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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always an update….i came up with mac again, 7 months post stoppage of antibiotics. so pulmonologists say let’s get in a few more monthly sputum samples and go back to 2x daily act and 7% nebs. I just had an exacerbation not related to covid (my grandkids germy coughs). after a week, i started doxycycline (feeling better..not perfect). now i need to talk to my pulmonologist next month.
hey sue,
I really tend to agree with you about the antibiotic use. I must admit , I had the cold for almost 2 weeks and then started with lo-grade fevers and just felt miserable! I try to rest(the grands make that hard). and take tylenol and guefenesin(2x daily always). and up act 3x daily. I will continue the doxycycline for full 7 days. (i had it in case of exacerbation on trip). Can you think of any other things I can do next time better(besides antibiotics)? thanks for the feedback.
cindy
I have a CT scan scheduled at the end of this month. My current pulmonologist never gets a sputum sample since my bronch with sputum and Dx, which was a couple of years ago. I am not pleased with her to say the least. I'll see what the CT shows and what she says. I've been on watch and wait for the past couple of years but it seems to be that my symptoms are slowly increasing plus these 2 exacerbations. If you have any further suggestions I'm all ears!
Find a doctor who does regular sputum cultures? That would be the best way to measure the level of infection.
I am having the same discussion with my doc, because I am stable for 4 years. I jus really want to know my current status to determine if my current regimen is enough.
Sue
A different doctor would be ideal but there is also the difficulty with the lab. The lab here (as with many labs) does not do a bacterial load count or other detailed reports that are talked about at the main centers like Tyler Texas or Denver. I don't know if it is possible to send sputum to one of these centers and have it still be a viable specimen? And if so, if my doctor would do such a thing. When my bronch was done all they did with my sputum specimen was culture and AFB smear. I think that is the extent of which most labs can do. Do you know if sputum could be sent and still be viable and if one of those centers accepts specimens from other places for testing?
Actually, the lab is not a problem. And yes, samples, once prepped in a lab, can be forwarded for testing.
My doctors in Minnesota send any suspected mycobacteria to the lab, and if the preliminary slide shows gram negative bacteria (they cannot identify which one(s) at this point) the sample is sent to NJH for the complete culture.
I know that others here have had their specimens sent to a variety of remote labs as well.
Sue
Hi Sue, can you send samples to other labs without an order from the doctor? I send my samples to the clinic I go see my doctor. Can I send to a different lab or LabCorp and etc? I mean without an order from the doctor.
I'm not sure what would be the point of doing that because there is no guarantee that they will see or accept your other lab results. It's better to work with, not in parallel with or counter to, your doctor or care team. It may take some research, persistence and persuasion on your part, but that is how you build a team...
This is what I might say -
"Good morning, doctor, I am part of a Bronchiectasis and MAC Support Group through Mayo Connect. This is very helpful to me because [choose one or more...MAC is so rare I never heard of it before my diagnosis, I don't know anyone else with this infection, I don't know how many cases you see every year...] On Connect, I communicate with hundreds of MAC patients across the country and even in other countries. Many of them are able to get very detailed information about their NTM from sputum samples, including species differentiation, colony counts and medications sensitivities. I would like for US to have the same information when WE make decisions about MY treatment. Can we find a lab, here in Texas, where you can send my samples for processing? Or, if there isn't one, I have done some research and found that National Jewish Health (NJH) in Colorado does this detailed testing and accepts outside specimens on request. There may be other labs that do this as well."
This would tell your doc you want to be an active participant, open a conversation between you, and maybe be the final "push" for you to find someone new if they are not receptive.
What do you think of an approach like this, either in person, on the phone, or through your patient portal?
Sue
PS. I may have been "fired" by a doc a few years ago when I tried to get help on my own, and they took great umbrage.
Thank you so much Sue. I'm learning a lot from you. I will try and do that. The culture result I get is always "light growth" or "scant growth" , "no acid AFB in 6 weeks". Never about species differentiation, colony counts and medications sensitivities. At the clinic, my doctor can see all these but I cannot see them in my portal.
Good info to know. I appreciate your answer about the samples being viable after prepping and that the other labs at the "main" centers do accept them for further testing. It will help give be back up when I next see my doctor. As you can probably sense, I don't trust her to be receptive of doing things outside of her particular view of standard treatment for MAC.
Also, I want to thank you for the time and effort you spend in answering questions and giving advice to us desperate MAC people. It is so very helpful having a sympathetic ear.