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

I use an Aerobika and have added the Active Cycle of Breathing. Is it best to do the ACB first or use the device first? Does it matter? Thanks!

Hi Linda,

Thank for posting this highly informative video. I learned a lot from Dr. McShane, but my own experience contradicts her view on diet and water not being important elements of treatment. I, for one, cannot do saline 7% nebulizing as she recommends so that is one treatment that doesn't work for me. I have a history of TB in my youth and had a massive hemoptysis event in 2012 at age 60 related to the damage my lungs had suffered as a young person. I almost died. I don't trust coughing a lot because one of the causes of hemoptysis is trauma to the lungs and any forceful air clearance approaches that threshold. I wasn't diagnosed with bronchiectasis until a year ago when for the first time (except for the massive hemoptysis) I started to have small bleeding episodes. I also suddenly started to have choking fits a couple of hours after I ate a hefty meal and little by little I realized that by modulating my diet--namely eating soups exclusively, and drinking a lot of hot water through th day, I could avert the choking episodes and the bleeding. I take a liquid mineral supplement to make up for the sodium loss b/c of the copious amounts of water I consume, and my last lab tests after following this protocol for a year said my minerals were normal. I also put miso in most of my soups.

I struggle every day but keeping a rigorous journal of the food I consume for over a year now, and how my lungs react to eating and drinking habits have clearly shown that those modifications have been very helpful for someone with my profile. I researched foods assiduously as I used to be a vegan and realized that I couldn't continue that diet because of the quantity of food one must consume to be a healthy vegan. It took a lot of trial and error, but I now have a good 70 grams of protein every day eating mostly vegetarian soups with bone broth at most meals as the base of my meal, and sardines or salmon in my soup once a week. I still struggle with caloric sufficiency and I continue to learn how to manage my sputum with the other techniques: autogenic drainage, active cycle of breathing, exercise (for me, yoga, dancing, walking (and Aerobika, which I am only adjusting to now b/c it tends to make me light-headed and I can't do it much yet.

I am so grateful that so many times, when I have very specifically felt a mucus plug in my right upper lung that is forcing me to cough, I can actually dissolve it with a lot of really warm water that I sit and drink patiently until the "crisis" passes. The plug I had felt minutes before disappears as the water somehow reached deep inside. I really don't know exactly how that works, but it does. I thought I would share this b/c after all this self-monitoring there is no doubt in my mind that a dense diet like I used to have creates a lot more sludge in my airways and that more liquidy foods and lots of warm water helps dilute these secretions significantly.

Hi Linda,

Thank for posting this highly informative video. I learned a lot from Dr. McShane, but my own experience contradicts her view on diet and water not being important elements of treatment. I, for one, cannot do saline 7% nebulizing as she recommends so that is one treatment that doesn't work for me. I have a history of TB in my youth and had a massive hemoptysis event in 2012 at age 60 related to the damage my lungs had suffered as a young person. I almost died. I don't trust coughing a lot because one of the causes of hemoptysis is trauma to the lungs and any forceful air clearance approaches that threshold. I wasn't diagnosed with bronchiectasis until a year ago when for the first time (except for the massive hemoptysis) I started to have small bleeding episodes. I also suddenly started to have choking fits a couple of hours after I ate a hefty meal and little by little I realized that by modulating my diet--namely eating soups exclusively, and drinking a lot of hot water through th day, I could avert the choking episodes and the bleeding. I take a liquid mineral supplement to make up for the sodium loss b/c of the copious amounts of water I consume, and my last lab tests after following this protocol for a year said my minerals were normal. I also put miso in most of my soups.

I struggle every day but keeping a rigorous journal of the food I consume for over a year now, and how my lungs react to eating and drinking habits have clearly shown that those modifications have been very helpful for someone with my profile. I researched foods assiduously as I used to be a vegan and realized that I couldn't continue that diet because of the quantity of food one must consume to be a healthy vegan. It took a lot of trial and error, but I now have a good 70 grams of protein every day eating mostly vegetarian soups with bone broth at most meals as the base of my meal, and sardines or salmon in my soup once a week. I still struggle with caloric sufficiency and I continue to learn how to manage my sputum with the other techniques: autogenic drainage, active cycle of breathing, exercise (for me, yoga, dancing, walking (and Aerobika, which I am only adjusting to now b/c it tends to make me light-headed and I can't do it much yet.

