence remains limited, particularly in low-resource settings.
Objective: To evaluate the effect of an 8-week pulmonary rehabilitation program on functional outcomes in post-COVID pneumonia patients with residual lung fibrosis at Nepal Mediciti Hospital.
Methods: This prospective cohort study was done from June 2020 to June 2021 and included adult patients with confirmed residual pulmonary fibrosis on imaging after COVID-19 pneumonia. Participants underwent a structured PR program comprising supervised aerobic and resistance training, breathing exercises, and patient education. Functional status was assessed using the 6-Minute Walk Test (6MWT), Modified Medical Research Council (MMRC) dyspnea scale, and ergometer pre- and post-intervention.
Results: Participants showed statistically significant improvements in all key outcomes. Mean MRC total score increased from 49.03 to 56.66 (mean difference 7.63, p < 0.001). Mean 6MWT distance improved substantially from 177.6 meters to 276.9 meters (mean difference 99.3 meters, p < 0.001). Significant reductions were observed in perceived fatigue and dyspnea, both at rest and after the 6MWT (p ≤ 0.003 for all Borg scale comparisons). The distribution of improvements varied among individuals, but most showed positive gains. Age showed a slight, non-significant negative correlation with the magnitude of 6MWT improvement.
Conclusion: Pulmonary rehabilitation significantly improves functional capacity, dyspnea, and quality of life in patients with post-COVID residual lung fibrosis. These findings highlight the importance of integrating PR into post-COVID care pathways in resource-limited settings like Nepal.
High-Resolution Computed Tomography (HRCT) Chest Findings in Active Pulmonary Tuberculosis
(Nepalese Respiratory Society, 2025) Adhikari, Deepak; Raut, Yuvaraj; Poudel, Dipesh; Paudel, Bigyan; Bhatt, Manali; Adhikari, Shital
Abstract:
Background: Tuberculosis (TB) is an airborne infection caused by the acid-fast bacillus Mycobacterium tuberculosis. It is estimated that about 10.8 million people fell ill with tuberculosis worldwide, and about 1.25 million of them died in 2023. In Nepal, nearly half of the population are estimated to harbor latent TB. Early diagnosis and effective treatment are the mainstay of the control of tuberculosis.
Objective: This study aimed to evaluate the diagnostic utility of high-resolution computed tomography (HRCT) of the chest in detecting active pulmonary tuberculosis (PTB).
Methods: It is a case-control study done in the Department of Radiodiagnosis at Chitwan Medical College, Teaching Hospital from August 2022 to January 2023. Adult patients with presumptive pulmonary TB who underwent both microbiological testing for Mycobacterium tuberculosis, and High-Resolution CT (HRCT) chest imaging were included. Patient’s demographics, clinical features, sputum microscopy for acid-fast bacilli (AFB), GeneXpert for MTB, and relevant HRCT chest findings were recorded in a predesigned proforma. Data were entered into Microsoft Excel and analyzed using IBM SPSS version 20.0.
Results: Data from 72 patients with active pulmonary TB were analyzed. Of these, 46 patients (63.9%) had Mycobacterium tuberculosis identified via AFB staining, while the remaining 26 (36.1%) were diagnosed using GeneXpert. The control group included 35 sputum-negative cases where bacteria could not be isolated using GeneXpert. The mean age of patients was 56 years, and the majority were male (68.1%). The most frequent HRCT findings in active TB cases included tree-in-bud appearance (69.4%), enlarged mediastinal lymph nodes (65.3%), and consolidation (56.9%). The tree-in-bud pattern was significantly more common in TB-positive patients compared to controls.
Conclusion: Common HRCT chest findings in pulmonary tuberculosis were tree-in-bud appearance, mediastinal lymphadenopathy, and consolidation. Tree-in-bud appearance in HRCT was significantly associated with bacteriologically confirmed pulmonary tuberculosis. When microbiological confirmation is delayed or negative, HRCT chest findings can support early initiation of treatment in suspected cases, thereby reducing community transmission and improving patient outcomes.
