After many months of coughing - CT chest scan shows bronchiectasis

I was also very nervous when I had my bronchoscopy in September 2022 but my Pulmonologist and the Nurses were great. It is the unknown that makes us fearful but the next time I need one I will know what to expect. It takes 4-6 weeks to get results back because they have to see if anything grows from the samples. That is how I found out I had MAC. I am waiting for an appointment at NJH as well.

Thank you so much for your kind words.

I would ask why a bronchoscopy is necessary when a sputem sample coughed up can be tested for Mac specie. I have gone to the Mayo clinic for Mac since 2013 and they have never given me a bronchoscopy.

Some people do not produce enough sputum for a sample. Even though I usually produce copious amounts, there have been a few times when I had to go to the pulmonolgist's office, neb 10% saline, then have the RT to percussion clapping on my chest and back to get enough of a sample to culture.
Also, if the infection is only in the lower lobe, the sputum coughed up may not have enough MAC in it - even though x-rays clearly show cavities or nodules.
Sue

At NJH, they teach you how to induce sputum via nebulized saline. They *seldom* fail to get a sample. Further, at NJH, they told me they rarely, if ever, do bronchoscopies, nor do they recommend them, as bronchoscopies are not without risk including 'popping a lung', not to mention the cognitive effects from anesthesia.

If they did not even recommend trying sputum induction as the first means of obtaining a sputum sample, I would question both their competence and ethics. I say ethics because it's common knowledge that in the highly marketized US healthcare system, it is far more profitable to bill for bronchoscopies than to do sputum inductions.

I am someone who rarely naturally produces sputum, but I have been able to successfully submit monthly samples for NTM assessment using sputum induction. Interestingly, when I've gone to NJH, there have been occasions where the sample looks relatively clear, but has been sufficient for their purposes.

@terrim02 Trying to get a sputum from me is the definition of insanity- doing the same thing over and over and expecting a different result!! It has been tried unsuccessfully many times. And I have had MAC for many years. The only way it can be definitively diagnosed with me is with a bronch and most recently a minimally invasive robotic biopsy. After many years on Arikayce and the Big 3, I am now MAC free. I have a new gift - invasive aspergillosis fumagatos. They are now trying to figure a way to find out if the medicine for that is working after six months. Unfortunately, the minimally invasive procedure became incredibly invasive with a collapsed lung, chest tube, and chest hemorrhage. If there were a way to get this dried up old woman to spit up something I would have gladly done it. So for me the bronch was a necessary evil and not about doctors/hospitals and the almighty dollar. If you know of something besides the usual spitting techniques I’d be very interested. I’m seeing my lung surgeon in a few weeks to see what he can come up with besides a bronch. Irene5

Please explain how to do sputum induction. I am another person that does not cough and does not produce sputum. I do have bronchiectasis, but have not been diagnosed with MAC or NTM. I would like to rule those out some day, so it would help to know how to induce getting a sputum sample. Thanks! Donna

Hello Donna, People who have trouble producing sputum should not try to force it on their own. Rather they should be referred to a respiratory therapist for assistance. In addition to nebulizing saline, there are breathing and coughing techniques, positional drainage, percussion and devices that can be used to help.

Forceful, unproductive coughing can cause pain and irritation to lungs, throat, even ribs.

My current pulmonologist actually has an RT on her staff. My previous doc had an experienced RN to help. My friend in a smaller group practice was sent to the respiratory department of the local hospital.

Sue

Thank you so much. You are always such a good source of information that we all need! Donna

Hi Donna,

I do sputum induction by nebulizing with 4ml of 7% saline. Occasionally, I have to use 2 ampoules, but generally, one does the trick. By about midway through, I have enough moisture built up that I can huff cough up a good sample. At NJH, if you don't produce sputum, they will increase your saline all the way up to 10%, which can be a bit overwhelming for some.