Chronic respiratory diseases, particularly chronic obstructive pulmonary disease (COPD), are the third leading cause of death worldwide behind only cardiovascular deaths (ischemic heart disease and stroke) and cancers. The issues of misdiagnosis and suboptimal management in COPD are evident from the global disease burden and disability-adjusted life years due to COPD. One of the many reasons for this could be a lack of awareness of the newer treatment modalities among the treating physicians. The recent years have seen the introduction of many new molecules for the treatment of COPD. Many of these drugs are extremely potent bronchodilators which, when used, can reduce overreliance on inhaled corticosteroids (ICSs). On the contrary, we need not refrain from the use of ICS particularly in cases where they are indicated. Targeted therapy of COPD is also coming up in a big way and is a sphere of medicine to watch out for in the future. Through this review, an attempt is made to summarize some of these recent advances in management of COPD.

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Background: Interstitial lung diseases (ILDs) are a heterogeneous group of disorders with a wide spectrum. Diagnosis of ILD is by a multidisciplinary approach with clinical, radiological, and histopathological correlation. With the increasing knowledge on the clinical and radiological spectrum, there is a renewed interest to clarify and research the pathological aspect too. Materials and Methods: A retrospective study was conducted at a tertiary care hospital based on the available medical records of 65 patients with IEC permission. The role of transbronchial lung biopsy (TBLB) in diagnosing ILD was studied by comparing with high-resolution computed tomography findings. Data were analyzed in percentages. Results and Interpretation: Out of 65 cases, there were 30 cases (46%) of chronic hypersensitivity pneumonitis (HP), 12 cases (18%) of sarcoidosis, 12 cases (18%) of usual interstitial pneumonia (UIP), 9 cases (14%) of nonspecific interstitial pneumonia (NSIP), 1 case (2%) of lymphocytic interstitial pneumonia (LIP), and 1 (2%) case of cryptogenic organizing pneumonia (COP). TBLB yielded pathological diagnosis suggesting ILDs in 65% of patients. In addition, ill-formed granulomas were observed in 14 of 30 (47%) of chronic HP, noncaseating granulomas in 7 of 12 (58%) of sarcoidosis, and diffuse lymphocytic infiltrates and organizing pneumonia pattern in 100% of LIP and COP patients, respectively, whereas yield in cases of UIP and NSIP is 17% and 33%, respectively. Conclusion: Thus, TBLB is a promising minimally invasive technique for diagnosing ILD with a total yield of 65%. More specifically, the yield is more in cases of sarcoidosis, chronic HP, and rare ILDs such as LIP and COP, as compared to UIP and NSIP.

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Introduction: Robust data of C-reactive protein (CRP) are available in bacterial infection, and it can be utilized in this coronavirus disease 2019 (COVID-2019) pneumonia pandemic for initial assessment before planning of treatment in indoor setting compared to other inflammatory markers and computerized tomography (CT) severity. Methods: A prospective, observational, 12-week-follow-up study, included 1000 COVID-19 cases confirmed with real-time reverse transcription-polymerase chain reaction; all cases were assessed with lung involvement documented and categorized on high-resolution computerized tomography (HRCT) thorax, oxygen saturation, and inflammatory marker as CRP at entry point and follow-up. Age, gender, comorbidity, use of bilevel positive airway pressure/noninvasive ventilation (BiPAP/NIV), and outcome as with or without lung fibrosis as per CT severity were key observations. Statistical analysis is performed using Chi-square test. Results: The HRCT severity score at entry point has significant correlation with CRP titer [P < 0.00001]. CRP titer has significant association with duration of illness (P < 0.00001). Comorbidities has significant association with CRP titer (P < 0.00001). CRP titer has significant association with oxygen saturation at entry point (P < 0.00001). BiPAP/NIV requirement during hospitalization has significant association with CRP titer (P < 0.00001). Timing of BiPAP/NIV requirement has significant association with CRP titer (P < 0.00001). Follow-up CRP titer during hospitalization compared to entry point normal and abnormal CRP has significant association in post-COVID lung fibrosis (P < 0.00001). Conclusions: CRP has documented a very crucial role in COVID-19 pneumonia in predicting severity of illness, progression of illness, and sequential CRP titers that will help assessing response to treatment during hospitalization and analyzing post-COVID lung fibrosis.

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Bedside ultrasonography holds an indispensable position in emergency medicine today in most of the Western countries. However, its use is still undermined in most of the developing countries. We present a case of a 55-year-old bronchial asthma patient presenting with suspected acute exacerbation; however, was diagnosed with pericardial effusion with tamponade by point-of-care ultrasound. Eventually, she was diagnosed to have a malignant pericardial effusion and treated appropriately. To conclude, the use of point-of-care ultrasound played a key role in timely diagnosis and treatment.

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Chronic occult aspiration is the chronic aspiration of small volumes of oral and gastric contents into the lung. This is also termed as chronic microaspiration. It can lead to symptoms of gastroesophageal reflux disease and later lung involvement. This process is less familiar than the acute aspiration syndromes. Here, we present the case of an elderly male patient having diffuse esophageal spasm manifesting as recurrent chest pain and interstitial lung disease.

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Signet-ring cell adenocarcinomas (SRCCs) are rare tumors that most commonly originate from the stomach, colon, or breast. Lung as a site of the primary signet-ring variant of adenocarcinoma is extremely uncommon. Primary SRCC of the lung is a highly aggressive variant of adenocarcinoma with characteristic clinicopathological features. Here, we present a case of a young female with a rapidly progressive tumor in the left lung with metastasis to the pleura, pericardium, and lymph nodes having a histopathological proof of primary adenocarcinoma with signet-ring features.

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