Antibiotic effect on mucus

My understanding is that azithromycin (a macrolide) helps with inflammation. Not so much as an antimicrobial. By reducing inflammation it's possible that phlegm will be reduced. It's used in those who have had frequent exacerbations (maybe 2-3 a year?) Studies show that 3 tablets MWF reduces exacerbations. You can read more here. https://pmc.ncbi.nlm.nih.gov/articles/PMC9453736/

Azithromycin is one of the big 3 treatments for NTM/MAC. So the most obvious con is that if you develop resistance to azithro and get MAC it cannot used in its treatment. In other words, it makes treating MAC more challenging. Other negatives are that it can cause stomach upset, impact hearing (ototoxicity) and prolongation of QT interval (heart related). The pros are that it can reduce exacerbations and lessen phlegm therefore improving quality of life.

Assuming it passes FDA approval Brensocatib (new drug specifically aimed at NCFB non cystic fibrosis bronchiectasis) targets neutrophil activity in the lungs and might help to reduce inflammation and phlegm. Anticipated mid 2025 in US and 2026 in Europe. 80% of NCFB is neutrophilic and 20% eosinophilic. https://journal.chestnet.org/article/S0012-3692(24)05304-2/fulltext

Another interesting drug that targets inflammation is https://ohtuvayre.com, which is aimed at the COPD population. The thought is if it helps with COPD inflammation it might also help in NCFB inflammation. It's a solution and inhaled via nebulizer.

Kudos to you that you've remained stable and infection free. Postural drainage can be challenging. Would it be possible to describe your routine?

@scoop Thank you for the detailed information. I have only read about postural drainage. My routine might not follow the exact process. I’ve never received instructions from a professional. I was using the Aerobika but found I was able to expel more mucus with the drainage / positioning body to help drain. I should start using Aerobika too, likely.
I drink a fair amount of water as this helps. I use NAC to thin out mucus.

My respirologist has said that I don’t need to nebulize or use mucinex. I have no allergies or previous lung issues. I have a fair amount of mucus but seem to be able to clear it or most of it. If I don’t clear it out by 1 or 2 pm each day, there is a heaviness in my chest. I don’t cough often during the day, otherwise. BE seems to affect everyone a little differently.

Routinely I do the postural drainage before lunch and before supper. Usually that is enough. Sometimes I cough up a bit first thing in the morning too.

I lay on my back with hands behind my head, and inhale for a count of 4 or 5. Then I exhale deeply for a count of five, engaging my diaphragm, so to speak. It produces a growling sound. It causes some rattling and I sit up and huff cough or repeat the inhale breath, hold my breath for a count of four and then huff cough. Sometimes laying to my side produces a bit more phlegm. I’ve been doing this for about 4 months.

Feedback from people about that technique would be welcomed. Maybe my technique needs to be tweaked. It would likely be difficult for some people to use this method if they have mobility or back issues.
I wonder what I’ll need to do later in life.

My condition developed after infections weren’t properly treated with antibiotics. That’s what I believe as my X-rays changed over a two year period of feeling really unwell and dealing with changing mucus issues, cough etc that doctor didn’t connect to possible lung issues. CT scan and respirologist confirmed BE. Gerd had been explored as the cause, but I have no Gerd. Well, everyone can have some acid reflux occasionally but I had nothing to warrant a diagnosis or using meds. As Sue has said, many of us likely need to be better advocates in our own health journey.
Thanks @scoop This is a helpful forum.