Airway clearance techniques

Posted by brian93 @brian93, 6 days ago

I have bronchiectasis and follow the Lung Matters Protocol ,(LMP) , and do airway clearance techniques (ACTs) 2x a day. I treated MAC for 2.5 years with antibiotics and am now MAC-free. LMP advocates using albuteral and hypertonic saline solution to clear the lungs and discourages use of any cough suppressants, steroids and many other things. Even doing ACTs, I still cough almost all the time. I'm at the point where I can't even socialize.

My question is: What can a pulmonologist possibly do to help me if I can't take any other drugs to help this cough? If I didn't have this cough, I would feel so healthy and normal.

I feel like I'm on my own with treating this condition with no relief in sight.

Interested in more discussions like this? Go to the MAC & Bronchiectasis Support Group.

@brian93 Hello, you might want to consider that we are all different, with different symptoms and underlying conditions and physiology. Lung Matters offers a lot of helpful information but as you are finding, it is not the best approach for every person who has Bronchiectasis or has had MAC.

A "one size fits all" protocol does not necessarily work for each one of us. And remember that the Lung Matters moderator is not a physician who knows your personal medical history - they are just promoting what works for them.

For example, due to essential tremor, I cannot use albuterol (or even levalbuterol) nebs- these send my tremors and heart rate into overdrive. And daily or twice daily 7% saline is too hard on my airways, making me cough uncontrollably.

With my pulmonologist, I have developed a regimen that includes a Symbicort inhaler, daily airway clearance and 2-3 times weekly saline nebs. This has kept me healthy and MAC free for over 4 years, with only a couple of exacerbations.

You can expect a pulmonologist review your health history, take a current look at your lungs and possibly a current sputum culture to make sure nothing else has attacked your lungs, and help you develop a treatment regimen that works for you and helps you control your cough.

Do you have a pulmonologist familiar with Bronchiectasis and MAC, or do you need to find someone?

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@sueinmn

@brian93 Hello, you might want to consider that we are all different, with different symptoms and underlying conditions and physiology. Lung Matters offers a lot of helpful information but as you are finding, it is not the best approach for every person who has Bronchiectasis or has had MAC.

A "one size fits all" protocol does not necessarily work for each one of us. And remember that the Lung Matters moderator is not a physician who knows your personal medical history - they are just promoting what works for them.

For example, due to essential tremor, I cannot use albuterol (or even levalbuterol) nebs- these send my tremors and heart rate into overdrive. And daily or twice daily 7% saline is too hard on my airways, making me cough uncontrollably.

With my pulmonologist, I have developed a regimen that includes a Symbicort inhaler, daily airway clearance and 2-3 times weekly saline nebs. This has kept me healthy and MAC free for over 4 years, with only a couple of exacerbations.

You can expect a pulmonologist review your health history, take a current look at your lungs and possibly a current sputum culture to make sure nothing else has attacked your lungs, and help you develop a treatment regimen that works for you and helps you control your cough.

Do you have a pulmonologist familiar with Bronchiectasis and MAC, or do you need to find someone?

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Thank you for your answer. My insurance changed so I can no longer go to my previous pulmonologist, and my current insurance doesn't have any local pulmonologists in their plan. Closest is 35 miles. Daniel Anderson in Hickory, NC.

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@brian93

Thank you for your answer. My insurance changed so I can no longer go to my previous pulmonologist, and my current insurance doesn't have any local pulmonologists in their plan. Closest is 35 miles. Daniel Anderson in Hickory, NC.

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If you have transportation, that sounds doable. I live in a Metro area, and my specialists can be anywhere within a 7 county area and beyond. In fact, in July and August we will travel 100 miles for my cataract surgery, because he is the best doc our clinical group offers for my eyes.

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@sueinmn

If you have transportation, that sounds doable. I live in a Metro area, and my specialists can be anywhere within a 7 county area and beyond. In fact, in July and August we will travel 100 miles for my cataract surgery, because he is the best doc our clinical group offers for my eyes.

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Is there any way to know which pulmonologists have more than average experience in bronchiectasis? My last doctor was fine with writing prescriptions but didn't provide much care or education about my condition. I was actually the one who suggested the saline treatment.

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Airway clearance takes a l o o n g time to exact. It's possible that you have pockets of bronchiectasis where it's difficult to clear. Understanding where those are might help you target those areas through specific postural drainage. Pulmonary RT told me I needed to clear until I was "dry". Really hard and super time consuming. The next best thing for me is to clear until the secretions show scant pale yellow, or even better clear. It keeps cough to a minimum but for very touchy times (weddings, funerals etc) I'll take a puff of albuterol and suppressant tessalon perels.

I agree with Sue about LMP -- one person's journey that worked for her. One size does not fit all. One of the biggest things that bothers me is that is zero room for discussion.

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@scoop

Airway clearance takes a l o o n g time to exact. It's possible that you have pockets of bronchiectasis where it's difficult to clear. Understanding where those are might help you target those areas through specific postural drainage. Pulmonary RT told me I needed to clear until I was "dry". Really hard and super time consuming. The next best thing for me is to clear until the secretions show scant pale yellow, or even better clear. It keeps cough to a minimum but for very touchy times (weddings, funerals etc) I'll take a puff of albuterol and suppressant tessalon perels.

I agree with Sue about LMP -- one person's journey that worked for her. One size does not fit all. One of the biggest things that bothers me is that is zero room for discussion.

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Thank you for your helpful suggestions. I've been doing LMP for a year and while it's been helping me clear my lungs, I definitely need something more.

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@brian93

Is there any way to know which pulmonologists have more than average experience in bronchiectasis? My last doctor was fine with writing prescriptions but didn't provide much care or education about my condition. I was actually the one who suggested the saline treatment.

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Call the office and ask them. Also, if there is no one with the expertise, visit the pulmonologist who is covered by your plan and ask for an out-of-plan referral to the Bronchiectasis Clinic at UNC.
According to Health Grades ( https://www.healthgrades.com/physician/dr-daniel-anderson-3dsyr ) Dr Anderson has experience with Bronchiectasis

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@sueinmn

Call the office and ask them. Also, if there is no one with the expertise, visit the pulmonologist who is covered by your plan and ask for an out-of-plan referral to the Bronchiectasis Clinic at UNC.
According to Health Grades ( https://www.healthgrades.com/physician/dr-daniel-anderson-3dsyr ) Dr Anderson has experience with Bronchiectasis

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Thank you, Sue. I'll do that

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@brian93

Thank you for your answer. My insurance changed so I can no longer go to my previous pulmonologist, and my current insurance doesn't have any local pulmonologists in their plan. Closest is 35 miles. Daniel Anderson in Hickory, NC.

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Where are you located? UNC Chapel Hill has a center there.

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@sweethighland

Where are you located? UNC Chapel Hill has a center there.

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I'm just north of Charlotte. Sounds like UNC - CH is my best option. Probably a 3-hour ride.

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