Best Climate for Bronchiectasis

As someone who moved from just north of Denver to the Alabama Gulf coast, clean air might at the top. Lower elevation has been a godsend. High humidity has not been great but tolerable. Finding Doctors has been the greatest challenge. P.S. I left my snow shovels in Colorado

So I think there are a lot of things to consider. As Rick mentioned, clean air, elevation and access to pulmonologists and infectious disease doctors who understand bronchiectasis and MAC. One thing that I did not have on my radar which is now is how the disease is distributed geographically. I was recently diagnosed with abscessus which is a hard one to treat and it turns out that abscessus is disproportionately common in FL where I spend half the year. So prevalence by location is another consideration. This is discussed more in the video by Dr Kamelhar at this link https://players.brightcove.net/3714047748001/experience_676ed37826b6b9879d00f525/share.html

From Dr Falkinhams paper: “Reducing Exposure to Nontuberculous Mycobacteria (NTM)”
Joseph O. Falkinham, III Ph.D. Updated: 3 May 2021

🔴Geographic Distribution of Mycobacterium Disease and Species in the United States.

The prevalence of NTM disease across the United States is not uniform, but exhibits “hot spots” and “low spots”. Florida, Louisiana, Santa Barbara, Philadelphia (Lande et al., 2019), and New York City are hot spots, while upstate New York and the southwest are low spots (Adjemian et al., 2012). High soil moisture content and humidity are strong predictors of NTM presence. High NTM numbers are also associated with recirculating hot water systems in hospitals and high-rise condominiums and apartments.
Distinct NTM species also have unique distributions. On the eastern coast of the United States there exists a “Fall Line” that separates the geology of the rocky Appalachian Mountains (Piedmont) from the sandy coastal Tidewater region. Cities on the “Fall Line” include: Philadelphia (PA), Georgetown and Richmond (VA), Fayetteville (NC), Columbia (SC), and August (GA). Florida is entirely to the east of the “Fall Line”. To the east of the “Fall Line” patients are more likely to be infected with Mycobacterium abscessus, while to the west of the “Fall Line” patients are more often infected with members of the Mycobacterium avium complex (MAC). One of the current objectives of the Falkinham Lab is to find out why.

Interesting feedback. We live in the Desert Southwest, apparently a low spot for NTM (although a high spot for valley fever, which I had 40 years ago). However, we sojourn in MS in the spring and fall and spend a lot of time cleaning our woods and building and burning brush piles. Makes sense that I might've developed MAC there. The trick is how to reduce exposure to MAC or where to live to breathe easier with bronchiectasis.

How could Santa Barbara be a hot spot? It’s dry most of the time so no moisture dirt. The coastal marine layer fog shouldn’t have MAC.

Whenever I see US maps for distribution of NTM, California is always highlighted as having higher levels. I have heard coastal communities generally have higher incidence of NTM. I don’t know why Santa Barbara’s rates would be any higher than LA or SF, or any other coastal community in CA.

There is some recent research into where NTM is more prevalent that indicates soil type can also be a factor.

What one needs to consider in deciding where to live is the whole picture, prevalence of NTM may be marginally more in one area than another, but there is also climate, geographical preference, proximity to work or family, cost of living, access to medical care, access to a major airport...

I don't believe there is enough difference from one location to another to make a decision solely on that basis. That said, I wouldn't choose high elevation due to less oxygen, or a swamp or backwater (possibly the highest exposure). But anywhaere else it would be just one factor.