Introduction:

Institute of Pulmocare and Research is a nonprofit organization working with motto of research, education and patient care since 2000 AD at Kolkata, West Bengal.

In last two decade, the institute, despite serious logistic limitations, has done several worthwhile jobs that can be regarded as milestones the path of serving its motto in the country.

The following briefs its activities and achievements of the institute:

1. Scientific innovations.
2. Educational activities.
3. Benevolence and
4. Recognitions

1) Scientific innovations:

The institute has developed quite a few new therapeutic procedures:

New procedure:

• The innovation of a new precision strategy to treat OAD (obstructive airway diseases):
  Our exercise and experience with glycopyrronium revealed that it could be safely used to assess the responsiveness as a bronchodilator (Lung India. 2023;40:3 ,227-234). Further, we observed that the glycopyrronium responsiveness exists in roughly 40 % of asthmatics and COPD (manuscript ID- ijmr_2404_23). Taking this information in consideration along with the standard salbutamol BDR and the Th2 activity status of a patient, we have proposed a precision therapy for obstructive airway disease as a whole (Lung India 2023;40: 490-1).
• The innovation of a New Treatment of Hemoptysis
  This remains a completely new method of treating bloody expectoration. The beauty of the method is that it is easy, economic, repeatable, can be performed in small set ups without costly instruments and the expertise can be easily prepared. This can largely substitute costly bronchial artery embolization and surgery. This method has the potential to help millions of people in the developing world. (CHEST 2002; 121: 2066-69), (Ind Jr Chest Dis Allied Sci 2007; 49: 137-42) and (Current Medical trend 2003;  7: 1384-88).
• The innovation of a New Treatment of Emphysematous Bullae
  This is an innovative method where big air-pockets in lungs can be easily decompressed and a lot of relief can be offered to many sufferers of emphysema. This procedure has prospect of further improvement and extension of the use / similar other innovations. (European Respiratory Journal 2007; 29: 1003-1006).
• The innovation of a New Treatment of Bronchopleural Fistula
  This is a novel method of treating a persisting hole in the lung leads to continuous expulsion of air from the lungs to its covering sac, the pleural space. This condition is really a pathetic one especially in patients with underlying lung disease as COPD. The treatment becomes a challenge especially if the leak is at the periphery (alveolo-pleural fistula). There are not many good methods to treat them and the method developed by us is, to our opinion, perhaps the best been discovered so far. (Ind Jr Chest Dis Allied Sci 2008; 50: 203-208).

Opening of a new horizon of the therapy for IPF (idiopathic pulmonary fibrosis).

• The innovation of a new therapeutic prospect of Idiopathic Pulmonary Fibrosis (IPF),
  with the novel repurpose use of a commonly used drug doxycycline
  IPF (idiopathic pulmonary fibrosis) is a condition of progressing scarring of the lungs with poor survival prospect. The available treatment for IPF is not that effective and is often very costly and many patients end up in lung transplantation. Our innovation has a significance of adding benefit to existing treatment. We have shown that the agent is well tolerated on long term and that its use is likely beneficial across the causes of fibrotic DPLDs (diffuse parenchymal lung diseases). It needs a detailed study to forward a stronger evidence; unfortunately, we could not proceed much for logistic constraints. The institute is sincerely trying to mobilize resources to do a proper double-blind placebo-controlled trial.
  (Ind Jr Chest Dis Allied Sci 2007; 49:180, Lung India 2009; 26: 81-85, and Lung India 2011; 28(3):174-179)

Unveiling new aspect of COPD – Left heart associations.

•  Left Ventricular Diastolic Dysfunction in COPD without any risk factor may have association with Myocardial Ischemia.
  The revelations of this work have a far stretched impact since it clarifies that COPD-LVDD (left ventricular diastolic dysfunction) association is not co-incidental but a marker of ongoing ischemia in myocardium. The outcome of the information may help thousands and millions of COPD patients to live possibly a longer life with better-quality.
  (European Respiratory congress at Vienna from 12th to 17th of September, 2009 oral presentation (no.2605). (CHEST 2005; 128: 4, 263S.), and (COPD journal 2012:9:1-5)
  We have also proved that the treatment of the condition (LVDD) can actually improve the health status of COPD patients. (Letter to editor. Lung India, 2012; 29: 392).

