How do you handle a flare up or exacerbation?

I tried to post my question regarding this topic but "it" would not let me.

Question: Are there specific treatments that should or can be done during a MAC "flare up"? Should one go to see their physician when they have a "flare up" or do you just have to deal with it until you get over it because there is no additional treatment other than your usual airway clearance ( aerobika, albuterol & saline nebs, cough, etc)?

Ha! I found a way aound the computer difficulty and posted my question! I would appreciate any insights into my question. Thank You!

Great questions @sueinmn !

Prevention
The usual: masking, hydrating, hand washing, fruits/veggies, avoid crowds (which at times is impossible) enough sleep and movement. Whenever there's a sunny and relatively warm day, I try to sit outside in the sun for 10-15 minutes.

What do you do when you feel a cold or other illness coming on?
There seems to be a fine line for me between feeling something coming on and illness, likely due to mild immune def and sinus issues.

Ideally for a flare, I will drop off a sputum sample at the lab. There must be an order in my chart, otherwise, the lab rejects it. This has happened more times than I care to remember. As a patient it would be great if I could check my chart to see if there's an order. (My medical center is transitioning to Epic and maybe that's a feature?) If I am feeling really crappy, doc will start me on something after the sputum drop, otherwise I wait to see what grows. Clearance increases from 2 times to 3 or even 4, which is really hard because I feel poorly. Rest as much as possible.

My pulmonary dr in the past gave me doxycycline and short term high dose oral prednisone for exacerbations. I haven't had any this year so I don't know if the treatment would be different.

Immunoology has me start prophylactic antibiotic therapy 3x/week around Halloween up until around Easter
For me, June is horrible, too. I live in Kentucky.

When you come off azithro after Easter do you find it difficult? Prophylactic antibiotics seem to reduce the mucus and adapting to increased mucus usually means longer clearance sessions. A drag for sure! The long clearance sessions are what I find onerous about this disease (bronchiectasis) and of course the infections and feeling poorly.

YES! I get inflammation every time. Same when I taper off prednisone.
Yet, my infections are much less. It's just all inflammation

Oh and btw I can't do zpack or bactrim anymore because of allergies. I developed an allergy to aspirin and all NSAIDS (Samter's Triad/AERD)
It's usually amoxicillin and doxy, which reeks havoc on my GI and they don't work as good
I am not a MAC patient, Mine is strictly MSSA

@sueinmn , I know this is an old post , but I just read it and found helpful. Thank you !
I’m sending in my first mucus sample to UT Tyler . It’s Sunday , so it will go out tomorrow. Can you tell me how this works…do they wait on culture confirmation before prescribing antibiotics ? How long does this usually take ? My local / Dallas pulmonologist never did sputum collections . I went to Tyler last Dec, and they will be coordinating care with my Dallas doctor . Historically , based on symptoms , my pulmonologist would decide if I needed antibiotics and possibly steroids. I have mild BE. I’m just curious how the process will work now, with the addition of the testing . Do you wait for the culture before moving forward with antibiotics ? I know I’ll find out, but just curious on this Sunday morning how things will play out .

@cholash Usually, unless you have severe symptoms, antibioyics are not prescribed until the sputum culture comes back. the last step is sensitivity testing to determine which ones to prescribe. this takes 6-8 weeks, but mycobacteria are very slow-growing, so waiting is not risky.

Sometimes, even i f the culture is positive, if the infection load is low and you have few symptoms, they may not start antibiotics right away. There is a protocol called watch and wait, where you do daily airway clearance and submit frequent sputum specimens for culture to see if you can reduce or eliminate the infection without drugs.

are you doing airway clearance?