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bronchiectasis updated

with 3 comments

Spiriva3   160px-Capsule_of_tiotropium_bromide_(with_puncture_holes_from_inhaler_device)      220px-%22Spiriva_HandiHaler%22-brand_dry_powder_inhaler_(open)

A lot has happened regarding my bronchiectasis recently, so I need to write about it here to learn more about the medication I’m on and what it might be doing to me.

I posted on this a couple of weeks ago, and that was an update on my first important post on the subject. But last time I wrote about an ‘acute exacerbation’, as the literature has it, of my condition, and what I believed was its cause. As it turned out, I was completely wrong. My doctor thought it might be viral, while I was privately convinced it wasn’t. I was given a doctor’s certificate and told to take a couple of days off, because I could benefit from the rest and because I might be infectious. I reluctantly did so, but was back at work the next day when I noticed a missed private call on my phone. It took me another day to respond, and it turned out to be my doctor telling me that my sputum tested positively for two viruses, influenza A and a human rhinovirus. Oh dear. I had to take more time off work, and my doctor told me not to worry about the antibiotics (it was a small course and I’d finished them anyway) and gave me a puffer with 60 doses of Alvesco®, which is ciclesonide, a synthetic corticosteroid which ‘prevents the release of substances in the body that cause inflammation’, according to this website. This was on top of the ingestible steroids, the subject of my previous post, though I didn’t go into detail about those pills, which I’ll rectify shortly. He also gave me a nasal spray for my rhinovirus, and arranged for me to have a consultation with a professor of Chesty Things at the RAH Chest Clinic.

So I’d like to look more carefully now at the medication I’ve been prescribed, apart from the antibiotics.

Firstly, Panafcortelone®, 30 white tablets each containing 25mg of prednisolone, an anti-inflammatory steroid much like ciclesonide. The worry about steroids is that they can interact with other medications to our detriment. They can also weaken our immune systems under some circumstances. I must say, though, that I’ve never yet had an adverse reaction to any medication I’ve taken. There’s quite a list of ailments that can be adversely affected by steroid use, no matter whether it’s prednisolone, ciclesonide or any other steroid, it seems. However, they shouldn’t be confused with anabolic steroids, notoriously misused by athletes.

Secondly, the nasal spray, Avamys®. Its active ingredient is Fluticasone furoate, yet another corticosteroid. According to the accompanying leaflet:

Avamys is used to treat symptoms of allergic rhinitis including stuffy, runny or itchy nose, sneezing, and watery, itchy or red eyes. The effects are usually felt within the first day, although some people will not feel the effects until several days after first taking it.

I took this medication regularly as prescribed for 5 or 6 days, then dropped off, as I obviously felt a lot better. It contains 30 sprays, and I wasn’t told to keep taking it to the end, as far as I can recall. The leaflet says that ‘once symptoms are controlled you may be able to decrease your dose to one spray in each nostril per day [down from 2]’. However it says elsewhere: ‘Do not stop using Amavys or change the dose without first checking with your doctor’. So I’ll try to keep taking it, though I don’t feel that I need it. My symptoms have always been mild compared to the description above.

Thirdly, the first medication prescribed by the Professor. Spiriva® is the brand name for capsules containing 18 micrograms of tiotropium (equivalent to 22.5 micrograms of tiotropium bromide, monohydrate), which are punctured and inhaled rather than orally ingested. It’s an anticholinergic bronchodilator used generally to manage COPD (chronic obstructive pulmonary disease), but not for acute exacerbations. Here’s what Wikipedia has to say on anticholinergics:

An anticholinergic agent is a substance that blocks the neurotransmitter acetylcholine in the central and the peripheral nervous system. Anticholinergics inhibit parasympathetic nerve impulses by selectively blocking the binding of the neurotransmitter acetylcholine to its receptor in nerve cells. The nerve fibers of the parasympathetic system are responsible for the involuntary movement of smooth muscles present in the gastrointestinal tract, urinary tract, lungs, etc. Anticholinergics are divided into three categories in accordance with their specific targets in the central and/or peripheral nervous system: antimuscarinic agents, ganglionic blockers, and neuromuscular blockers.

Tiotropium is described as a muscarinic receptor antagonist (MRA), which means that it blocks the muscarinic acetylcholine receptor, found in the cell membranes of some neurons and other cells. Muscarinic receptors are divided into types, and the one I’m concerned with is the M3 receptor, which plays a role in bronchoconstriction.

Finally, the second medication prescribed by the professor is Nuelin™, aka theophylline (200mg in a sustained release form), which causes the muscle lining of the airways to relax, according to the leaflet. It is used to treat asthma and other conditions where breathing is difficult. According to the netdoctor site,

Theophylline is a type of medicine called a xanthine bronchodilator. It is used to open the airways.
Theophylline causes the muscles surrounding the airways to relax by a mechanism that is not fully understood. This allows the airways in the lungs to open.
In conditions where the airways tighten, such as asthma or chronic obstructive pulmonary disease (COPD, eg emphysema and chronic bronchitis), it is difficult for air to get in and out of the lungs. By opening the airways, theophylline makes it easier to breathe.