Opening new horizons of treatment of asthma and COPD:

• Both these two conditions are rampant all over the globe and though different, both the conditions have a common feature of gradual stiffening and thickening of the airway wall. This is called remodeling and it leads to airflow limitation that is not well reversible. So far, there has been no treatment of remodeling. The institute claims to have shown an innovative way (breakthrough) to address airway remodeling pharmacologically. This may change the face of treatment of these two common and debilitating diseases.

Remodeling of different lung pathologies/ structural changes:

• Disease induced structural changes can cause physiological jeopardy and suffering. They can often create confusion with even malignancy morphologically. We consider it as a kind of remodeling of the lung parenchyma as a response to insult (physical, chemical, or biological). The re-remodeling of these lung pathologies may of extreme help to a suffering patient. This is likely possible and we have proved the concept on clinical documentation. This means that even architectural changes in lung and pleura can be reverted to normal with medication. This type of reparative/ regenerative medical effort was not thought of so far. Thus, our observation and research can open up a new horizon in the treatment of pulmonary diseases.
  (Innovative Journal of Medical and Health Science, 2014; 4: 3, 99 – 105.) and (Lung India 2015; 32:40-3).

Making a CDSS (Clinical Decision Support System) for care of asthma.

• Development of a clinical decision support system software on asthma named ACCESS:This simple clinical decision support system will help diagnosis, guidance to management and self-monitoring of the diseases to, avert exacerbations. This will help to bridge the huge gap between the guideline recommendations and practice behavior. This will surely help people to live better and save a lot of man power and healthcare related expenses.
  (Copyright no. L-30805/2008 dated 26.06.08, Diary no 2916/2008 – CO/L, Date of application: 16/05/08). in collaboration with SMST, IIT Kharagpur

Making a simple instrument to analyze lung sound to diagnose different diseases.

• The institute has been engaged in a collaborative research to find out the digital signature of lung sound (both normal and abnormal) to diagnose different lung diseases non invasive way. Despite logistic constraints, the institute has sponsored the work and we have been able to make it possible to identify DPLD patients successfully on digital signature of lung sounds from normal people.(The Scientific World Journal,2014:10.1155). (Springer Plus, 2013: 2:512). 2013 Indian Conference on Medical Informatics and Telemedicine (ICMIT) page-43-47. (IEEE Proceedings of 4th International Conference on Intelligent Human Computer Interaction, Kharagpur, India, December 27-29, 2012). (Journal of Medical Engineering & Technology, 2011, 1-10). Respirology 2015; 20 : 633-639.(The Scientific World Journal,2014:10.1155). (Springer Plus, 2013: 2:512). 2013 Indian Conference on Medical Informatics and Telemedicine (ICMIT) page-43-47. (IEEE Proceedings of 4th International Conference on Intelligent Human Computer Interaction, Kharagpur, India, December 27-29, 2012). (Journal of Medical Engineering & Technology, 2011, 1-10). Respirology 2015; 20 : 633-639.

Feasible and cost-effective rehabilitation program for the rural COPD patients:

• COPD rehabilitation is a recognized, non-pharmacological intervention that makes a lot of positive impact (quality of life, reduced symptoms, better functional capacity, less hospitalization etc.). The formal COPD-rehabilitation is a costly and effort intensive

• process which is hardly available outside a few tertiary care centers in the country. We have made a protocol with inclusion of rural practitioners (quacks) in the process of monitoring and proved that the single point intensive education and training followed by local monitoring and encouragement by rural volunteers can improve the quality of life and this effect can be long lasting (>one year). (International Journal of COPD 2018:13 3313–3319)

Making a way out to treat COPD-PH:

• COPD is a problem of epidemic dimension in India and a global menace of increasing incidence. PH (pulmonary hypertension) is a common complication of COPD that affects the quality of life and compromises survival prospect. There is no guideline to treat PH developed in COPD patients (COPD-PH) although there are several medications to treat PH. We, at the institute, innovated a way to treat COPD on simple cost-effective evaluation. It is also hemodynamically endorsed.