I am so grateful that so many times, when I have very specifically felt a mucus plug in my right upper lung that is forcing me to cough, I can actually dissolve it with a lot of really warm water that I sit and drink patiently until the "crisis" passes. The plug I had felt minutes before disappears as the water somehow reached deep inside. I really don't know exactly how that works, but it does. I thought I would share this b/c after all this self-monitoring there is no doubt in my mind that a dense diet like I used to have creates a lot more sludge in my airways and that more liquidy foods and lots of warm water helps dilute these secretions significantly.

Hi Linda,

Thank for posting this highly informative video. I learned a lot from Dr. McShane, but my own experience contradicts her view on diet and water not being important elements of treatment. I, for one, cannot do saline 7% nebulizing as she recommends so that is one treatment that doesn't work for me. I have a history of TB in my youth and had a massive hemoptysis event in 2012 at age 60 related to the damage my lungs had suffered as a young person. I almost died. I don't trust coughing a lot because one of the causes of hemoptysis is trauma to the lungs and any forceful air clearance approaches that threshold. I wasn't diagnosed with bronchiectasis until a year ago when for the first time (except for the massive hemoptysis) I started to have small bleeding episodes. I also suddenly started to have choking fits a couple of hours after I ate a hefty meal and little by little I realized that by modulating my diet--namely eating soups exclusively, and drinking a lot of hot water through th day, I could avert the choking episodes and the bleeding. I take a liquid mineral supplement to make up for the sodium loss b/c of the copious amounts of water I consume, and my last lab tests after following this protocol for a year said my minerals were normal. I also put miso in most of my soups.

I struggle every day but keeping a rigorous journal of the food I consume for over a year now, and how my lungs react to eating and drinking habits have clearly shown that those modifications have been very helpful for someone with my profile. I researched foods assiduously as I used to be a vegan and realized that I couldn't continue that diet because of the quantity of food one must consume to be a healthy vegan. It took a lot of trial and error, but I now have a good 70 grams of protein every day eating mostly vegetarian soups with bone broth at most meals as the base of my meal, and sardines or salmon in my soup once a week. I still struggle with caloric sufficiency and I continue to learn how to manage my sputum with the other techniques: autogenic drainage, active cycle of breathing, exercise (for me, yoga, dancing, walking (and Aerobika, which I am only adjusting to now b/c it tends to make me light-headed and I can't do it much yet.

I am so grateful that so many times, when I have very specifically felt a mucus plug in my right upper lung that is forcing me to cough, I can actually dissolve it with a lot of really warm water that I sit and drink patiently until the "crisis" passes. The plug I had felt minutes before disappears as the water somehow reached deep inside. I really don't know exactly how that works, but it does. I thought I would share this b/c after all this self-monitoring there is no doubt in my mind that a dense diet like I used to have creates a lot more sludge in my airways and that more liquidy foods and lots of warm water helps dilute these secretions significantly.

Paxmundi, so you do not have MAC but you do have bronchiectasis. I also understand that you do not need to cough because of you diet. So the soups are just liquid, no veggies? How do you manage, I am sorry to ask, the bowel movement. It’s just interesting and strange but if it works for you, it’s what you do yes?

TO: paxmundi and all who wish to read the posts in our Mayo Clinic Connect to explain our experiences.

