Airway clearance and how I feel throughout the day

Posted by @ling @wangling, May 4, 2023

Hi everyone,
I know it might be a diffuse question, but let me try.
My pulmonologist told me if I do the airway clearance correctly. I
should feel clear of mucus during the day. I spend almost 30 minutes
doing it (flutter + autogenic drainage in the morning and evening). But throughout the day, I have to constantly clear out mucus most days. I am wondering what your experience is, is it normal for you? Maybe I am too sensitive about it.
Your experience is greatly appreciated.
Many thanks!
Ling

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

@scoop

From the app itself:
The Autogenic Drainage app provides a customizable timer with voice commands to aid in doing autogenic drainage. Autogenic drainage is a breathing exercise that is used to clear mucus from the lungs in people with lung disease. Autogenic drainage requires no equipment and is done entirely through controlling your breathing.

This app contains a default autogenic drainage session that was customized by a person with cystic fibrosis and also contains a fully customizable session if the defaults do not work for you. You can customize the length of every inhale, exhale, time holding your breath, and total number of breaths in each phase of autogenic drainage. Hit start and voice commands tell you when to breathe in, hold, and breathe out. The timer also displays how long your session is, the current breath number, and how many breaths you have remaining. The app also contains a reference section.

This app was designed to the specifications of a single person with cystic fibrosis and was developed as an aid in doing autogenic drainage for people with cystic fibrosis or perhaps other lung diseases. This app was not developed by doctors, respiratory therapists, or any other medical professional. This app is not intended to replace any existing medical treatment and should be only used as an aid to people already doing autogenic drainage or those eager to try it.

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I have searched it in App Store but nothing comes up?

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@ingekunga

I have searched it in App Store but nothing comes up?

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In app store, search for "autogenic drainage".

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@irenea8

Dear Ling, I do my best but it is not easy! It is rather hard to answer the question about infections in my case. I believe that I live with some level of chronic infection all the time. But it is a matter of degree. I have the mucoid form of Pseudomonas and normally that would be treated ongoing since it is not considered something you can get rid of. Treatments with antibiotics have only happened twice in 20 years believe it or not (LONG story). First time worked and second time did nothing. Currently struggle with bad GI issues and Kidney so getting by with my nebulizing and "remedies". Treatment with the right antibiotic would help but these other co morbidities are a barrier. Each time I use the Aerobika I do 15 breaths. And I do that approx 13 times. You would not need to do so much!! Probably no one does this much but me! But once I am done I have expelled almost 3 ounces each day.

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Dear @irenea8
I hope you have recovered from your GI and kidney problems. Feel better!!! I remember in one of your previous notes that you mentioned you had bronchiectasis for more than 20 years. And for 20 years you did not even use a flutter or nebulizing, only used your own breathing techniques.  But you managed your condition well enough to avoid being infected by mycobacterium. I often think about you and how you successfully manage the condition for over 20 years. I feel so lucky to have you here in the group and generously share your experiences so others can benefit from. My pulmonologist recommended me to use an inhaler, especially in the spring time for a couple of months (ADVIRE) to prevent airway inflammation which will make bronchiectasis worse. I don't think I have asthma. I do dream to keep my bronchiectasis condition stable, but I am hesitant to use an inhaler. I guess I want to know if you have to use anything or an inhaler to avoid airways being inflated from time to time? And I guess I want to know what would be a proper maintenance path for me now. Like you, I don't think I have MAC even though I have not tested it yet. Fluttering and nebulizing would be enough? My pulmonologist has not prescribed me with nebulizing stuff yet. He asked me to use Albuterol before fluttering. So far it is working for me. I do use the inhaler sometimes, since I am still trying to find what I should minimally do to keep me safe from infections and keep my bronchiectasis condition stable.  You also mentioned that you always have some kind of chronic infection, did the infection make your bronchiectasis worse? Like always, your experience will be greatly appreciated. 
Ling

