I think that we need to think about awareness by providers as an exercise in probabilities.

When it comes to lung conditions, depending on age, symptoms and general health, the most common causes are considered and treated first - in order of commonality, these would be virus, bacterial infection, allergy, asthma, sinusitis or GERD causing drainage to the lungs, COPD, Emphysema or chronic bronchitis and lung cancer, each of which affects millions of people in the US, and is seen daily by primary providers. These are the conditions that should be top-of-mind when they see patients.

Way down the list, each affecting one-half million people or fewer, would be Bronchiectasis, Pulmonary Fibrosis and Cystic Fibrosis. That is where specialists come in - they have the training to diagnose and treat these rare conditions.

Just to put a number on it, there are an estimated 350,000-500,000 with Bronchiectasis in the US and about 100,000 or so with NTM. In comparison, there are 25 million with Asthma, and about 15 million each with COPD or Emphysema/chronic bronchitis.

Primary medical care is too overwhelmed and understaffed to expect them to know everything, or even to have the time to learn and use every diagnostic tool or medical article that comes along.

I think where the under-diagnosis comes in is with primary providers who are reluctant to order more diagnostics (insurance issue) or to recognize they need another set of eyes, or with practices that are afraid of insurers and their response to "too many referrals", or patients who resist referral due to costs or the hassle of getting appointments.

There are no easy answers here, but adding more to the primary care burden is just not likely to be fruitful.