Quiz: Man with chronic cough

42 year old gentleman with chronic productive cough for the last 5 years. The phlegm is white most of the time but may be greenish or yellowish occasionally.

What is your diagnosis?

This is a magnified version of the image:

Diagnosis: Cystic bronchiectasis

Bronchiectasis is a disease state defined by localized, irreversible dilation of part of the bronchial tree caused by destruction of the muscle and elastic tissue. It is classified as an obstructive lung disease, along with emphysema, bronchitis, asthma, and cystic fibrosis. Involved bronchi are dilated, inflamed, and easily collapsible, resulting in airflow obstruction and impaired clearance of secretions. Bronchiectasis is associated with a wide range of disorders, but it usually results from bacterial infections, such as infections caused by the Staphylococcus or Klebsiella species (Source).

Bronchiectasis on CT

Multicystic space within the base of the left lower lobe which is continuous with the small airways and is representative of cystic bronchiectasis (source).

Try another Quiz?

chronic hypersensitive airway - bronchial asthma

hypersensitive airway aka bronchial asthma prevalence increasing worldwide especially amongst children.

environment vs genetic factors blamed for the rise.

various stimuli (allergen) can trigger bronchospasm of the hypersensitive airway.

May 5 annually is World Asthma Day

This year theme is ” YOU CAN CONTROL YOUR ASTHMA”

lastest GINA guidelines 2008 showed the following:-

replacing the following, found in their GINA 2002 guidelines

reference:-

1) http://en.wikipedia.org/wiki/Asthma

2) http://www.who.int/respiratory/asthma/en/

3) http://www.nhlbi.nih.gov/health/public/lung/index.htm#asthma

4) http://www.nationalasthma.org.au/cms/index.php

5) http://www.nationalasthma.org.au/content/view/249/639/

6) http://www.asthma.org.uk/

7) http://www.ginasthma.com/Guidelineitem.asp??l1=2&l2=1&intId=60

8) http://www.patient.co.uk/showdoc/40000622/

The Devastating Effects Of Depression When It Accompanies A Chronic Disease

The damage that co-morbid depression has on a patient’s health is greater than that caused by such chronic illnesses as diabetes, angina, asthma and arthritis, according to an article published in The Lancet. In other words, depression with diabetes is more damaging than diabetes with angina or asthma or arthritis.

Dr Somnath Chatterji, World Health Organisation (WHO), Geneva, Switzerland and team looked at data on 245,404 people from the World Health Survey (WHO). They discovered that the prevalence of a depressive episode during the previous year was 3.2% – for diabetes this figure was 2%, for arthritis 4.1%, for angina 5.4% and for asthma 3.3%.

They found that a large number of people had one or more of these chronic diseases as well as depression – between 9% to 23% of them.

They found that depression has the largest effect on worsening health compared with the other listed chronic illnesses, even after adjustments were made for socioeconomic factors and health conditions. Depression, accompanied by one or more chronic disease(s) gave patients the worst health scores – these scores did not alter much from country to country around the globe.

“The co-morbid state of depression incrementally worsens health compared with depression alone, with any of the chronic diseases alone, and with any combination of chronic diseases without depression. These results indicate the urgency of addressing depression as a public health priority to reduce disease burden and disability, and to improve the overall health of populations,” the authors wrote.

An accompanying Comment pointed out that while 80% of patients with arthritis and 90% of patients with asthma receive an acceptable standard of care, the case is nowhere near the same for depression. “In Australia, less than 30% of patients receive good treatment with anti-depressants, cognitive behavioural therapy, and proactive maintenance care. Perhaps differential access to treatment is one reason why disability is less with the physical disorders. Treatment for depression should at least be on a par with that for other chronic diseases.” The Comment was written by Professor Gavin Andrews and Dr Nickolai Titov, Clinical Research Unit for Anxiety and Depression, University of New South Wales at St Vincent’s Hospital, Sydney, Australia.

thelancet