Normal flora

[Catsncrochet]

Hi, glad to join. I have asthma and bronchiectasis following a chemical accident with ammonia 11 years ago. Whenever I have a “chest infection” my doctor sends off a sputum sample (before antibiotics started) but it always comes back as normal flora.

My respiratory consultant says this is not a chest infection, as it’s normal flora, though the sputum is copious and green.

Has anyone else had this and found any solutions, please? I take Fostair, Qvar, Seebri and ventolin, and have Salbutamol, Atrovent and saline nebules.

Many thanks

[Jandm]

Hi catsncrotchet

I have a combination of TBM, bronchiectasis and asthma. I too go through periods where my mucus production has increased but I don’t feel systemically unwell, but there is definitely something going on. Due to the nature of my condition, ( I take saline nebs, ventolin nebs, ipratroprium, seretide, spiriva, ventolin, montelucast and prophylactic antibiotics) I’m treated immediately with different antibiotics and steroids because otherwise it could turn pretty nasty very quickly. It’s the perfect condition for bacteria to grow. From my understanding, it’s not always possible to detect certain bacteria unless you are looking for them specifically. I’ve had on a few occasions a bacterial growth of stenotrophenomis (the spelling may need checking) that was totally undetected. It came to light when the only drug that seemed to help was septrin, (steno is only controlled with trimethoprim which is in septrin) so they sent another sample looking for that, it takes longer to grow that particular bacteria but it was there. Now if it recurs, I’m given 6 weeks of septrin and that clears it up.

[Catsncrochet in reply to Jandm]

Thanks, with me it’s been moxifloxacin that has been effective. Glad they’ve found a source of your infections. Thanks for your reply.

[Saassii in reply to Catsncrochet]

Do you have any signs of mold of water damage in your home or workplace? Bacteria behave much differently in the presence of mold. Eg. streptomyces are told by water damage molds to explore and be aggressive via quorum sensing. If you guys are especially susceptible to inhaled bacteria this is something you should never have around. Other helps would be removal of all carpet, alternative is to use ceramic tiles (no curing difficulties or offgassing like with varnish etc. Remove all wallpaper and paint with low VOC's paints. Never allow mold in the bathroom or need to clean it. Instead use accelerated drying techniques like using a squeagy, then drying with a towel after so mold can never form. Cover all drains with a silicone lid, use in shower when not in use, put plugs into sinks when not in use. In hospitals if a sink is located in an operating theatre patients die of bacterial infection, the beds closest to the sinks on wards have the highest incidence of bacterial infection. Know your enemy and evade it. Much love to you both xx

[Catsncrochet in reply to Saassii]

Thanks Saassii, I’ve been tested and am not allergic to mould or dust, but I get your point about locations of bacteria, thanks.

[Saassii in reply to Catsncrochet]

You're not allergic to the few molds they tested you for which are common outdoor molds**** There are so many....those affected by microbes until in chronic inflammation typically don't show an IGE mediated allergy via RAST test even though they may still be systemically allergic to a mold/s or intolerant. Make sure there is zero around. What tends to trigger this asthma/lung inflammation if it's not dust nor common mold? Do you know?

[Catsncrochet in reply to Saassii]

This one started with a virus I guess- I had a sore throat one day on holiday and started coughing and wheezing the next.

I do have a high allergic response to something but when I asked, both locally and at the Brompton, they shrug and say they can’t find it.

[Saassii in reply to Catsncrochet]

Maybe you picked up the virus on holiday from an environmental source different to what in regularly perceived. Interestingly contamination from a water damaged building tends to be called microbial contamination because such a slew of microbes cohabitate together during these events and cause different behaviours and they're mold, bacteria, virus, along with their microbial volatile organic compounds. In the wrong person it's quick. I barely stood up to it and nothings been the same since. Don't be around it now irrespective, use accelerated drying techniques to prevent bathroom infestation.

[Catsncrochet in reply to Saassii]

Thanks, I was by the sea in Dorset so it’s possible. It was quite hot but sometimes humid. Not there anymore anyway. My aspergillum tests were negative but I take your point about microbes and moulds.

[Saassii in reply to Catsncrochet]

Maybe Intal would be useful to try? It's a mast cell stabilizer. If it's bacteria that's triggering it then mast cells are the white blood cells and innate immune system. That's going to address symptoms and likely well more than the other pharmaceuticals and more safely. However that doesn't address any underlying cause of one can ever avoid it, you should have no sources in your home or workplace ever. Get old carpets out. Become a minimalist. Spotlessly clean. Don't allow it in the bathroom, instead is accelerated drying techniques. Don't be the cleaner. Use respirator when unavoidable... To minimise more damage ever.

[Ayeup in reply to Saassii]

That is so informative- thank you. I'm struggling with recurrent chest infections and think it could be linked to mould in my bedroom under the bay window. I think I've finally joined the dots!

[Newproblems]

I have been prescribed Qvar but I don't think it is always effective. It relies on my being able to have a good pull on it. Therefore I tend to take my blue inhaler (Bricanyl) about 15 mins prior to using my Qvar. That way I know I will get a decent dose. I don't know if this will help at all.

[Catsncrochet]

This is the advice from the Asthma nurses, for info.

In your email you ask about your sputum sample always showing normal flora.

This is not uncommon at all. Your GP is following the bronchiectasis treatment guidelines by sending a sputum. However, your consultant says normal flora means no infection. The green sputum you describe does happen during flare ups of bronchiectasis indicating significant inflammation in an area of your lung. But this may not have bacteria present. Your consultant is probably very worried about using repeated doses of antibiotics in your case resulting to resistance. But the pros and cons of this must be assessed by the GP when you present and how unwell you are.

Flare ups with large amounts of green mucus are a feature of bronchiectasis. This is managed using your breathing techniques, alongside coughing and clearance, which your physio will have taught you at diagnosis.

Bronchiectasis and asthma together are difficult to manage, and you should have a robust action plan outlining what to do, when to do it and when to shout for help. Your consultant or specialist nurse should provide this for you.