Current Respiratory Medicine Reviews - Online First

Adverse drug reactions (ADRs) to antitubercular therapy (ATT) pose a major challenge in tuberculosis (TB) management, especially in patients with comorbidities. This study evaluated the prevalence, patterns, and risk factors for ADRs among TB patients with and without comorbidities receiving first-line ATT in India.

A prospective observational study was conducted at Erode Tertiary Care Hospital from July 2023 to January 2024. A total of 300 TB patients (207 without comorbidities, 93 with comorbidities such as diabetes mellitus, HIV, hypertension, and COPD) were enrolled. ADRs were assessed through clinical monitoring, lab investigations, and structured interviews using the WHO causality and Modified Hartwig and Siegel severity scales.

The prevalence of ADR was 49.33%, which was significantly higher in patients with comorbidities (55.91%) than those without (46.37%, p = 0.048; RR = 1.20, 95% CI: 0.96-1.52). Diabetes mellitus had the highest ADR rate (60.53%, p = 0.032). ADRs were more frequent in comorbid patients during the intensive phase (59.32% vs. 41.61%, p = 0.018) and in pulmonary TB. Gastrointestinal ADRs were most common, with nausea/vomiting, gastritis, and diarrhea significantly more frequent in comorbid groups. Comorbid patients also had more multiple ADRs (40.38% vs. 33.33%, p = 0.027) and required more medication changes (17.31% vs. 7.29%, p = 0.013). Discussion: Higher ADR frequency in patients with comorbidities may reflect the impact of disease. The increased burden during the intensive phase and in pulmonary TB underscores the importance of tailored pharmacovigilance.

TB patients with comorbidities, particularly diabetes, face significantly higher ADR risks. Enhanced pharmacovigilance is essential. Age-related physiological vulnerability may independently increase ADR risk in elderly patients without comorbidities.

Complete or partial collapse of the upper airway for a few seconds during sleep is the cause of obstructive sleep apnea (OSA). OSA affects about half of the world's population. Although there are numerous treatment options for OSA, continuous positive airway pressure (CPAP), mandibular advancement device (MAD), and surgeries are regarded as mainstream therapies.

Since MAD is a better alternative to CPAP for patients who are unwilling to utilize CPAP therapy or who do not comply with it, our current review focuses on how effective MAD is at managing OSA.

To find publications relevant to the safety and effectiveness of MAD in the treatment of OSA, online databases such as Medline/PubMed/PMC, Scopus, Web of Science, Google Scholar, and reference lists were searched.

Through the reduction of apnea-hypopnea index (AHI), snoring, and improved sleep quality, a number of prospective and retrospective observational studies, randomized controlled clinical trials and meta-analyses showed that MADs are beneficial for patients with mild-to-moderate OSA and snoring. Although CPAP therapy is the gold standard for treating OSA, patients who cannot or do not want to utilize CPAP therapy may benefit from MAD therapy as an alternative or as a supplementary treatment. For patients with OSA, the use of oral appliances, including MAD, is advised by the American Academy of Sleep Medicine (AASM), American Academy of Dental Sleep Medicine (AADSM), and National Institute of Clinical Excellence (NICE) guidelines.

Numerous randomized controlled clinical trials, prospective and retrospective observational studies, and meta-analyses have demonstrated that MADs are beneficial in treating OSA patients by reducing snoring, enhancing sleep quality, and lowering the apnea-hypopnea index (AHI). A licensed dentist should utilize a custom, titratable MAD when a sleep physician prescribes oral appliance therapy for an adult patient with OSA. The patients managed with MAD therapy should be advised to pay follow-up visits.

Growing evidence suggests an increased risk of venous thromboembolism (VTE) in chronic respiratory disease (CRD) patients. Persistent lung inflammation, repeated hospitalization, and associated comorbidities render patients prone to VTE. Considering the limited data, we intended to determine the clinical profile and risk factors of VTE in CRD.

A retrospective case-control study was conducted at the Department of Pulmonary Medicine in a tertiary respiratory care center. The medical records of CRD patients from January 2020 to March 2023 were reviewed and data were collected. Confirmed cases with VTE (n = 50) using Doppler and computed tomography pulmonary angiogram (CTPA) and matched controls (n = 50) without VTE were included in the study. Clinical and radiological profiles of these patients, including age, sex, presence of comorbidities, duration of illness, severity of CRD, treatment details, chest radiograph, electrocardiogram, CBC, CRP, and D-dimer levels, were recorded. Predictors for VTE were assessed using univariate and multivariate analyses.

VTE was found more commonly in middle-aged patients and those with TOPD and COPD. Univariate analysis showed high pulse rate, low oxygen saturation (SpO2), higher diastolic blood pressure, higher mMRC grade of breathlessness, evidence of cor pulmonale on 2D echo, elevated WBC count, and CRP and D-dimer levels to be the predictors of VTE. In the multivariate analysis, low SpO2, higher mMRC grade of breathlessness, and elevated CRP and D-dimer levels were found to be independent predictors for VTE. We found 72% and 80% sensitivity and specificity for serum C-reactive protein at 58mg/dl and 84% and 100% sensitivity and specificity for D-dimer values at 560 ng/LFEU, respectively.

VTE was found to be more common in tuberculosis-associated obstructive pulmonary disease (TOPD) than COPD at our centre. Low SpO2, greater severity of breathlessness, and elevated serum CRP and D-dimer levels were considered independent predictors of VTE in CRD. In CRD patients presenting with clinical worsening, evaluation for VTE in the presence of these risk factors can be useful in reducing morbidity and mortality.