Padukudru Anand Mahesh

Background: Accurate spirometric interpretation depends on appropriate reference equations. The Global Lung Function Initiative (GLI-2012) equations are widely used internationally, but South Asian populations were sparsely represented in their derivation and their applicability in Indian adolescents remains uncertain. Methods: We performed a cross-sectional analysis of baseline data from the multicity Air Pollution Exposure on Adolescents’ Lungs cohort. Healthy, non-smoking school-going adolescents aged 11–14 years from Delhi, Mumbai, Bengaluru and Mysuru underwent spirometry using standardised American Thoracic Society/European Respiratory Society procedures. GLI-2012 z-scores for forced expiratory volume in 1 s (FEV ₁ ), forced vital capacity (FVC) and FEV ₁ /FVC were calculated using the Asian reference category. Fit was assessed using mean z-scores and the proportion below the lower limit of normal (LLN; z<−1.645). Results: Among 4175 adolescents (2148 males), mean z-scores were −2.44 (SD 1.27) for FEV ₁ , −1.34 (0.93) for FVC and −0.78 (1.11) for FEV ₁ /FVC, all well outside the accepted ±0.5 range for adequate fit. Overall, 74.6% were below the LLN for FEV ₁ , 36.8% for FVC and 19.3% for FEV ₁ /FVC, compared with the expected 5% in a well-calibrated healthy population. The leftward shift in z-score distributions was consistent across sex, city, age, height and body mass index strata. Conclusion: GLI-2012 equations, as currently applied in the absence of South Asian-specific references, demonstrated substantial calibration mismatch relative to this cohort of Indian adolescents and risk major overclassification of low lung function. Population-specific validation and recalibration are needed before routine clinical or epidemiological use in this population.

This study estimated birth cohort effects on lung function using BOLD (Burden of Obstructive Lung Disease) data from 28 569 adults born between 1902 and 1976 across 41 sites in 34 countries. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV ₁ ) and the FEV ₁ /FVC increased across successive birth cohorts in both high-income countries (HICs) and low- and middle-income countries (LMICs), with mean values rising steadily with later birth year. In fully adjusted models, FVC increased by 21.4 mL, FEV ₁ by 24.6 mL and FEV ₁ /FVC by 0.25% per birth year. These positive associations were consistent across sex, smoking status and country-income subgroups (HICs and LMICs).

Summary: Small airway dysfunction affected one in five adolescents and varied substantially across four Indian cities. Age, sex and study city, but not ambient PM _2.5 or NO ₂ , were independently associated with FEF _25–75 .

Allergic Rhinitis and its Impact on Asthma (ARIA) was, up until 2017, a guideline using the best evidence (Grading of Recommendations, Assessment, Development and Evaluation, GRADE) and developed as a change management strategy. A second change management strategy—in collaboration with the European Academy of Allergy and Clinical Immunology (ARIA‐EAACI)—was developed as a person‐centred, digitally enabled, artificial intelligence‐assisted care (person‐centred care) with strong political involvement. The digital tools of ARIA are mainly based on MASK‐air, an Organisation for Economic Co‐operation and Development (OECD) Best Practice for integrated care for chronic diseases. Artificial intelligence was used, in particular, to approach the patients' views and expectations. The current paper describes the steps to build and achieve a new change management strategy. The future of the Change Management strategy is (i) a collaboration between ARIA and EAACI, (ii) the development of ARIA 2024‐2025 guidelines, (iii) the new ARIA‐MeDALL classification of multimorbid airway diseases and (iv) embedding MASK‐air in a registry for severe allergic diseases. The ultimate goals of the ARIA‐EAACI change management strategy will be (i) the transformation of health and care in rhinitis and asthma multimorbidity and (ii) the development of novel guidelines and policies in a cost‐effective manner, improving shared‐decision‐making.

Summary: Food sensitization formed reproducible network‐based phenotypes in an Indian allergy cohort. Spice, cereal, and legume sensitization predominated, differing from Western allergy patterns.

Summary Box: Urban aeroallergen sensitization exhibits stable indoor/insect and polysensitized phenotypes with distinct multimorbidity profiles. Polysensitization shows a clear dose–response relationship with rhinitis–asthma overlap, supporting sensitization burden as a potential risk indicator.

Rapid urbanization intensified spatial variability in air pollution across India, while monitoring networks are limited in capturing local exposure conditions. This study develops and evaluates an exposure assessment framework, with pilot findings from the Air Pollution Exposure on Adolescents’ Lungs (APEAL), a multi-centre prospective cohort study conducted in Delhi, Mumbai, Bengaluru, and Mysuru, which represent diverse air pollution levels. Residential measurements of fine particulate matter (PM2.5) and nitrogen dioxide (NO2) were conducted using standardized protocols. Results from pilot-phase showed that mean outdoor PM2.5 concentrations were highest in Delhi (90.4 ± 12.0 µg/m³), followed by Mumbai (57.2 ± 12.8 µg/m³), and Bengaluru (53.0 ± 9.0 µg/m³), with Mysuru having the lowest at 32.3 ± 9.3 µg/m³, indicating a north-south gradient attributed to anthropogenic activities. Optical properties of PM2.5, including absorption coefficients (Babs370 and Babs880), and calculated Absorption Angstrom Exponent (AAE), show significant variations and are primarily influenced by combustion sources. Further, this approach will include seasonal monitoring, chemical characterization, toxicity analysis, land-use regression (LUR) modelling, and time activity pattern to generate high-resolution exposure estimates. This methodology provides a robust, scalable framework for epidemiological studies and urban air pollution assessment in resource-limited settings, with relevance for urban planning and policy making.

