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bronchiectasis once more – resistance, viruses, treatment

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Having fallen ill again, for the first time really in a few years, with debilitating dry coughing, breathing problems and fatigue, and having had no great relief from a first course of broad-spectrum antibiotics, I think it’s a good time to review the condition I suffer from – bronchiectasis.

I’ve tried to put it in the back of mind and have been mostly successful, except now and then to marvel that it hasn’t come roaring back for a year, then two years, then three years. Still, I’ve never quite gotten rid of a niggling cough, and every time I have a sneezing fit my mind turns, however briefly to what might finally await me…

Bronchiectasis literally means ‘widened or widening airways’. The airways leading to the lungs have become permanently distended and develop ‘cul de sacs’ in which bacteria gather as in a stagnant backwater. The increased bacterial load means that those with the condition are easier prey for bacterial and viral pathogens. The causes of this condition are various, including genetic conditions such as cystic fibrosis, or a general immunodeficiency. In my case it was most likely an early childhood infection, the cause in about a third of all adult cases. The sad thing is that with each new flare-up the damage to the airways is increased, the condition worsens, and there’s no cure, but it can be contained through specific exercises designed to clear the airways, postural drainage and other techniques. Above all (he adonishes himself) always get regular flu and pneumococcal jabs. I was diagnosed with this condition about four and a half years ago, but I think I’ve been suffering from it for much longer. Like many stupid men I’ve tended not to go to the doctor till I’m at death’s door. I’ve improved a little in that area in recent years, but not enough.

The recent flare-up has been traced to a relatively common virus, called respiratory syncytial virus (RSV). My doctor sent me for a virology swab after my second visit. On my first visit I presented with my severe cough, and I explained my bronchiectasis, which he knew something about as I’d had my records transferred to him from a previous establishment. Although I expressed concern about antibiotics, having experienced what I presumed to be resistance to erythromycin previously, I was prescribed a broad-spectrum antibiotic called roxithromycin GH. Desperately wanting to get rid of this debilitating and spirit-weakening cough, I got the set of ten tablets – a five-day dose – together with a repeat dosage. I’m currently two tablets away from finishing the repeat. It was also recommended that I get a bottle of Bisolvon®, which ‘thins, loosens, clears mucus from the chest’ and ‘helps clear stubborn chest congestion’.

This first consultation was on a Friday. I was contracted for a two-day work week at Eynesbury College starting the following Thursday, and I really wanted to be fit by then. However, by Monday-Tuesday I was worried. The antibiotics, I felt, had been initially successful but then my condition seemed to deteriorate. On Wednesday I had my second consultation. I explained my amateur theory that the antibiotics had an immediate impact, but then the resistant strain of the bacteria continued to multiply, took over the territory of the non-resistants, and the illness came sweeping back. Classic evolution, in a sense: from random variation the environment of my body selects the stronger, resistant strain. The doctor agreed, or said he did, but pointed out that the problem was that my infection was probably viral rather than bacterial. In my enthusiasm for my own cleverness I hadn’t thought of this. And this probably explained the ineffectiveness of the erithromycin in the past. Maybe I’m not resistant at all.

So I was sent to the nearest Clinical Labs testing centre for a swab. I was also advised to continue with the antibiotics. The swab is applied by means of a long needle-like instrument wrapped in something like cotton wool at one end. This material is soaked in a virus-detecting solution and inserted fairly deeply into the nasal cavity. I visited the testing centre more or less immediately after the consultation, and received word the next day that the results were out. On Friday, I think, I attended my third consultation and was given the read-out. Ten viruses tested for were presented, including influenza A and B, and types 1 to 4 paraainfluenza, all undetected. The other undetected viruses were adenovirus, rhinovirus and metapneumovirus. RSV, an RNA virus (as are most viruses), was the only one detected.

