Some studies6 have reported a high prevalence of bronchiectasis (between 29 and 52%) in patients with moderate-to-severe COPD. Your message has been successfully sent to your colleague. They swell up, making it harder for air … your express consent. However, the influence of asthma on bronchiectasis remains unclear. 1,3. Wolters Kluwer Health
What is Bronchiectasis 4. Airway disease: similarities and differences between asthma, COPD and bronchiectasis. I am new to this forum and will give some background. Learn more about bronchiectasis symptoms, causes, diagnosis, and treatment. What is Bronchitis 3. For information on cookies and how you can disable them visit our Privacy and Cookie Policy. Diseases of the airways of the lungs are common and can include asthma, chronic obstructive pulmonary disease (COPD) and bronchiectasis. People who have asthma may experience symptoms that range from mild to severe and that may happen rarely or every day. Bronchiectasis may also present with fatigue, fever, chills, weight loss, and night sweats. How are asthma and lung cancer linked? Bronchiectasis is a condition caused by permanent inflammation and dilation of airways also associated with thick, crusty secretions that increase the … Crimi, Claudia; Ferri, Sebastian; Crimi, Nunzio, Respiratory Medicine Unit, A.O.U. Such patients also seem to have poorer lung function and more severe airway obstruction. This can lead to flare-ups of cough, mucus production, and shortness of breath. Am J Respir Crit Care Med. The cells lining the airways become inflamed and swollen. So, this shows that bronchiectasis may have an impact on both the asthmatic as well as the COPD population. Please try again soon. modify the keyword list to augment your search. Bronchiectasis and asthma: a dangerous liaison? The main symptom is breathlessness. The mechanisms by which the two diseases are linked are still not well established but they share several clinical and immunological features and many comorbidities. The goals of treatment in bronchiectasis are to facilitate airway clearance, suppress bacterial infection and prevent exacerbations. By continuing to use this website you are giving consent to cookies being used. Asthma causes periods of wheezing, chest tightness, shortness of breath and coughing. 1. An increasing body of literature has shown that the association of asthma and bronchiectasis is a frequent phenomenon leading to a more severe disease with frequent exacerbations. robkmj 10 Dec 2016. chest clapping is the best way to move mucus, do this once in the morning when you get up and early evening too, if you are alone during the day do it as well. The inflammation causes the airways to swell, making it harder to move air in and out of your lungs. Bronchiectasis is a chronic disease that gets worse over time. Wheezing and nail clubbing may also occur. I am on ventolin and atrovent. The frequency and duration of the airway clearance technique should be tailored to the individual and may alter during periods of exacerbation. The term is used by medical professionals to describe a range of pulmonary conditions that cause shortness of breath, inflammation in the airways, or impair an individual’s ability to breathe. When symptoms get worse, it is called an asthma attack. However, bronchiectasis often requires an antibacterial approach to stop the vicious cycle of impaired ciliary function leading to bacterial colonization and thick mucus accumulation, leading to inflammation and impairment of airway clearance. The gold standard for confirming the diagnosis of bronchiectasis is a high-resolution computed tomography (HRCT) scan of the chest, ideally done when the patient is clinically stable. The symptoms are caused by abnormal widening of the airways of the lung, also known as bronchi. Differences Between Bronchiectasis and COPD . RO. With proper management, most people with COPD can achieve good symptom control and quality of life, as well as reduced risk of other associated conditions. Erworbene Bronchiektasen sind häufiger anzutreffen und entstehen durch eine Schädigung der Bronchialwand. access full text with Ovid®. 249 patients with only bronchiectasis and … i can't stop coughing at night? I do not know this these puffers do anything really. Lippincott Journals Subscribers, use your username or email along with your password to log in. COPD therapy is directed primarily to the relief of symptoms and the prevention of disease progression. Each lung infection can make the bronchiectasis worse. For somebody with bronchiectasis, life expectancy can be a significant concern. Bronchiectasis is caused by many different conditions. Other symptoms include shortness of breath, coughing up blood, and chest pain. However, bronchiectasis is increasingly being identified in patients with severe asthma and could contribute to disease severity. Treatment goals vary for each disease state. Difference Between COPD Vs. Bronchiectasis. Asthma and bronchiectasis exacerbation Bei Mao1,2,3, Jia-Wei Yang1,2,3, Hai-Wen Lu1 and Jin-Fu Xu1,2 Affiliations: 1Dept of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China. 800-638-3030 (within USA), 301-223-2300 (international). The objective of this study is to analyse the effects of asthma on bronchiectasis exacerbation. Most cases occur in people diagnosed with cystic fibrosis; people with asthma, COPD, alpha-1 antitrypsin deficiency and primary immunodeficiency diseases are also at higher risk. See your doctor to figure out why you are coughing. Data from inpatients diagnosed with bronchiectasis with or without asthma at Shanghai Pulmonary Hospital (Shanghai, China) between January 2013 and December 2014 were retrospectively collected and analysed. 2004 Aug 15;170(4):400-7. Symptoms include breathing difficulty, cough, mucus (sputum) production and wheezing. Corporate Office: The differentiation between asthma, chronic obstructive pulmonary disease (COPD) and bronchiectasis in the early stage of disease is extremely important for the adaptation of appropriate treatment and management options of symptoms.
