Treatment Options - Asthma and Bronchiectasis

Posted by narelled23 @narelled23, 12 hours ago

I know these questions have been asked before, and over time the answers may change. I also appreciate that Sue has patiently explained her treatment options to me...however, after having severe asthma symptoms for the first time over the last few months while away...now that I am home I am continuing to have severe shortness of breath, so I am forced to look at Asthma treatment.

I did, for years, use products like Symbicort, which didn't appear to be doing anything for my asymptomatic Asthma/Bronchiectasis (cough, mucus). When I learned about the dangers of steroids I decided to ditch the Symbicort (much to the annoyance of most of the specialists I have seen) because I was convinced my main issue was the Bronchiectasis.

Since my recent extreme Asthma reactions (over East) I am feeling that Asthma may be causing silent damage to my airways and perhaps the risks associated with the use of eg Symbicort might be outweighed by the benefits if it reduces inflammation which may be doing additional damage to my airways. This, I believe is why Sue uses Symbicort, or the equivalent.

Could Sue and anyone else who has experience with these two intertwined conditions please comment so I can achieve more clarity?

My GP, in trying to address the SOB and avoid steroids at my request, gave me a script for Formoterol, a LABA...but when I researched it there were warnings about using it without a steroid to address inflammation...because being a bronchodilator it could help breathing at the cost of masking underlying inflammation which could become fatal. So after the first use I stopped and because I am sure there is a lot of inflammation in my case I have for the time being gone back to using Symbicort 2 x day...until I can sort this out. My Dr did mention something about End Stage Asthma...I have to question him about this, because I am hoping he wasn't indicating that was my situation.

I would very much appreciate your input.

Interested in more discussions like this? Go to the MAC & Bronchiectasis Support Group.

Sue, Volunteer Mentor | @sueinmn | 5 hours ago

@narelled23 My concerns were the same as yours, but my pulmonologist, who is an expert in Bronchiectasis and in treating asthma and bronchiectasis together, convinced me that the risk of not treating the asthma was greater than the risk of infection from steroid use. She was pretty blunt in saying uncontrolled asthma can kill me, but it is unlikely that Bronchiectasis will, and if that worsens we will have time to deal with it.

Here is another thing she pointed out - before Symbicort, I was getting asthma flares that required a course of steroids about 4 times per year. Those four bursts of prednisone to the whole system are far more risky than the very small daily dose to the lungs. And repeated use of systemic prednisone is more risky to bone health than the inhaled version.

So what is my experience after almost 4 years? ONE exacerbation that required steroids, and that was after a bout of Covid. NO lung infections, and still NTM/Pseudomonas free as of latest sputum count. Improved lung function due to less inflammation and less shortness of breath. And the "tight band" around my chest only happens with strenuous exertion, and can be managed with another shot of Symbicort.

Now, I couldn't find a study of risks/benefits for Asthma/Bronchiectasis, but I did find one for Asthma/COPD (they have similar risks to us for pneumonia and other lung infections.) If you want to take a "deep dive" into a research study, you can read it.
https://www.sciencedirect.com/science/article/pii/S0954611120304182
The tables are useful in showing the risks of infection and osteoporosis with various medications, showing low-dose Symbicort to be the least risky. (Remember about 40% of COPD patients continue to smoke, which also affect the risks.) My rheumatologist has ordered a Dexa scan with a trabecular bone score as a precaution.

scoop | @scoop | 3 hours ago

@narelled23 Like you I have taken myself off Symbicort from time to time thinking the issues were solely from bronchiectasis. Those trials never ended well, sadly. Given my allergic profile verified by skin testing, high eosinophils, and symptoms over time I have come to accept my asthma/bronchiectasis diagnosis.

Have you considered Brinsupri? While I've been on it less than 2 months, I believe it has helped with inflammation as there is less mucus and coughing. I still need to do airway clearance. It does not replace the steroid inhaler for now but maybe over time the steroid dose may able to be reduced. Time will tell.