Pakistan Journal of Chest Medicine

Technique Over Technology: Rethinking Inhaler Use in Obstructive Airway Disease

Anila Basit — Tue, 02 Dec 2025 00:00:00 +0000

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.

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

Nabi Rahman, Ubaid Ullah — Tue, 02 Dec 2025 00:00:00 +0000

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

Tariq Durrani, Ahmad Tariq, Nabi Khan, Sardar Alam — Tue, 02 Dec 2025 00:00:00 +0000

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.

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

Nadeem Shah, Latif Rehman, Muzamil Shah, Fatima Qamar — Tue, 02 Dec 2025 00:00:00 +0000

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.