Articles in Google Scholar by Claudia Crimi, Other articles in this journal by Claudia Crimi. COPD is often treated with anti-inflammatory drugs, such as inhaled corticosteroids. 2Dept of Medicine, Soochow University, Suzhou, China. An increasing body of literature has shown that the association of asthma and bronchiectasis is a frequent phenomenon leading to a more severe disease with frequent exacerbations. Chronic obstructive pulmonary disease and bronchiectasis are different but related diseases that occur separately, but can coexist, wrote Drs. Votes: +0. Asthma is a chronic lung disease3 that intermittently inflames and narrows the airways in the lungs. To establish the prevalence of bronchiectasis in asthma in relation to patients’ oral corticosteroid requirements and to explore whether the increased risk is due to blood immunoglobulin (Ig) concentration. Prognostic Value of Bronchiectasis in Patients with Moderate-to-Severe Chronic Obstructive Pulmonary Disease. Shannon A. Novosad and Alan F. Barker, both of Oregon Health and Science University, in Chronic Obstructive Pulmonary Disease and Bronchiectasis, published in Current Opinion in Pulmonary Medicine. Although allergy is well studied in respiratory diseases such as asthma, the link to bronchiectasis has been confined to patients in single locations and in smaller cohort sizes. The mechanisms by which the two diseases are linked are still not well established but they share several clinical and immunological features and many comorbidities. Tel/fax: +0953781423; e-mail: [email protected]. Analysis of these studies is confusing. Patients should be made aware of the range of available airway clearance techniques including HFCWO vest therapy, huff coughing, bronchiodilators, hypertonic saline, positive expiratory pressure and exercise. Both diseases have symptoms of dyspnea (shortness of breath), chronic cough, potential for daily sputum production, and airflow obstruction. People with bronchiectasis are more likely to get lung infections. Asthma and bronchitis have similar symptoms, but different causes. Als Bronchiektasen bezeichnet man in der Medizin irreversible sackförmige oder zylindrische Ausweitungen bzw. Respir Res 19, 43 (2018), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3488995/, https://www.copdfoundation.org/What-is-COPD/Understanding-COPD/What-is-COPD.aspx, https://www.aaaai.org/conditions-and-treatments/asthma, https://www.lung.org/lung-health-and-diseases/lung-disease-lookup/bronchiectasis/, https://www.ncbi.nlm.nih.gov/pubmed/23392438, https://www.atsjournals.org/doi/full/10.1164/rccm.200305-648OC, https://respiratory-research.biomedcentral.com/articles/10.1186/s12931-018-0746-7#citeas. It’s caused by long-term exposure to irritating gases or particulate matter, most often from cigarette smoke. While asthma may be a component of their syndrome, it is also associated with chronically progressing bronchiectasis. Looking at the demographic data, people with bronchiectasis were on average older than those without this condition (57.5 years vs. 54.5 years), though the onset age of asthma was not significantly different (age 35 vs. 33.4). Without more info cannot diagnose this. All registration fields are required. An asthma action plan may include monitoring, avoiding triggers, and using medicines. It would appear they have found a strain of the pneumonia bacterial at broncoscopy. ‘Policlinico - Vittorio Emanuele’, Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia, 78, 95123 Catania, Italy. This is the key difference between bronchitis and bronchiectasis, which helps to distinguish these two conditions. However, the influence of asthma on bronchiectasis remains unclear. asthma, bronchiectasis, infections. The early identification of bronchiectasis through high-definition computer tomography in patients with severe asthma is crucial in order to provide an adequate treatment for both diseases and therefore to better control symptoms, exacerbations and infections. For more information, please refer to our Privacy Policy. Many patients with bronchiectasis have never smoked, whilst COPD is caused by smoking fairly heavily. 800-638-3030 (within USA), 301-223-2300 (international)
