Well, if we have to identify the patient with bronchiectasis, it's not an easy task, uh, because bronchiectasis presents as a uh chronic cough with sputum production, sometimes, not always. And uh recurrent infection, uh, recurrent exacerbations. So it overlapped with a number of uh respiratory diseases. And this lead to the problem of late diagnosis. We performed a study in Italy, uh, looking to the uh uh the timeline between the the starting of the symptoms and the diag and the time of diagnosis. And the results are quite impressive. Uh, it takes from 5 to 10 years before having a diagnosis of bronchiectasis. So it's clearly that when we have a patient with chronic cough, uh, productive or not productive, uh, with the presence of some problem on pulmonary function testing. Uh, that's, we have to have a light in our mind and look to the possibility that these symptoms could be related to bronchiectasis. The diagnosis passed through CT scan, and CT scan is mandatory if you want to have a correct diagnosis. And then the patient could be also followed by MRI or whatever you want, but bronchitisis diagnosis passed through CT scan. And the other point is, as as bronchiesis and heterogeneous disease, looking to the different etiologies, it's quite important to have a look to the possible etiology to identify treatable traits of our patient in order to optimize our treatment. One of the point is that uh we, we have a, a ERS guidelines uh look into the uh etiological diagnosis and a uh uh diagnostic bundle that this has been proposed in 2017 and uh uh in this case, the, you know, uh, the minimal bundle uh is, is quite important to have symptoms, to have CT scan. And look into the presence of ABPR to have the level of IgG, IgM and so a sort of history of the disease that is quite important to identify. But when you go to a further examination, you can reduce the so-called idiopathic bronchiasis and Published a paper looking into adding some information and some exams to the bundle proposed by guidelines and just look into the subfraction of I, you can identify about 15% more patients with some problem in the immune response. So it's quite interesting that going in depth in the diagnosis can reduce the number of the so-called idiopathic bronchitisis, and this is quite important because identifying the underlying causes are quite useful for controlling the disease because in many cases there are some possible treatment that can help us to control the so-called treatable traits in this patient. And improve their uh uh the the diagnosis and management.
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