Question

Many conditions of the airways feature common symptoms, caused by divergent mechanisms that underpin what for all intents and purposes can be identical symptoms to the untrained eye. Compare and contrast asthma to the following:

1- Tuberculosis

2- Interstitial lung disease

3- Hypersensitivity reactions

List their causes, discuss the clinical presentation of each condition, explain the innate and adaptive immunological status underpinning each disease, and outline the current and emerging options for therapy.

Answer 1

Asthma is a reactive airway disease ,where the inflammation of airway leads to mucus production and bronchospasam leading to reversible obstructive lung disease.

Where as Tuberculosis is a disease caused by a bacteria known as mycobacterium tuberculosis or other mycobacterium species. Asthma will only affect lungs but TB can occur to any part of the body.

ILD which is disease also known as restrictive lung disease which causes fibrotic changes in the lung and the cause is unknown.

Hypersensitive reaction is an allergic reaction that causes inflammation (swelling and tenderness) in and around the air sacs (alveoli) of the lungs and the smallest airways (bronchioles).

1.TUBERCULOSIS

Its a bacterial infection mainly affecting lungs but can occur anywhere in the body.
causes and risk factors

-caused by bacteria called mycobacterium tuberculosis

-Risk factors include :-

-Smoking

-Immunocompromised state eg patients having HIV, Diabetes etc

-Poor hygiene and stay in crouded community

-Health care worker

-low body weight and poor nutrition.

clinical presentation

-Cough

-Fever mostly evenings

-Weight loss

-Chest pain

-Breathless

-loss of appetite

-night sweats

-Weakness

Immunological status

The innate immune cell types involved in tuberculosis are macrophages, dendritic cells ,neutrophils and natural killer cells. These immune cells recognize the TB-causing pathogen and destroy it.The adaptive immune response to M. tuberculosis in the lungs is delayed and has limited efficacy.

Treatment

ATT ( anti tuberculine drugs)

First line anti tuberculine drugs include

-Isoniazid

-Rifampicin

-Ethambutol

-Pyrazinamide

Second line ATT

-levofloxacin

- moxifloxacin

-bedaquiline

- delamanid

- linezolid.

-ethionamide

-amikacin

-streptomycin

2.ILD

Its an idiopathic disease leading to inflammation and sebsequent fibrosis to lung parenchyma leading to hypoxia and breathlessness.

Causes and risk factors

cause is unknown

risk factors can be :-

-increased age

-Smoking

-Familial

-Mucin gene MUC5B

-Telomerase + surfactant mutation

clinical presentation

-Progressive dysponea

-Non productive cough

-Dry velcro crackles on auscultation

-Clubbing of nails

-Cyanosis

Immunological status

not specific as its not a pathological disease

Treatment

-No proven therapy

-Oxygen supply for dyspnoea

-Lung transplantation

-Few responds to steroid therapy.

3.Hypersensitivity

Its a lung disease causing inflammation of the lung tissue causing breathing difficultly and which lead to irreversible lung scarring over time.

Causes and risk factors

-Allergents like dust, pollen ,fume ,spray , pets etc

Risk factors

-Farmers, including those working with dairy cattle or vegetables

-Animal handlers

-People who work in flour mills or wood mills

-Wallboard and paper manufacturers

-plastic manufacturing, and painting industries

certain factors can also cause which includes inhalation of

-Bacteria

-Molds and fungi

-Some chemicals

-Certain proteins

clinical presentation

-Shortness of breath

-Dry cough

-Weight loss

-Chest tightness

-Chills

-Fatigue

-Fever

Treatment

-Avoid allergents

-Antihistamine

-Antibiotics if infection and fever

-immunosuppressant

-Bronchodilator in case of breathlessness