Bronchiectasis what are the stages and symptoms

Posted by raney @raney, Oct 18, 2021

I was diagnosed with bronchiectasis about the time that Covid hit the US and the pulmonologist are overworked, so I have lots of unanswered questions. I also am taking Bisoprolol Fumarate 2.5 mg (a beta blocker) for heart issues. This is the 3rd cardiac med that has been prescribed in hopes of finding something that works with heart and does not interact with pulmonary meds.
Is there away to shorten the time of treatment?
1. Will I have to spend 3 hours 2 X a day for the rest of my life with nebulizer treatments, smart vest, gargles and nasal washes?
2. Is there anyway to shorten the time of nebulizer. (I have been prescribed (a) Levalbuterol which I can not use because it makes breathing more difficult (b) Sodium Chloride 7% (c) Budesonide all by nebulizer.
I use Aerobika and Smart Vest at intervals during nebulizer treatment.

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

@raney

I have tried again and the message was lost. What am I doing wrong. I click on Reply and then type in the box that says comments. How do I send the message/reply?

Jump to this post

O.K. I clicked reply after typing the above and it went That is what I failed to do with previous.

REPLY
@sueinmn

That's a lot of questions! Let's start at the beginning with a welcome to Mayo Connect and to our group of extremely knowledgeable and helpful MAC & Bronchiectasis group members.

First, I too was on a beta blocker for heart rhythm issues, and had to stop it because it rendered my asthma meds ineffective. My PCP and her med specialist/pharm doc could not find any others that worked for me, so I just live with it.

Second, that's a lot of treatments for bronchiectasis unless you have other issues. Most of us neb and use either a Smart Vest or Aerobika. I'm not sure how many also do nasal washes & gargling - what was the explanation for needing these? My treatment is 7% saline + Aerobika once a day, unless in an exacerbation. Then it is twice a day + Duoneb (budosenide + albuterol.) Neb plus airway clearance takes less than 30 minutes, while I read email and the newspaper.

Can you tell us a little more about what led to your diagnosis (symptoms, tests, etc) and whether you have been tested for any infections in conjunction with the Bronchiectasis? Were you diagnosed with any other issues at the same time? You mentioned you do have a heart problem, but what about asthma, GERD, sinusitis, cough, shortness of breath...

Finally, are you seeing a pulmonologist who is experienced in treating bronchiectasis?

Once we know more about your symptoms and other conditions, I'm sure you will hear lots of suggestions. In the meantime, there is a lot of information available in this discussion that may help you in this journey.

Sue

Jump to this post

I have bronchiectasis and MAI, also have had pseudomonas in lungs about 9 months ago. Treated 3 weeks with Cypro. Diagnosed 2 years ago but problem started with severe and lengthy bronchial infection.
Other problems: Heart block with pace maker and beta blocker, (Bisoprolol Fumate to control atril fib.
GERD following a bleeding ulcer 3 years ago.
Chronic sinusitis with post nasal drip
Have had reactions to nasal sprays and inhalers due to interaction with beta blocker for heart. Caused Shortness of breath and one severe reaction with rash over entire body and an ER visit.
Bronchodilators (Albuterol and Levalbuterol help with mucus clearing but severe tachycardia and SOB, so stopped brochodilator 1 week ago.
Now only Neb 7% saleine followed by Budesonide and using Smart Vest and Aeroika at intervals during the 7% saline inhalation.
I am on oxygen at 2 L/M for sleep Oxygen was dropping to dangerously low during the night.
Would like suggestions on:
1. Ways to decrease the airway clearance time
2. Meds for chronic sinusitis ( I have tried Azelastine;
Fluticasone Propionate; Mometasone. Each worked for sinusitis but could not use because of causing sever SOB .
3 Bronchodilatro that may work with cardiac Beta blocker, Bisoprolol Fumarate.

REPLY
@gej53

I am sorry but unsure how to start a new post. I just received a Volara nebulizing machine with instruction from the respiratory therapist. I used it for the first time this morning. There is still saline in the nebulizing port. Does anyone have this Volara and does it not use up all the saline during a treatment? My machine is also set on "medium" for now. The therapist said to start there and work up to the "high" setting. Maybe more solution will be gone on that setting? And do most use the high setting? I do feel it works better than my nebulizer I had that was 3 years old. Thanks for any help/suggestion.

