Treatment Guidance Please...Bronchiectasis/Asthma/Reflux

I am feeling confused and would welcome your informed input. Diagnosed with Bronchiectasis and more recently with NTM – MAC and now a decrease in lung function by 25% compared to last test 6 years ago.

Although also diagnosed with asthma in 2009 I had never felt the treatment of it (puffers/inhalers and most commonly Symbicort) made any real difference to the issues bothering me - initially my cough. So generally I have been referred to as uncompliant with regard to treatment for it.

Over the last 18 months I have been following a protocol proposed by the Lung Matters (Facebook group) which specifies daily nebulising with salbutimol followed by 7% hypertonic saline (with no steroids or other puffers inhalers).
My recent NTM lung infection diagnosis may have only been picked up since I have been taking more sputum samples during this protocol. I have also recently found that the salbutimol aggravates my GERD/reflux problems and so I have been nebulising with the saline only.

My recent lung function test apparently shows that I have had a drop of 25% in lung function since the previous test 6 years ago. The physio I saw at this recent RPH specialist appointment has recommended I do gentle huff coughing instead of the nebulising (which I feel is not going to be sufficient). The registrar I saw at this specialist appt once again was pushing Symbicort and/or fluticasone and told me that my bronchiectasis was mild and shouldn't be causing the issues I am experiencing (presumably referring to the at least 7oz cup of fluid from my lungs each nebulising). She seems to think it is asthma/post nasal drip.

I am wondering if I should go back on a trial of Symbicort or something similar to see if it makes a difference.

I am worried that my lung function is decreasing so dramatically and also about the volume of mucus I clear each day (since I have not been able to find anyone else who regularly produces so much).

Clinical history:
2008 no HRCT evidence of emphysema/no convincing HRCT evidence of bronchiestases. Mild bronchial wall thickening mostly basal segments. No small airways disease, non calcified pulmonary nodules < 5mm

2009 Tested POSITIVE to histamine provocation for asthma, peak flow variations between 20 - 25% of peak flow, small airways obstruction and increased relative gas transfer, allergic to house dust Mite and cat, cold air and rapid air flow (talking/laughing/exertion), post nasal drainage, Lung nodules < 5mm, THOMPSON

2011 Small component of eosinophilic/inflammation/involvement of eosinophils, inflammation still occurring, but more likely through different mechanism. Low levels nitric oxide.
PETA GRAYSON

2013 CT - mild general peribronchial wall thickening both fields, mild changes of cylindrical bronchiestases mainly lower lobes. Minor areas of scarring no consolidation, minor areas compressive atelectasis, no endobronchial lesion, small nodules - previous granulomatous disease?
a little calcium in aortic artery, prominent oesophagus related to hiatus hernia?
CHRIS DENZ

2017 lung function shows mild airways limitation; chronic cough thought to be result of undertreated asthma, reflux, and post nasal drip.
BENTLEY RESPIRATORY

2023 CT mild interim generalised bilateral central peribronchial wall thickening both fields, and in lower lobes with interim increase in dilated bronchial wall thickening. Scarring noted, was only faint in 2013. Nodules unchanged. No pleural effusions/thickening.

2024 Told 25% decrease in lung function compared to 6 years ago.