1. < MAC & Bronchiectasis

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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sweethighland | @sweethighland | Jul 12, 2023
In reply to @spider109 "I was just treated with prednisone & Doxy also for about 30 days. Tapering down prednisone...." + (show)
@spider109

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

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May I know the dose for Doxy. What bacteria did you grow?

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1 reply
spider109 | @spider109 | Jul 13, 2023
In reply to @sweethighland "May I know the dose for Doxy. What bacteria did you grow?" + (show)
@sweethighland

May I know the dose for Doxy. What bacteria did you grow?

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I was taking 100mg twice a day for 14 days. It was never determined what bacterial infection (if any) I had.

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1 reply
leilam | @leilam | Jul 13, 2023
In reply to @scoop "@rstel7272 please explain acronyms ACTs and RUL ACT - airway clearance techniques ? RUL -" + (show)
@scoop

@rstel7272 please explain acronyms ACTs and RUL

ACT - airway clearance techniques ?

RUL -

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I think RUL means right upper lobe

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scoop | @scoop | Jul 13, 2023
In reply to @rstel7272 "For myself, I had a bad withdrawal agter prednisone was discontinued. I was on 4 other..." + (show)
@rstel7272

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.

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@rstel7272 Sorry to hear you are dealing with these complications. Hope you continue to get better.

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sweethighland | @sweethighland | Jul 13, 2023
In reply to @spider109 "I was taking 100mg twice a day for 14 days. It was never determined what bacterial..." + (show)
@spider109

I was taking 100mg twice a day for 14 days. It was never determined what bacterial infection (if any) I had.

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Thank you. So, it was not for 30 days?

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1 reply
spider109 | @spider109 | Jul 13, 2023
In reply to @sweethighland "Thank you. So, it was not for 30 days?" + (show)
@sweethighland

Thank you. So, it was not for 30 days?

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No I was prescribed 28 pills taking two pills daily.

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1 reply
sweethighland | @sweethighland | Jul 13, 2023
In reply to @spider109 "No I was prescribed 28 pills taking two pills daily." + (show)
@spider109

No I was prescribed 28 pills taking two pills daily.

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Thank you. Have you done any sputum culture yet?

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1 reply
spider109 | @spider109 | Jul 13, 2023
In reply to @sweethighland "Thank you. Have you done any sputum culture yet?" + (show)
@sweethighland

Thank you. Have you done any sputum culture yet?

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Yes, back in January at Mayo Jax and most tests they said came back negative.

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1 reply
sweethighland | @sweethighland | Jul 13, 2023
In reply to @spider109 "Yes, back in January at Mayo Jax and most tests they said came back negative." + (show)
@spider109

Yes, back in January at Mayo Jax and most tests they said came back negative.

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Oh. That is such a good news. I have Burkholderia cepecia colonized which is hard to treat. 🙁 sometimes, if I take Doxy, the symptoms better for a month and after that coughing and producing mucus again. 🙁 Stay well.

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Mentor
Sue, Volunteer Mentor | @sueinmn | Jul 14, 2023

@wsbme74 Hello - I was out of touch for a few days visiting family, and just saw your post - yes, according to both my pulmonologist and my recently retired PCP whose practice included many lung patients, the Zithro/Prednisone route can be the best for some of us. I also have asthma with bronchiectasis, and was previously treated for MAC.
I actually use Symbicort (which contains a tiny steroid dose with a long-acting beta agonist) as my daily inhaler. It has reduced my exacerbations over the past year from every 4-5 months to ZERO. It has reduced my Levalbuterol nebs for asthma attacks from at least once a week to TWO in a year. It has reduces my Levalbuterol rescue inhaler use from multiple times a day to once or twice a month.
For 2 1/2 years before that, I had on hand a 7 day steroid packs plus a 5 day Azithromycin pack. I was using them 2-3 times a year.
When I see my Pulmonologist next month, she will need to renew these because they have expired.

Full disclosure - I have also needed to use steroids for 10-30 days to calm inflammatory flares in my body several times as well.

I guess my point is that different things work for different people. This regimen has worked for me for almost 4 years without causing MAC to flare up. And my Dexa says it hasn't affected my bones either.

Sue

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