Jump to this post

I use the smart vest, 7% saline and now the Volara at the same time. I usually nebulize twice daily. Occasionally once a day on busy days. I have stayed healthy with no other flare ups or infections. My Volara uses about half of the saline in the cup.

REPLY
@raney

I have bronchiectasis and MAI, also have had pseudomonas in lungs about 9 months ago. Treated 3 weeks with Cypro. Diagnosed 2 years ago but problem started with severe and lengthy bronchial infection.
Other problems: Heart block with pace maker and beta blocker, (Bisoprolol Fumate to control atril fib.
GERD following a bleeding ulcer 3 years ago.
Chronic sinusitis with post nasal drip
Have had reactions to nasal sprays and inhalers due to interaction with beta blocker for heart. Caused Shortness of breath and one severe reaction with rash over entire body and an ER visit.
Bronchodilators (Albuterol and Levalbuterol help with mucus clearing but severe tachycardia and SOB, so stopped brochodilator 1 week ago.
Now only Neb 7% saleine followed by Budesonide and using Smart Vest and Aeroika at intervals during the 7% saline inhalation.
I am on oxygen at 2 L/M for sleep Oxygen was dropping to dangerously low during the night.
Would like suggestions on:
1. Ways to decrease the airway clearance time
2. Meds for chronic sinusitis ( I have tried Azelastine;
Fluticasone Propionate; Mometasone. Each worked for sinusitis but could not use because of causing sever SOB .
3 Bronchodilatro that may work with cardiac Beta blocker, Bisoprolol Fumarate.

Jump to this post

It sounds to me like your questions are mostly surrounding me dicationsand issues you have with the side effects and interactions. We don't provide medical advice here, but when ihad a conflict, a thorough consult with our clinic's medication management specialists, who are pharmacists with additional training got me on track. I used a beta blocker for heart rhythm management, and after several trials, it was determined that my breathing issues were more crucial, so I sometimes have to rapid heartrate.
As for mucus clearing, I use Mucinex LA which thins the mucus without affecting my heart or asthma. It also seems to relieve post nasal drip, so I don't need sprays or nasal washes.
How was your MAI diagnosed, and has any decision been made about treating it?
Sue

REPLY
@sueinmn

It sounds to me like your questions are mostly surrounding me dicationsand issues you have with the side effects and interactions. We don't provide medical advice here, but when ihad a conflict, a thorough consult with our clinic's medication management specialists, who are pharmacists with additional training got me on track. I used a beta blocker for heart rhythm management, and after several trials, it was determined that my breathing issues were more crucial, so I sometimes have to rapid heartrate.
As for mucus clearing, I use Mucinex LA which thins the mucus without affecting my heart or asthma. It also seems to relieve post nasal drip, so I don't need sprays or nasal washes.
How was your MAI diagnosed, and has any decision been made about treating it?
Sue

Jump to this post

Thank you. Yes, I also take Mucinex LA 2 times a day. Thank you for suggestion of clinic medication management specialist. MAI. Another story. It was seen on a sputum culture and areas in my lungs that doc suspected was MAI. Treatment? I changed PCP & pulmonologist about 6 months after the sputum spec and CT Scan when I saw on the summary from Pulmo to PCP that: "....I do not believe that this lady is a good candidate for long term antibiotic therapy." Neither of them had explained to me what MAI was or what the treatment was or possible other fungus in the lungs? I have a different PCP and a different Pulmo now and I have been to UNC Chapel Hill, NC' Bronchiectasis Clinic. The Pulmo at UNC Chapel Hill told me that I should have a local pulmo and I will go to Chapel Hill every 6 months.

REPLY

@raney Hi, sorry for your troubles! For sinus disease (colonized m. Abscessus);

Stanford prescribed Gentamcin + Budesonide via my Navage device, and it has calmed my recalcitrant pneumonia and kept my sinus disease “quiet”. God Bless you!

