Out Patient Service

Training and teaching:

Faculty is involved in guiding MD, DM, PhD students (80 students) working on asthma, cystic fibrosis, HIV, chronic lung diseases.

Division regularly gets short and long term trainees from India and abroad

Faculty is involved in Projects of Indian academy of Pediatrics like preparation of asthma training module (ATM), Respiratory tract infections group education module (RTI GEMS), HIV training module, Cystic Fibrosis module.

Division has developed following modules

Reading of   Chest X ray

Cystic Fibrosis

Pulmonology grand round

Specialized services provided:

Sweat chloride estimation: 600 tests per annum performed free of cost. Test performed by prior appointment (011-26594610) on Mon-Wed afternoon in room number 3067, III floor teaching block, AIIMS.

Spirometry: 750 tests performed free of cost per annum in Pediatric Chest Clinic and also in room number 3067 by prior appointment.

Impulse oscillometry: 750 tests performed free of cost (as part of research grant)

Infant Pulmonary function test: Started from 2009 using Tidal Breath Volume Loop (TBVL), Rapid Thoracic compression (RTC) and raised volume rapid thoracic compression (RVRTC) by prior appointment.

Exhaled NO (Fe NO) for patients with asthma (Part of research project)

Exhaled breath condensate (EBC) for children with asthma (Part of research project)   

Bronchoscopy and bronchoalveolar lavage: 250 per annum, using fiber optic bronchoscope and videoscope by prior appointment.

Saccharine clearance test (screening test for Primary ciliary dyskinesia): 15-20 tests per annum.

Cystic Fibrosis services:

Services established for >20 years with grants from International Cystic Fibrosis (Mucoviscidosis) association and Cystic Fibrosis Worldwide (CFW).

Diagnostic services: sweat test and mutation analysis

Clinical services: After diagnosis, patients are called every 1-3 months for follow up. CF nurse and physiotherapist receives patients, assess basic data, checks for adherence, Physiotherapy, PFTs, SpO2, records weight/ height, events since last visit, takes cough swabs/ sputum for bacterial cultures, Patients are assessed and records entered in pre-designed format and sent back to nurse for next appointment. 

Periodic patient education program is organized once in 6 months.

A Cystic Fibrosis South Asian Trust formed and registered with Government of India and is affiliated to Cystic Fibrosis Worldwide

Asthma services: This includes detailed clinical assessment, treatment and regular follow up. Suitable treatment regimen is selected in consultation with consultant. Suitable inhalation device is selected after assessment by the nurse and the techniques are demonstrated to the parents and child. Patients are reviewed every 8-16 weeks by appointment (day and time).

Follow up: Patients are called at interval of 12 (8- 16) weeks by prior appointment. Patients directly report to Doctor. Assessment is recorded in pre designed half page proforma, PEFR measured, medications are checked, adherence recorded and actual inhalation by the child is seen and recorded. Assessment is recorded, drugs are prescribed and next appointment is given. In addition, the patients can also visit the clinic earlier than the scheduled appointment, if required.

Services to HIV infected children: This includes counseling, clinical care and protocol based treatment. After diagnosis, all HIV infected children are followed up every 4-12 weeks. When indicated, they are treated with antiretrovirals (ART). In addition, they are managed for any concurrent infections/ conditions. Appropriate prohylaxis measures are also offered. Data are being collected for natural history of these patients. 

RESEARCH:

Division is actively involved in clinical and basic sciences research in pediatric asthma, cystic fibrosis, HIV infection and other chronic lung diseases.

Research conducted or ongoing in childhood asthma

Epidemiology: Prevalence in school going children, risk factors for development of asthma, Risk factors for development of severe asthma, Socio-economic impact of asthma on child and family

Diagnosis: Pulmonary function tests

Treatment: Randomized controlled trials: Ketotifen as maintenance treatment double blind trial, Home made spacer versus commercial spacer, Rotahaler v/s spacer, Terbutalin v/s salbutamol in acute asthma, oral montelukast versus placebo in acute asthma, montelukast versus low dose inhaled steroids in long term asthma, addition of ipratropium to salbutamol in acute exacerbation; Salmeterol vs formeterol, rapid bronchodilator action of Formoterol versus salbutamol Association of vitamin D status with the level of control of asthma

Basic sciences: Integrated -omics approach to childhood asthma,  CFTR polymorphisms in asthma; role of early childhood respiratory infections on development of asthma

Research: Respiratory infections:

Epidemiology: Risk factors for development of severe pneumonia, factors determining outcome of severe pneumonia

Etiology: bacterial and viral etiology

Role of Mycoplasma and chlamydia in community acquired pneumonia

Throat swab as surrogate for sensitivity of microbial agents

Treatment: Treatment of non-severe pneumonia with short course of amoxicillin, approach to child with rapid respiration and wheezing, determinants of outcome of severe pneumonia

Role of zinc as adjunct treatment in acute severe pneumonia

Collaborative research with department of microbiology in relation to multiplex PCR for respiratory viruses.

Cystic Fibrosis:

Prevalence and common mutations profile

Development and validation of inexpensive method of sweat testing

Development of alternative to sputum sample in children with CF (Throat swab after physiotherapy in place of sputum)

Molecular characterization of Pseudomonas in children with CF.

Demonstration of cross infection and multiple strains of pseudomonas in same patients by molecular techniques

Clinical profile and atypical clinical features in Indian children with CF

Documentation of effect of seasonal changes on growth of CF patients

Training of CF nurse and Physiotherapist

Randomized controlled trial of low and high doses of Azithromycin in children with cystic fibrosis

Gastrointestinal manifestations in children with cystic fibrosis

Glucose intolerance in children with cystic fibrosis  

Zinc supplement in children with cystic fibrosis: randomized controlled trial

Randomized controlled trial of 3% vs 7% saline inhalation in children with cystic fibrosis

Clinical services

Weekly clinic: Thursday 2 PM in Pediatrics OPD, Ground floor

Weekly Clinic attendance: 120-150 per clinic (500 new cases per annum)

Break up of cases: Asthma: 60%, CF 10%, HIV infection 10%, other chronic lung diseases 20%