Bronchiectasis and lung infection

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.

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?)

Is this your PCP who is on vacation?? If not ask him/her to order a sputum culture.

My pulmo returned. He took an xray, says it is clear so it is not an infection but inflammation. I still wanted a sputum test. He says there is no reason. I have an exacerbation and he is giving antibiotics and steroids and now inhaled steroids.

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?

As @sueinmn writes: “ 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. “

It really illustrates how the standard of care for patients with Bronchiectasis varies so widely. It is still considered a rare disease though one of the top lung diseases and becoming more prevalent worldwide.

Maybe a memo should go out to pulmonologists who refuse sputum tests. I thought only people like my own doctor who knew nothing of the chronic condition took those decisions.

It is such a relatively easy test for many to achieve and so critical to proper diagnosis for antibiotics, at a time when we really want to target antibiotic use.

As @sueinmn writes: “ 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. “

It really illustrates how the standard of care for patients with Bronchiectasis varies so widely. It is still considered a rare disease though one of the top lung diseases and becoming more prevalent worldwide.

Maybe a memo should go out to pulmonologists who refuse sputum tests. I thought only people like my own doctor who knew nothing of the chronic condition took those decisions.

It is such a relatively easy test for many to achieve and so critical to proper diagnosis for antibiotics, at a time when we really want to target antibiotic use.

So if I ask another doctor to do a sputum test, I don't have to tell him what to look for? I don't have to know all the possible things a sputum should test for? I just say "sputum" and that test will look for everything I need including MAC, NTM, pseudo, rsv, bacteria, hib?