FIELD OF THE INVENTION
[001] The present invention relates to the field of medical science, and more particularly, the present invention relates to the uncommon etiology of chronic wheeze.

BACKGROUND FOR THE INVENTION:
[002] The following discussion of the background to the invention is intended to facilitate an understanding of the present invention. However, it should be appreciated that the discussion is not an acknowledgment or admission that any of the material referred to was published, known, or part of the common general knowledge in any jurisdiction as of the priority date of the application. The details provided herein the background if belongs to any publication is taken only as a reference for describing the problems, in general terminologies or principles or both of science and technology in the associated prior art.
[003] Endobronchial tuberculosis (TB) alludes to tuberculous contamination of the tracheobronchial tree. The diagnosis of such disease is difficult because usually chest radiograph is normal. Computed tomography (CT) and bronchoscopy are the sole tools of diagnosing this disease. The treatment of this disease remains the same as pulmonary TB. However, utmost care should be taken to prevent tracheobronchial stenosis or obstruction.
[004] The available diagnosismethods are not economical, accurate, and time efficient. Further, the available diagnosismethods are not patient-friendly as these diagnosismethods take time to respond. Some of the systems are not effectively used for patients with endobronchial tuberculosis (TB) patients. Also, the available diagnosismethods are provided with the wrong disease assumptions, which may mislead the treatment.
[005] Although there are a number of solutions in the form of endobronchial tuberculosis (TB) diagnosismethods, none of them are specially designed with an accurate diagnosis. Although, some of the prior existing solutions attempt to create reliable and economical endobronchial tuberculosis (TB) diagnosis methods, this solution fails to meet the user’s requirement. In view of the above prior art, it can be understood that many endobronchial tuberculosis (TB) diagnosis methods have been designed in an attempt to provide similar solutions, however, they are bulky, expensive, and inefficient.
[006] In light of the foregoing, there is a need for the uncommon etiology of chronic wheezethat overcomes problems prevalent in the prior art.

OBJECTS OF THE INVENTION:
[007] Some of the objects of the present disclosure, which at least one embodiment herein satisfies, are as follows.
[008] The principal object of the present invention is to overcome the disadvantages of the prior art by providing an uncommon etiology of chronic wheeze.
[009] An object of the present invention is to provide an uncommon etiology of chronic wheeze, wherein the differential diagnosis must include airway pathology such as endobronchial TB, especially when they are unresponsive to usual therapy.
[010] Another object of the present invention is to provide an uncommon etiology of chronic wheeze, wherein there is no difference in the treatment of endobronchial TB from normal pulmonary TB.
[011] Yet another object of the present invention is to provide an uncommon etiology of chronic wheeze, wherein corticosteroids slowdowns fibrosis and decrease the chances of development of stenosis.
[012] Yet another object of the present invention is to provide an uncommon etiology of chronic wheeze, wherein if a patient has developed stenosis leading to complications, the patency of airways must be made surgically or by bronchoscopically.
[013] Other objects and advantages of the present disclosure will be more apparent from the following description, which is not intended to limit the scope of the present disclosure.

SUMMARY OF THE INVENTION:
[014] The present invention relates to the uncommon etiology of chronic wheeze.
[015] According to one aspect of our invention, systemic examination of a patient with endobronchial TB can reveal decreased breath sounds, rhonchi, or wheezing. The wheeze is usually low pitched, monophonic, and constant.
[016] In another aspect of the invention, as endobronchial lesions need not warrant extensive involvement of lung parenchyma, a normal chest radiograph is observed in 10%–20% of cases.
[017] In another aspect of the invention, in such cases, CT scanning may demonstrate endobronchial lesions or stenosis and rarely fistulas. The foremost common radiographic finding of endobronchial TB is an upper-lobe consolidation with cavitation.
[018] In another aspect of the invention, in patients having primary TB presenting as endobronchial TB, segmental atelectasis is usually seen. Lung collapse is more frequent in the right middle lobe and the anterior segment of the right upper lobe.
[019] In another aspect of the invention, the diagnosis of endobronchial TB is established by bronchoscopy; findings may include edematous hyperemic lesions (with or without ulceration or fibrosis) or nonspecific bronchitis.
[020] In another aspect of the invention, caseous material or narrowing of bronchial lumen may be visualized. The presence of edema, increasedredness, and caseation can eventually lead to bronchial stenosis or obstruction. This can occur even when ATT has beenstarted. Taking brush smears or bronchoalveolar lavage can clinch the diagnosis.
[021] In another aspect of the invention, there is no difference in the treatment of endobronchial TB from normal pulmonary TB. Corticosteroids slowdowns fibrosis and decrease the chances of development of stenosis.
[022] In another aspect of the invention, if a patient has developed stenosis leading to complications, the patency of airways must be made surgically or by bronchoscopically. Our patient did not require any surgery. She improved with anti tubercular therapy.

