Author Topic: Diagnosed with Bronchiectasis  (Read 7796 times)

Diagnosed with Bronchiectasis
« on: May 24, 2014, 10:02:47 am »
Had four chest infections in the last 12 months, in the midst of my sixth since I started counting in 2013. I work with a member of the editorial board of the Cochrane airways group. Sweating my way through a meeting, running out of breath speaking, he took me down to see an asthma consultant. Had my treatment bumped up the treatment ladder (I'm asthmatic) and got booked in for a high resolution ct scan in January. Heard nothing for ages, then got a call back for a normal ct scan. Got told by radiology that it was routine. Forgot about it.

I'm off to Naples and was aware that the sore throat I've got would become a chest infection - anything I get goes on my chest. Head down to GP on Thursday, who looking through my notes finds a letter from February informing them that I've got "mild sub segmental and right middle lobe and basal lobe bronchiectasis".

I'm away for a week now. i have people I can speak to at work when I get back. However, any heads up welcome. I've read there are devices called acapella and flutter. Any clues? I've got a power breathe device already, and have read a bit about the benefits of inspiratory muscle training because of work with closetleftie. GP gave me a big stash of  antibiotics and steroids as well as my usual inhalers and antihistamines.

Sure enough, sore throat has become a source of nice thick green gloop. In trying the active cycle of breathing technique, and that seems to be helping.

The clinical report has more detail:

"Lungs well expanded, satisfactory appearance of central airway. Mild cylindrical brochiectasis involving the medial segment for both the lower lobes. The lower lobe changes are better evaluated on the prone examination. There is peri bronchial thickening with minor mucus plugging. In addition, patchy ground glass changes are seen in the left lower lobe, suggesting super added infection.

There is no evidence of septal thickening, tractional bronchiectasis or architectural distortion to suggest fibrosis. There is no significant mediastinal lymphadenopathy. Visualised upper abdominal organs are unremarkable (rude!)."

Any additional insights? GP saw me at 6pm. Pointed me at Google, and said "you just need to be on top of it with antibiotics and steroids. It won't affect you".

I think I'd like a bit more detail :)

hellymedic

  • Just do it!
Re: Diagnosed with Bronchiectasis
« Reply #1 on: May 24, 2014, 01:26:33 pm »
I am not a respiratory physician! In general, I'd agree with the GP. Get on top of any infection with antibiotics and steroids to limit both temporary and permanent harm from chest infections.

Bronchiectasis is a feature of long-term lung damage from previous trouble. (Straight tubes get wide and develop little sacs in which infection/pus can fester.) This makes future trouble more severe and troublesome so you ought to wade in PDQ with antibiotics and steroids whenever things hit your chest.

One cause of bronchiectasis is whooping cough.

Re: Diagnosed with Bronchiectasis
« Reply #2 on: May 24, 2014, 01:41:23 pm »
Reading more, cylindrical is the mildest form, and I don't even have chronic cough.

Already been told I've got heterozygous alpha-1 atrypsin deficiency. I've never smoked, albeit parents did / do. Men on my old dears side get emphysema. Don't want that!

Re: Diagnosed with Bronchiectasis
« Reply #3 on: May 24, 2014, 02:47:12 pm »
Reading more, cylindrical is the mildest form, and I don't even have chronic cough.

Already been told I've got heterozygous alpha-1 atrypsin deficiency. I've never smoked, albeit parents did / do. Men on my old dears side get emphysema. Don't want that!

Good luck, I, I'm sure you'll et on top of it.  My brother has emphysema and you're right - you don't want it!

Re: Diagnosed with Bronchiectasis
« Reply #4 on: May 24, 2014, 02:50:05 pm »
Sounds horrid. I hope you get on top of it soon.

Re: Diagnosed with Bronchiectasis
« Reply #5 on: May 24, 2014, 02:56:28 pm »
The steroids are making me *really* buzzy. Haven't been able to get to sleep much before 3 the last two nights, but I'm feeling really great. Admittedly, it's the sweaty palms, "alright mate, nice one geezer, what a tune!" sort of great, but beats feeling rough. Looking through the side effects lists, I struck lucky.

Re: Diagnosed with Bronchiectasis
« Reply #6 on: May 24, 2014, 03:30:39 pm »
My breathing got really bad in 2007 when I went through a series of wet PBP qualifiers, a wet PBP and some wet rides after. I can hear it on the narration on the PBP DVD I did. Perhaps I should have done more to counter it at the time.
I've shyed away from too much riding in the rain since then.

hellymedic

  • Just do it!
Re: Diagnosed with Bronchiectasis
« Reply #7 on: May 24, 2014, 04:54:58 pm »
Hard luck about the alpha1 anti-trypsin deficiency! You obviously can't change the genetic hand you've been dealt.
You're avoiding the cigs as everyone should so I don't think there's much else you can do.

I'm thinking of future management of this condition; do you know if your sons have it?

