Hi, I am new to this community but I have had bronchiectasis for 29+ years. This is my first question to this community.
Has anyone got exacerbations from bronchiectasis after even very mild exercising? (*) I observe that I had these and wonder if this is common. I feel like that I now have a dilemma between exercising (maintaining muscle strength) and avoiding exacerbations (preventing further damage to my lung)
Thanks!
-- HM
P.S.
(* By mild exercising I mean that during the exercises I had no or little breathlessness -- e.g. running just for a few minutes or swimming for less than 200 meters)
(In case you want to know more about the details of my case, I have a longer version posted on the hub of "Bronchiectasis Support": healthunlocked.com/bronchie... )
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HMBS
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After 67 years of bronch I would say that you need the exercise to keep your lungs working and to loosen the mucus which collects in the lungs so that you can get rid of it efficiently. Which I am sure you know needs to be done rigorously every day.
By exacerbation do you mean that you cough up more mucus after you have exercised? If so, this is a not an exacerbation but a sign that the exercise is doing what it should.
If you are making more mucus than you have been used to or it is a darker colour this may be due to a change in the bronch itself or the need for an antibiotic. In that case, a call to your consultant’s secretary to see what the consultant advises is a good idea.
Mucus can sit down there and fester away, leading people to believe that there isn’t any, until it is disturbed and begins to come up.
I hope that helps a bit.
I have just had a look at your longer post. You could be on the wrong antibiotic which is not tackling the particular bacteria which is in there. Or another condition could have developed alongside the bronch. Only investigations could show this.
Shortness of breath with bronch is usually to do with mucus blocking the lungs and airways plus, of course, the loss of lung capacity associated with the original lung damage.
When I was six my lungs had all but closed down. A radical specialist put me on a lifetime regime of breathing exercises, general exercise and inhaled antibiotic treatment which did not come into regular use for bronchs until nearly twenty years later. This saved my life and gave me the quality of normal and active life which I continue to have.
I believe that you are in the US and so am not familiar with their health system. I do think that in addition to having the mucus tested to see if a different antibiotic is needed, a talk with a physiotherapist about the exercise/lung clearance would be a good idea. As far as number of exacerbations are concerned, bronchs vary greatly in how many they may have in a year. I have had one in eight months, which is good for me. Currently I am nebulising ventolin, isotonic saline and ceftazidime once each day. Some people need several IV ab sessions in a year and then nothing for months. It is a very complex condition and it definitely requires exercise.
By exacerbation I mean I felt sick (fever, fatique, general feeling of unwellness) that I had to take oral antibiotic (my doctors let me keep a few course of antibiotic so that I could start treatments immediately without having to wait to see her/him).
Recently (in the last 18 month) I changed to see a new doctor (an NHS lung specialist in the UK) and he asked me to send a sputum sample after finishing each AB courses. This was not always possible but for the 2-3 times that I did, the tests came back negative. He discussed these results with me, but he also said that it is not uncommon a negative result was a false one.
I actually never had shortness of breath. Not during or after my exercising, nor during my lung infections. I just had repeated lung infections with symptoms of fever, fatique, and general feeling of unwellness. During or after my exercising, I did NOT feel too much stress on my body (I even felt pretty good). The problem, however, is that in several occassions I fell sick after 24 or 48 hours. The timing of my felling sick was so close to an exercise that I have quite a strong feeling that the exercise was the trigger.
My bronchiectasis was confirmed by CT-scan and reviews of my infection history. This was done by different doctors over the last 29+ years and the diagnoses have been consistent.
I once had a physiotherapist last year. She is very good and I wish I could keep seeing her regularly. But about six months ago I received a letter from NHS saying that the program has been cancelled ...
I certainly want to keep exercising. However, since I feel that it sometimes cause exaberations I am very reluctant to resume it. As I said, every year I have 4-10 exacerbations (each requires a course or two of oral antibiotic to treat) and that number seem to be quite high. By not exercising I may be able to achieve a lower number of exaberations ... hence the original question.
Thank you also for sharing your side of the story. It is very helpful and encouraging. You said you have been taking ceftazidime once per day. My understanding is that this is antibiotic taken as a preventive measure. May I know for how long you have been taking preventative antibiotics? My NHS doctor recently also prescribed me amoxicillin as preventative antibiotics. So far it seems to have cut down the number of exerberations a bit but since the "experiment" duration is not long enough we cannot be very confident on the conclusion -- a longer duration and more data will be needed.
Thank you for your explanatory reply. I still feel that it isn’t the exercise which is causing these bacterial infections. Rather perhaps that you have been given the wrong antibiotics in insufficient doses for these exacerbations for too long. They have not done the job properly and therefore the infection keeps multiplying and raising its ugly head. For instance, after so many years of bronch, amoxil is about as useful at fighting the bugs we get as taking smarties.
The coincidental timing is probably leading you to conclusions.
Lab tests on sputum are notoriously inaccurate and often come back negative when it is obvious that something is there.
Do you have a bronchiectasis specialist? GPs know next to nothing about bronch and general respiratory consultants very little more. They do not have the training or experience in this complex condition. But don’t like to admit it.
The GP needs the advice of a bronch specialist as to which antibiotics to give you. The specialist will also decide whether a course of IV is needed to get control of the particular bacteria, followed maybe by long term inhaled antibiotics to keep the numbers down. There are many who nebulise antibiotic long term and it certainly helps. That is what I do with the ceftazidime. Some people also take oral azithromycin three days per week long term and find that useful in keeping exacerbations at bay.
A bronch specialist will also have a physiotherapist in their clinic who can help you when you attend.
You need to discuss your exercise concerns with a bronch specialist because I am afraid that whatever I or other bronchs tell you, you will believe that exercise is causing your exacerbations unless an expert goes through it with you. The sooner you do this the better because stopping exercise for some time can only be detrimental to your health.