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@wangling

Dear @irenea8
I hope you have recovered from your GI and kidney problems. Feel better!!! I remember in one of your previous notes that you mentioned you had bronchiectasis for more than 20 years. And for 20 years you did not even use a flutter or nebulizing, only used your own breathing techniques.  But you managed your condition well enough to avoid being infected by mycobacterium. I often think about you and how you successfully manage the condition for over 20 years. I feel so lucky to have you here in the group and generously share your experiences so others can benefit from. My pulmonologist recommended me to use an inhaler, especially in the spring time for a couple of months (ADVIRE) to prevent airway inflammation which will make bronchiectasis worse. I don't think I have asthma. I do dream to keep my bronchiectasis condition stable, but I am hesitant to use an inhaler. I guess I want to know if you have to use anything or an inhaler to avoid airways being inflated from time to time? And I guess I want to know what would be a proper maintenance path for me now. Like you, I don't think I have MAC even though I have not tested it yet. Fluttering and nebulizing would be enough? My pulmonologist has not prescribed me with nebulizing stuff yet. He asked me to use Albuterol before fluttering. So far it is working for me. I do use the inhaler sometimes, since I am still trying to find what I should minimally do to keep me safe from infections and keep my bronchiectasis condition stable.  You also mentioned that you always have some kind of chronic infection, did the infection make your bronchiectasis worse? Like always, your experience will be greatly appreciated. 
Ling

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Dear Ling, It is a rather long story as to why I managed my Bronchiectasis without anything other than "coughing up" daily for so many years. I cannot say I avoided MAC since I was never tested for it all those years. But when I finally saw a better Pulmonologist just a few years ago he did test me for it twice and so far it has come up negative. But I do have chronic or mucoid strain Pseudomonas which is just as bad or worse. I do have days when I feel my airways are more constricted from more inflammation. On those days the mucus is harder to expel and I feel worse. But my Dr has never suggested an inhaler or even Albuterol since I am quite certain the Albuterol would make my heart race as I am prone to that now. I guess I would ask if your Pulmo is someone who specializes in Bronchiectasis. If not you might consider finding one that does. Inflammation is a big part of Bronchiectasis but so is infection. They go hand in hand. Another Pulmo might tell you to use saline but maybe you just do not have any reason for it yet. I lived with some level of infection for many years until I had a doozy of an exacerbation. No doubt letting it go that long made my Bronchiectasis worse but I cannot say for sure. I do know that the saline and flutter and positional drainage are critical for me now. If I did not answer something please feel free to ask. I really wish you well Ling and hope you can manage your Bronchiectasis better than I did! Anything I can tell you to help I am happy to.

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@irenea8

Dear Ling, It is a rather long story as to why I managed my Bronchiectasis without anything other than "coughing up" daily for so many years. I cannot say I avoided MAC since I was never tested for it all those years. But when I finally saw a better Pulmonologist just a few years ago he did test me for it twice and so far it has come up negative. But I do have chronic or mucoid strain Pseudomonas which is just as bad or worse. I do have days when I feel my airways are more constricted from more inflammation. On those days the mucus is harder to expel and I feel worse. But my Dr has never suggested an inhaler or even Albuterol since I am quite certain the Albuterol would make my heart race as I am prone to that now. I guess I would ask if your Pulmo is someone who specializes in Bronchiectasis. If not you might consider finding one that does. Inflammation is a big part of Bronchiectasis but so is infection. They go hand in hand. Another Pulmo might tell you to use saline but maybe you just do not have any reason for it yet. I lived with some level of infection for many years until I had a doozy of an exacerbation. No doubt letting it go that long made my Bronchiectasis worse but I cannot say for sure. I do know that the saline and flutter and positional drainage are critical for me now. If I did not answer something please feel free to ask. I really wish you well Ling and hope you can manage your Bronchiectasis better than I did! Anything I can tell you to help I am happy to.