paxmundi: Much of what you have said I found my way to it in the last year since finding out I have BE (Bronchiectasis) and MAC/MAI bacteria.
DIET: I was not able to put weight on until I realized my decision to eat more of a vegan diet was not helping me to put weight on and increase my BMI (Body Mass Index). Since going back to a moderate amount of typical protein intake etc. I have gone from 94lbs to 105lbs. so far. I also think it might be related to the possibility of my having less MAI showing up in my sputum sent in, hope so.
I also, early on, decided upon soups and salad for evening meal with the broth being a homemade chicken broth. I will just use either avocado oil or olive oil as the dressing.
I also feel that when I eat a dense meal etc. it causes much mucus is develop and I find myself needing to clear out what appears to come up to my throat. For me most of the time I suck it up and out rather than huff cough during these times.
WATER/SODIUM: With drinking as much water as I feel is best for me I make sure I have nuts and seeds with sea salt to make up for the loss of sodium with drinking much water and liquids. If I don't do that I begin to have leg cramps. I have been wanting to introduce myself to the white miso, need to make a special trip to a grocery store that would have it.
MY PERSONAL THERAPY: Now what I am going to divulge is going to be something that today's medical professionals would probably question and be concerned with...yet it was a "tool" for many in previous years to the saline. Some people do better with the saline and I believe some do better doing as I do, steam. I boil COLD tap water for long enough. approximately fifteen minutes after it comes to a boil, to reach 200 degrees or better. I then carefully breath in the steam just as one would do with the saline solution or the Aerobika by breathing in, holding the breath and then releasing the breath. I do this repeatedly. Previously to breathing in the steam of the boiled water I am walking and doing clapping percussion on my front and back. I then do postural drainage and clear whatever is ready to be cleared out after this. I then begin the breathing in the steam again, then doing again the clapping percussion and postural drainage before doing the autogenic/air way clearance of active cycle breathing.....breathing in/holding/release and finally the huff coughing. The moisture and warmth of the warm steam, I believe, helps release much of what needs to come up and out. AGAIN, this is NOT what the medical professionals have gone to today in this day and age but it has worked for me. When I did the saline I became extremely cold with doing the 7% saline and felt pressure in my eyes. I may have been working too hard or doing it wrong??? I also had the vest and developed pain on my left side, so the reason I went to doing my own clapping percussion. I also have a hammer message tool (manual tool) that I use to help with doing percussion on the lung areas. I often also do the clapping percussion during the day if I find myself in a place and time that I can. P.S. I bought pink Himalayan salt and a couple of times a week, or more, I put it in the boiling water. Now that I have learned much in my year of knowing I have MAI I may use the 7% saline/Aerobika once a week.
SUPPLEMENTS: I also take supplements to help keep my immune system up. I for sure take Vitamin D every day, zinc, garlic and C. All appear to be good for helping with infections.
I do other supplements but I alternate and do not necessarily take them every day, I prefer to alternate. One has to be careful, as they say with medications.... or as I feel...even with supplements etc.
RESULTS: With all the above said the results are that I am able to release mucus plugs, clear mucus bubbly foamy moisture, light colored loose sputum during the day and mostly in the late afternoon early evening after my normal activity during the day is when the most mucus plugs come up and out and as well.
MY GENERAL HEALTH: I am very fortunate because I feel well and am reasonably strong and my PFT (Pulmonary Functions Tests) are all good. My last CScan showed less inflammation and less plugging in an area, however, I did have new showings in the lower lobes. I am now making sure I do my clapping percussion in the lower side areas of my torso in the back area above the wait and hope this will help more so. I haven't had a cold, flu, pneumonia, RSV etc. since having had Legionella/Mycoplasma Pneumonias in 1986. Yes to Covid this past February which I believe was caused by non required masking in the Pulmonary Rehab Department of Mercy Hospital. It was the one thing I had done differently since Covid was known. I went for three days and by the third day....COVID.

Please, please remember that we are all different and what I do is my choice at age 82. We must only do what we are comfortable doing in all aspects of this journey with BE and MAC/MAI.

Wanting all of us, you, to find our, your, way to what is working for us, you, and what is best for you!
Barbara

Sorry it took so long to reply! I work and I had deadlines I had to meet. Fell off the research wagon for a bit. Just to clear up a few things:

As far as I know I don't have MAC but a mild to moderate case of bronchiectasis and a lot of scarring from my TB history. I have never been able to produce a good sputum sample and my pulmonologist doesn't really advise a bronchoscopy. My poor little lungs have been through enough hell already. But who knows if I have it or not. He isn't worried about that.

