Bronchiectasis?

[netochka]

Hi. I posted on here before about atypical asthma. Sorry for all this detail! I am really hoping someone might read this who has some relevant experience or knowledge to share.

I was on Clenil or Fostair (neither seemed enough), and with Montelukast added seemed to get through more colds without developing bronchitis. I would still feel a bit rubbish but get a bit of a dryer cough. This seemed to throw unfamiliar GPs off as the crackle and wheeze were missing, even when a problem (aggressive cough) was developing.

Back in November I struggled with bronchitis for about 2 weeks, not quite giving in, using lots of salbutamol, until I cracked and got the rescue pack of Pred (40mg/day x 5). I saw a new GP to check in and he was thrown by the lack of crackle and wheeze, but by then I was waking up during the night and sitting up coughing for an hour at a time and not in any mood to wait longer for Pred.

I finished the pack on Friday and got sicker over the weekend, resting on Saturday and spending Sunday in bed. That evening I realised I was shivering, got back under the covers, took my temperature (39.5) and realised things were worse. I saw an out of hours doctor who put me on a nebuliser and gave me Amoxicillin (7 days) and Pred.

Back at the GP a few days later I tried walking and injured myself so badly from coughing that I am still in pain now and unable to wear a bra. The following week I was still feverish so I had a week on a broad-spectrum antibiotic (Clarithromycin?). Altogether it was 2 weeks in bed before I started gradually going outside again. After 3 weeks or so on 40mg/day of Pred, I am now tapering gradually by 5mg/day every 7 days. I feel 100% better (in fact like a superwoman; I wish I could take Pred all the time even though I know that's really a terrible thing for people that have to).

My mother had bronchiectasis and her symptoms were very similar (her dad had emphysema, his mum died young of asthma). I have been referred back to see a consultant and I am really hoping they will give me a CT scan to rule this out (my x-rays are fine and I have normal spirometry when well, but I believe the same was true of my mum and it is common in bronchiectasis). But I have never needed antibiotics before this bout of pneumonia (I have been given them before but always suspected they were unnecessary and had never previously had a fever related to a chest infection or been ill in that exact way).

Clearly I have some asthma (though I have unusually good peak flow as my baseline and rarely wheeze), given the inflammation that develops from any cold. I have exercise-induced asthma and react to cold air and smoke.

Does anyone know anything about what else is going on (especially why steroids work but not well at low doses)? Particularly, does bronchiectasis sound likely?

[moogle]

might be a good idea to post this on British Lung Foundation part of HU too.

[netochka in reply to moogle]

That is a very smart idea, thank you. I will c&p when I have a chance to get on the computer.

[Matman]

If it helps there's a very up to date (Nov 2016) and highly detailed article on the numerous forms of bronchiectatis on the website GPOnline, including symptoms, treatments etc. Well worth a read.

[netochka in reply to Matman]

Thank you. That was very interesting and I learnt a lot. I was surprised to see that regular viral infection (more common for me) can apparently be a feature, as well as the use of Pred etc. This will be really helpful for asking questions with doctors.

[SheilaC]

I sound very similar to you netochka and have a CT scan booked for the 22nd of this month. We are off on holiday the following Thursday so I will probably not get the result before we go. However we are going somewhere hot so I should be fine.

[netochka in reply to SheilaC]

Good luck with it. I'll be interested to know how things go for you. I wish you a great hot (non-gritty/without airway irritants) holiday and an amazing recovery or treatment plan to follow.

[Hidden]

Hi netochka. I have asthma, bronchiectasis and ABPA. You'll know from your mum that bronchs usually (but not always) produce quantities of thick, sticky sputum, which stagnates in over-dilated alveoli & gets infected. We have to stick to a daily regime of chest physio to clear our lungs, & most of us take prophylactic antibiotics as a matter of course. An HRCT is the only way of diagnosing it, so if I were you I'd press for that, as many people with bronch only get diagnosed after years of continual chest infections, & by that time have incurred irreparable lung damage.

[netochka in reply to Hidden]

Ah Hanne my reply got deleted... thank you for your comments and sorry to hear about your bronchiectasis.

I have to look up abpa now to understand properly.

You are right about delayed diagnosis (my mum's was asthma with endless infections for 20 yrs from her 40s and I have about 20 yrs of that behind me now at 38).

I don't know if mum produced volumes of sputum (she died from another condition). She did cough blood during exacerbations, which I don't. I don't have loads of phlegm myself, so maybe I don't have bronchiectasis, though I will ask for the CT as asthma doesn't quite cover it. I get a productive, persistent cough but usually swallow all mucus and I know it is clear and rarely tastes infected. (Sorry tmi).

I hope you are keeping well this winter.

[Hidden]

Hi please don't let any chest infections go on because you don't want to take the ab's. Each time you get an infection it can cause further damage to your lungs. It is better to take them uneccesarily than not take them when you need them. x

[netochka in reply to Hidden]

Thank you and I promise since this pneumonia incident I am no longer cocky about not needing antibs! I was a bit 'just give me the Pred' with doctors, but now I will listen x

[Hidden in reply to netochka]

Good on you. Usually with a chest infection you cough up coloured gunk. Then you need ab's and maybe steroids as well. If not then probably just steroids.

Not always though as a chest infection can 'hide' deep within your lungs and you get no obvious symptoms apart from feeling extra breathless and generally tired and unwell. x