1. < MAC & Bronchiectasis

Listen to Dr PJ McShane's Recent Talk on Airway Clearance!

Posted by becleartoday @becleartoday, Jul 10 2:01pm

Have you had a chance to listen to Dr PJ McShane's talk on the importance of airway clearance? I'm still reviewing it, but here are some takeaways:

MUCUS

Mucus plays a vital role in lung health. It contains mucins, which act like a sponge, absorbing water and creating a gel-like substance. This gel traps dust, germs, and toxins, protecting the airways. However, in bronchiectasis, the balance is disrupted.

The excess mucins in bronchiectasis make the mucus thicker and heavier. This overwhelms tiny hairs called cilia lining the airways. Normally, cilia act like miniature brooms, sweeping mucus upwards to be coughed out. But burdened by the dense mucus, they struggle to function effectively. This leads to mucus buildup, creating a breeding ground for infections and further inflammation.

Dr. McShane offers a reassuring message. "Scientists are working on fixing this problem based on drugs that target those receptors and target the mucin. We cannot fix that by our diet, so you're not doing anything wrong. Keep living your life. And stay tuned because science is moving forward."

THE IMPACT OF DRINKING WATER AND DAIRY ON MUCUS

"With bronchiectasis mucus becomes heavy and weighs down the epithelial cells and the cilia. So now the mucus becomes stagnant.. Don't go rushing to your refrigerator and grab a bottle of water and start drinking.

I want you to understand that if this is nothing that you're doing wrong and you can't fix this by drinking your water. In fact, if you do drink more water, you're going to lower your sodium in your blood and then you're going to have symptoms and have to go to the ER and it's going to be a nightmare. So, just drink if you're thirsty. You can't fix these abnormal abnormalities in your mucus by your diet.

Many of my patients will say that (they) shouldn't have dairy products because it increases the mucus. And I'm not sure that's 100% scientifically based. I would rather my patients, get the dairy, get the protein, get the calcium from the dairy in their diet, and understand that the abnormalities of their mucus are coming from something different than just what they eat in their diet."

COUGH

Why isn't a cough enough? Why do people living with bronchiectasis need to do daily airway clearance?

During a cough, air is expelled from the lungs at high speed, clearing the airways of irritants, mucus, or foreign particles. This forceful action can also bring up mucus from the lungs.

Furthermore, coughing relies on the elasticity of the airways to manage the increased pressure. But, in conditions like bronchiectasis, the airways lose their elasticity and do not respond normally to the pressures exerted during a cough.

According to Dr. PJ McShane, "This is why you can cough your head off to the point that you're exhausted and nothing's coming out and you don't feel like it's effective, and instead you're just getting tired. So that's where airway clearance comes in. And that's why it's so important to learn techniques you can do, other than just a simple cough."

AND THERE IS LOTS MORE!!

Enjoy,
Linda Esposito

Interested in more discussions like this? Go to the MAC & Bronchiectasis Support Group.

Moderator
Colleen Young, Connect Director | @colleenyoung | Jul 11 11:01am

Hi all, I’ve add the video to the original post. Here it is here too:

REPLY
becleartoday | @becleartoday | Jul 11 11:09am

Thank you!! I think using Tiny URL was the culprit. Will try to remember not to do that again. Linda

REPLY
liz440 | @liz440 | Jul 11 11:13am
In reply to @becleartoday "Sorry to hear that you’re dealing with tons of mucus on a daily basis. Perhaps some..." + (show)
@becleartoday

Sorry to hear that you’re dealing with tons of mucus on a daily basis. Perhaps some of the airway clearance techniques that Dr. McShane mentions could be helpful additions to your current self-care.

Best,
Linda

Jump to this post

The "tons" is normal for me because I have pseudomonas. It is worse on allergy and rain days for some reason. My airways sound clear to doctors and the nurse today and my airway clearance is very productive also.

REPLY
alleycatkate | @alleycatkate | Jul 11 11:24am

@becleartoday .... Linda, Such a wonderful video. Thanks for posting...I learned so much.
Kate

REPLY
becleartoday | @becleartoday | Jul 11 11:27am
In reply to @blm1007blm1007 "I can vouch about the amount of water and how if affects the sodium. With all..." + (show)
@blm1007blm1007

I can vouch about the amount of water and how if affects the sodium. With all the reasons that come into play later in life and as well with Bronchiectasis....the bladder releases more fluid with sodium. If I am not taking in enough sodium to replace the lost sodium I have leg and foot cramps. I watch the sodium on a daily basis and drink at least four glasses of warm water a day and soup at night. I boil purified water, my choice. This has worked for me somewhat, as I still turn out on tests to be dehydrated. The sodium count was O.K. to my understanding. Nothing mentioned of not having enough sodium. For me at 81 and 7 months I have made it a practice for years to know my body's needs as best i can. Everything is different for each of us . I also, since being diagnosed with BE, am careful with what I eat so not to weaken my immune system. Mostly plant based protein, veggies and fruits. I believe I have had BE for several years but it did not flare up with the need to clear my throat until a few years back and then in 2022 my PCDoctor felt it was time for a C Scan due to my weight loss. To date I have not had an exacerbation and waiting to know if antibiotics are going to be suggested with several positive MAI sputum results. My main problem is that I am not sure why I constantly have mucus on its own coming up into my throat and my having to clear it out...all day long. However, without medical confiration other than having a hiatal hernia, this mucus might be because of what happens with a hiatal hernia...mucus to counter acid. So hard to know in the big picture of things. Thanks Linda for your post(s).

