Having first exascerbation and don't know what to expect

Posted by bernadene24 @bernadene24, 7 hours ago

I was diagnosed with mild BE and ILD in January of 2025. A broncoscopy found a lot of Pseudomonas and some MAC. At that time watchful waiting was recommended since I had very little coughing or SOB. I went along with nebulizing and airway clearance 2x a day. My scans and lung function tests were pretty stable since first getting sick with pneumonia in Sept, 2023. In January 2026, I changed insurance from Kaiser to original Medicare and was able to go to Georgetown, which is a center of excellence near me. At my first appointment I was told that I had traction bronchiectasis caused by lung scarring. We could continue the watchful waiting.
In mid August 2026, I suddenly got hit with fever, and terrible malaise. I just wanted to be in bed. Since I live alone, I thought I'd better try to figure out what this was. I looked up symptoms for flu, covid, and pneumonia and they didn't seem to fit. My coughing and mucus had been slowly increasing for several months, but I hadn't been feeling bad. I had mentioned it to my new pulmonologist in March and July when I saw her, but she didn't seem concerned. I gave my first sputum sample in time to be finished by July. There was nothing, but I have a lot of trouble getting sputum up into my mouth. I always know it is there because I swallow it.
This time in August I had more sputum than I had ever had--still not a ton, but enough that I was able to collect it. The following day I took it to Labcorp.
Results came back that I had pseudomonas and the doctor prescribed levofloxacin. I started feeling better by the next day and by the end of the course, I had no fever. I also had virtually no coughing or sputum, even when I nebulize. The only thing left is weakness and some SOB when I exert myself.
It has been 5 days since I stopped the Levofloxacin and I still have no coughing or sputum. Is this how it usually goes? I have not had any antibiotics to treat this before. I'm wondering if it is a good thing or a bad thing not to cough up the mucus. It is my understanding that it is important to get some of the bacteria out.
I understand that we are all different in how we respond to anything related to this disease, but I would really appreciate hearing from others who have had a somewhat similar experience and how it went for them.
While I like my new doctor very much it is REALLY hard to communicate through the system, so I am expecially grateful that this group exists!!

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@irenea8
you know so much about pseudo maybe you could respond to this?

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For me not coughing up mucus during or after an antibiotic is a good thing. Otherwise my chronic Pseudomonas infection causes a heavy load of mucus every day. It has only been 5 days for you so far. If the results continue for a long time, I would count myself very lucky that the treatment worked well to tamp the pseudo down. But you may find that the mucus starts to build back up either quickly or over time. It is really a matter of how long do the results last before you need treatment again. If you are not coughing up anything just keep nebulizing anyway twice a day with saline and doing ACT.

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