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
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?
Zenforce