7% saline continues to deliver.

I found that adding a neb of albuterol, levalbuterol or duoneb (irpatropium bromide plus albuterol) just before the saline then doing airway clearance with belly breathing and "huff" coughing helps move the deeper stuff out.

And when I had an exacerbation, I did it 4 times a day for a few weeks and really brought up some deep, old nasty looking stuff from my lungs. Now I plan to do it 2-3 days in a row about every 10 days.

Going from .9% to 7% made a huge difference. But our clinic (my brother, daughter and I all go to the same, but 2 different docs) have become 7% converts over the past 2 years.

It may be that you need the big 3 for a while to knock the bacteria down, then switch to saline. I recently found an article that says saline alone doesn't work well for cavitaty Bronchiectasis, only the nodular kind. My cavities had healed over before I switched.

You need to be your own advocate - MAC plus Bronchiectasis is classified as a rare condition, so not a lot of docs have experience treating it.

Let us know what the doc says.
Sue

Sue, do you use abuterol inhaler or do you neb with it?
My doc recommended one puff of inhaler and neb with 7% saline followed by Brio. However he said to increase times if needed. I don’t cough, but if I “huff” cough randomly throughout the day, I can hear the rattle and need to clear my throat. I wonder if this means I need to increase amounts of time and start neb with albuterol. I neb albuterol alone when I was first misdiagnosed from another pulmonologist. I got dizzy so he switched me to Brio. Now that I’m educated 😂 I see one does not replace the other! I’m so thankful I went to another doc who did a CT and found bronchiectasis.

I neb duoneb or levalbuterol before the saline, my primary switched me to this when I had a flare and it is much more effective than the puffer. Then I stop several times during the saline neb to move around, bend over, etc. - that helps bring up a lot of mucus. Sometimes, I stop after half a neb if I'm coughing well, then go back in an hour or two and finish. That is very effective for me.

I use my long-acting inhaler as soon as I get up and again at bedtime. My primary says those are the most effective times because if you use it while you are still coughing from the neb, you may cough it right out of your lungs.

You are right - after years of dealing with lungs, there is always more to learn. Also, years ago I found albuterol makes my tremors much worse, and was switched to levalbuterol, which used to be a very expensive brand-name drug called Xopenex, but is now available as a generic in both inhaler and neb.

Sue

I have a "smart vest". It does a good job for me and comes with it's own luggage as well.

Hi, My name is Hattie and am new to the blog. I have been dealing with MAC/Bronchiectasis for about 4 years. I have not started any meds yet because of my age and other medical issues. There are very few antibiotics I can tolerate. I am trying to find a doctor in the Phoenix area that deals with MAC,. Any suggestions from any of you. We do have a Mayo in Scottsdale, but does not take my insurance. I may have to switch insurances in Oct. You all are so informative, thank you for all I have learned.

Hello, and welcome to Mayo Connect - here in the MAC & Bronchiectasis group I hope you will be able to find answers to your questions. The way Mayo Connect works, the members all learn from one another. If you post your question in the group, you have hundreds of people who see it and can share their experiences.
If you do not hear from anyone in your area, you can try a couple of things - one is to look at some of the larger practices, perhaps affiliated with a hospital your insurance covers. In the physician bios, you can often see their special areas of interest or expertise, and their hospital affiliation and insurances accepted. Once you find a doc you are interested in seeing, call and ask specifically if they treat MAC. You may need to ask to talk to their nurse because appointment centers often do not have the info.
Sue

@hattie1995 I also live in Phoenix area (Sun City) and go to Mayo in Phoenix. After 4 other Pulmonologist, and 1 IDD, I went to Mayo and was so glad. It was the best thing I could have done for myself. Please let me know if I can answer any other questions! Glenda

Hi Glenda, Thank you so much for your prompt response I did call Mayo and they do not take my insurance. I guess I will have to look around for a different insurance in Oct. I lived in Sun City West for about 8 years, then moved to Maricopa to be closer to family. I really liked it out there but just too far away. Thanks again and will let you know if I have any luck in Oct.

Thank you Sue! I did hear from someone here in the Phoenix area. I will have to wait until I can do something different with my insurance in October. Then I will get a consult for Mayo.

Sounds good!