We report a case of Pancoast tumor with Superior vena cava obstruction and thoracic outlet syndrome in 60 year old patient who has been diagnosed to have undifferentiated lung carcinoma on evaluation. Patient was a chronic smoker from 40 years on treatment for chronic obstructive pulmonary disease and presented with hoarseness of voice, puffiness of face, pain in right arm and chest.

Chest radiography and computerized tomography of thorax showed homogenous density in right upper lobe extending in to superior mediastinum with involvement of multiple groups of lymphnodes. CT guided biopsy confirmed diagnosis of undifferentiated large cell carcinoma. Patient developed clinical features of superior vena caval obstruction in a period of 15 days.

Normally in clinical practice the evaluation of lung pathophysiology follows a functional and mechanical evaluation primarily through spirometry and plethysmography. The Small Airways (SAW) are one of the most important targets for respiratory diseases and various studies underline their strict relations with chronic diseases like asthma or COPD, although it is nowadays recognized their role in a lot of other pathological entities. The evaluation of SAW is not always easy and often more than one functional test must be done. So, the possibility to known the “scenario” of available functional respiratory tests, both in clinical and research setting, represents a central point in the respiratory world. Moreover the correct interpretation of the lung function tests is necessary not only to better evaluate the actual clinical status of the respiratory disorders but also to allow the appropriate therapeutic choice. The aim of the current review is to direct the readers attention to the importance of lung function evaluation and its specific role both in clinical and research setting.

Saber sheath trachea refers to diffuse coronal narrowing of the intra-thoracic portion of the trachea with concomitant widening of the sagittal diameter. It is considered to be widely associated with Chronic Obstructive Pulmonary Disease (COPD). The diagnosis is based on the calculation of the tracheal index which is the ratio of coronal to sagittal length in the axial plane measured 1cm above the upper margin of the aortic arch. Saber sheath trachea is considered to be present when the tracheal index is less than 0.67. The tracheal index has been associated with severity of obstruction and most notably with hyperinflation and extent of emphysema in COPD patients. Thus, it can have clinical importance. The presence of saber sheath trachea and its clinical implications should be further explored in COPD as well as in other diseases in which emphysema represents a major component, as Combined Pulmonary Fibrosis Emphysema (CPFE).

Background: Chronic Obstructive Pulmonary Disease (COPD) and type 2 Diabetes Mellitus (DM) are common and under diagnosed chronic non-communicable medical conditions in India. The escalating epidemic of DM is a great challenge for the clinicians treating COPD as large number of patients have Poor Glycemic Control (PGC). We undertook this trial to study the influence of PGC on severity and disease outcome in COPD subjects with concomitant DM.

Materials and methods: COPD patients either known or newly diagnosed DM cases as per WHO criteria were enrolled in the study and grouped into patients with PGC and Optimal Glycemic Control (OGC) based on HbA1c measurements. Subjects were closely monitored for 1 year.

Results: Of the 490 subjects analyzed, 336 (68.57%) had PGC and 154 (31.43%) had OGC. COPD patients with PGC had more severe disease compared to OGC (Mean FEV1% predicted 48.47 ± 13.7 vs 67.4 ± 13.86, p= 0.0061) and also DOSE score (4.35 ± 1.88 vs 3.18 ± 2.30 p= 0.0052) at the baseline. After 1 year, patients with PGC had statistically significant high rates of exacerbations. The mean DOSE scores were statistically greater in PGC patients after 12 months suggesting worsening of COPD symptoms and quality of life. Hospitalization was significantly frequent and longer in PGC patients. (6.56 ± 1.70 vs 4.16 ± 1.26 p= 0.0004).

Conclusion: Patients with PGC had more severe COPD, poor lung function, high symptom score, and increased risk of exacerbations with frequent and prolonged hospitalizations.

Chronic Obstructive Pulmonary Disease (COPD) is a significant illness that lends itself well to telehealth – the remote monitoring of patients at home. Currently, COPD telehealth is usually led by community nurses. Given the multifaceted needs of patients with COPD, we argued that a Multidisciplinary Team (MDT) approach is a better way of holistically managing patients on telehealth. We present our experience of working as part of a community MDT to review patients already undergoing COPD telemonitoring. We collected data on the MDT activity during a six months period with the aim of highlighting deviations from best practice. The MDT prospectively reviewed 95 patients and issued 141 recommendations which were fed to the patient’s usual General Practitioner (GP) or directly implemented by the telehealth staff. We concluded that a multidisciplinary review of COPD telehealth patients is feasible and has the potential to add value to what is largely a technology-led service.