Bronchiectasis can have a heterogeneous presentation, uh, almost universally associated with cough, but, uh, symptoms such as fatigue and, and weight loss are very common. Uh, a very important, uh, trigger. A very important historical sign that bronchiectasis is present is recurrent respiratory infections, uh, usually requiring antibiotic. Uh, and those recurrent respiratory infections can occur over months, years, even decades, uh, before someone is, is diagnosed with bronchiectasis. Um, Perhaps the most important, uh, factor associated with progression of the bronchiectasis, it, it is associated, uh, infections, uh, either bacterial, mycobacterial, or fungal. The most common bacterial pathogen is Pseudomonas, but other Gram-negative, uh, uh, bacteria can also be associated with, uh, bronchiectasis as well as, uh, staph and Haemophilus. Once one of these bacteria uh is uh established in the tracheobronchial tree, It is essentially impossible to sterilize uh the bronchial tubes again. Um, and so the approach to the bacterial pathogens is not just to treat acute flares of the bronchiectasis, but also to try to suppress them. The non-tuberculous mycobacteria, uh, also, uh, occur frequently in bronchiectasis patients. Uh, in my opinion, uh, the initiating factor is the bronchiectasis, uh, which, uh, creates, uh, uh, an environment in the bronchial tubes that is favorable to, uh, the mycobacterial, uh, invasion of the lung. Um. But uh that also raises the question about if you treat the mycobacteria, do you uh help improve uh the, the, uh, inflammation? I, I think there is a growing uh understanding of the complexity of what is called the microbiome uh of the uh bronchial tubes, particularly with bronchiectasis, where we may isolate a predominant bacterial or mycobacterial organism. But that doesn't necessarily mean that there aren't multiple other organisms uh in that same environment. Uh, uh, that, that is a, uh, an area of intense study, uh, and I think we're only just beginning to understand it. Uh, and the other, uh, very important, uh, aspect of the, uh, of the identification of the bronchiectasis is initiation of what's called airway clearance, uh, in an effort to move as much of the, uh, airway secretions as possible out of the lung, uh, in an efficient way.
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