British Lung Foundation

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What is difference between a lung infection and a flare up of bronchiectasis? How can I tell?

Apologies for sending two posts. Age (78) and fear of the virus is definitely affecting my clarity of thought. It would be good if I knew the difference between a lung infection and a flare up. I have been on doxy for 7 days without improvement. Is this fairly normal? if it was working wouldn't I see some improvement in my condition by now? I am not coughing and sputum seems normal with test coming back positive. But right lung feels congested and sometimes quite painful, chest discomfort/tightness and sometimes painful and overall feeling unwell but temperature and vital signs (blood pressure, blood/oxygen is normal). Worse at night.

Thank you all once again and best wishes.

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Doxy

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The way I understand it is flare up is a worsening of symptoms without having symptoms of a lung infection.

You probably know the symptoms of a lung infection as you have been treated for that already.

Flare ups generally go on their own when the trigger or cause has been removed.

Lung infections require antibiotics and prednisolone. (I'm speaking from experience with emphysema and bronchiectasis)

Reading information on these pages may help you understand the situation more:

blf.org.uk/search/site/Bron...

Your symptoms could indicate the lung infection remains, discuss these with your doctor asap.

Thank you. Will do.

Make sure you are well hydrated too - hope you are soon feeling better.

Thanks again Bkin. Just a thought - what do you mean that flare ups generally go on their own when the trigger or cause has been removed.I ask because everything was going fine until I walked to the hospital last Thursday and I realised I had made a mistake it being cold and windy and I began to feel ill again the next day.

Basically know and avoid those things that cause or trigger the flare up, manage your illness so that it remains stable. Take your medication as prescribed under such cirumstances, symptoms that persist and do not respond to already advised and prescribed by your own medical professional should be discussed with them further. Seeking treatment for a persistent lung infections should never be delayed. Further information as explained in the BLF link as mentioned previously.

Flare up is a vague term that means different things to different people, sometimes depending on underlying diagnosis, and quite often used interchangeably with exacerbation and/or infection depending on what the diagnosis is. In COPD (emphysema and chronic bronchitis etc.) a flare up is often used by both patients and medics to mean a worsening of symptoms such as wheeze or breathlessness where there is no underlying infection. By comparison, my understanding is that with bronchiectasis, the term flare up is generally used in the same way that it is in cystic fibrosis (which often features bronchiectasis as one of the major lung changes), and essentially means an infection: as you know, the major problem with bronchiectasis aside from the sputum production, is that excess sputum leads to a lovely environment for bacteria to move into. The bacteria and infections are actually what make it particularly problematic. A flare up in bronchiectasis (as with cf), would be symptoms like cough, increased sputum production, a change in colour and/or thickness, possibly the presence of wheeze and/or increased breathlessness, or any other symptom which is indicative of an underlying infection.

Antibiotics will only work if the underlying problem is an infection, and only if they’re the right antibiotics for the job: do you know what your sputum was positive for? In bronchiectasis, the bacteria are often things like pseudomonas or other environmental bacteria that don’t effect people unless they have lung conditions, which often require specific antibiotics to treat. You also need to have longer courses (at least 14 days), and sometimes it can still take a week or more to see effect. As a general rule of thumb, I’ve always been told it can take anything from 3 to 10 days for antibiotics to really kick in where there’s underlying lung disease, but that they would hope to see something within the first week, so I would be getting back in touch with whoever is managing your bronchiectasis care and see what they say about how you’re still feeling. Hope that helps.

Antibiotics only work if its a bacterial infection and as you say the appropriate antibiotic.

I think we all appreciate antibiotics only work in zapping bacterial infections. However many people with bronchiectasis, including myself, find if they have a viral infection it will invariably turn into a secondary bacterial infection.

So true.

Quite right and so it does in All lung infections not just from bronchiectasis

I couldn’t possibly affirm that as I don’t have knowledge of All lung conditions, just bronchiectasis and asthma.

Lung infections being the operative words, not Lung conditions.

What would we do without you and your expertise

Have a nice day cof - I hope you can find some joy in the day ahead

Its great to share support

Bkin, I’m not sure I understand what the disagreement is? You yourself have bronchiectasis so must know that people dealing with BE, and other conditions like cf where the primary issue caused is infective exacerbations, generally accept that the word infection is always inferred to mean bacteria. If someone has a virus, then that’s the term that would usually be used instead. As for viruses, although the risk is increased with conditions like COPD and asthma, many people with underlying lung conditions regularly have viruses without developing secondary bacterial infection: it may well trigger a flare of their symptoms, but that’s already been established as not the same thing depending on what condition you have. To the best of my knowledge and understanding, the exception is bronchiectasis and cf, where viruses also lead to a flare of symptoms, but the two primary symptoms for both conditions are sputum production leading to recurrent bacterial infection, meaning secondary bacterial infection in response to a virus is almost the expected. Cold and respiratory viruses lasting more than a couple of days are actually routinely covered with a fortnight’s antibiotics in cf to try and prevent secondary infection, but the difference between ncfbe and cf that makes secondary infection normal compared to other lung conditions is the overly hospitable environment the diseases create, along with any pathogen already routinely resident. Most secondary bacterial infections in ncfbe and cf are caused by chronic internal lung bacteria, rather than new, external bacteria finding their way in as is more usually the case in secondary infections for people with other diagnoses.

I have no disagreement Charlie just adding my experience and understanding, in the hope our shared understanding and views combined can help F12 and I am sure they do

Thanks for that explanation Charlie. In fact I can already feel its making my chest bad. I am nearly certain I am on the wrong antibiotics, Doxycycline, and I should be on Co-Amixiclav which, I think, worked well last time. What with all my anxiety over the virus and having to attend hospital on another issue, it all got rather complicated with different instructions. I will try and get hold of the specialist and thank you once again.

Doxycycline doesn’t work for me either - I always have co-amoxiclav for 2wks and have an emergency supply always .

See if your consultant can prescribe this for you .

Brilliant reply from Charlie_G. No need to add to it.

Totally agree. Cx

Hope you're feeling better soon. Maybe speak to your GP. x

Hope you have managed to make contact with your doctor today F12 and I hope soon you will be feeling much better. Take good care of yourself.BK

Thank you BKN and Big thank you to all those who have replied. Situation has now changed as result of my X-Ray which they want to re-shoot; reason given either suspicious nasties or shirt buttons! However, I fear the worst as the shadows are on the lung where the pain is. Keep you all posted when I get the next result. Cross fingers (and legs). Lots of good wishes to all.

Hope it works out ok for you, if its any consolation years ago, I had shadows on my lung for many months, as a result of a lung infection that didn't respond to antibiotics. It did eventually respond with a longer course of prednisolone. I hope your shadow is just buttons though xox Do keep us posted and good luck with pending xray and results.

💖🌺

Thank you so much for your reply. Has given me a little boost of hope!

Got everything crossed for you good luck and hope you start to feel a little better. Good advice from everyone though nothing more to add. X🙂

I have Bronchiectasis and if I go out on a cold and windy day my lungs hurt for about three days. And my breathing is terrible. So for me I don't go out if its below zero. Hope you feel better soon

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