Bronchiectasis and lung infection

Scoop, I’m sorry, but I answered wrong about the sputum results-must have needed more coffee. One of those specimens did grow pseudomonas putida and the Penn doc offered inhaled gentamicin for 4 weeks. I declined because the count was low and I was improving by the time it came back and I discussed with doc. He was ok with watching. I also have some hearing loss and gent can cause more.
. I’d had neg cultures of the yellow stuff before I went to Mayo for diagnosis and plan and into Penn for follow up.

I’m wondering if the lighter yellowish sputum might be from different lobe areas of the lung. When I get deep huff coughs sputum is more greenish in colour. It happens whether I have a flare up or not. I assume that is from the deeper part of the lung?

That question, when addressed to 2 different pulmonologists, was met with a "maybe" - each said color TENDS to indicate possible infection activity, but not always. And when my original diagnosis of both severe pseudomonas and MAC was made, my mucus was very thick and sticky, but only a very pale yellow. That doc was surprised by the pseudomonas. And even more surprised that the MAC grew in the lab in less than 4 weeks.
On the other hand, if I get a sinus infection, my mucus is immediately dark-green/brown and smelly.
So I guess that, as with everything related to Bronchiectasis, it depends on the individual and their lungs and other ailments.

Yes Sue. I have had similar color results to yours though I don't have MAC. I was also told by several pulmos that color is not a final indicator of anything in particular unless of course it's bloody. The color also can change a lot during the course of a day.

Thanks @sueinmn The colour tends to indicate infection possibly, but it is inflammation nonetheless, I suppose. This constant inflammation is concerning but something that seems inherent with Bronchiectasis. Eating well etc and good airway clearance is the best way we can deal with it.

How do you know you have MAC or pseudomonas? I just had an xray and it didn't show any problems that were not there a few years ago. I am on prednisone now after doxycycline didn't help. I am doing much better. The phlegm was about 1 c a day a week ago but is back to 1/4c. Pulmo still says I don't need any sputum tests - he doesn't believe they do any good. So how do I know if I have MAC or pseudomonas?

Sorry to be negative about your doctor, but if you have bronchiectasis and are coughing up large amounts of sputum and you have an infection and doxycycline didn't help, you NEED a sputum culture (not just an AFB slide test) to determine exactly what bacteria is in your lungs so it can be properly treated.

Prescribing doxycycline will do nothing for the two most common bacteria to infect people with bronchiectasis - Mycobacterium Avium Complex (referred to as MAC or NTM) or pseudomonas. And probably not for staph or strep, the other two frequent culprits which tend to be doxycycline resistant when in the lungs.

A sputum culture means they do 2 specific tests on your sputum in your usual lab - to check for the presence of mycobacteria. My lab also tests for staph and strep at the same time. If either NTM or Pseudo is found, the specimen is sent to a specialty lab to be grown in an incubator for up to 8 weeks. This will show exactly what "bug" it is, and then they test to see which antibiotics have an effect on it.

Also, if you have Bronchiectasis and a lung infection, oral prednisone is not usually prescribed because it can suppress your body's natural ability to fight infection.

If your doctor doesn't understand this, it means they are not familiar with Bronchiectasis and NTM, and you will probably need to see someone else. This does not mean they are not a good doc for others, but few are experienced in treating MAC & Bronch because they are quite rare. If you cannot change pulmonologists, perhaps you can be referred to an infectious disease doc for consultation.

Do you have the option of changing doctors?

Not to put too fine a point on it, but....I was hospitalized with pneumonia in one lung and pseudomonas recently and was given Merepenem (for the pseudo) IV and high dose prednisone for wheezing and asthma response and general inflammation of lungs and recovered from that quite quickly. So to be clear, you can receive prednisone in certain cases like this. (the pseudomonas was determined by culture to be susceptible to Merepenem (sp?)

This is the best Bronchiectasis doctor in the area. He specializes in that as well as cystic fibrosis. I just changed to him after my last doctor would not order sputum test. This doctor agrees that my xrays show no problems. I have another condition called cvid, which means I get serious infections with the slightest issue (even a cut or dental work). My pulmo has to work with my immuno doctor on everything.
I tried to get a lab to take sputum and I pay for it, but can't find one that does that. Anyone know how I can get it done on my own? Apparently, the doctors don't think I need one.

Ask your immunologist to order a sputum culture for you. They love ordering tests! Not necessary to do on your own and it would be way too $$$$.

Unfortunately X-rays do not show enough detail about what's really going on in your chest. A CT scan is standard of care. Ask immunologist to order one, or suggest they speak with pulmonologist on the necessity of one, at least for baseline if you've not had one.

Regarding your earlier question about how to know if you have MAC and/or pseudo? The answers are CT scans, sputum samples and sometimes bronchoscopy.