@macsucks Lots of questions to answer here.
Airway clearance is one of the keystones to managing bronchiectasis and the associated infections. Our damaged lungs do not expel mucus normally, so special strategies are required to coax it out, because it provides a breeding ground and hiding place for bacteria.

The process involves opening the airways with albuterol or a similar medication, either via inhaler or nebulizer. Then saline solution may be used to thin the mucus, and finally controlled breathing and coughing are used to expel the mucus. This is done one to three times each day.

Here is an excellent description of airway clearance and why it is so important, from one of the leading experts in the country:

Frequency and dosage of antibiotics is based on the exact bacteria in your lungs, what drugs it is sensitive to, and the severity of infection. Daily dosage in high quantities is usually reserved for severe infections.

The severity of a MAC infection is determined by all of these:
The quantity and specific type of bacteria in your sputum cultures
Two or more consecutive cultures must show bacteria
Symptoms (cough, fatigue, weight loss, fever...)
Condition of your lungs on a CT scan (nodules, ground glass opacities, cavities)

On the CT scan, "ground glass opacities" are gray areas that MAY indicate a current infection. Nodules are areas thought to contain or encapsulate infectious material. Cavities are areas where infection has severely damaged the tissue - essentially holes where no air exchange can take place. Bronchiectasis appears as little white "O's" on the scan - areas where the airways are no longer opening and closing properly. The doctor should be able to show you these areas on the scan.

When you say you are seeing a "MAC specialist" do you mean an Infectious Disease doctor? Like many pulmonologists, ID doctors may or may not have expertise in treating MAC infections. Both bronchiectasis and MAC are rare diseases, and many doctors see only a few cases a year, so they may not be aware of the latest protocols for management and treatment.

The fact that nobody has taught you about airway clearance leads me to believe that your doctors may be in that category.

Can you tell us what issues led you to see the doctors?