Thanks Sue for your help. I think it is the strong saline solution that may caused issue with my lung. I stopped neb the following day and picked up diluted saline solution. Still have low fever in early afternoon and evening, which seems to suggest the MAC bug is more active now. I will keep monitoring.

Yes, I am new member to Mayo Connect. I'm 86 years old, retired teacher living in Shanghai. So glad to find this forum now. Since 2017-2018 I used Inspire.com as the forum to learn about this disease. My profile there has my story (https://www.inspire.com/m/caoNTM/). I copy my link here and some posts I did back then, as well as some tips I shared. Long story short, I got formally diagnosed in late 2017 as having MAC, although it had been several years with the symptom. I took antibiotics for 2 years but without much help. Stopped med in end of 2019 based on my own research. I had occasional needs to get 2 weeks' antibiotics every 1-2 month for about 1 year. I was able to keep bug in check for the past 1 year with high dose vitamin C and fish oil to boost my immune system. However, since Dec 2021, i started low fever again, and I am back to my quest for better cure. This is how I find your forum. I'm still learning and want to get back to the 7% nebulizing routine, except I cannot find the solution anymore due to covid (I used to get it from US when my family /friends visited me from US). Recently I made my own saline solution, but I guess when i steam the solution for sterilization it become more condensed and probably irritated my lung. I now made new solution with less concentration. Hopefully through my self-help I can fight MAC bug again. Thanks.

My post in Aug 2018 on Inspire.com:
A brief history of my condition: (1) had dry coughing constantly in 2010, and diagnosed with Bronchiectasis after coughing up blood, (2) over the following 5 years, still coughed occasionally but no blood, while started losing weight significantly over time, and walking became more and more challenging. During this period, had lung CT and found some cavity, but not treated with anything. (3) in summer 2017 I had low fever everyday in the afternoon and saw a pulmonary specialist and ran CT again, doctor suggested sputum culture, while being put on Big 3 for suspected TB. However, after 3 months' on Big 3, doctor found it wasn't TB, but NTM (MAC string).

Fast forward: from September 2017, doctor changed medication to Clarithromycin and Faropenem, with monthly blood test for liver function, kidney function, white blood cell, etc.. During this period while on these two antibiotics, I had skin rash, dizziness, diarrhea from the drug side effects. Liver function got worse in a few months until I started taking 100B probiotic and Milk Thistle which helped.

In April 2018, liver function was back to normal. Did CT again but it showed no improvement on cavity, and doctor took Faropenem off because she thought it was not effective in reducing the cavity size. Had a new sputum culture in April 2018 and result came back in June indicating no more MAC, but showed presence of M. abscessus. Doctor said it is highly resistant to med, therefore the main goal is to improve immune system and avoid infection or exacerbation.

Currently: I’m still taking Clarithromycin because doctor thought it might keep the bug in check. To help with airway clearance, I use Aerobika and acapella twice daily, take NAC twice daily (600mg each) and have back percussion by family once daily; started 7% saline nebulizer twice daily since last week. – With all these effort, I am able to cough up many mucus, some thick and brownish, with majority whiteish sticky ones. To help with immune system, I drink lots of liquid, eat fresh fruit and veggie, take dietary supplement Ensure (similar to baby powder), take probiotic and milk thistle, and do light walk and senior sitting yoga.

My post on June 2021 sharing a tip on Inspire.com:
Since late 2017 I was diagnosed MAC, I had been taking cocktail of antibiotics for nearly 2 years. But my MAC didn't go away while my mobility got worse due to the side effect of antibiotics on my nerve system. Through some research I decided to stop antibiotic and start my alternative approach. I add lots of protein to my diet and do my physical therapy daily: arobika cough to chear mucus twice daily; oxygen machines for a couple of hours daily. I also started high does vitamin C and high dose fish oil to fortify my immune system since 2020. I check my body temperature several times daily. Often my temp is normal for two months before I got low fever in early afternoon and my mucus shows yellowish as opposed to white. When that happened I take antibiotics for 1-2 weeks as conditions improved. After several months of high vitamin C, I rarely have low fever and it has been stable for 6 months now. Just thought I'd share this.