Re: Diagnosed with Bronchiectasis
« Reply #8 on: May 24, 2014, 05:02:37 pm »
It's on my do list to get them checked out. My four year old has had enough chest infections in the last 12 months to warrant screening (if I've read the guidelines in thorax correctly).

hellymedic

  • Just do it!
Re: Diagnosed with Bronchiectasis
« Reply #9 on: May 24, 2014, 05:24:52 pm »
Poor mite!
Still, aggressive management of infections makes much sense in his case.

Re: Diagnosed with Bronchiectasis
« Reply #10 on: June 03, 2014, 06:27:40 pm »
It's on my do list to get them checked out. My four year old has had enough chest infections in the last 12 months to warrant screening (if I've read the guidelines in thorax correctly).

Find a good respiratory physician. Then do what they tell you. You have enough on your plate without qualifying in another field! I have, f'rinstance, completely abdicated any responsibility over my children's health (mostly because my record was quite so terrible when they were little  :-[ :-[ :-[ ). "Ask your mum" is about all I'm willing to tell them when they say they're poorly.

Re: Diagnosed with Bronchiectasis
« Reply #11 on: June 03, 2014, 06:42:50 pm »
You have my sympathy.  I'm very careful about chest infections since going out of the bike too much during an extended period of freezing fog in the early 90's (house hunting in York).  Rather than the cold, I put it down to the trapped pollutants from coal burning power stations. It turned into a chest infection - not nice at all.

Sic transit and all that..

Re: Diagnosed with Bronchiectasis
« Reply #12 on: June 25, 2014, 11:30:00 pm »
Waiting for the results of second CT scan. Currently on 3x 750mg of carbocisteine, 1x Omeprazole for the heartburn it gives me, 2x250ug x3 Seretide, and desloratadine. Also 40mg of prednisolone and Amoxicillin whenever I get an exacerbation. Whenever I take the prednisolone, I get a load of PBs on strava.

Have felt rough, and my asthma hasn't felt well controlled lately. Starting to feel better now.

GP said today "nobody in my practice who doesn't smoke dies of this. You'll get a bit wheezy in your late 70s and die of whatever you would've died of".

Cheery chap :)

@closetleftie - nice to see you on the commute. Must do beer. Will call later this week.

hellymedic

  • Just do it!
Re: Diagnosed with Bronchiectasis
« Reply #13 on: June 26, 2014, 12:37:56 am »
Does carbocysteine PONG like other SH-containig compounds?
Just curious like...

Re: Diagnosed with Bronchiectasis
« Reply #14 on: June 28, 2014, 06:23:30 pm »
See this is the problem - I'm supposedly well and you have this terrible chest condition. And then you utterly humiliate me on a hill.  ;D  :-[  >:(

hellymedic

  • Just do it!
Re: Diagnosed with Bronchiectasis
« Reply #15 on: June 28, 2014, 06:49:42 pm »
EVERYONE ALWAYS humiliated me on a hill!
I do not have asthma.
I do not have heart trouble.
I was a little chubby but never VERY heavy.
But I was S-L-O-W...

Re: Diagnosed with Bronchiectasis
« Reply #16 on: June 29, 2014, 10:48:07 pm »
See this is the problem - I'm supposedly well and you have this terrible chest condition. And then you utterly humiliate me on a hill.  ;D  :-[  >:(

I was properly late for a meeting - did shout to jump on the back. Maybe a fast tracked TUE from the UCI is in order. 40mg of prednisolone is great.

Re: Diagnosed with Bronchiectasis
« Reply #17 on: July 01, 2014, 10:46:03 am »
See this is the problem - I'm supposedly well and you have this terrible chest condition. And then you utterly humiliate me on a hill.  ;D  :-[  >:(

I was properly late for a meeting - did shout to jump on the back. Maybe a fast tracked TUE from the UCI is in order. 40mg of prednisolone is great.

I tried but couldn't hold on...   :-[

Re: Diagnosed with Bronchiectasis
« Reply #18 on: July 11, 2014, 02:48:52 pm »
So, double appointment with GP. Lots of self-efficacy boosting stories, had a go with spirometry for the first time - averaged FEV1 of 5.01 , which I was pleased with, 'cos even if Helly describes it as a "pretty facade", I can say "lungs of a 20yr old".

Carbocisteine or the Omaprozole is giving me a really sore, dry tongue, which has been getting me down - tongue horrible sore on waking, nothing tastes nice, and crunchy things are sore. However, pharmacist found me some tongue lube. Works a charm.

Transitioning off my prednisolone - over a hundred PBs on strava since I started on it, despite being the heaviest I've been in ages. Just sick of getting 4hrs sleep a night and feeling bugs crawling around in my wrists.

I can tell you, prednisolone would be awesome on a 600! If I ride through next time I do one, I'm claiming a TUE.

