Treating flareups with prednisone and azithromycin

Posted by wsbme74 @wsbme74, Jul 10, 2023

Hello.
I have broncheictasis (newly-diagnosed) and asthma. I have a local pulmonologist whom I see regularly (though newly) who has some background with CF and Bronchiectasis, though not a ton. And a more specialized pulmonologist in Boston, who I will see for clinic maybe 2x per year. He said to try and avoid prednisone when I can with flareups but to treat with azithromycin (5 days on; 5 days off; another 5 days on if needed). Whereas the local pulmonologist said she would treat with both prednisone and azithromycin (no MAC now).
I am wondering if there is a "standard" for Bronchiectasis flareups and are both meds usually prescribed?

Thanks.

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Rick | @rstel7272 | Jul 11, 2023

I will never use a steroid such as prednisone or symbicort again.

liz440 | @liz440 | Jul 11, 2023

They treated my flair ups with Doxy and 5 days of prednisone 40 mg. At that short of a prednisone dose there is no need to taper (allegedly). Sometimes it helps and sometimes it doesn't. If it doesn't help then the Dr. does further testing for pneumonia.

spider109 | @spider109 | Jul 12, 2023

In reply to @rstel7272 "I will never use a steroid such as prednisone or symbicort again." + (show)

Rick, can I ask why you won’t use prednisone again?

spider109 | @spider109 | Jul 12, 2023

I was just treated with prednisone & Doxy also for about 30 days. Tapering down prednisone. And I think it helped me tremendously.

irenea8 | @irenea8 | Jul 12, 2023

One question for those treated with Doxy and Pred. Did they do any sputum culture first? Or is this just a standard one size fits all treatment option for Bronchiectasis flairs? And how much of a flair do you get before resorting to it? What symptoms? Wonder why they pair the Doxy with Pred and you could just take Doxy alone.

liz440 | @liz440 | Jul 12, 2023

In reply to @irenea8 "One question for those treated with Doxy and Pred. Did they do any sputum culture first?..." + (show)

The prednisone is for inflammation as I understand it. It's especially helpful if you have asthma too because any fair up in the lungs exacerbates the asthma

Rick | @rstel7272 | Jul 12, 2023

In reply to @spider109 "Rick, can I ask why you won’t use prednisone again?" + (show)

For myself, I had a bad withdrawal agter prednisone was discontinued. I was on 4 other meds at that time. 3.5 years of Symbicort contributed to a serious fungal infection I have now that one Dr wants to remove my RUL. I have stopped the symbicort, symptoms are slowly getting better and I switch Dr.s

From the Lungs Matter Group on FB ..
𝗪𝗵𝗮𝘁 𝗡𝗼𝘁 𝗧𝗼 𝗨𝘀𝗲
For ACTS, we do not want to use bromides (Tiotropium or Ipratropium), long-acting bronchodilators, rescue doses, or steroids:
✔️ Bromides, steroids or any immune suppression encourages infections and makes sputum thicker and less mobile. If someone posts about frustration with ACTs, my first suspicion is ongoing bromide or steroid use in any form.

liz440 | @liz440 | Jul 12, 2023

I have no trouble with airway clearance even though I use inhaled steroids and the occasional 5 day oral treatment regime. I also have asthma and allergies so I also have much more coughing of mucus than some others on here. I am always amazed at people who have trouble with airway clearance because it is so easy for me. All I have to do is think about it and I can produce a sample!