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Many thanks @irenea8 for your thoughtful response. I think finding a pulmonologist specializing in Bronchiectasis is very good advice. I should seek one. I will if something else comes up.
Take care!
Ling

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@wangling

Many thanks @irenea8 for your thoughtful response. I think finding a pulmonologist specializing in Bronchiectasis is very good advice. I should seek one. I will if something else comes up.
Take care!
Ling

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It seems that the pulmo's who do not know a lot about Bronchiectasis end up prescribing just Albuterol or steroid inhalers. And not the saline. If you are coughing up much sputum with any color I should think the saline would be a good idea but if not you may be ok with his advise at least for now?

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@irenea8

It seems that the pulmo's who do not know a lot about Bronchiectasis end up prescribing just Albuterol or steroid inhalers. And not the saline. If you are coughing up much sputum with any color I should think the saline would be a good idea but if not you may be ok with his advise at least for now?

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@irenea8,
That is a good thought. I don't have a lot of mucus and my mucus has no color. But I think at least consulting a specialist is a good way to go and to be on the right path is crucial. These days, finding a good specialist is very challenging. You mentioned that Bronchiectasis and airway inflammation are hand in hand. If that is the case, What keeps the inflammation down. Does saline have that effect too or just loosening mucus? That is the question in my mind.  
Many thanks again!
Ling

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@wangling

@irenea8,
That is a good thought. I don't have a lot of mucus and my mucus has no color. But I think at least consulting a specialist is a good way to go and to be on the right path is crucial. These days, finding a good specialist is very challenging. You mentioned that Bronchiectasis and airway inflammation are hand in hand. If that is the case, What keeps the inflammation down. Does saline have that effect too or just loosening mucus? That is the question in my mind.  
Many thanks again!
Ling

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If you do not have a lot of mucus and it is clear then you are doing well. What brought about your diagnosis of Bronchiectasis? What symptoms were you having? There is a map of USA that shows where the specialty clinics/drs. are located for Bronchiectasis. I will try to find that map and post the link later today. Bronchiectasis can cause numerous airway infections. Infection and inflammation usually go hand in hand. But as far as i know inflammation is an issue with Bronchiectasis no matter what. Saline is not for inflammation it is to help the mucus come up. It loosens it along with flutter device. Less mucus less chance of bacterias taking hold. So perhaps in some round about way it would help with Inflammation. But the steroids and Albuterol are more directly for that. A good diet and certain supplements may help with overall inflammation.

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@wangling

@irenea8,
That is a good thought. I don't have a lot of mucus and my mucus has no color. But I think at least consulting a specialist is a good way to go and to be on the right path is crucial. These days, finding a good specialist is very challenging. You mentioned that Bronchiectasis and airway inflammation are hand in hand. If that is the case, What keeps the inflammation down. Does saline have that effect too or just loosening mucus? That is the question in my mind.  
Many thanks again!
Ling

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@irenea8

If you do not have a lot of mucus and it is clear then you are doing well. What brought about your diagnosis of Bronchiectasis? What symptoms were you having? There is a map of USA that shows where the specialty clinics/drs. are located for Bronchiectasis. I will try to find that map and post the link later today. Bronchiectasis can cause numerous airway infections. Infection and inflammation usually go hand in hand. But as far as i know inflammation is an issue with Bronchiectasis no matter what. Saline is not for inflammation it is to help the mucus come up. It loosens it along with flutter device. Less mucus less chance of bacterias taking hold. So perhaps in some round about way it would help with Inflammation. But the steroids and Albuterol are more directly for that. A good diet and certain supplements may help with overall inflammation.

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My CT scan shows I have mild bronchiectasis after a year-long struggle with pneumonia and lung infections. I did mention using saline to my pulmonologist, he said I don't need it. I hope he is right. I do want to make sure that I understand when I should use it. what would be the trigger to start using it. He believes that inhalers will control the inflammation. I am 71, I think if the inhaler works the way he says, I could use it from time to time. We alway have to juggle the pros and cons, and make the right choice. In my upbring, all medicine has 3% of poison in it, well, this is the saying, not really poison. Thank you for telling me what the mucus means in my case. That is very comforting.
Many thanks again and take care.
Ling

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