Tuberculosis (TB) remains a major public health challenge in India despite extensive efforts under the National TB Elimination Programme. Delays in diagnosis and treatment initiation contribute substantially to ongoing transmission and poor clinical outcomes. This study assessed the duration and determinants of patient, health system, and total delays among TB patients in Mysuru, South India. A hospital based cross-sectional retrospective study was conducted at the Princess Krishnajammanni Tuberculosis and Chest Diseases (PKTB) Sanatorium, Mysuru, between January and June 2025. A total of 331 microbiologically confirmed TB patients were interviewed using a pretested semi-structured questionnaire. Delays were defined as patient delay (>30 days from symptom onset to first healthcare consultation), health system delay (>7 days from the first consultation to treatment initiation), and total delay (>37 days). Logistic regression analysis was used to identify factors associated with prolonged delays. The median (IQR) durations for patient, health system, and total delays were 30 (25), 12 (16), and 43 (32) days, respectively. Patient delay was independently associated with informal education (AOR: 1.95; 95% CI: 1.02–3.71) and poor TB-related knowledge (AOR: 31.40; 95% CI: 3.46–284.74). Health system delay was associated with socioeconomic vulnerability, including daily wage occupation (AOR: 6.15; 95% CI: 1.81–20.85), below-poverty-line economic status (AOR: 13.89; 95% CI: 3.38–57.17), first seeking care at private facilities (AOR: 17.28; 95% CI: 5.86–50.94), and visiting more than three healthcare facilities before diagnosis (AOR: 3.01; 95% CI: 1.23–7.32). Prolonged total delay (>37 days) was associated with informal education (AOR: 4.91; 95% CI: 1.64–14.76), being married (AOR: 4.34; 95% CI: 1.12–16.85), consulting private facilities initially (AOR: 15.80; 95% CI: 5.45–45.78), and multiple healthcare visits prior to diagnosis (AOR: 24.81; 95% CI: 10.34–59.50). Nearly two-thirds of TB patients experienced diagnostic delay. Poor awareness, socioeconomic disadvantage, and initial consultations at private facilities were the major contributors. Strengthening community awareness, improving engagement with private practitioners, and addressing socioeconomic barriers are essential to reducing delays and supporting India’s TB elimination goals.

Introduction: Asthma is a heterogeneous chronic airway disease marked by variable airflow limitation and bronchial hyperresponsiveness. While eosinophilic inflammation is well studied, neutrophil-driven and mixed eosinophilic–neutrophilic patterns are increasingly recognized in severe or poorly controlled asthma. Olfactomedin-4 (OLFM4), a neutrophil-expressed glycoprotein involved in immune regulation, has emerged as a potential biomarker of neutrophilic inflammation, though its role in asthma is underexplored. This study aimed to evaluate serum OLFM4 levels in asthma patients and examine their association with disease severity and control. Methods: A pilot cross-sectional, hospital-based comparative study was conducted at JSS Medical College, Mysore, between June 2023 and December 2024. Eighty participants were recruited: 60 asthmatics (20 each with mild, moderate, and severe asthma) and 20 healthy controls. Serum OLFM4 was measured using ELISA. Asthma severity was assessed by spirometry, and asthma control by the Asthma Control Test (ACT). Associations with hematological and pulmonary function parameters were analyzed. Results: Serum OLFM4 levels were significantly higher in asthmatics compared to controls (4,309.23 ± 1,533.97 vs. 1,344.41 ± 256.38 pg/mL; p < 0.001), with progressive elevation across severity (mild: 2,947.49; moderate: 4,371.45; severe: 5,608.75 pg/mL). OLFM4 correlated negatively with ACT scores (r = −0.820, p < 0.001) and lung function indices, and positively with leukocyte, neutrophil, and eosinophil counts. Multivariate Firth’s penalized logistic regression identified serum OLFM4 as an independent predictor of asthma severity (p < 0.001). ROC analysis showed excellent discrimination between asthmatics and controls (AUC = 0.997) and between non-severe and severe asthma (AUC = 0.89). Conclusion: Elevated serum OLFM4 levels correlate with asthma severity, poor control, and lower lung functions, highlighting its potential as a biomarker for disease stratification. These findings suggest that OLFM4 may be a useful biomarker reflecting overall disease burden and control status in asthma. Although the biological role of OLFM4 in asthma pathophysiology requires further investigation, its consistent association with clinical severity and control supports its potential utility in asthma stratification and monitoring.