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Treatment Options - Asthma and Bronchiectasis
MAC & Bronchiectasis | Last Active: Nov 10, 2025 | Replies (13)Comment receiving replies
@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.
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@sueinmn
Thank you so much for that, Sue. It sounds like you have a very good team of experts behind you...something I will attempt to address myself. I need someone to spell out the whole story to me so that I can make an informed choice...not just prescribe something to accommodate my concern about eg steroids, and then be very offended if I question the drug after research. He actually said that I should be reassured because Formoterol was available commercially! However he has, on the whole, been patient and very accessible, but as a general practitioner of the older variety, he may not have enough expertise and doesn't like to be challenged.
However, the specialists for years have been indicating that my excess mucus and other symptoms seem to be coming from other than my mild bronchiectasis and wanted me to take eg Symbicort. When I didn't notice any difference in taking it, I would inevitably drop it. However, in those days I wasn't suffering any obvious Asthma symptoms or so much sob...so maybe the Symbicort can help that at least...and prevent further unnecessary airway damage.
Below I will attempt to paste some info I emailed my Dr some months ago, and which we haven't really addressed, about how an ongoing flareup can cause airway remodeling and permanent damage.
"How a flare-up can become ongoing:
Persistent Inflammation:
Triggers, like allergens, cause the airways to become inflamed, swell, and produce excess mucus.
Chronic Inflammation:
Repeated exposure to these triggers can turn the inflammation into a persistent, chronic condition, leading to ongoing damage.
Airway Remodeling:
Over time, chronic inflammation can cause structural changes in the airways, such as thickening of the airway walls and enlargement of mucous glands, further narrowing the airways."