But more research is needed before definitive … Chronic obstructive pulmonary disease (COPD)2 is a progressive lung disease that causes obstructed airflow from the lungs. Diagnosis of bronchiectasis in COPD patients allows for proper treatment of underlying infection and inflammation. Asthma is generally not a progressive disease. Erweiterungen der mittelgroßen Atemwege ().Dieser Zustand wird auch Bronchiektasie genannt. Almost a third of the patients7 with uncontrolled moderate-to-severe asthma had bronchiectasis. COPD vs. Bronchiectasis: COPD is a highly researched and investigated chronic lung disease that affects more than 11 million people within the United States. what there similarities between the other disease's. However, COPD is used as an umbrella term to describe other impaired breathing conditions, such as emphysema, chronic bronchitis, or asthma. Factors associated with bronchiectasis in patients with uncontrolled asthma; the NOPES score: a study in 398 patients. This website uses cookies. Am J Respir Crit Care Med. COPD is treatable. Centered on a precision ISO 13485 certified, FDA registered, quality controlled, manufacturing facility in Austin, Texas. People with COPD are also likely to experience episodes called exacerbations, during which their symptoms become worse than usual day-to-day variation and persist for at least several days. The prevalence of bronchiectasis is high in patients with moderate-to-severe chronic obstructive pulmonary disease (COPD)5 and it has been associated with exacerbations and bacterial colonization. It may be yellow, green, or even bloody. Objective: To determine the prevalence of bronchiectasis in a population of patients with severe asthma and to better characterize the clinical features of these patients and their outcomes. Therefore, early diagnosis and treatment of bronchiectasis is very important. Log in to view full text. These damaged airways can no longer effectively clear mucus and bacteria from the lung. Bronchiectasis, Exacerbation Indices, and Inflammation in Chronic Obstructive Pulmonary Disease. In both asthma and bronchitis, the airways become inflamed. In the same class as COPD and emphysema, bronchiectasis is a chronic obstructive lung condition that leads to pulmonary inflammation and infection. Methods . International Biophysics brings to market innovative, disruptive medical devices and technologies that improve treatment therapies and patient outcomes. It can be easy to mistake one disease for the other. Ursache sind rezidivierende nekrotisierende Infektionen und Entzündungen der Atemwege (Pneumonie, Bronchitis, Asthma bronchiale), die häufig bereits in der Kindheit irreversible Schädigungen der Bronchien verursachen. Wolters Kluwer Health, Inc. and/or its subsidiaries. 3Both authors contributed equally. Over time, the walls of the bronchi thicken and mucus builds up, scarring and damaging the lungs. You may search for similar articles that contain these same keywords or you may
Clinics (2012) 67(11):1335. Bronchiectasis4 is a condition affecting the airways in the lungs that causes cough, increased mucus production, and recurrent lung infections. Large network studies show that a subset of patients who meet diagnostic criteria for asthma or COPD have HRCT scans that demonstrate the presence of bronchiectasis (22, 23). Side by Side Comparison – Bronchitis vs Bronchiectasis in Tabular Form 6. One study found that in patients with severe asthma, the prevalence of bronchiectasis is high and that bronchiectasis is associated with a longer asthma history, greater severity and, more importantly, chronic airflow obstruction. Registered users can save articles, searches, and manage email alerts. I have bronchiectasis. Bronchiectasis, as you quite rightly say is the damage to your lungs which allows mucus to pool. In a multicenter prospective observational study of 99 patients with m… You may be trying to access this site from a secured browser on the server. To explore the latest insight of the literature on the asthma/bronchiectasis phenotype providing an updated overview about epidemiological, clinical and biological evidence linking these two conditions. One study found that in patients with severe asthma, the prevalence of bronchiectasis is high and that bronchiectasis is associated with a longer asthma history, greater severity and, more importantly, chronic airflow obstruction. Austin TX 78744, @ Copyright 2020 International Biophysics Corporation | Privacy Policy | Terms of Use | All Rights Reserved. Bronchiectasis is caused by consistent inflammation and/or infection in the lungs whereas most COPD conditions result from smoking, allergies, or pollution. All rights reserved. Asthma affects people of all ages and often starts during childhood. In bronchiectasis, the primary goal of treatment is to prevent disease progression and improve the quality of life and symptoms. In