Antibiotic effect on mucus

My understanding is that azithromycin (a macrolide) helps with inflammation. Not so much as an antimicrobial. By reducing inflammation it's possible that phlegm will be reduced. It's used in those who have had frequent exacerbations (maybe 2-3 a year?) Studies show that 3 tablets MWF reduces exacerbations. You can read more here. https://pmc.ncbi.nlm.nih.gov/articles/PMC9453736/

Azithromycin is one of the big 3 treatments for NTM/MAC. So the most obvious con is that if you develop resistance to azithro and get MAC it cannot used in its treatment. In other words, it makes treating MAC more challenging. Other negatives are that it can cause stomach upset, impact hearing (ototoxicity) and prolongation of QT interval (heart related). The pros are that it can reduce exacerbations and lessen phlegm therefore improving quality of life.

Assuming it passes FDA approval Brensocatib (new drug specifically aimed at NCFB non cystic fibrosis bronchiectasis) targets neutrophil activity in the lungs and might help to reduce inflammation and phlegm. Anticipated mid 2025 in US and 2026 in Europe. 80% of NCFB is neutrophilic and 20% eosinophilic. https://journal.chestnet.org/article/S0012-3692(24)05304-2/fulltext

Another interesting drug that targets inflammation is https://ohtuvayre.com, which is aimed at the COPD population. The thought is if it helps with COPD inflammation it might also help in NCFB inflammation. It's a solution and inhaled via nebulizer.

Kudos to you that you've remained stable and infection free. Postural drainage can be challenging. Would it be possible to describe your routine?

@scoop Thank you for the detailed information. I have only read about postural drainage. My routine might not follow the exact process. I’ve never received instructions from a professional. I was using the Aerobika but found I was able to expel more mucus with the drainage / positioning body to help drain. I should start using Aerobika too, likely.
I drink a fair amount of water as this helps. I use NAC to thin out mucus.

My respirologist has said that I don’t need to nebulize or use mucinex. I have no allergies or previous lung issues. I have a fair amount of mucus but seem to be able to clear it or most of it. If I don’t clear it out by 1 or 2 pm each day, there is a heaviness in my chest. I don’t cough often during the day, otherwise. BE seems to affect everyone a little differently.

Routinely I do the postural drainage before lunch and before supper. Usually that is enough. Sometimes I cough up a bit first thing in the morning too.

I lay on my back with hands behind my head, and inhale for a count of 4 or 5. Then I exhale deeply for a count of five, engaging my diaphragm, so to speak. It produces a growling sound. It causes some rattling and I sit up and huff cough or repeat the inhale breath, hold my breath for a count of four and then huff cough. Sometimes laying to my side produces a bit more phlegm. I’ve been doing this for about 4 months.

Feedback from people about that technique would be welcomed. Maybe my technique needs to be tweaked. It would likely be difficult for some people to use this method if they have mobility or back issues.
I wonder what I’ll need to do later in life.

My condition developed after infections weren’t properly treated with antibiotics. That’s what I believe as my X-rays changed over a two year period of feeling really unwell and dealing with changing mucus issues, cough etc that doctor didn’t connect to possible lung issues. CT scan and respirologist confirmed BE. Gerd had been explored as the cause, but I have no Gerd. Well, everyone can have some acid reflux occasionally but I had nothing to warrant a diagnosis or using meds. As Sue has said, many of us likely need to be better advocates in our own health journey.
Thanks @scoop This is a helpful forum.

I use postural positions while using the Aerobika. Back (hips raised, head slightly lower), then each side. The back position is the only way I can get up the majority of my daily mucus production. Otherwise it will not come up.

Scoop, my pulmonologist said that Brensocatib would be prescribed to those with only bronchiectasis, not to those with bx plus MAC. Have you (or Linda @becleartoday) heard anything to that effect? Thanks.

That is possible… But I heard that they’re going to be looking at NTM diseases as well. I’m attending the NYU conference in December so I’ll have more info after that!

Enjoy the day, Linda

Your question of "I wonder what I'll need to do later in life" is something I have frequently, silently, said/asked myself this last year having understood and learned about postural drainage. I tried different ways of lowering the upper torso and was frustrated and said '" how will I do this later in life this is hard to manage getting in the position and getting up from it.'
I think I have found my answer for now (P.S. I'm 82 and thankfully strong for my age).
I will try to describe what "I" do for myself.
I use the end of the narrow sofa arm, place my wedge pillow inside the sofa with the high end resting up against the sofa arm, place the high end of a bed reading arm "pillow"on the arm of the sofa, for cushion and height. I lay over the reading arm pillow and the wedge pillow and therefore resting my head on the sofa cushions. By doing it this way it is easy for me to get in the position and as well remove myself from the position easily. Yes the legs are hanging out there beyond the sofa (I can bend the legs so that they are bent upward towards the ceiling while I hold the postion) and this allows me to use the legs/feet to drop to the floor and easily place my two feet back on the floor for a standing position. It works for me, for now.
Barbara

@blm1007blm1007
Thank you for sharing, Barbara. I think the key is also trying to stay as strong as we can (as you said) and finding a location for the postural drainage technique that works and is safe for someone.
Thanks.

Agree....."that workds and is safe for someone." Every other way I tried I did not (for me) feel safe in doing, for various reasons.
Barbara

This is the second time to have MAC for me. After getting rid of it the ID put me on Azithromycin 500 3x per week to keep it at bay. I tolerate Azithromycin very well. It stayed away for the last 9 years. It has returned but not treating it at the moment. I have Mac and another one that is proving itself hard to kill. Been treated for the last 3 months and it won't go away. Just turned in another sputum sample and hopefully it is gone and the MAC no worse hopefully. Not sure if I am bringing up enough mucus or not. I just know when the color and texture changes . . . . here we go again! This is the first time that I have had two different infections at one time. Off the one med so back on Azithromycin regiment of 3x per week. I have recently started the 3% saline. I thought that it was the other drug but now I am beginning to think that it is the saline that makes my throat so sore. Does the saline do that to anyone else?

Thank you, Linda. Fingers crossed!