So, progress has been made, and I was prescribed one more medication, a Turbuhaler® called Symbicort®, often used for symptomatic treatment of asthma. Instructions are to inhale two doses a day of the oral powder, which consists of budesonide and eformoterol fumarate dihydrate. There are 120 doses in my inhaler.

Budesonide is a corticosteroid, commonly used in this inhaled form for long-term treatment or management of asthma and COPD. It’s been around for a while, having been patented in 1973, and in commercial use as an asthma medication since 1981. It’s also on the WHO list of essential medicines. According to Wikipedia, ‘common side effects with the inhaled form include respiratory infections, cough, and headaches’, and at the moment I have a headache, and have suffered from severe coughing fits.  I’m also producing quite a lot of mostly clear mucus, through the nose. I’ve attributed these symptoms to the virus, not the medication, but who knows?

Eformoterol is a more recent addition to the arsenal of anti-asthma type medications. This 1997 article in Australian Prescriber describes it as ‘a long-acting beta2 adrenoceptor agonist’ – a type of beta-blocker. Here’s some further interesting info from this site:

After inhalation of eformoterol powder, bronchodilatation begins within 3 minutes. This effect lasts for 12 hours with a peak effect within two hours of inhalation. These properties make eformoterol suitable for twice daily inhalation in patients who require regular, long-term treatment of reversible airways obstruction. It is not recommended for use in acute asthma. Patients should have a short-acting agonist, such as salbutamol, available to help deal with acute attacks.

Unfortunately my airways problems aren’t reversible, though particular obstructions and their causes may be treated effectively.

So what I have in my little Turbuhaler is a combo of a corticosteroid and a long-acting betaagonist (i.e. a bronchodilator). According to Wikipedia ‘combinations of inhaled steroids and long-acting bronchodilators are becoming more widespread’.

It doesn’t seem as if there’s much I can do but wait for my condition to slowly improve. It’s been nine days since my first consultation, and I’ll be revisiting my doctor in a day or two. Mucus still flows freely and the distinctive, whistling wheeze I developed about a week ago is still present (I’ve never experienced this before). Physical exertion quickly makes me exhausted, but I’m hoping I can soon be sufficiently recovered to consider specific exercises to improve my condition and support me against further setbacks. Don’t want to end up slowly drowning in my own phlegm.

Written by stewart henderson

July 30, 2018 at 3:13 pm

bronchiectasis and steroids

with 3 comments


My bronchiectasis has just ‘acutely exacerbated’.

Today I’m off work because I’ve got another infection, the first since I finished the course of broad-spectrum antibiotics back in May. The symptoms are an increase in phlegm, a slightly sore throat, a nasty cough and a scratchy voice, not good for teaching. And generally I feel rundown and a little depressed. This morning I visited the doctor for the first time since February. It was a new doctor, as my usual doctor apparently doesn’t work in the mornings. I didn’t want to take any time off work as I’m saving my pennies for an overseas trip, so I was planning to go to work straight afterwards because I didn’t start teaching until 1 o’clock. However the doc put the kibosh on that by giving me a sick certificate for Thursday and Friday, telling me I needed the rest and that I might be infectious. He also prescribed steroids along with the usual antibiotics, in this case Augmentin forte – though I bought the cheapie alternative called Curam Duo Forte – tablets containing a mix of amoxycillin (875mgs) and clavulanic acid (125mgs).

I’m often overly passive and docile with doctors, as with everyone else, and I often don’t clarify my thoughts until after the consultation. So in my usual docile fashion I rang in sick for work straight afterwards, even though this would mean I would lose hundreds of dollars in pay when I could ill-afford it. It’s true that my voice can barely stand the strain at the moment but I enjoy the energy my work gives me. More importantly, I don’t think I’m infectious.

While I recognise of course that our brains often play tricks on us, or more accurately that our brains and our memories aren’t always reliable, that doesn’t always mean that the doctor knows better than we do.