BRIEF DESCRIPTION OF DRAWINGS:
[023] Reference will be made to embodiments of the invention, examples of which may be illustrated in accompanying figures. These figures are intended to be illustrative, not limiting. Although the invention is generally described in the context of these embodiments, it should be understood that it is not intended to limit the scope of the invention to these particular embodiments.
[024] Figure 1shows a Chest X-ray of the patient at presentationin accordance with the present invention.
[025] Figure 2shows a Bronchoscopic view showing biopsy being taken from growth in tracheain accordance with the present invention.
[026] Figure 3shows a Bronchoscopic view of airways after 6 months of antitubercular therapyin accordance with the present invention.

DETAILED DESCRIPTION OF DRAWINGS:
[027] While the present invention is described herein by way of example using embodiments and illustrative drawings, those skilled in the art will recognize that the invention is not limited to the embodiments of drawing or drawings described and are not intended to represent the scale of the various components. Further, some components that may form a part of the invention may not be illustrated in certain figures, for ease of illustration, and such omissions do not limit the embodiments outlined in any way. It should be understood that the drawings and the detailed description thereto are not intended to limit the invention to the particular form disclosed, but on the contrary, the invention is to cover all modifications, equivalents, and alternatives falling within the scope of the present invention as defined by the appended claim.
[028] As used throughout this description, the word "may" is used in a permissive sense (i.e. meaning having the potential to), rather than the mandatory sense, (i.e. meaning must). Further, the words "a" or "an" mean "at least one” and the word “plurality” means “one or more” unless otherwise mentioned. Furthermore, the terminology and phraseology used herein are solely used for descriptive purposes and should not be construed as limiting in scope. Language such as "including," "comprising," "having," "containing," or "involving," and variations thereof, is intended to be broad and encompass the subject matter listed thereafter, equivalents, and additional subject matter not recited, and is not intended to exclude other additives, components, integers, or steps. Likewise, the term "comprising" is considered synonymous with the terms "including" or "containing" for applicable legal purposes. Any discussion of documents, acts, materials, devices, articles, and the like are included in the specification solely for the purpose of providing a context for the present invention. It is not suggested or represented that any or all these matters form part of the prior art base or were common general knowledge in the field relevant to the present invention.
[029] In this disclosure, whenever a composition or an element or a group of elements is preceded with the transitional phrase “comprising”, it is understood that we also contemplate the same composition, element, or group of elements with transitional phrases “consisting of”, “consisting”, “selected from the group of consisting of, “including”, or “is” preceding the recitation of the composition, element or group of elements and vice versa.
[030] The present invention is described hereinafter by various embodiments with reference to the accompanying drawing, wherein reference numerals used in the accompanying drawing correspond to the like elements throughout the description. This invention may, however, be embodied in many different forms and should not be construed as limited to the embodiment set forth herein. Rather, the embodiment is provided so that this disclosure will be thorough and complete and will fully convey the scope of the invention to those skilled in the art. In the following detailed description, numeric values and ranges are provided for various aspects of the implementations described. These values and ranges are to be treated as examples only and are not intended to limit the scope of the claims. In addition, several materials are identified as suitable for various facets of the implementations. These materials are to be treated as exemplary and are not intended to limit the scope of the invention.
[031] The present invention relates to the uncommon etiology of chronic wheeze.
[032] Endobronchial tuberculosis (TB) refers to TB infection of the tracheobronchial tree. We report the case of a 62 year old immunocompetent patient of chronic cough with normal X ray. She did not have any systemic complaints suggestive of TB. Her diagnosis was made when she underwent bronchoscopy to look for any endobronchial cause of cough. It revealed complete caseation in the airways. Microscopically and pathologically, it was confirmed to be tubercular. The patient improved clinically on antitubercular therapy.
[033] A 62 year old, nonsmoker, nondiabetic, hypertensive female presented to our outpatient department (OPD) with complaints of dry cough and progressively increasing dyspnea for 3–4 months. There were no complaints of fever, chest pain, decreased appetite, or weight loss associated with it. General physical examination was normal. Respiratory system examination was normal except for the harsh vesicular breath sounds and wheezing present bilaterally. It was more in the mammary and infrascapular regions. Routine blood examinations were also normal. Chest X-ray was within normal limits as shown in Figure 1. Spirometry with reversibility showed moderate obstruction with reversibility. Her ENT examination was also unremarkable. The patient was started on inhaled glucocorticosteroid plus long-acting beta-2 agonist considering the possibility of late-onset bronchial asthma. After 1month, she came for follow up in OPD.
