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?