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Pulmonary Fibrosis

Bronchiectasis, Asthma, Aspergillosis

08/23/2011

Question:

I am a man of 42yrs.I have asthma for 10yrs and step-IV Rx was taking ie, Seretide 25/250 evohahaler, Monteleukast,Salbutamol inhaler.In 2010 I had intermittent haemoptysis,mild fever for which test was done.On HRCT Cavitary lesion was found and other test results were insignificant.I took anti-TB drug for 9 months without improvement.My asthma attack was several times in last 1 yr. The severe asthma episodes were much longer and much troublesome.I had Left lung Lobectomy in 17 july, 2011.Histopathology showed Brnchiectasis with Chronic Pneumonitis with interstitial fibrosis with Aspergillosis. Now I feel tired on exertion. Lobectomy was done 1 month back. Cough improved. Spirometry showed Moderate Restriction. What will be my fate? Please answer my query.

Answer:

Bronchiectasis is a condition that results in the airways becoming enlarged and irregular. In this situation, secretions (mucus) can build up in the enlarged airways and the normal airway cells can be damaged, making it difficult to clear the mucus from the lung. Bronchiectasis can be caused by inherited conditions (such as cystic fibrosis, immotile cilia syndrome, and alpha-1-antitrypsin deficiency) or acquired conditions (such as tuberculosis, allergic bronchopulmonary aspergillosis, hypogammaglobulinemia, or non-tuberculous myocbacterial infection).

The first step in approaching bronchiectasis is to determine the cause since some of these conditions are treatable (for example, alpha-1-antitrypsin deficiency, non-tuberculous mycobacterial infection, or hypogammaglobulinemia). 

The second step is to develop strategies to clear the excess mucus and reduce infections of the airway in order to prevent further damage to the airways. Medications that can facilitate clearing mucus and decreasing mucus secretion include, bronchodilators and inhaled steroids. Other measures include the use of "flutter valves" or "chest vests" to help eliminate mucus. To reduce infections, we use regular vaccinations (for influenza and pneumonia), oral azithromycin, inhaled tobramycin, and intravenous or oral antibiotics when infections occur.

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Response by:

James N Allen, Jr, MD James N Allen, Jr, MD
Clinical Professor of Pulmonary, Allergy, Critical Care & Sleep Medicine
College of Medicine
The Ohio State University