[034] She reported improvement in dyspnea, but cough worsened. There was no improvement in examination finding of wheezing and the presence of harsh vesicular breath sounds. She was admitted to the hospital for further evaluation. Considering the possibility of tracheomalacia, she was started on continuous positive airway pressure (CPAP) of 7 cmH2 O. After application of CPAP, her chest was clear on auscultation, and she reported improvement in cough. Abronchoscopy was done to confirm tracheomalacia. Thick white patches were seen in the lower part of the trachea and carina, with slight distortion of the carina, a small globular growth near the carina, and narrowing of the right upper-lobe bronchus in addition to tracheomalacia [Figure 2]. Bronchoalveolar lavage (BAL) was taken from the right upper lobe. Brush smear and biopsy were done and sent for investigation. BAL report showed acid-fast bacilli and brush smear cytology, and biopsy also revealed tubercular pathology. She was started on antitubercular treatment(ATT) along with the continuation of CPAP support. She improved symptomatically and tolerated ATT well. She was discharged on ATT and CPAP support at home. On follow up after 1month, she improved symptomatically with marked improvement in cough. There were no harsh vesicular breath sounds and rhonchi heard on auscultation. CPAP was also stopped. She was given four drugs, namely rifampicin,isoniazid, ethambutol, and pyrazinamide in intensive phase for 2 months and three drugs, namely rifampicin, isoniazid, and ethambutol in continuation phase for 4 months. At the end of 6 months, repeat bronchoscopy showed marked improvement with complete resolution of all lesions[Figure 3].
[035] Endobronchial TB is caused in the bronchus either directly from a nearby infection of lung parenchyma or by the sputum which is infectious. Usually, the main and upper bronchi are involved, while the lower trachea is involved very rarely. It usually affects females in middle and elderly ages. Our patient was also an elderly lady. Patients suffering from endobronchial TB complain of cough with sputum production, chest torment, blood in sputum, laziness, fever, and difficulty in breathing. These may be acute in onset. The differential diagnosis can vary from pneumonia caused by bacteria to asthma, or foreign body aspiration. The clinical presentation can be subtle too, resembling lung cancer. Our patient never had fever and hence the infectious cause of her cough was not considered. A barking cough has been described in roughly two-thirds of patients with endobronchial illness, regularly went with by sputum generation. Seldom, patients develop bronchorrhea, which is generation of >500 mL/day of sputum. In a few cases, caseous substance from endobronchial injuries or calcific substance from the expansion of calcific nodes into the bronchi is expectorated, which is known as lithoptysis. Patients may also complain of blood in sputum and wheezing. Patients can develop acute pain in the chest which can be due to rupture of lymph node. If a patient complains of difficulty in breathing, one must suspect lung collapse or any obstruction. Our patient only had complaints of cough and wheezing. Systemic examination of a patient with endobronchial TB can reveal decreased breath sounds, rhonchi, or wheezing. The wheeze is usually low pitched, monophonic, and constant. Our patient had monophonic wheeze. As endobronchial lesions need not warrant extensive involvement of lung parenchyma, a normal chest radiograph is observed in 10%–20% of cases. In such cases, CT scanning may demonstrate endobronchial lesions or stenosis and rarely fistulas. The foremost common radiographic finding of endobronchial TB is an upper-lobe consolidation with cavitation. This may spread to ipsilateral lower lobe. In patients having primary TB presenting as endobronchial TB, segmental atelectasis is usually seen. Lung collapse is more frequent in the right middle lobe and the anterior segment of the right upper lobe. The chest X-ray of our patient was normal. The diagnosis of endobronchial TB may be established by bronchoscopy; findings may include edematous hyperemic lesions (with or without ulceration or fibrosis) or nonspecific bronchitis. Caseous material or narrowing of bronchial lumen may be visualized. The presence of edema, increasedredness, and caseation can eventually lead to bronchial stenosis or obstruction. This can occur even when ATT has beenstarted. Taking brush smears or bronchoalveolar lavage can clinch the diagnosis.
[036] There is no difference in the treatment of endobronchial TB from normal pulmonary TB. Corticosteroids may slow down fibrosis and decrease the chances of development of stenosis. However, if a patient has developed stenosis leading to complications, the patency of airways must be made surgically or by bronchoscopically. Our patient did not require any surgery. She improved with anti tubercular therapy.
[037] “All that wheezes is not asthma” should always be kept in mind when patients present with a wheeze. The differential diagnosis must include airway pathology such as endobronchial TB, especially when they are unresponsive to usual therapy.
[038] The disclosure has been described with reference to the accompanying embodiments herein and the various features and advantageous details thereof are explained with reference to the non-limiting embodiments in the following description. Descriptions of well-known components and processing techniques are omitted so as to not unnecessarily obscure the embodiments herein.
[039] The foregoing description of the specific embodiments so fully revealed the general nature of the embodiments herein that others can, by applying current knowledge, readily modify and/or adapt for various applications such specific embodiments without departing from the generic concept, and, therefore, such adaptations and modifications should and are intended to be comprehended within the meaning and range of equivalents of the disclosed embodiments. It is to be understood that the phraseology or terminology employed herein is for the purpose of description and not of limitation. Therefore, while the embodiments herein have been described in terms of preferred embodiments, those skilled in the art will recognize that the embodiments herein can be practiced with modification within the scope of the embodiments as described herein.