I have often felt the urge to cough, but drinking a lot of warm water quells that cough remarkably well, seems to unplug the mucus plugs. I am now starting the day with warm water as soon as I wake up to help loosen the night's secretions before I start my day. As I said previously, I supplement with liquid trace minerals. And do take a variety of other supplements.

The soup-based diet is part of that whole rationale of thinning the secretions as much as possible since I can't employ the more agressive means of airway clearance because of my history of massive hemoptysis. BUT my soups DO include veggies. I steam a variety of veggies (I rotate the variety constantly) and puree them in a Vitamix blender and have those in the fridge for a day or two of soups. In my soups I put some of the puree, hight-quality chicken bone broth, 1/2 a cup of some whole grain like quinoa or millet or buckwheat groats and either a half a cup of lentils of various kinds, sometimes also pureed, or else a slab of high-protein tofu. When the mucus load seems more manageable, which is more often in the past few days after so much trial and error, I add a piece of sprouted whole wheat toast cut up in small chunks to the soup. Never want it to be too thick so I add boiling water to it, and a tablespoon of miso usually, and grate some ginger in there and a dash of lemon to help with the mucus as well. I also often put in a tablespoon of nutritional yeast, which is high in protein and b vitamins. Also seaweed flakes sometimes. I eat three bowls of this a day, so my entire life has changed in the past year in terms of what I can eat. I also put four tablespoons of organic avocado oil and/or virgin olive oil (from Costco) in every bowl of soup I eat for the fat. I eat a small salad a few times a week with only oil and lemon as dressing.

I have to abide by this very Spartan regimen if I want to avoid small bleeds and being up several times a night with the urge to cough and having to drink and drink warm water until I dislodge whatever is stuck in my airways. I had to be hospitalized twice for observation since March for bleeds that scared me b/c of my history. And then had to have IV antibiotics, and then a course of heavy antibiotic when I went home. I want to do the best I can to avoid that since it plays such havoc with the gut microbiome, so am willing to sacrifice eating all the delicious things I was once able to eat. I'm grateful that so far the price is not at all too great to be able to manage.
I can only eat a nut or too very cautiously and hardly ever now--when previously I could just grab a small fistful of walnuts or pecans, or pumpkin seeds for an added snack. I also eat berries of various kinds, and other fruits, and crunchy watery vegetables like red peppers and cucumbers, very well chewed with my warm water always by my side. I eat a small can of sardines a week, smash them into my soup over two meals, and salmon about every other week--not doing so well with it right now in terms of congestion. That I also have to put in the soup. I eat a few spoonfuls of yoghurt here and there, but not often. And when stable, I have a croissant snack with fruit and lots of warm water with it. That has helped with the weight gain, though I can't tolerate it when I have had an exacerbation.

I should add that I am 5'2" and usually have weighed around 104. I am saying that in case you think that the above diet is impossibly sparse. It is, but not too far from what works when I am my usual weight for someone of my petite frame. This last year I went down to 90 pounds because I could hardly tolerate any food at all. My lungs were really in distress. Now I weigh around 100 lbs, which is not enough, but it's the best I can do without triggering some pulmonary distress. At least I am well-nourished and all my blood tests are good. I average seventy grams of protein a day. I am working on very slowly gaining weight.

I have one good bowel movement a day.

One of the things I really liked about Dr. McShane's video is how she laid out the holistic protocol for taking care of one's airways. Really committing to doing all the things that are helpful since the end of the year has already made a difference! Now I am back to doing my morning yoga religiously and doing deep breathing with it. I looked at some of the positions in physiotherapy for B, and they are the same as some age-old yoga postures that I am familiar with but hadn't been settling into in terms of the breathing. I also take a brisk walk while doing Active Cycle of Breathing/Autogenic Drainage, and just a short session of Arobika b/c it still makes me light-headed, and some dancing too for the aerobic benefit and just b/c I love to dance. My favorite form of exercise. I don't really spit up much sputum, but I intuitively feel that I am doing a better job of keeping the secretions flowing in my airways instead of stagnating.

I just had two really good days--the first in two months where I didn't feel vigilant and fragile most moments of the day. I am hopeful about all these techniques and all the wonderful resources and tips that all the caring people on this site have so generously shared. So grateful to be here.