Deciphering Obstructive Sleep Apnoea Syndrome: A Clinical Profile Analysis of Patients in a Tertiary Care Hospital in Eastern Nepal
(Nepalese Respiratory Society, 2025) Bhatta, Karuna; Ghimire, RamHari; Kayastha, Jyoti; Kumar Mishra, Navin; Shrestha, Saree; Chand, Hema
Abstract;
Background: Obstructive Sleep Apnoea Syndrome (OSAS) is a common disorder comprising repeated events of partial or complete obstruction of the upper airway during sleep, thereby disturbing sleep and other physiological events and leading to long-term consequences. The condition is often left underdiagnosed, particularly in regions like Eastern Nepal, where awareness and access to diagnostic tools are limited.
Objective: This paper will examine the clinical profile of OSA in the eastern region of Nepal, focusing on its risk factors and associated comorbidities.
Methods: This study was conducted as a hospital-based descriptive cross-sectional study at Nobel Medical College and Teaching Hospital from November 2023 to November 2024. A sample of thirty adults diagnosed with OSA by polysomnography (PSG) according to American Academy of Sleep Medicine diagnostic criteria were included. Patients with untreated OSAS were included; those with respiratory failure, heart failure, shock, and recent ICU admission were excluded. Data regarding demographics, risk factors, co morbidities, spirometry, and PSG data were collected and analyzed with SPSS version 25.
Results: A total of 30 OSA patients were enrolled in the study, comprising 20 males (66.7%) and 10 females (33.3%). The mean age was 54.07 years, with the 40–60 age group being the most common. Among the participants, 14 (46.7%) had mild OSA, 11 (36.7%) had moderate OSA, and 5 (16.7%) had severe OSA. Additionally, 7 patients (23.3%) had hypertension, and 4 (13.3%) had diabetes. Regarding spirometry findings, restrictive patterns (46.7%) were predominant among patients, followed by obstructive patterns (20%) and normal findings (33.3%).
Conclusion: OSA is a complex, multifactorial disease with distinct phenotypes commonly prevalent among the Nepalese population, which needs early diagnosis and proper treatment. OSA evaluation should comprise both sleep-related complaints and nonspecific symptoms simultaneously.
Prevalence of COPD among Patients on Bronchodilator Therapy Presenting to a Tertiary Care Center
(Nepalese Respiratory Society, 2025) Mishra, Navin Kumar; Thakuri, HemaChand; Shrestha, Sareen; Rai, Utshav; Dhamala, Rasmita; Nepali, Rohit; Dahal, Suresh; Sha, Parmeshwar; Khadka, Gaurav; Lamichhane, Aayush; Bhatta, Karuna
Abstract;
Background: Chronic Obstructive Pulmonary Disease (COPD) is the most common non-communicable disease in Nepal and the third leading non-communicable disease globally. Despite its significant burden on public health, proper research is limited in local settings.
Objective: This study aims to find out the utilization of spirometry in establishing the diagnosis of COPD.
Method: A single-center, prospective, cross-sectional study design was conducted that included all patients more than 40 years old on bronchodilator therapy for COPD coming to the Pulmo OPD of Kathmandu Medical College Teaching Hospital (KMCTH). COPD was diagnosed by GOLD COPD. Criteria of fixed post-bronchodilator FEV1/FVC ratio <0.70. A Chhabra et al. 2014 reference equation from the North Indian population was taken for percentage prediction.
Result: A total of 6789 patients visited the pulmo OPD. 877 (12.92%) patients were being treated for COPD at different centers. Out of 877 patients, only 371 cases (42.3%) were properly diagnosed with COPD followed by bronchodilator therapy, and 185 (21.09%) cases were mistakenly treated for COPD, i.e., overdiagnosis, as proven by spirometry later on. Among 692 COPD-confirmed patients, 380 (54.91%) were female and 312 (45.09%) were male.
Conclusion: We conclude that a significant proportion of individuals who are on bronchodilators lack spirometry confirmation to diagnose COPD. Moreover, our study also shows a slightly increased prevalence of COPD among females.