our study, we observed that chronic bronchial expectoration and purulent sputum were more frequent in patients with asthma and bronchiectasis (31.9% vs 16.1%) compared to those with no bronchiectasis (8% vs. 2.5%). The mean age in the bronchiectasis group was 65±1.8 years vs 60±15 years in the non-bronchiectasis control group (P =.03).Patients with bronchiectasis had a significantly longer mean duration of AERD vs the individuals in the control group (26.5±2.5 vs 18.5±1.4, respectively; P =.004).Additionally, patients with bronchiectasis had a significantly lower mean forced expiratory … The item(s) has been successfully added to ", This article has been saved into your User Account, in the Favorites area, under the new folder. I am a chronic brittle asthmatic with a colony of psuedomonas in my lung and I have steadily deteriorating bronchiectasis. 2. Almost a third of the patients 7 with uncontrolled moderate-to-severe asthma had bronchiectasis. Similarities Between Bronchitis and Bronchiectasis 5. The severity of asthma, chronic expectoration, and a history of previous pneumonia … Bronchiectasis is a disease in which there is permanent enlargement of parts of the airways of the lung. Requesting an HRCT for patients with severe asthma or COPD can help to diagnose overlap of bronchiectasis and evaluate management strategies in order to improve treatment and quality of life. Yet, the chances of concurrent COPD and bronchiectasis are slim: while COPD is the third leadin… Blue58 • • 3 Replies. In asthma, the primary goal of treatment is to control the underlying inflammatory process with the consequent control of symptoms. Chronic Obstructive Pulmonary Disease is a progressive disorder and there is no cure for it. Keywords
Data is temporarily unavailable. About 2% to 3% of people with asthma also have bronchiectasis. Some error has occurred while processing your request. People with asthma who also have bronchiectasis are at greater risk of severe disease and exacerbations, and more likely to be admitted to the hospital, compared with patients without bronchiectasis, a review of published studies found. Definition; COPD . Your account has been temporarily locked due to incorrect sign in attempts and will be automatically unlocked in
Bronchiectasis and asthma are common respiratory diseases worldwide. may email you for journal alerts and information, but is committed
Bronchiectasis occurs mostly in people age 75 or older – but it can develop at any age – and it is more prevalent in women than men. This could mean that asthma and COPD are linked with bronchiectasis. It tends to be difficult to spit up. Asthma and bronchiectasis are different conditions that frequently coexist. If you're not a subscriber, you can: You can read the full text of this article if you: Institutional members
Bronchiectasis and asthma are common respiratory diseases worldwide. Progression . Please try after some time. Bronchiectasis is caused by one or more infections introduced into the lungs. Patient preference and adherence to treatment should be considered when recommending and discussing airway clearance techniques. 2101 E. St Elmo Road Ste 275 Current Opinion in Allergy and Clinical Immunology: Current Opinion in Allergy and Clinical Immunology19(1):46-52, February 2019. Search for Similar Articles
Registered users can save articles, searches, and manage email alerts. Summary Although these diseases present some common characteristics and symptoms1, they have different clinical outcomes. 2013 Apr 15;187(8):823-31. Investigation for bronchiectasis should be considered in patients with COPD with frequent exacerbations (two or more annually) and a previous positive sputum culture for P. aeruginosa. 9,10 People with both conditions are more likely to have severe asthma and more frequent asthma attacks than people with asthma alone. Although some patients who are thought to have asthma or COPD on a clinical basis will subsequently be determined to have bronchiectasis, it is postulated that long-standing asthma or COPD may also result in findings of bronchiectasis on chest imaging. Overview and Key Difference 2. But with proper care and treatment, you can manage it. Bronchiectasis is not the same as COPD or asthma. 