REPLY

Thanks for that Info. I will definitely follow up on it. I bought a Navage last week, but it says it only works if you use their companies saline pods What type Navage do you have? May God Bless you also.

REPLY
@raney

Thank you. Yes, I also take Mucinex LA 2 times a day. Thank you for suggestion of clinic medication management specialist. MAI. Another story. It was seen on a sputum culture and areas in my lungs that doc suspected was MAI. Treatment? I changed PCP & pulmonologist about 6 months after the sputum spec and CT Scan when I saw on the summary from Pulmo to PCP that: "....I do not believe that this lady is a good candidate for long term antibiotic therapy." Neither of them had explained to me what MAI was or what the treatment was or possible other fungus in the lungs? I have a different PCP and a different Pulmo now and I have been to UNC Chapel Hill, NC' Bronchiectasis Clinic. The Pulmo at UNC Chapel Hill told me that I should have a local pulmo and I will go to Chapel Hill every 6 months.

Jump to this post

I am so glad you have found the Chapel Hill Clinic, as well as local PCP and pulmonologist.
The medication regimen for MAI is definitely tough, so if you are well-controlled, the 7% saline may just be the thing for you (it has worked for me for 22 months now after I had to stop the antibiotics due to side effects.)

Sorry I cannot help with the Navage question - my ENT told me years ago that I wasn't a good candidate for nasal washes, which didn't hurt my feelings one bit! Putting liquid up my nose makes me feel like I am drowning.

Sue

REPLY
@sueinmn

I am so glad you have found the Chapel Hill Clinic, as well as local PCP and pulmonologist.
The medication regimen for MAI is definitely tough, so if you are well-controlled, the 7% saline may just be the thing for you (it has worked for me for 22 months now after I had to stop the antibiotics due to side effects.)

Sorry I cannot help with the Navage question - my ENT told me years ago that I wasn't a good candidate for nasal washes, which didn't hurt my feelings one bit! Putting liquid up my nose makes me feel like I am drowning.

Sue

Jump to this post

Thank you Sue. I have so many questions and this group is a blessing. I have read about "flare ups" with fever, etc. But wondering if the thick clear mucus (large amounts) daily is to be expected forever or with right treatment will it eventually be less. That is another reason the airway clearance takes 3 hours each time. I never get all the mucus at any session.

REPLY
@raney

Thank you Sue. I have so many questions and this group is a blessing. I have read about "flare ups" with fever, etc. But wondering if the thick clear mucus (large amounts) daily is to be expected forever or with right treatment will it eventually be less. That is another reason the airway clearance takes 3 hours each time. I never get all the mucus at any session.

Jump to this post

For many of us, the mucus is a forever thing, whether thick or thin. Clear is a very good sign. For others, it indicates a coming flare up.
I have never, in 3 1/2 years, even tried to "get all the mucus" in any session. When I use the 7% saline, I cough for 5-10 minutes - when it subsides, I quit or I too would be at it 3 hours a day. My mucus is always present, but in greater amounts if I am stressed, don't drink enough fluids, have a bout with allergies or asthma...

As for that thick mucus, I have found a direct correlation between the amount of water, broth & herbal tea I drink and thinning it out some. My goal is 64-72 ounces a day. If I miss for one day, it is thick like honey - miss more than that it is like glue. I just brewed up a 16 oz mug of Breathe Easy Tea to have with my early lunch. I will have another with my afternoon break, and water in between. Means a lot of bathroom trips, but that is better than choking on mucus.

What does everyone else do?

Sue
PS I was looking at the Heart Association web site to answer a different question and found something that was in the back of my mind regarding your Afib - beta blockers are not the only available drugs to moderate heart rate (https://www.heart.org/en/health-topics/atrial-fibrillation/treatment-and-prevention-of-atrial-fibrillation/atrial-fibrillation-medications)
"Potassium channel blockers help the heart’s rhythm by slowing down the electrical signals that cause AFib.
Examples may include:
Amiodarone (Cordarone® or Pacerone®)
Sotalol (Betapace®)
Dofetilide"
Perhaps by using one of these you would be able to tolerate levalbuterol as part of you treatment regimen.

REPLY
Please sign in or register to post a reply.