• (J Pulm Respir Med 8: 469. doi: 10.4172/2161-105X.1000469 and accepted for publication in Journal of Pulmonary and Respiratory Medicine, manuscript ID- jprm-19-3756)

Innovating a regression equation for diagnosis of DPLD from PFT:

• DPLD (diffuse parenchymal lung disease) is a condition of drying up of the lungs. The lungs get scarred and the patient suffers from progressive shortness of breath. The diagnosis of the condition is done by HRCT (high resolution computerized tomography) chest of the lungs. We have observed a new change in a common investigation as spirometry and evolved a regression equation to diagnose DPLD with high predictive power.(Presentred in APSR (A0194)- {Respirology 2018; 23 (Suppl.2), 78-79}

Detecting HRCT changes in HP from avian antigen and determining a sign to predict
increased risk of PH in them:

• This is simple observation on HRCT chest of the patients of chronic HP (hypersensitivity pneumonitis). We have seen a change (a sign) as pleural based thickenings that corelate well with the presence of pulmonary hypertension in them. The observation needs further validation.
  • (Lung India 2018; 35: 215-9)

Determination of AMA responsiveness of airway diseases:

• There are two classes of bronchodilators for airway diseases as asthma and COPD. We can do salbutamol bronchodilator test with a particular class to assess the treatment responsiveness but cannot do so for the other class (AMA, antimuscarinic agents) in a clinic setting. We have evolved a protocol with a short-onset but long acting AMA glycopyrronium that dictates the AMA sensitivity in a patient of airway disease. This
  will help immensely to phenotype airway diseases and decide customized treatment. {European Respiratory Journal 54(suppl 63) PA2480;DOI:10.1183/13993003}, {submitted to JACP (manuscript ID: JACP_34_20)}

Innovation of a new exercise test to substitute 6MWT:

• Exercise test is an integral part of evaluation of the patients with different cardiopulmonary diseases. One such test, 6MWT (6 minutes walk test), is well established in clinical practice and research. However, it is not popular for some inherent logistic issues related to the performance of the test. So, we have innovated a substitute of 6MWT which is claimed to be a more cardiopulmonary stress specific and is easy to perform (possible even in the consultation room itself). The test is named 2CT (2 chair test) and is accepted for publication.
  {(on the process of publication in BMJ open respiratory research journal (manuscript id: bmjresp-2019-000447)}

Revelation of new mechanism of COPD in smokers and identification of smokers at risk for COPD:

• This is a joint work with Late Professor Indu Bhusan Chatterjee of the Department of Biotechnology, University of Calcutta. Primarily, it is Prof. Chatterjee’s innovation of a chemical substance (semi-benzoquinone) in cigarette smoke that is converted to parabenzoquinone (pBQ). Dr Chatterjee found that the parabenzoquinone is neutralized by its antibody. It is seen that those who develop COPD has depleted amount of anti-pBQ antibody the reason of which is not known yet. The detection of inadequate level of anti-pBQ antibody possibly leads to a weakness in protection of the lung injury from pBQ. We took part in the work of identifying the antibody in COPD subjects. The research has significant applied importance since it can identify the susceptible smokers who will develop COPD on smoking. This can help us prevent COPD.
  (International Journal of COPD 2017:12 1–10)

Revelation that disproportionately high pulse rate can signify subtle left ventricular myocardial dysfunction in post covid-19 patients.

• This work is made of the measurement of the ventricular strain pattern in post Covid-19 patients who presented to us with relatively more than expected shortness of breath on exertion according to our clinical appreciations and their resting cardiopulmonary status. It was interesting to observe that these patients had poor recovery response as regards the settlement of the pulse rate is concerned.
  (JAPI ) and also the abstract by Sayoni

The wellbeing of the COPD patients during Covid-19 was related to the better quality of food and reduced pollution of the ambient air.

• This was a survey on a cohort of COPD subjects. They unanimously agreed to a relative wellbeing at the lock-down period and perceptually attributed it to several factors. Of them reduced air-pollution and the improvement in the quality of food (being home cooked and simple) appeared to be statistically significant. Incidentally, the perceived wellbeing on semi-quantitative scale correlated significantly with the published reduction in pollution level measured in terms of PM2.5. (International Journal of COPD 2017:12 1–10)

The real world situation in the practice of investigations for ILD in India

• The research was a survey amongst the self-declared ILD practicing pulmonologist and physicians. It is revealed that the ILD treating experts are mostly practicing in the metropolitan and urban areas. HRCT chest and spirometry are done near universally suggest a good practice standard as far as the exercise for diagnosis is concerned. However, further evaluations for assessment of etiological nature, functional status, etc. are grossly suboptimal. Affording the logistics for proper evaluation and treatment appears to be a major difficulty by many of our patients. Such operational research is the first of its kind in the country. It points towards the deficits and the need for further research and it calls for action to improve the state of affairs.
  (International Journal of COPD 2017:12 1–10)

