Patients of bronchial asthma were put on salbutamol, ipratropium bromide and salbutamol plus ipratropium bromide inhaler in a cross over manner to assess the relative efficacy of the drugs. Both salbutamol and ipratropium bromide inhalers were found to produce significant rise in airway functions i.e. FEV1, PEFR and FEF25-75% (p<0.005). The mean rise was higher in patients while they were on salbutamol as compared to ipratropium bromide (P<0.01). Addition of ipratropium bromide to salbutamol inhaler further enhanced the bronchodilator action of the latter drug (p<0.02). Adverse reactions were minimal and self-limiting. Majority of the patients preferred salbutamol inhaler as compared to ipratropium bromide.

The aerosol budesonide was compared with oral prednisolone for its efficacy, tolerability and adrenal suppression. Twenty-eight patients, randomly divided into two groups of 14 patients each, participated in the trial. The study revealed that aerosol budesonide (200 mg twice daily) was significantly more effective than oral prednisolone (0.5 mg/kg body weight) as measured by peak expiratory flow rates (PEFR) and by symptom scores. Further, aerosol budesonide did not produce any hypothalamic – pituitary – adrenal axis suppression while oral prednisolone did.

Airway hyperreactivity was assessed by graded histamine aerosol (0.03 to 25mg/ml) in 15 normal, 52 asthmatics and 107 chronic bronchitics. The mean PC20 was 8.2±1.53, 0.4 ±0.54 and 0.6 ±0.85 mg/ml. in the respective groups. While there was a significant tendency for those with lower FEV1 to show hyper-reactivity; this was more evident in bronchitis (p<0.05). There was very significant relationship between index of obstruction (FEV1/FVC%) and greater hyperreactivity, again more closely in bronchitics. While there were no differences as a group for reactivity between two patient groups, in bronchitics greater obstruction or lower FEV1 seem to account for a higher reactivity. There was no relation to degree of bronchoreversibility in both but asthmatics showed much greater prevalence of cutaneous atopy.

Spirometric function, histamine PC20, blood and sputum eosinophilia, cutaneous atopy and IgE levels were compared in a selected group of 25 bronchial asthma and 16 chronic bronchitis subjects. The former were younger nonsmokers and 44% showed a family history of allergy; for clinical symptoms both groups had similar duration (5.9 to 6.2 years). The asthmatics had higher FEV1 and FEV1 improvement after bronchodilator (p<0.05). While there were no differences for blood eosinophil levels, for sputum eosinophilia the values were 2.12 ±1.8 and 0.8 ±1.0 respectively (p<0.05). Histamine PC20 concentrations were 0.13 ±0.21 and 0.33 ±0.26 mg/ml for asthma and bronchitis subjects (p<0.05). For cutaneous allergy score (4.9 ±2.5 and 0.9 ±0.9) and IgE (852 ±467) and 379 ±237 IU) the differences were significant. Thus, between two groups of obstructive airway subjects, these criteria may serve to identify difficult cases.

This paper reports the results of a study of spirometric parameters among healthy subjects from the southern state of Karnataka. A total of 560 healthy, non-smoking subjects (379 male and 181 female) were studied. The regression equations for the important parameters, Forced vital capacity and Forced Expiratory Volume in one second have been arrived at.

Delay in diagnosis of pulmonary tuberculosis affects the community control of tuberculosis. One thousand two hundred fresh cases of pulmonary tuberculosis were analysed. In 30 per cent, the patients, and in 3.33 per cent, the health personnel were responsible for the delay in diagnosis, and in 66.6 per cent of the cases both were responsible. Eightyeight per cent of the patients complaining of haemoptysis were diagnosed within first three months. Other factors are discussed. It was found that patients prefer to seek medical attention at general hospitals and dispensaries and private practitioners rather than tuberculosis institutions; only 18 per cent of the patients reached the tuberculosis hospital directly. However, in 63.3 per cent of the patients the final diagnosis of tuberculosis was achieved at tuberculosis hospital only. The societal implications are discussed.

The Mantoux test, (Mx) immunoglobulin levels, and indirect haemaggluination test (IHA) for the presence of anti purified protein derivative antibodies were performed in 70 asymptomatic “normal� children. IgG and IgA were significantly higher in Mx Reactors. No children who were Mx reactors were negative for the IHA test. Seventy five percent of the Mx non-reactors, had positive IHA titre. Mantoux is not a reliable indicator of post-vaccination allergy.

An unusual case of Sprengel’s deformity occurring in association with multiple congenital anomalies in the form of cervical scoliosis, hypertrophy of both transverse processes of seventh reported. This non-random association of congenital anomalies is discussed and pertinent literature reviewed.

A 40 years old male patient who presented with a massive, uniformly haemorrhagic, left sided exudative pleural effusion was found, to have associated pancreatic pseudocyst on investigation. The case history is presented with review of relevant literature.

Drug resistance is a major problem in tuberculosis treatment. The mechanism of development of resistance, its current status and the possible solutions for combating this problem are all reviewed.

The current status of management of lung cancer has been reviewed. While chemotherapy benefits patients of small cell lung cancer, the same is disappointing for non-small cell cancer. Surgery is the definite mode of therapy for the latter type, if detected in early stages. The role of radiotherapy and other modes of treatment are discussed in the light of current knowledge.