Bronchiectasis

[Shonkie]

Having had this for 12 years, mostly not too bad but now severe, there are a lot of things I find difficult to understand about it. My specialist says that the sample testing system does not always find an infection even when there is one and I do not follow the usual pattern of discolouration of sputum . Trying to decide if I have an infection is therefore really tricky since I cough heroically anyway. I am currently bothered by coughing up red stuff rather than the usual pink. I plan to ask about this. Any comments?

[Hidden]

With the caveat that I’m not medically qualified. Unfortunately, no, testing (bacterial culture) is not always accurate. Cough swab, which is the method used for people who don’t produce or can’t cough up sputum, is said to only be accurate about once in every three tests. Sputum analysis has a higher degree of accuracy, but even that isn’t 100%, and some scientists have suggested that it’s a 50/50 chance. So, in practice, a positive culture result can be trusted that the identified bacteria is present (but it has to be kept in mind that it may not have actually picked up all bacteria causing problems), but a negative one has to be looked at in the context of symptoms at the time, and lung function (spirometry). One of the reasons that testing can so often give a false negative is because infections are often localised to individual parts of the lung, particularly in respiratory conditions like bronchiectasis. The bacteria making someone unwell might only be lurking in a very small area at the base of one lung, where it’s harder to obtain samples from to begin with due to how human lungs are structured, and the sample provided might come from somewhere higher up, or the other lung. This is why initial choice of antibiotics when symptom worsen is usually based on what a person is known to routinely grow, or has grown in recent history, and why respiratory medicine in general involves a lot of educated guesswork. A negative culture doesn’t mean there are no bacteria. It’s also one of the reasons why culture should be repeated, particularly if the initial sample was negative but a person remains symptomatic above their usual baseline. Hence why a patient in hospital will (should) usually send off at least one if not two sputum samples a week in the UK.

With regards to your own situation, red would suggest the presence of fresh blood. This can be for a few reasons, including purely from forceful coughing, but if occurring regularly in small quantities within your sputum, particularly if your other symptoms seem worse, it can be a good indicator of active infection. When was the last time you had any spirometry done, and are you known to have any chronic infections like pseudomonas? If so, are you on maintenance nebs? Hopefully other members with bronchiectasis will come along and reply, but with my daughter who has bronch as part of wider lung disease, aside from sputum appearance (which in her case can sometimes be clear even with detectable bacteria), we look at volume of sputum - larger quantities can align with a bacterial infection - functional breathlessness, frequency of cough, energy levels, how she feels in herself, and appetite, including if she’s losing weight. It’s all that in combination that dictate how we initially respond to a possible infection, following up with sputum culture and looking at how the result stacks up in the wider picture.

[Alberta56 in reply to Hidden]

Thank you, Charlie, for that brilliant explanation. I wish I felt all doctors knew as much about bronc as you do.

[Shonkie in reply to Hidden]

Thank you for your very helpful post, I now understand a lot more. I believe I have pseudomonis and aspergillus lurking in the lungs but apart from occasional floxacin antibiotics when things get desperate I am not on any medication. A saline nebuliser I had was disastrous to my throat. Thank you again.

[Patk1 in reply to Hidden]

Great reply,Charlie x

[Alberta56]

I can't add anything to Charlie's comment, except to wish you good luck in getting some suitable treatment for the lurking bug.

[Collienut]

If sputum cultures don't grow anything, it doesn't mean there isn't an infection as the infection could be where you can't get the sputum out. If sputum cultures continue to be negative, but you still get symptoms blood tests can be done. Not sure if it's for all infections, but when I kept having symptoms and negative sputum samples my consultant was going to do this at my next appointment. I grew pseudomonas before the next appointment, so never found out how they get the results from a blood test.Hugs. x

[Shonkie in reply to Collienut]

My experience too but the blood test showed a big spike in white blood cells which indicated an infection, also pseudomonas otherwise no one was sure what was going on though I did feel terrible. Thanks for your comments.

[Straddie]

what a great reply from Charlie. I too have had bronch for about 12 years but didn’t know anything like the detail Charlie gave about infections etc. His reply has certainly helped me, and I hope it helped you too. Good luck.

[cofdrop-UK]

Dear Shonkie,

You’ve had some gexcellent replies from your friends on here. If I were you I would be asking consultant for a review. If you have either pseudo or aspergillsis, both need the appropriate medication. Pink or red sputum can be something simple eg from coughing but it needs checking out by your consultant - you need some answers.

Just wondering what strength of saline you were using. Some folks can find 7% can be harsh. Isotonic (meaning the same strength as other bodily fluids 0.9. There is also 3 strengths of hypertonic 3%,6% and 7%. Usually better, especially if you also have asthma to nebulise a bronchodilator first. Apologies if you already know this.

Be your own advocate and go for it.

Cx

[Shonkie in reply to cofdrop-UK]

Thank you for your good advice. Fortunately I am pretty assertive about getting help. I think the pseudomonas is under control currently but my consultant is reluctant to treat the aspergillus as the treatment is very challenging and long term. It might well do more harm than good. Not sure what th nebuliser saline strength was but it really damaged my throat so I gave it back @

Thank you again.

[Lilianne]

I suspect that the red is blood which my consultant told me was one of the symptoms of Bronchiectasis. I usually take Doxycycline when this happens and, like you, I never have a result from a sputum test, so sometime feel that take antibiotics for no reason. Please be guided by your consultant on this, please let them know what you are coughing up so that they can prescribe something to help. Best wishes, Lilianne.