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Bronchiectasis-just diagnosed, not a smoker
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Bronchiectasis-just diagnosed, not a smoker

I began having chest pains at age 15, and never got any diagnosis for this.  Now I am 55, and just this week I was diagnosed with bronchiectasis - after a long history of being told my chest pain was "just stress", or "just a cold", or "maybe pleurisy".  My cardiologist actually found it, after trying to rule out heart vessel problems via a very expensive  CT of my heart.  I'm grateful to her for the testing, and glad I have a diagnosis, but now am trying to figure out what my next step should be?  I left the cardiologist's office with this big word in hand, and basically told that I had to go back to my PCP, so they could talk with me about "who they were going to send me to".  The cardiologist told me that the CT showed nodules, told me what the big word was, and said it basically meant that I had "mucus in my lungs".  Now, after Googling this, NO - THAT ISN'T WHAT THIS MEANS.

What does this mean?  I am not sure what I am to ask at the next appointment, and don't know what to do.  I have shortness of breath, but don't cough up much mucus.  Right now, I am tired most of the time, and have chest pain most of the time.  Sometimes the pains are very sharp, and grabbing.  I am lost, and feel like I've been set adrift among the sharks.
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The following is taken from Murray & Nadel’s textbook of Pulmonary Medicine and edited (to make it more understandable) by me. The Table 42-1 is a list of the many disease states associated with bronchiectasis.  The word associated may mean that these conditions can cause BXSIS or that BXSIS can predispose the lungs to one of those listed, especially in the realm of infectious disease where a host of bacterial organisms including the more common bacteria (those that commonly cause pneumonia).  In recent years the combination of BXSIS and what are called Atypical Mycobacteria (related to TB) has been seen with increasing frequency.  In these instances the question often remains, which came first?  The infection that caused BXSIS or the preexisting BXSIS that predisposed the lungs to this type of infection.

Some further information follows:

INTRODUCTION
The condition of bronchiectasis (BXSIS) is defined by dilation, of the airways. The primary clinical manifestations of BXSIS are recurrent, chronic, or refractory infections. Other significant sequelae include coughing up blood,  chronic airflow obstruction, and progressive impairment of breathing.  Pain is not a common symptom and so diagnosis and treatment of the BXSIS and, by the way it is a very treatable disease, may not provide an explanation for your chest pain.
There are many and varied pathways that lead to the development of BXSIS (Table 42-1). Broadly, BXSIS may develop due to an incidental event or episode that does not reflect the patient's intrinsic host defenses. Examples might include a necrotizing (tissue destructive) pneumonia following aspiration or chronic infection distal to an obstructing bronchial adenoma. Often, however, BXSIS evolves due to conditions that are inherent to the patient's basic genetic constitution. The most common and dramatic example of this is cystic fibrosis (CF).   While CF is usually believed to be a disease of children and young adults, in recent years the diagnosis has been made for the first time in individuals in the 4th or 5th decade of life.

TABLE 42-1.   -- Conditions Associated with Bronchiectasis

POSTINFECTIOUS CONDITIONS
   Childhood lower respiratory tract infections
   Granulomatous infections
   Necrotizing pneumonias in adults
   Other respiratory infections

PRIMARY IMMUNE DISORDERS
   Humoral defects
   Cellular and/or mixed disorders
   Neutrophil dysfunction
   Other

CYSTIC FIBROSIS
   Classic CF
   Variants of CF
   Young's syndrome

ALPHA1-ANTITRYPSIN SYSTEM
   Deficiencies
   Anomalies


HERITABLE STRUCTURAL ABNORMALITIES
   Ciliated epithelium
   Cartilage
   Connective tissue
   Sequestration, agenesis, hypoplasia
   Dwarfism

IDIOPATHIC INFLAMMATORY DISORDERS
   Sarcoidosis
   Rheumatoid arthritis
   Ankylosing spondylitis
   Systemic lupus erythematosus
   Sjogren's syndrome
   Inflammatory bowel disease
   Relapsing polychondritis


INHALATION And obstruction
   Gastroesophageal reflux/aspiration pneumonia
   Toxic inhalation/thermal injury
   Postobstruction accident
   Foreign body
   Tumors, benign and malignant
   Extrinsic airway compression
   Allergic bronchopulmonary aspergillosis/mycosis

MISCELLANEOUS
   HIV infection/AIDS
   Yellow-nail syndrome
   Radiation injury


There is a difference between BXSIS and lung nodules, both in appearance and significance.  The first step for you and your doctors is to determine the validity of the diagnosis of BXSIS.  Actually, the first step is for you to request consultation with a lung specialist; a Board Certified Pulmonologist.  I suggest this for, as you can appreciate from the information I have provided above, this is a complex situation that will demand the diagnostic skills of one with expertise in pulmonary disease and, ideally, a physician with a particular interest in BXSIS

The exposure of one’s lungs to substances toxic to the lungs can cause a variety of lung diseases, dependent in large measure on one’s age at the time of the exposure, the duration of the exposure and the intensity of the exposure.  The same holds true for certain types of lung infection.  You ask, “Is this possible?” and the answer is yes but any confirmation of this would require the expertise of a physician specialist in Environmental Medicine.  

In checking-out immune diseases, your physicians are being thorough and if an underlying cause is found it might well be responsive to treatment.

Good luck
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I went to the PCP yesterday.  I have to go to the pulmonary specialist now.  The PCP thinks this might be the result of something that happened when I was young - maybe exposure to toxins (I lived and played as a child on a Superfund site).  Is this possible?  

I just don't know what to think.  And does the cause matter?  They are doing blood tests, to check for immune issues, and rheumatology issues.  I feel like it has some importance, like if they know there is an underlying cause and treat it then I might gain some relief in that regard.  Other than that is there more significance?

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