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Mucociliary Escalator: What is your airway clearance routine?
Did your medical team ever discuss the mucociliary escalator with you? My New York doctors never mentioned it, and I came across the term on the Australian Bronchiectasis Toolbox website,
The “mucociliary escalator” is a term used to describe a built-in mechanism to keep our airways clean. Just as we might run water on a patio to sweep off leaves and debris, this is what happens automatically in our air passages.
This clearing system is complex, but in the simplest terms, it uses mucus to trap dirt, air pollution particles and pathogens. Then cilia, small hairs that undulate in the moving mucus, sweep the unwanted matter towards our throat where it is expectorated or swallowed.
This cleansing system is ongoing in healthy lungs as they too produce daily mucus to clear the decks. However, in diseased lungs such as those in bronchiectasis (BE), the ciliated areas are damaged and therefore, we make more mucus to compensate. The body does its best to sweep the airways clean, but often it is a herculean task that cannot be automatically accomplished day after day.
For this reason, we need to help out our lungs with daily airway clearance. Airway clearance is a broad term describing the effort to help the mucociliary escalator function more effectively. With BE, there are damaged areas in our lungs with little or no cilia allowing mucus to pool. This mucus needs to be removed, otherwise bacteria, viruses and fungi can feed on it and multiply.
Whether we use exercise, breathing and coughing techniques, gravity, or medical devices will depend on availability and preferences. What is important is that we do our best to assist our lungs in clearing airways regardless of how often we cough or how much mucus Linda us throughout the day. Working together with our lungs is essential to maintaining overall health and well being.
How do you feel about airway clearance? Do you do it daily or when you have an exacerbation?
Linda Esposito
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I'm sorry, that was five years ago and the details have escaped me...
Maybe someone else is dealing with this now?
Sue
What causes the body to suddenly decide to "go crazy" and have an exacerbation or "flare up" with all the usual symptoms (nausea, weight loss, SOB, terrible lung sounds, weakness, etc) ? The disease is "slow" so I know it can't be a sudden overgrowth of the mycobacterium. I will be feeling normal and then it slaps me in the face out of nowhere.
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2 Reactions@lilianna mucous plugs seem to go with the territory. If you can tolerate 7% saline it might be helpful in getting the plugs out. When using the AD app try gently squeezing from the inside emptying out all the air from your lungs, like at the end of blowing up a balloon. Sadly, it's rinse and repeat everyday....!
Well, if I could answer that, I could be a billionaire!
Keep in mind that each of us is different, but here is my short story.
My diagnosis is asthma, bronchiectasis and hyper reactive airways, and here's what causes exacerbations for me - stopping airway clearance, viral respiratory infections like a cold, getting extremely stressed and overtired, not managing my asthma & allergies, being exposed to smoke (like this summer's fires) and some chemicals. I will get inflamed airways, bronchitis, pneumonia or even pseudomonas (I think that is always lurking in my lungs, along with MAC, but grows much faster.)
If I catch it immediately & treat with extra levalbuterol & saline nebs, extra rest and lots of good fresh fruit & vegetables, I can sometimes recover spontaneously. If not, it is on to steroids and antibiotics.
Can you figure out your triggers based on your most recent exacerbation?
Sue
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2 ReactionsI have not been able to pinpoint a common thread or cause for an exacerbation. I have no history of asthma or other lung disease other than MAC. I have experienced 2 exacerbations in a span of 5 months. None prior to that. Those 2 were quite harsh and I still have been unable to regain my weight from the last one. I'm thinking I am over the wait and watch and go ahead and try the treatment although that is scary.
Thank you. I can use only 3% because my dr says 7% could cause a bronchospasm. When I asked her about the mucus plugs she had no advice for me. She said I don’t qualify for a vest yet (?) and the respiratory therapist will call me to make an appointment. He will show me how to do postural drainage. She said they don’t even do it any more because there are vests- easier probably. So I keep doing what we all do: mucinex, albuterol, sodium chloride and AD app and mucus plugs are still there. But thank you that you found time to respond to my concerns.
I guess that 2 exacerbations so close together would make me start thinking about antibiotics too. What does your pulmonologist recommend?
Does your latest CT show progression of the infection compared to the previous one? Or the latest sputum sample show a higher level of infection? Those would be 2 keys for me.
But, I would try really hard to put on some weight first - a dietician can help you design a really high calorie meal plan, and a way to continue it during treatment. I lost 20% of my body weight in 18 months on the antibiotics, in spite of forcing myself to eat something high-calorie & nutrient dense every 1-2 hours during treatment.
How long have you been on "watch and wait"?
Sue
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1 ReactionWas your Drs recommendation to only use 3% specific to you? Are you prone to bronchospasm? Or is that her general opinion about 7%? Many people seem to find that 7% keeps the exacerbations at bay better than the 3%. That was my experience. Also at this point I can only get up less than half of the mucus while sitting up nebulizing or using aerobika. Most of the mucus will only come up if i use positional drainage at the same time that I use aerobika. I use it while laying on my back, hips slightly elevated and head slightly downhill. I also use it while on each side.
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2 Reactionsmy exacerbation this week was caused by a “cold” not covid. I waited a week, it then felt like fatigue and a low grade fever would keep me from my normal routine for another week or ???? I had a script for 7 days of doxycycline for an “exacerbation “ if it happened on a trip. I started it yesterday and am starting to feel better already. Has anyone else used this? I also turned in a sputum culture before I started antibiotics so I could review with my doctor later.
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1 ReactionHmm- I am going to suggest that "feeling better" after one day on doxy is just because you didn't wait long enough for your body to recover from the cold virus. Colds can last from 7-14 days, depending on the specific virus and our own immune systems. This is very typical of people who keep a "Z-pack" on hand, start taking it on day 5, 6 or 7 of a cold, and believe it cured them. Actually, time cured the cold, and they took unnecessary drugs.
I stopped the antibiotics for MAC at the end of 2019 (I was still MAC positive). At that time, I was sure I was going to have frequent exacerbations because it was my "pattern" for years before my MAC & Pseudo were diagnosed and treated.
I talked to both my ID doc and my primary about having an "emergency" script like I with some other meds for treating my asthma and frequent herpes flares. Both said "NO!" and gave me many reasons, but especially because I did have this history, and had been on many antibiotics, some effective, some not. Their logic was that treatment is available everywhere if I become ill (I travel over 6 months of the year), or by phone consult with one of them. They wanted no chance of over, under, or incorrect treatment, and forming yet another antibiotic resistance.
Last week, I came across an very interesting article about who succeeds in MAC treatment, and it talked specifically about the other infectious organisms present in those patients. My takeaway is that we really need to back off on antibiotic use unless absolutely necessary, because overuse can and does actually kill off beneficial organisms. So, I am pretty sure my docs were right in their approach - you can read the article here:
https://www.ncbi.nlm.nih.gov/books/NBK537076/#
May I ask you what additional steps (above typical airway clearance) you took to push back the exacerbation and let your body recover from the cold virus?
Sue
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