Had pneumovax yesterday, plus a get out of jail free card for DIY and gardening (avoid dusty jobs and compost). GP is a ironman type in his mid 60s. His advice was mix in some interval work: "do some eyeballs out stuff to really clear the lungs - you audaxers don't go very fast".

All in all, feel like I'm coming out of the cloud that the diagnosis has felt like.

Re: Diagnosed with Bronchiectasis
« Reply #19 on: July 12, 2014, 10:21:57 am »
Glad to hear things seem to be getting better for you, I.


GP is a ironman type in his mid 60s. His advice was mix in some interval work: "do some eyeballs out stuff to really clear the lungs - you audaxers don't go very fast".

Bit of willy-waving from your GP there, I think!  Iron-man is often the acme of "slow-long"!  Anyone who had seen you zig-zagging up Hardknott and Wrynose would know that effort is occasionally, just occasionally, involved in Audax - especially up here.  I should think effort was the key and not speed when it comes to clearing the lungs - easily achieved by a few spins up West Chevin before breakfast.

Continued good luck!

Peter

PS My GP (one of them) is also a long-distance tri-athlete.  I'm not there very often but it's good to have docs. who understand our madness!

Re: Diagnosed with Bronchiectasis
« Reply #20 on: July 14, 2014, 09:07:59 am »
Well done DrM. Ongoing good wishes.

(From an Audaxer for whom "slow" and "eyeballs out" quite often coincide!)

Re: Diagnosed with Bronchiectasis
« Reply #21 on: August 25, 2014, 06:20:00 pm »
So. Dr Mekon. Not only did we share most of the LEL2013 experience together, so it turns out we both have Alpha-1 Antitrypsin Deficiency? A 1:3500 genetic disorder? How unlikely is that?!

So far, I've not had the same lung problems as you - I put down my "Emphysemic changes in upper lobes of both lungs" to 35 pack years of smoking, but apparently my A1AT level is about 40% what it should be, so not one of the bad ones - but enough to have an effect.

I have my first appointment with the COPD clinic next week. I'm expecting to share the waiting room with a lot of coughing, wheezing, grey-faced smokers. Maybe I'm wrong?!

Re: Diagnosed with Bronchiectasis
« Reply #22 on: August 26, 2014, 07:29:54 am »
I would also suggest finding a Physio with chest experience and ask about postural drainage and other techniques for improving the removal of green gunk without coughing.

Re: Diagnosed with Bronchiectasis
« Reply #23 on: September 01, 2014, 12:36:14 pm »
So. Dr Mekon. Not only did we share most of the LEL2013 experience together, so it turns out we both have Alpha-1 Antitrypsin Deficiency? A 1:3500 genetic disorder? How unlikely is that?!

So far, I've not had the same lung problems as you - I put down my "Emphysemic changes in upper lobes of both lungs" to 35 pack years of smoking, but apparently my A1AT level is about 40% what it should be, so not one of the bad ones - but enough to have an effect.

I have my first appointment with the COPD clinic next week. I'm expecting to share the waiting room with a lot of coughing, wheezing, grey-faced smokers. Maybe I'm wrong?!

I've skipped all that - back door entrance to a research clinic. However, I'm probably going to get referred to a different consultant, as it's a bit weird being seen by colleagues.

Have you got any good drugs yet? I swear prednisolone is the best audaxing drug ever. If you were on Strava you could tell when I take some because I get PBs non-stop.

I'm doing inspiratory muscle training on top of steroids, antihistamine, and mucolytics (plus a pill to counteract the reflux I get from them). I'd like physio too, but not been offered it yet.

The inspiratory muscle training is hateful, but feels effective. I'm using this one that I got off peli

http://www.wiggle.co.uk/powerbreathe-plus-respiratory-trainer/

Re: Diagnosed with Bronchiectasis
« Reply #24 on: September 01, 2014, 02:38:01 pm »
The only drugs I'm on are low-dose Ramipril (ACE Inhibitor), more as a precaution than anything, given my hypertensive reaction to exercise (260 systolic on the treadmill). Turns out, A1AT sufferers can also have elevated muscular angiotensin converting enzyme (the same ACE that ACE inhibitors inhibit) which can manifest in acute hypertension during exercise. It can also cause peripheral circulation issues like Raynaud's (which I suffer badly from in winter, when cycling) because of the vasoconstricting effects of the ACE.

I'm hoping the Ramipril will help with all that. So far, I think my dose may be too high - I've had some fainting from postural hypotension, and have had some really low BP measurements (90/40 after I DNF'd the Mildenhall 200, feeling like crap - oddly enough!) which I can really do without.

Fboab has suggested the power-breathe thingy a couple of times, as I pant much more than her when we're climbing on the tandem. I'll ask the COPD people on Friday. I have a growing list of questions to ask!

But, aside from a dry tickly cough that I get for a few weeks in late spring that's usually responsive to Citirizine (some kind of pollen reaction presumably), I'm mostly fine, respiratory-wise.