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Hi there! I agree. It is often difficult to know the cause of mucus and although it is something we probably don't want to hear, it could be coming from multiple sources! That's why going to a center like the Mayo, National Jewish, or where I go, NYU, makes a difference. Their bronchiectasis team is multi-specialty and hopefully, the clinicians work together to figure things out.

For example, if you chronically clear your throat that causes irritation and can be a source of your body trying to protect tissues by laying down a coat of mucus. Or, it could be coming up from your lungs. Or, as you said, the hernia might be causing reflux. Also based on Dr. Huitt, the retired head of Infectious Disease at NJH, all the water you are drinking could cause reflux.

I jokingly say her name should be "Gerdtrude" instead of Gwen because she strongly believes and many at NJH still do, that reflux is a prime player in bronchiectasis as refluxate can be aspirated into the lungs and cause inflammation and infection.

She would suggest patients only consume 6 ounces of liquid (this includes shakes, fruits, vegetables and soups) per hour. Her fear was that larger consumption of liquids would slosh into the esophagus and cause reflux and perhaps be aspirated. Dr Huitt suggested that if we must drink more than 6 ounces, to eat a piece of bread, some pretzels or a similar carb to absorb the liquid and keep it in the stomach.

I am a health educator and not a clinician so before you change your current practices, consult your medical team. This is just food for thought and discussion points.

Here is one of my favorite Dr Huitt talks:


BE well,
Linda Esposito

REPLY
3 replies
blm1007blm1007 | @blm1007blm1007 | Jul 11 2:28pm
In reply to @becleartoday "Hi there! I agree. It is often difficult to know the cause of mucus and although..." + (show)
@becleartoday

Hi there! I agree. It is often difficult to know the cause of mucus and although it is something we probably don't want to hear, it could be coming from multiple sources! That's why going to a center like the Mayo, National Jewish, or where I go, NYU, makes a difference. Their bronchiectasis team is multi-specialty and hopefully, the clinicians work together to figure things out.

For example, if you chronically clear your throat that causes irritation and can be a source of your body trying to protect tissues by laying down a coat of mucus. Or, it could be coming up from your lungs. Or, as you said, the hernia might be causing reflux. Also based on Dr. Huitt, the retired head of Infectious Disease at NJH, all the water you are drinking could cause reflux.

I jokingly say her name should be "Gerdtrude" instead of Gwen because she strongly believes and many at NJH still do, that reflux is a prime player in bronchiectasis as refluxate can be aspirated into the lungs and cause inflammation and infection.

She would suggest patients only consume 6 ounces of liquid (this includes shakes, fruits, vegetables and soups) per hour. Her fear was that larger consumption of liquids would slosh into the esophagus and cause reflux and perhaps be aspirated. Dr Huitt suggested that if we must drink more than 6 ounces, to eat a piece of bread, some pretzels or a similar carb to absorb the liquid and keep it in the stomach.

I am a health educator and not a clinician so before you change your current practices, consult your medical team. This is just food for thought and discussion points.

Here is one of my favorite Dr Huitt talks:


BE well,
Linda Esposito

Jump to this post

Thank you Linda. I had not seen this particular one with Dr. Huitt. What was interesting in the one I did see with her giving a talk....she was on reflux medications for a long period and then realized the negative sides of its usage and stopped using it. So, obviously we all learn our lessons, including fine doctors like Dr. Huitt. So sorry she retired. For myself, I turned down the meds for acid reflux due to all I read before seeing her video that mentioned her experience. I was at NJH 7/2023 and now go to Tyler. I'm a Jersey born but have lived in OKC most of my adult life. NYC now has a good couple of resources for those of us with BE...so if I have to move back to Jersey I know where to go. Thanks for the info about eating bread etc. after drinking water etc. I was told not to do it, drink water, late before bed nor when I wake up at night (Per Dr. L at NJH) due to acid reflux and have not been doing that, however, water, water ,water during the day. SO...I will be sure to have something to absorb the water during the day and hope there will be a difference. THANKS for making me realize what I didn't get, understand what needed to be done. Also the McShane video was needed by me. Another Thanks. You also, be well! Barbara Minkoff

REPLY
blm1007blm1007 | @blm1007blm1007 | Jul 11 5:43pm
In reply to @becleartoday "Hi there! I agree. It is often difficult to know the cause of mucus and although..." + (show)
@becleartoday

Hi there! I agree. It is often difficult to know the cause of mucus and although it is something we probably don't want to hear, it could be coming from multiple sources! That's why going to a center like the Mayo, National Jewish, or where I go, NYU, makes a difference. Their bronchiectasis team is multi-specialty and hopefully, the clinicians work together to figure things out.

