What is going on?

[Chicagorda]

Ive started to wonder if I am indeed having a mild exacerbation. I have known about my bronchiecstasis, acute asthma and allergies since last September and after being put onto new drugs (Relvar and inclus) both inhaled powders seemed to be a lot better. I have read and re-read the contra-indications of these drugs and they appear worrying - one even saying that they could cause cold/flu symptoms. My problem is that every month I seem to have sore throats, swollen glands and then, as this week, aching in every joint like a flu and no energy. I’ve had good advice from the community before - one telling me to gargle both before and after using the meds, but I’m wondering if anyone else has experienced this kind of problem. I am only just starting to cough after 3 days of feeling unwell, but there is nothing there. I had read that it is a good idea to keep a course of antibiotics and prednisolone in reserve, but my doctor will not concur with this. I eat a very healthy diet, exercise regularly and take supplements, including D3. What does the community think??

[corriena]

If its affecting your breathing go to your gp. If it goes on longer than a cold or the flu would go to your gp. Other than that treat as a cold/flu and look after yourself. The emegancy steriods and antibiotics are realy usefull to start straight away if you have an exarsperation and or an infection especialy over a weekend. Maybe another word with your dr or consultant

[santisuk in reply to corriena]

Yes Chicargorda, perhaps ask your doctor to read the British Thoracic Society Guidelines for Adults with Bronchiectasis and then explain to you why he considers you 'not suitable' to have antibis at home'. In a nicer way than my facetiousness implies of course! I'm a mild bronchX sufferer (now down to 1 exacerbation a year from 3-4 a 3 years ago) and have read thoroughly around the subject and this website over that time and I've never heard of doctors advising against having rescue antibis at home. Perhaps if you were very old/confused/forgetful ....??!!

Here's an extract from the Guidelines

"Does antibiotic therapy improve outcomes in patients with an exacerbation of bronchiectasis?

Good practice points:

.......

✓✓ There should be prompt treatment of exacerbations and suitable patients should have antibiotics to keep at home."

The BTS guidelines also address steroids both oral (=prednisolone) and inhaled (=cortiscosteroid inhaler);

"➢➢ Do not routinely offer inhaled corticosteroids to patients

with bronchiectasis without other indications (such as

ABPA, chronic asthma, COPD and inflammatory bowel

disease)...

➢➢ Do not offer long-term oral corticosteroids for patients with

bronchiectasis without other indications (such as ABPA,

chronic asthma, COPD, inflammatory bowel disease)."

So if you do not have CHRONIC asthma then there is apparently no determinative guidance (in the bronchiectasis guidelines at least) to suggest you should be keeping steroids at home. That's not the same as saying it's a bad idea, but i'd leave that for other asthma sufferers to opine.

Patients who only have bronchiectasis (ie without asthma) should note that there is no support in the BTS guidelines for use of any kind of steroids in maintenance or exacerbation treatments. Personally I did think I benefited from a corciscosteroid inhaler in the early years of my bronchX treatment (and it also had a long term bronchodilator which I also thought benefited my relatively slight wheezing and that is also seemingly not recommended for bronch-X-alone sufferers). When I read similar authoratative guidance a year ago in the previous version of the BTS Guidelines I dropped the use of my Symbicort (combo corciscosteroid and long term bronchdilator) inhaler and have not noticed any deterioration in my condition. I have since though, on a couple of occasions, during a period when i have felt some reduction in breathing function - relatively slight but still noticeable - used the inhaler for a few days and have to say that I think it helps and for a short dose probably has no adverse impact on me from a long term side effect viewpoint. No-one should copy that though without medical advice - I can rely on the fact Papworth Hospital lung defence team never instructed me to cut out the Symbicort even when I was taking it full time based on prior advice of my Thai pulmonologist (who wasn't sure at that time what the hell I had by way of named condition!).

Simlarly I was offered prednisolone for an exacerbation to go with my regular antibi (amoxycillin+clavulanic) about 18 months ago. That was suggested/prescribed by a hospital infectious disease doctor who had only vague recollections of what bronchX was about until I briefed her, a colleague of my then-unavailable Thai pulmonologist. The combo worked quickly like a charm and again I can't believe that a 10 day course of 5 x 1g prednisolone was going to give me the well-documented long term potential bad side effects. Next time I met my pulmo he commented that he wouldn't have prescribed that himself but he wouldn't knock it if it worked!

[Hidden]

The problem with recue pack is, you still have to take a sputum sample to your GP. If you think you have a cold or flu, would you be able to get to surgery?

[Bella395 in reply to Hidden]

I agree with your comment about rescue packs. In my experience it is best to obtain a good sputum sample for analysis prior to taking antibiotics. With bronchiectasis there is a chance that the rescue antibiotics are not effective if the person has pseudomonas or other resistant infection.

[Hidden in reply to Bella395]

Which I have, although it's relatively quiet at the moment.