Yeah, understanding the, the different endotypes of bronchiectasis or non-cystic fibrosis, bronchiectasis, uh, it, it can be important. I mean, there, there's a variety of etiologies, uh, that, that cause bronchiectasis. So, of course, cystic fibrosis, um, but outside cystic fibrosis, you know, there are some inherited deficiencies, alpha-1 antitrypsin. Um, there's, you know, primary ciliary dyskinesia. These are fairly rare entities, but we do find them from time to time. Uh, patients that have, um, Immunodeficiency, you know, common variable immunodeficiency or hypogamma mia. I mean, these patients can get, uh, repeated infections when they're young, and those infections can, can cause, um, bronchiectasis. Probably, if I had to guess, 50% or more of bronchiectasis is probably due to, Infectious insults, either as a child or during lung development or even as a young or older adult, uh, post tuberculosis, bronchiectasis would be really classic and maybe one of the ones we think of the most, but, but certainly any, uh, pneumonia or really, You know, uh, severe or moderately severe infection, uh, during someone's lifetime can lead, lead to a localized airway damage. Now, now, once that airway is damaged, if it's dilated and its mechanisms for clearing itself, i.e., that, those, that cilia that is there, beating one direction, which leads to the efflux of secretions and particulate matter. That's been breathed in. I mean, all you got to do is get a little part of your airway where it's damaged. It can start collecting debris from the environment. Now, that debris can be particulate matter and, Um, that in itself could cause inflammation. It can be organisms. It can be infections, and those, um, can obviously drive inflammation. So, if you have an area of, uh, an airway that's damaged and chronically inflamed, that, that can essentially spread throughout the airway. Um, I mean, spread, yeah, sure, infection can spread, but really more the inflammation can, Um, just keep kind of cooking along the airways. So, you get development of bronchiectasis for a variety of, uh, reasons, but, but probably the most common reason is there was an infectious insult. It may have been a long time ago. Um, and then, uh, you, you acquire new pathogens as you age. Um, certainly there are cases where people acquire a pathogen. And that pathogen just smolders along for years and quietly or indolently, um, causes bronchiectasis. We probably most commonly see that with Mycobacterium avium or other non-tuberculous mycobacterium. Um, patients can have bronchiectasis and, of course, they can become secondarily infected with those organisms later on, but certainly those organisms can be causative of bronchiectasis, just much like TB, um, would be, it's just clinically, of course, they appear quite differently. Um, you know, other parts of, uh, you know, the rest of bronchiectasis, the ideologies are, you know, uh, unknown or idiopathic, we say. Um, I, I, I, maybe I'm biased. I'm an ID guy, but I think a lot of the people who have idiopathic bronchiectasis, it's all due to a prior infection. Um, but, but again, there are some states where we, you know, we should do investigations and see if we can find a reason. Um, if they're alpha 1 deficient, of course, we can replace alpha one. If they're IgG deficient, we can replace IgG. So, it's important to, to take a look and see if you can find a reason for this. And I'll also say that, you know, some of these people have cystic fibrosis variants, um, even though they're labeled as non cystic fibrosis, Um, patients where they have a heterozygote state, but, but again, ruling out or understanding whether the patient has an abnormal sweat test or a CF mutation, uh, could be useful in your management of that patient.
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