For example, if you chronically clear your throat that causes irritation and can be a source of your body trying to protect tissues by laying down a coat of mucus. Or, it could be coming up from your lungs. Or, as you said, the hernia might be causing reflux. Also based on Dr. Huitt, the retired head of Infectious Disease at NJH, all the water you are drinking could cause reflux.

I jokingly say her name should be "Gerdtrude" instead of Gwen because she strongly believes and many at NJH still do, that reflux is a prime player in bronchiectasis as refluxate can be aspirated into the lungs and cause inflammation and infection.

She would suggest patients only consume 6 ounces of liquid (this includes shakes, fruits, vegetables and soups) per hour. Her fear was that larger consumption of liquids would slosh into the esophagus and cause reflux and perhaps be aspirated. Dr Huitt suggested that if we must drink more than 6 ounces, to eat a piece of bread, some pretzels or a similar carb to absorb the liquid and keep it in the stomach.

I am a health educator and not a clinician so before you change your current practices, consult your medical team. This is just food for thought and discussion points.

Here is one of my favorite Dr Huitt talks:


BE well,
Linda Esposito

Jump to this post

Linda - Regarding Dr. Heuitt and NJH "strongly believes and many at NJH still do, that reflux is a prime player in bronchiectasis as refluxate can be aspirated into the lungs and cause inflammation and infection." This is probably the reason they (NJH) involve the gastroenterologist and the various tests he does to see if anything shows that might indicate reflux. For a good couple of years prior to my BE diagnosis I was waking up with a burning tongue and thought acid was the cause and didn't know why it was happening. It did not happen during the day. BE diagnosis was diagnosed 8/2022 OKC and Hiatal Hernia 10/2023 during my first visit at NJH. To me and knowing my history this does make sense about reflux and BE. I am following the Acid Reflux precautions. However I failed on the intake of bread etc. for water absorbtion in the stomach. I do not wake up with burning tongue any longer and hope with adding more items to intake just before taking in liquid, it will help with the mucus. Thanks Linda

REPLY
nick52 | @nick52 | Jul 12 10:20am
In reply to @spider109 "Sorry Linda, I have the address i believe to see Dr. Mcshanes presentation on You Tube..." + (show)
@spider109

Sorry Linda, I have the address i believe to see Dr. Mcshanes presentation on You Tube but can’t seem to navigate it to get it so I can view it. It’s always so helpful to get ANY information or practices that can help us with this awful condition. Can you take the time to explain to me how to watch the presentation? Sorry I’m not that technological savvy. Thank-you in advance.

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I was dealing with tons of cough and mucus for 6 months. They did a broncoscopy and the results of my culture revealed that I had 2 kinds of pseudomonas. I am on intravenous Taxocin and cypro by mouth. My 3rd day on antibiotic and I hardly cough and very few mucus spitting. Today no coughing and spitting so far. I will give you feedback on the overcome of the treatment!

REPLY
liangni1 | @liangni1 | Jul 13 4:16pm
In reply to @becleartoday "Hi there! I agree. It is often difficult to know the cause of mucus and although..." + (show)
@becleartoday

Hi there! I agree. It is often difficult to know the cause of mucus and although it is something we probably don't want to hear, it could be coming from multiple sources! That's why going to a center like the Mayo, National Jewish, or where I go, NYU, makes a difference. Their bronchiectasis team is multi-specialty and hopefully, the clinicians work together to figure things out.

For example, if you chronically clear your throat that causes irritation and can be a source of your body trying to protect tissues by laying down a coat of mucus. Or, it could be coming up from your lungs. Or, as you said, the hernia might be causing reflux. Also based on Dr. Huitt, the retired head of Infectious Disease at NJH, all the water you are drinking could cause reflux.

I jokingly say her name should be "Gerdtrude" instead of Gwen because she strongly believes and many at NJH still do, that reflux is a prime player in bronchiectasis as refluxate can be aspirated into the lungs and cause inflammation and infection.

She would suggest patients only consume 6 ounces of liquid (this includes shakes, fruits, vegetables and soups) per hour. Her fear was that larger consumption of liquids would slosh into the esophagus and cause reflux and perhaps be aspirated. Dr Huitt suggested that if we must drink more than 6 ounces, to eat a piece of bread, some pretzels or a similar carb to absorb the liquid and keep it in the stomach.

I am a health educator and not a clinician so before you change your current practices, consult your medical team. This is just food for thought and discussion points.

Here is one of my favorite Dr Huitt talks:


BE well,
Linda Esposito

Jump to this post

Thank so much for sharing this video,very helpful!

REPLY
mruskin | @mruskin | Jul 13 5:02pm

Most helpful presentation I've heard thus far but i still want more specifics - I was essentially given a vest and a nebulizer and sent on my way. No context, no instruction from doctor or vendor on how to use optimally. Pretty much figured out on my own but clearly there's more I could/should be doing based on this presentation. One question: I noticed she does not prescribe Mucinex which is one thing my dr. recommended daily? I am hesitant to take anything i don't have to and have been avoiding.

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