If you don’t have a bronch specialist, look for one close to you on the internet. They are usually at large teaching hospitals. Take the name to your GP and insist on a referral. Don’t take no for an answer.
Thank you for your very useful suggestions! I will discuss them with my doctor next time I see him.
I think the hospital where I am seeing my current doctor Dr X (since Feb 2019) is not a university/research hospital (could not find such mentioning in their webpage), but Dr X is indeed a speciallist in Bronchiectasis. The following are listed on his official profile page.
At one point, he told me that he and another doctor (officially they are in the Thoracic Medicine Department of the hospital) together look after a few hundreds of patients in our city (or "catchment area" of the hospital?). I guess not all of these patients are having bronchiectasis, however (I can ask him next time I see him).
I did discuss my concerns about exercising causing exacerbations. I think his response was a very general one saying "exercise is good for you, but of course don't overstress yourself". I will try to raise the question again.
On a different note, recently I got a chance to see another doctor Dr Y (whom I used to see about 20 years ago in my home town, which I am in right now). Dr Y is a very famous lung specialist in my home town and have taught/trained many other doctors/specialists there. He used to teach in a university but have been in private practice now for many years. He recommended me taking an inhaler Anoro Ellipta 62.5/25 micrograms. I trust his advice but I also understand that Anoro is something you don't take off from once you started taking it (*). So I prefer to wait until I have a discussion with my current doctor (Dr X) to have a long-term plan on whether or I am starting to take the inhaler. (I will return from my home town back to my current town in September).
One of my impressions (could be wrong) is that Anoro Ellipta treats COPD with breathing problems, but I do not have breathing problems but just frequent exacerbations (flare-ups).
The issue of inhalers hilights the wide differences between individual patients with bronchiectasis. For those with only bronchiectasis and no element of asthma, inhalers are not the standard treatment for bronch. They are, however for asthma and copd. There are bronchiectasis with only bronch who use inhalers and derive benefit from them.
I did not have an inhaler from diagnosis aged 3 to age 57. I was given spiriva and fostair by a registrar in 2007 when I had been plagued by anaerobic infections for several years. There is no actual proof in my spirometry that either of these helps my breathing but the fostair does seem to keep down the inflammation in my lungs. My consultant ( who co wrote the current guidelines) aways jokes ‘ why do we treat you as though you have asthma when you don’t’ but I seem to have less exacerbations than I had begun to get in 2007 so we stick with it.
I have not had the inhaler that you mention. This is something to discuss with your consultant.
Thank for the pointer on the study. This is the first time I have ever heard of the term EIB and I definitely will have a look. I also googled around for research of similar title and found this one (I will also take a look). It seems to have been done by different researchers from those of the work that you cited:
As for my original question, I have discussed it with my doctors. Their responses are very general -- "exercising is certainly good for you, but of course you should not over-stress yourself ..." which is reasonable. But I want to know more.
As I said, I did not feel overstressed during my exercising, so there were no signal from my body -- at that moment -- telling me when to stop. The exacerbations (if they happened) occurs about 24-48 hours after the exercise.
"The exacerbations (if they happened) occurs about 24-48 hours after the exercise."
Doesn't make any sense to me, exercise induced would normally occur at the time of exercise.
Possibly there is another trigger for what you are experiencing. Does your doctor know the exacerbation of symptoms (if they happen) occur 24-48 hours after exercise?
I would go with what your doctor advises on this and the information available recognised in the country you are residing.
Just keep a record of these events that cause you concern, symptoms, date, time, activity prior to etc. that is immediately before or within past few hours.
Hi, not sure I can add to what others have said, but BEFORE I was diagnosed with bronchiectasis (over 20 years ago ) I seemed to get monthly chest infections that appeared to happen after strenuous exercise. When I was referred to the chest clinic, The consultant told me that I had a lot of “rubbish” (my term) in my lungs that started to come up when I exercised as I needed to breathe deeply in exercise. After having a bronchoscopy & CT scan to help with diagnosis I was started on a long course of antibiotics to make sure the infection cleared & then went onto long term antibiotics/ inhaler & nasal spray (as it was also found that I had chronic sinusitis and possible post nasal drip)
What I’m trying to say in a v long winded way is that exercise is unlikely to be a a trigger for exacerbation but is probably that there is a lot of “gunk” (my term) still in your lungs that hasn’t been cleared. When mucous stays in your lungs bacteria really grow in it.
I had a brilliant physiotherapist in my early days of being diagnosed that helped me with exercises & gave me a flutter to help with bringing the excess mucous up.
Not sure what the situation is where you are but a physiotherapist may be helpful.
Thank you very much. Your sharing is very useful to me.
May I seek a clarification from you? You said you took a "long course of antibiotics" and then went onto "long term antibiotics/ inhaler & nasal spray". After these, did you still have infections after strenuous exercises? May I also know if you think that, in my case, having 4-10 exacerbations every year is too frequent or not. (I did ask the same questions to my doctors but their answer typically is "the fewer the better" but I would like to know some numbers as a reference) Thanks!
Hi, no I tend to only have an exacerbation / chest infections after heavy colds in the winter now.
It’s difficult to put a number on these things as everyone is different & I think it is a question of finding what treatment works for you.
Have you asked to be referred to a ‘chest clinic’ to be re-assessed by the respiratory team? Treatment for bronchiectasis has changed over the years & I wonder if that would be helpful for you?
Thanks for your insight. It is good to know that you are now not suffering from the problem that I am facing. I wish I can improve my situation to the level that you have achieved.
No I have not been asked to be referred to a 'chest clinic'. I am not sure what that is, but I can bring the question to my doctor (who is a specialist in respiatory medicine) next time I see him.
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