During the consultation the doctor asked me what I thought had caused this latest infection. I said I thought it might be something I ate. He didn’t seem too impressed with that and thought it might be something I picked up from my students, something viral. Hence the idea that I might spread the infection. Here’s the rub though – I actually felt quite certain that it was something I ate, and I know what it was and when it was. And this is not the first time I’ve felt such certainty about one of my many infections. Once it was a glass of wine which gave me a furry tongue, followed by the usual full-blown symptoms, and on other occasions it was food that I’d left a day or so too long in the fridge. These were clearly bacterial not viral infections. On this occasion it was an odd concoction of tabouleh salad, tuna, beans and roast potato that I’d constructed and taken to work for lunch, but had forgotten to eat. I found it later in my bag and scoffed it, half-knowing that I was making a mistake. The first symptoms soon followed.

I wonder how the doctor would have reacted if I’d insisted that it was food and not people that had infected me. It’s not a major issue, but now I also wonder if he’d have given me steroids for a purely bacterial infection. Strangely I didn’t wonder about the steroids until I got home. My neighbour was suspicious of this, saying that steroids were pretty strong stuff. I’ve certainly never had them prescribed for me before and now I wonder why.

According to medicine-net:

Steroids are used to treat a variety of conditions in which the body’s defense system malfunctions and causes tissue damage. Steroids are used as the main treatment for certain inflammatory conditions, such as systemic vasculitis (inflammation of blood vessels) and myositis (inflammation of muscle). They may also be used selectively to treat inflammatory conditions such as rheumatoid arthritis, lupus, Sjögren’s syndrome, or gout.

Bronchiectasis would be classified as an inflammatory condition I suppose, but pertaining to the upper airways, and nothing is mentioned specifically about this. Bronchiectasis is, however, a relatively rare condition (though possibly under-diagnosed). I’ve found a really good, thorough account of the treatment and management of bronchiectasis on medscape, but it says nothing about using steroids. So now I’m just a bit concerned, though I’m sure I’ve been prescribed a low dosage.

Actually on closer inspection I have found a section on medscape, dealing with anti-inflammatory therapy for bronchiectasis, where corticosteroids and other anti-inflammatory drugs crop up. I note that I’ve been given prednisolone tablets by the pharmacist (unfortunately I didn’t check the doctor’s prescription before handing it in, and I wasn’t given it back, so I can’t be sure if this was what the doctor prescribed). Prednisolone, according to Wikipedia, is a corticosteroid commonly prescribed for liver failure, but also used for treating auto-immune conditions such as asthma – so now we’re in the ballpark, so to speak. There are known side-effects for up to 5% of users, but i’ve never suffered any side-effects from any drugs I’ve been prescribed, not that I’ve been prescribed many. And side-effects are more often associated with long-term usage – aren’t they?

Medscape reports the literature on inhaled and oral corticosteroids for use with the many varieties of bronchiectasis and finds it promising but not entirely conclusive. I noted this line in conclusion:

A practical approach is to use tapering oral corticosteroids and antibiotics for acute exacerbations..

It almost seems as if my doctor has memorised this line. I’m feeling a bit more reassured now, but I have no idea what ‘tapering’ oral corticosteroids are. Well, I suppose it’s pretty obvious that it means gradual reduction..

Anyway, here’s hoping for a speedy recovery, and I’ve really got to take more care over food.

A few last words – the doc sent me to Healthscope next door to give a sputum sample, which, astonishingly, is the first time i’ve been asked to give one. The trouble is, if the medication works, I might not revisit the doctor for months, and will never find out the results of the tests on my sputum, just as i haven’t received the result of the blood tests I requested at my last consultation. I wanted to know if my mild anaemia had righted itself, as well as all the other health indicators – HDL and LDL cholesterol, triglycerides, etc. But they never provide you with the results if you don’t persistently ask for them. This is something I might explore further in another post.

Written by stewart henderson

November 28, 2014 at 12:02 am