Patents applied for: We have several patent applications to our credit.
2) Educational activities:
PULMOCON: It is an annual All India Post Graduate Pulmonary Update with workshops, symposia, lectures, orations, quiz etc. for 2 days. Pulmocons have been graced by renowned faculties from home and abroad and delegates from all across the country and the neighboring nations. We observed the 21th Pulmocon in a series in 2023. Each Pulmocon has a section on young scientists to present their work with both poster and platform presentations.
Update on several focused issues: updates being held on fungal infections, nosocomial pneumonia, sleep related disorders etc.

Summer symposium: we hare holding a symposium in every summer on a focused issue for last 7 years. This has become a popular platform for interaction between the basic researchers and the clinicians.

Regular topic discussions: almost every Thursday, we hold a topic discussion session.

Reorientation programs for the practicing doctors:held regularly (presently in suspension) with the practicing doctors addressing the common issues of pulmonary medicine relevant in their day to day practice. These programs are highly successful and we have formulated a six-hour module to impart education to our colleagues.

Nurses education programs: these programs were held with an idea to train the existing nursing staffs of the nearby nursing homes (where we keep patients) to prepare them to better tackle the emergencies and not to take certain mistakes. The program is also highly successful.

HRD activity: preparing manpower to assist physicians in practice: the institute has ben trying to prepare a manpower to assist doctors and support the population in community to access proper attendance in need. We had got affiliation of two courses from the Netaji Subhas Open University, but we could not find candidate. Of late we have got a course syllabus approved by the National Skill Development Corporation and we are planning to start them soon

https://apprenticeshipindia.org/courses/type/optional.

Consensus Draft on strengthening the Anti TB Campaign: Initiated and completed a consensus statement to strengthen the anti-TB campaign for the country and the globe as a whole. The draft had been forwarded to appropriate authorities for proper consideration.

Picture of the front page

Consensus Draft on end of life care:taken initiative to publish a consensus statement on ‘end of life care’ it is under the process of development; one meeting is held on 20/12/12 and the initial draft has been prepared.

Rural COPD education programme: we have carried out this in different areas of Birbhum district for 3 years. The activity is presently suspended for logistic reasons

                         

The Pulmoface:we initiated a bulletin in 2000 and continued it till 2016 when we decided it upgrade it to a journal. We published it regularly for over two years but finally retreated for logistic reasons.

Front page pictures:

                    

The manpower development:we are presently holding the small certificate and diploma course young (post H.S.)people to make trained manpower to assist pulmonary physicians in practice.

3) Benevolence:

Rural education cum training camps: 

• This is a unique programme where the patients of COPD are screened from the community, brought to a program to be evaluated with standard investigations including spirometry, ECG, chest X-ray, and common blood tests. The patients were imparted with a formatted syllabus based (developed by us)  one- point intensive education and training, and were given with free medication. The patients who received the training have shown significant improvement in the quality of life as a result of the effort. This has been highly encouraging and we feel that this may make a substitute for the formal COPD rehabilitation (neither feasible nor possible in our country by and large) and help millions of patients to live a better-quality life.
  This has got a tremendous impact on the quality of life of the patients in underserved areas all across the globe.
  
  Concession: We have been providing substantial concession to the indoor patients who are financially weak or constrained. In every year, despite our financial limitations we have provided substantial direct concessions to our outdoor patients and arrange indirect concession of huge amount by making them to avail subsidized investigations etc. through our efforts. Apart, we always try to help with free medication from small donations from our colleagues, pharmaceuticals and drug trials.

4) Recognitions:

• SIRO: Recognition by the Govt. of India as a SIRO (Scientific and Industrial Research Organization).
  Income tax exemption: Granting of the IT provision under 80G that enables a profession and corporate donor to enjoy tax exemption.
  Chest Foundation Award: Our chief functionary, Dr Parthasarathi Bhattacharyya, has been awarded with the Chest Foundation Award in 2008 by the American College of Chest Physicians.
  Acceptance by the people: we are happy that our patients, by and large, love us and encourage us continuously with gestures