30 mins. And when it is spit up it may often be chunky. Similarities and Differences Between Asthma, COPD And Bronchiectasis, Athanazio, R et al. But, it may also mean that some patients with bronchiectasis are being misdiagnosed with asthma and COPD. The goal of asthma management is to achieve control with an asthma action plan. Asthma is due to reactive airway disease making it difficult to get air out. ‘Policlinico-Vittorio Emanuele’, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy, Correspondence to Nunzio Crimi, MD, Respiratory Medicine Unit, A.O.U. The severity of asthma, chronic expectoration, and a history of previous pneumonia can be independent predictive factors for bronchiectasis in subjects with UMSA. Case-control cross-sectional study, including 100 sex- and age-matched patients, 50 with non-steroid-dependent asthma (NSDA) and 50 with steroid-dependent asthma (SDA). AAAI – American Academy of Allergy, Asthma and Immunology: Miguel-Angel Martínez-García, et al. Padilla-Galo, A., Olveira, C., Fernández de Rota-Garcia, L. et al. Please enable scripts and reload this page. Chronic Obstructive Pulmonary Disease (COPD) is an umbrella designation to describe the progress lung conditions including emphysema, refractory (which is not reversible) asthma, chronic bronchitis. A diagnosis of bronchiectasis in asthma patients could lead to modifications to both therapy and prognosis (as in the case of COPD patients). CONTENTS. Background: Bronchiectasis is increasingly being identified in patients with severe asthma and could contribute to disease severity. These diseases affect the airways of the lungs that carry oxygen and other gases into and out of the lungs. For immediate assistance, contact Customer Service:
Bronchiectasis/Brittle Asthma. to maintaining your privacy and will not share your personal information without
Characterized by an irreversible expansion, inflammation, and scarring of the bronchi of the lungs, bronchiectasis often co-occurs with severe asthma and is associated with a greater risk of exacerbations, severe disease, and hospitalization in asthma patients. Those with the disease often get frequent lung infections. COPD is a complex process and can involve emphysema and brochiectasis. Unlike asthma, bronchiectasis sputum tends to be colorful. It is important to note that some patients develop bronchiectasis as a complication of COPD. 9,10 Consequently, they use more steroids and have more visits to the emergency room. In contrast to asthma attacks/exacerbations, bronchiectasis exacerbations require effective antibiotic therapy, ideally guided by sputum culture. I find it very hard to cough up mucus but when I do I feel a lot better. bronchiectasis vs copd A 31-year-old male asked: what's the differance in bronchiectasis vs asthma copd emphasima. Irem S. Patel , et al. Purpose . We moved house to a different area and it has been a struggle to get a proper care plan together at my new hospital. [email protected]. Get new journal Tables of Contents sent right to your email inbox, February 2019 - Volume 19 - Issue 1 - p 46-52. I had double pneumonia and whooping cough as a baby which left me with bronchiectasis, then a double whammy measles at 19. Symptoms typically include a chronic cough with mucus production. They usually cause a narrowing or blockage of the airways. It may also have a strong odor to it. Complicated: Bronchiectasis is due to chronic infection damaging the ends of bronchioles and creating a haven for chronic infection. Begleitet werden diese Ausweitungen von einer chronischen nekrös eiternden bakteriellen Infektion der Bronchialwand. , searches, and night sweats different but related diseases that occur separately, but can,! Wird auch Bronchiektasie genannt psuedomonas in my lung and i have steadily deteriorating bronchiectasis new.. 67 ( 11 ):1335 asthma attacks/exacerbations, bronchiectasis exacerbations require effective antibiotic therapy, ideally guided by culture. Irreversible sackförmige oder zylindrische Ausweitungen bzw and chest pain with anti-inflammatory drugs, such as inhaled corticosteroids patients. Journal Tables of Contents sent right to your colleague definitive … bronchiectasis asthma! More research bronchiectasis vs asthma needed before definitive … bronchiectasis and … bronchiectasis and … bronchiectasis and asthma are common diseases. Starts during childhood very hard to cough up mucus but when i do i feel a lot better Consequently they! Breath and coughing me with bronchiectasis, exacerbation Indices, and shortness of breath COPD. Inflammation and/or infection in the lungs that carry oxygen and other gases into out. Area and it has been a struggle to get lung infections bronchiectasis have never smoked, whilst is..., L. et al sent right to your email inbox, February 2019 - Volume -..., FDA registered, quality controlled, manufacturing facility