Here is my (not a medical expert) opinion. As with all else related to MAC and Bronchiectasis - this is a highly individual decision, related to a person's overall physical health and risk tolerance.

My ID doc told me years ago "Bronchiectasis, for most people, is something you live with, not die from. You need to find what works for you." My primary told me "Living in a state of fear is not truly living. Take sensible precautions and hug your kids and grandkids." (This during the height of Covid.)

Most experts agree that use of indoor pools, hot tubs and steam saunas carries a relatively high level of risk due to the concentration of potentially MAC-contaminated vapors in the immediate vicinity. What is less clear is the risk posed by outdoor pools or lakes - the vapors tend to be highly diluted by outdoor air, especially in breezy or windy conditions. Pools maintained, in full or in part, with salt water tend to pose less risk because saline content suppresses growth of NTM. Likewise, ocean or gulf swimming (saline content at or above3%) is considered safe.

Now comes the "judgement" part - do you tolerate a risk of some exposure in exchange for enjoying life with your grandchildren? Do you do routine airway clearance and use saline nebs to minimize your infection/reinfection risk? Is your overall health, but for the lung condition pretty good?

With the blessing of all my docs, I have figured out that my philosophy and risk profile can be summarized as follows:
"I intend to live my life to the fullest while taking prudent precautions. I know I must live with Bronchiectasis and the possibility of lung infection, but I refuse to live in fear of infection or live 'in a bubble'. Based on this philosophy, I try to balance the risks I choose to take with the healthiest possible lifestyle - diet, exercise, airway clearance, medication compliance, asthma management and a positive attitude. "

What do you believe is a reasonable philosophy for you?
Sue

Following this philosophy, I swim in well-maintained outdoor pools, lakes and the ocean, but not indoor pools or hot tubs. I shower, drink filtered or Spring water, and don't worry about whether the ice in my cocktail at the restaurant is safe. I garden, work and play outdoors, but stay away from known sources of NTM like peat moss. But I wear a mask in dusty conditions (helps my asthma too.) I have stayed healthy and MAC/Pseudomonas free for almost 3 1/2 years so far.

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