Bronchiectasis with a side of asthma

No my pseudomonas is probably not gone. Have not had sputum checked lately but it is in a quiet phase. It only showed up last November with high amounts, colonized. May have been there for a long time before because I did not have it checked. My dose is 250 mg three times a week. I think the suggestion is that I go off it after one year which will be this December. One pulmonary doctor said he advised 6 months on during the worst times for you and 6 months off (like over the spring summer period). So I expect to stop it in December/January and resume the following fall. I also do 3% sodium chloride.

It does not get rid of Pseudomonas. My pulmo once told me that Pseudo likes to be with other bacterias or some such thing. And if you keep those lower then Pseudo might retreat more. So maybe it helps due to that? Also found this explanation online:

The macrolide antibiotic azithromycin (AZM) provides a paradigmatic example of an “unconventional” antibacterial drug. Besides its growth-inhibiting activity, AZM displays potent anti-inflammatory properties, as well as antivirulence activity on some intrinsically resistant bacteria, such as Pseudomonas aeruginosa.

Hi sweethighland! Glad you have an appointment to discuss this possible step. I do hope you will have the same success.
All the best!

6 months on during the worst times for you and 6 months off (like over the spring summer period). This sounds like a wise advice. I will ask my doctor.

Thank you for this information. Good to learn. Have you got better from taking AZM?

Hello, I never took the Azithromycin. I tried just one 250 ml and had a heart reaction. The reaction was strong enough to make me afraid to try it again. I am sure my reaction was rare. I know many people are able to take AZ and do ok.

Today at pulmonologist meeting I asked "how do I know it's asthma" vs something else.

Answer:
1) Symptoms: cough, wheeze, SOB, tightness (esp, tightness)
2) Triggers: GERD, pets, allergies
3) Asthma gets better with asthma medication (albuterol, symbicort, etc)

I take Tezspire for my severe asthma and just use a nebulizer for my bronchiecstasis. I had pseudomonas for six months and used a pic line for two weeks and after it came back used Tobramycin in my nebulizer. But I had a strong asthma reaction to the Tobramycin and had to go off it after one month. That seemed to be enough to eliminate it. Because I once tested positive for MAC, though not confirmed on subsequent sputum tests, my pulmonologist took me off azithromycin to reduce risk of immunity. My question is about the nebulizer. Both my pulmonologist and my second opinion pulmonologist suggest I first do albuterol to open my lungs and then saline to expectorate. Problem is I am a figure skater and skate early in the morning. It is such a long routine, in addition to my regular inhalers. I also would like to combine the albuterol and saline just to shorten the time. To top it off I have TMJ, which makes the nebulizer very uncomfortable. I cough up a lot of discolored phlegm when I skate. Is the exercise enough to reduce use of nebulizer? Can I combine albuterol and saline to shorten time? My lung capacity test showed significant difference after using rescue inhaler so asthma is probably worse than bronchiecstasis but they combine badly.

I can address 1 question. It is not recommended to combine Albuteroland saline since it changes concentration of the saline. One question you might ask doc: is it ok to use albuterol inhaler prior to nebbing the saline, at least part of days? My doc ok’d it when I travel. I don’t get up much though.
Are you using hypertonic 3 or 7% saline? That might help you get more secretions out.

" Is the exercise enough to reduce use of nebulizer? "

This depends on who you ask. My pulmonologist says empathically NO but I've read here that others say yes. I would think it depends on the extent of your bronchiectasis (how many lobes involved, how long you've had it, how productive you are, your disease state, comfort level with skipping nebs, etc.)

Personally, I could never skip a morning session because I wake up with so much gunk to expel. Plus, I want to avoid my chest becoming a breeding ground for pseudo, mac etc. My a.m. session is 45-60 minutes every morning and it cuts into all sort of a.m. activities, which really pisses me off!

Perhaps you could time shift. Skate and then use nebs afterwards? In any event definitely use your puffer prior to skating. The key, I believe, is to get two nebs in along with airway clearance twice a day.