Clearly, the incidence of prevalence of bronchitis is increasing. Um, and it's increasing in the US, it's increasing in Asia, and Europe, pretty much everywhere it's been measured. Um, some of that is artifactual, I think. I mean, you know, we, we do more and more CT scans of the chest, and that is what allows us to see bronchiectasis. Uh, chest radiographs are generally not sensitive enough to, to see bronchiectasis. And this is, of course, it has a radiologic definition, you know, that. That airway that corresponds with the, uh, the, you know, vessel, the blood vessel that runs alongside it, it has to be, um, you know, a certain amount larger than the blood vessel. And so, I mean, you see that, and they meet the, the case definition of bronchiosis. That being said, a person may not have symptomatic bronchiectasis. Um, a lot of people are running around out there with, with various levels of bronchiectasis, but, but it's undiagnosed and they have no symptoms. Um, I mean, we see those patients all the time, you know, random CT scans in the ER for some other reason, and, yes, they have a little bronchiectasis. Is it an issue? No, but are you glad you know about it? Sure. Um, at least it's on the radar screen. It's something that can be followed or, or, um, managed, you know, over time if it becomes a problem. Uh, and then perhaps there's things we should be doing to prevent it from becoming a problem. So, again, if you get a diagnosed, it's good to know about, but you may not be sick from it. You may not have symptoms. Um, You know, then we talk about people who have symptomatic bronchiosis, which we're really are the people we, we're talking about. We're talking about, you know, people who have symptoms and, um, the symptoms were cough, fatigue, um, windedness, often sputum production. Sputum can be, uh, fairly benign, and sometimes it can be pretty nasty in terms of volume and color and etc. So, um, a lot of people have daily symptoms, and it's, uh, it's problematic. And we want to alleviate those, those symptoms. Um, You know, in terms of, uh, the history I look for, I mean, patients, particularly middle aged and older, who have a chronic unexplained cough, I mean, that's usually how this starts. And oftentimes, they have the history of, you know, having 23 respiratory infections a year, every year, every winter and every spring, every cold I get, doc, turns into a need for antibiotics. I get treated for a URI. I mean, this, this is the history you tend to see, and this usually goes on for a few years, and then eventually someone gets a CT scan and they see they have this condition, or there's a sputum culture obtained, and it grows out. Some of the bugs that we characteristically find in bronchiectasis, that can be a clue that that's really what's going on. But it's often that history of chronic cough, um, and the history of needing antibiotics for, for upper respiratory infections several times per year. And you, you hear that, and that, that's the kind of person you should be targeting as, um, a quote unquote suspect, if we can use that word. Uh, and, and really, Look more deeply to see whether they have bronchiosis. And again, the way to do that is with the, with the chest CT. Uh, it doesn't have to be a high resolution scan. We don't, uh, our scans are so good now, you just order a regular noncontrast chest CT scan, uh, and that will be good enough to look for evidence of chronic infection or evidence of, of bronchiectasis.
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