So all these medications are to help me breathe easier, but of course I’m hoping to be cured, and the professor, a lively and interesting gentleman, informed me that my lung function test, like the previous one earlier this year, came up very positively. That’s to say, my lung functionality is above average even for a normal person, so I’m really not having any difficulty breathing at all, I think… In fact, the professor mentioned a lung capacity of 106%, which doesn’t make much sense to me, and I forgot to ask for clarification (I’ve never given a student more than 100% for any test I’ve given them).

In any case I’m to go back to him around April for another consultation, by which time all these medicaments will be consumed. I think the hope is that some of the blocked areas as revealed on my CT scan will be a little less blocked. So maybe there’ll be another CT scan in the pipeline. The professor took me on a tour of my lungs via the previous scan, pointing out that because the whole of the right lung is affected by little blockages all through it, no operation would be possible, as might be the case if it was one localised very badly blocked region. presumably he was talking about an operation to remove a section of the lung. The left lung is not affected at all, which is apparently quite unusual.

Anyway, I’m always the optimist, and I’m hoping that maybe I can yet be cleared of all this gunk, and so cured.

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Written by stewart henderson

December 24, 2014 at 7:38 am

Posted in health, medicine

Tagged with , ,

3 Responses

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  1. I had bookmarked your website long time back, because when I was researching on COPD and Bronchiectasis, I got your site. I wanted to tell u my experience from the last time I checked your site. I slipped from bad to worse with my steroids starting a slow onset of Osteoporosis (not even osteopenia). I always had more faith in science and very less faith in miracle healing, But i started researching on all alternate medicines because of desperation. I knew Homeopathy was a farce (had researched a lot on it), Alopathy (English or the scientific medicine i have been taking) is effective but also has side effects. Something that i have been looking at for a long time is Ayurveda (I am an indian and from ancient days, Ayurveda has always been competing with Alopathy, so usually the advices comes from forefathers) But i was always skeptic about getting a right experienced person. Because like everything else in this world, Ayurveda has become commercialized and everyone claims having medicines for everything. Most of the Ayurvedic folks are religious and that usually gives me jitters and drives me away. So I decided not to talk to any ayurvedic physicians untill I met a proper one. It had been almost 3 months after osteoporosis diagnosis (8 yrs since ayurvedic research and waiting for a right person) when I happened to by chance get adviced by 3 different sources about a person here in Bangalore who is a ayurvedic physician who ppl were claiming to be good. I thought “what the hell” and gave her a visit and started the treatment ( I suffer from Aspergellosis, COPD, Bronchiectasis) The Ayurvedic treatment is partially herbal (before you start with the quinine theory of cinchona bark for malaria, I want to tell you the studies have always shown that most of the plants, vegetables, herbs, shrubs always give the right dose of ingredients for the body without really causing side effects. Ayurveda also partially uses pranayama (breathing exercises) and yoga (postures) to help the body and organs . I started on October 2014, i was on 8mg Prednisolone daily, got it down to 4mg prednisolone daily and then reduced it to alternate day and then thrice a week to twice a week. Currently I am prednisolone 4mg twice a week and regular salmeteral inhalers. Feels good and also feel better that someday I may be able to just live off inhalers or off the medicines if things go well. I thought if something helped me, I should tell others about it. I am not sure where you are from ( I am guessing Australia). See if you can research on Ayurveda and check if is it useful to you or not. And no, I wont tell you who you should contact and all that because I am not here to sell and idea or market about something 🙂 I am sure you will be able to get a good physician on ur own. Have a good day

    Akshay

    May 9, 2015 at 3:25 am

    • Thanks Akshay for your interesting comments – I’ll respond a little more fully soon.

      stewart henderson

      May 9, 2015 at 8:20 am

    • Hi Akshay,

      I have recently been diagnosed with bronchiectasis. We are currently looking into Ayurvedic therapies.
      To give you a better idea about my disease state:
      I don’t have any previous history of smoking, TB or pneumonia. I have no other medical conditions besides the bronchiectasis.
      I have had cough for a very long time, however doctors were unable to determine the cause for this.
      Starting from the end of 2014, I started expelling phlegm. Then in May 2015, I started coughing blood. This continued for a week.
      When I went to see the doctor, he was prescribed a 10-day antibiotic course and referred to a pulmonologist. The pulmonologist performed a bronchoscopy and found E. Coli cultures, while also diagnosing me with bronchiectasis. The pulmonologist started another round of antibiotics for 5 weeks (the course ended in the third week of July).
      After this course, the blood in phlegm disappeared but the coughing and expelling of phlegm continued.
      However, starting in the last week of September, I again started expelling phlegm covered with blood. We saw the pulmonologist during the first week of October, and he began a 21-day anti-fungal regime, which I currently taking. Again blood in phlegm started from Oct. 10th and pulmonologist has put me on two anti-bio. I am also on two puffers which I will have to take regularly. I am terrified of this recurring infection.

      I too am an Indian and looking for Ayurvedic treatment but as you said “Ayurveda has become commercialized and everyone claims having medicines for everything.” It is hard to find right one.

      Could you please provide me with name and contact info of the practitioner

      Dipak

      Dipak

      October 21, 2015 at 1:28 am


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