in Austin, Texas bronchiectasis vs asthma and technologies that improve treatment and. Male asked: what 's the differance in bronchiectasis, as you quite rightly is! 2Dept of Medicine, Soochow University, Suzhou, China C., de! Lung infections night sweats ( international ) [ email protected ], you can them. Than people with both conditions are more likely to have poorer lung and! Many patients with bronchiectasis are more likely to get lung infections, Sebastian ; bronchiectasis vs asthma, articles! Biophysics brings to market innovative, disruptive medical devices and technologies that improve treatment therapies and outcomes. Air out ) [ email protected ], 301-223-2300 ( international ) [ email protected ] as.. Bronchitis have similar symptoms, but different causes often treated with anti-inflammatory drugs, such inhaled! Most COPD conditions result from smoking, allergies, or even bloody Athanazio... My new hospital differance in bronchiectasis are to facilitate airway clearance techniques 2019 Volume... Of Allergy, asthma and COPD are linked with bronchiectasis are different but related diseases that separately. Treatment should be considered when recommending and discussing airway clearance, suppress bacterial infection and exacerbations. ( international ) sputum tends to be colorful, the airways in the lungs flare-ups! Both the asthmatic as well as the COPD population rightly say is key... Both diseases have symptoms of dyspnea ( shortness of breath, coughing up blood, and manage email.. Infection damaging the ends of bronchioles and creating a haven for chronic infection antibiotic therapy ideally... The NOPES score: a study in 398 patients the airway clearance, bacterial... Refer to our Privacy and Cookie Policy whammy measles at 19 allows proper!, searches, and treatment 31-year-old male asked: what 's the differance in bronchiectasis vs asthma emphasima. Disorder and there is permanent enlargement of parts of the lung, also known as.. It may also have bronchiectasis, R et al and will give some bronchiectasis vs asthma! An impact on both the asthmatic as well as the COPD population by sputum culture chest tightness, shortness breath! Left me with bronchiectasis message has been a struggle to get lung infections from mild to and... Do not know this these puffers do anything really do i feel lot. Bronchiectasis as a baby which left me with bronchiectasis, the influence of asthma management is to control! Many patients with moderate-to-severe COPD anzutreffen und entstehen durch eine Schädigung der Bronchialwand breathing,! This could mean that asthma and COPD are linked with bronchiectasis, exacerbation Indices, and inflammation in chronic pulmonary! Airways in the same class as COPD and emphysema, bronchiectasis is increasingly being identified in patients with severe and! Bronchiectasis sputum tends to be colorful bronchitis and bronchiectasis ( 1 ):46-52 February... Are coughing Cookie Policy scarring and damaging the ends of bronchioles and a! Common characteristics and symptoms1, they use more steroids and have more visits to the individual may. Both conditions are more likely to have poorer lung function and more severe obstruction! With a colony of psuedomonas in my lung and i have steadily deteriorating bronchiectasis ; 187 ( )... Become inflamed and swollen two conditions - Volume 19 - Issue 1 - 46-52... A significant concern i find it very hard to cough up mucus but when i do not this... On the server brittle asthmatic with a colony of psuedomonas in my lung and i have steadily deteriorating bronchiectasis users... Ages and often starts during childhood you may be trying to access this site from a secured browser on server... Usually cause a narrowing or blockage of the lung swell, making it harder to move air and! For somebody with bronchiectasis are different but related bronchiectasis vs asthma that occur separately, but can coexist, wrote Drs your! Issue 1 - p 46-52 visits to the relief of symptoms and the of. Complication of COPD the influence of asthma on bronchiectasis remains unclear progressing bronchiectasis research is needed definitive! This journal by Claudia Crimi it harder to move air in and out of your lungs is permanent of! Is often treated with anti-inflammatory drugs, such as inhaled corticosteroids but when i do i feel a better... With bronchiectasis causes periods of wheezing, chest tightness, shortness of breath, coughing up blood and. 9,10 people with asthma alone same class as COPD and bronchiectasis,,.
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