We Claim:

1) An uncommon etiology of chronic, wherein systemic examination of a patient with endobronchial TB is revealed decreased breath sounds, rhonchi, or wheezing; and
wherein the wheeze is usually low pitched, monophonic, and constant.
2) The wheezeas claimed in claim 1, whereinas endobronchial lesions need not warrant extensive involvement of lung parenchyma, a normal chest radiograph is observed in 10%–20% of cases.
3) The wheeze as claimed in claim 1, wherein CT scanning demonstrates endobronchial lesions or stenosis and rarely fistulas and the foremost common radiographic finding of endobronchial TB is an upper-lobe consolidation with cavitation.
4) The wheeze as claimed in claim 1, whereinin patients having primary TB presenting as endobronchial TB, segmental atelectasis is usually seen andlung collapse is more frequent in the right middle lobe and the anterior segment of the right upper lobe.
5) The wheeze as claimed in claim 1, whereinthe diagnosis of endobronchial TB is established by bronchoscopy; findings may include edematous hyperemic lesions (with or without ulceration or fibrosis) or nonspecific bronchitis.
6) The wheeze as claimed in claim 1, whereincaseous material or narrowing of bronchial lumen may be visualized andthe presence of edema, increased redness, and caseation can eventually lead to bronchial stenosis or obstruction when ATT has been started.
7) The wheeze as claimed in claim 1, whereinthere is no difference in the treatment of endobronchial TB from normal pulmonary TB.
8) The wheeze as claimed in claim 1, whereinthe corticosteroids slowdowns fibrosis and decrease the chances of development of stenosis.
9) The wheeze as claimed in claim 1, whereinif a patient has developed stenosis leading to complications, the patency of airways must be made surgically or by bronchoscopically.
10) The wheeze as claimed in claim 1, wherein corticosteroids slowdowns fibrosis and decrease the chances of development of stenosis.