7 replies to this topic

[Trudy]

First of all, thanks so much for taking the time to answer questions this week, Helen. We appreciate it so much. And thanks, Jane, for making it possible!

I have chronic bronchitis, asthma, and brochiectasis. I so often get infections. My question is concerning scarring in the bronchial tubes. My bronchial tubes are so easily irritated, and I so easily get infections. Do infections increase scarring? Can scarring close up the bronchial tubes more? It seems the last couple of years I get exacerbations more easily and I have to go on Prednisone more often to settle down the inflammation and cough. I often get so irritated in my chest that I have blood streaks in my mucus. I hate taking the Prednisone, but I can't deny it settles things down. Sometimes it feels I'm breathing through such small holes, and often I feel so suffocated until I keep blowing out and out and out. Do the bronchial tubes tend to narrow as this disease progresses?

Thanks, Helen.

[Helen RRT]

...and thank you for allowing me to do this!
I wish I could assure you that the infections are not doing damage but they are. Yes, infections lead to inflammation and tissue damage and this leads to irreversible dilation and damage to the bronchial walls. Scarring on the inside of our bodies is like scaring on the outside - it is a build up of tissue...a little scarring is no big deal, but everytime you have an infection there is inflammation and healing which can cause more scarring. Are you on antibiotics on a regular basis? Do you do any chest drainage techniques? Are you taking in enough water? If you are a coffee drinker (like me) you cannot count coffee as a liquid - has to be water! There are some new treatments being investigated for bronchiectasis - one of them being a higher concentration of saline (hypertonic saline). Because you also have chronic bronchitis and asthma this makes medical management a little tricky - but ask your doctor if there is something you can try to prevent infections and clear out the secretions so you can breathe easier.
Helen

[Trudy]

Helen, I am on the vibrating vest ever since they found out I have bronchiectasis, too, last July, and it has helped a lot. No, I'm not a coffee drinker, but I do drink herbal teas and a can of diet soda a day. I carry water with me and drink buckets. I am on rotating antibiotics once a month, but I seem to have to take them quicker than that sometimes.

You said, "There are some new treatments being investigated for bronchiectasis - one of them being a higher concentration of saline (hypertonic saline). Because you also have chronic bronchitis and asthma this makes medical management a little tricky..." Will you please expand on this? What kind of treatment is this saline? And how or why do the chronic bronchitis and asthma make medical management tricky?

Thanks again!

[Helen RRT]

Trudy, on Feb 26 2008, 04:51 PM, said:

Helen, I am on the vibrating vest ever since they found out I have bronchiectasis, too, last July, and it has helped a lot. No, I'm not a coffee drinker, but I do drink herbal teas and a can of diet soda a day. I carry water with me and drink buckets. I am on rotating antibiotics once a month, but I seem to have to take them quicker than that sometimes.

You said, "There are some new treatments being investigated for bronchiectasis - one of them being a higher concentration of saline (hypertonic saline). Because you also have chronic bronchitis and asthma this makes medical management a little tricky..." Will you please expand on this? What kind of treatment is this saline? And how or why do the chronic bronchitis and asthma make medical management tricky?

Thanks again!

Here is a copy of an article that was published a while back;

Inhaled hyperosmolar agents for bronchiectasis
Posted 07/01/2007

P Wills

Introduction
Date of Most Recent Substantive Amendment: 2006 01 17

Background
Mucus retention in the lungs is a prominent feature of bronchiectasis. The stagnant mucus becomes chronically colonised with bacteria, which elicit a host neutrophilic response. This fails to eliminate the bacteria, and the large concentration of host – derived protease may contribute to the airway damage. The sensation of retained mucus is itself a cause of suffering, and the failure to maintain airway sterility probably contributes to the frequent respiratory infections experienced by many patients.

Hypertonic saline inhalation is known to accelerate tracheobronchial clearance in many conditions, probably by inducing a liquid flux into the airway surface, which alters mucus rheology in a way favourable to mucociliary clearance. Inhaled dry powder mannitol has a similar effect. Such agents are an attractive approach to the problem of mucostasis, and deserve further clinical evaluation

Trudy, You may want to talk to your physician about this. Because I do not know you at all and do not know what other medicines you are taking or if you have high blood pressure - or anything like that - I can't say if this would even be something your physician would consider - because sometimes hypertonic saline makes asthma worse...but it is always worth asking about - right? Hypertonic saline is just a stronger concentration of saline. The saline we mix medicine with in the hospital is 0.9%. Hypertonic saline of 3% - 5% is being used now for patients with lots of secretions and seems to be working well.

[Trudy]

Thanks, Helen.

I'm on the following meds: oxygen at night, albuterol/neb treatments at least 4x a day, rescue inhaler when needed, Advair, Spiriva, Veramyst, Zyrtec, Singulair, and presently Prednisone and Zithromycin. Also on Prozac and Nexium. So do any of these interfere with each other to make the asthma component worse? Are there any other combinations of meds that would be more beneficial for me? I will have to ask my doc about this hypertonic saline inhalation. Thanks!

Is there anything else that would keep my airways more calmed down? I had allergy shots years ago, until it didn't seem to help anymore. Do you think it would be a good idea to try again? Also, I don't know if Xolair is more accepted now by insurance, but do the benefits exceed the risks?

Thanks so much, Helen!

[Helen RRT]

Trudy, on Feb 27 2008, 06:03 PM, said:

Thanks, Helen.

I'm on the following meds: oxygen at night, albuterol/neb treatments at least 4x a day, rescue inhaler when needed, Advair, Spiriva, Veramyst, Zyrtec, Singulair, and presently Prednisone and Zithromycin. Also on Prozac and Nexium. So do any of these interfere with each other to make the asthma component worse? Are there any other combinations of meds that would be more beneficial for me? I will have to ask my doc about this hypertonic saline inhalation. Thanks!

Is there anything else that would keep my airways more calmed down? I had allergy shots years ago, until it didn't seem to help anymore. Do you think it would be a good idea to try again? Also, I don't know if Xolair is more accepted now by insurance, but do the benefits exceed the risks?

Thanks so much, Helen!

Hi Trudy,
You know, most of my students would be amazed by the amount of medicines you are on...they see patients with "simple" problems in the hospital, treat them and send them home - and really do not even begin to realize the extent to which people have to depend on medications. Just off the top of my head - I do not see any "red flags" with the medicine - but I would sure get a pharmacist to do a consult on you - they can put all the names of the meds you are on into a computer and the computer will automatically let the pharmacist know if there are potential problems....perhaps you have already done this. I really am not too familiar with the benefits of allergy shots and from my understanding Xolair is actually useful only if you have allergic asthma - so if the allergy shots did not work - I wonder if the Xolair would be of any help?
I wish I could tell you something helpful - actually I wish I could just sit down and visit with you, face-to face...probably would not hep much, but patients have always been my favorite people and getting to know you over the Internet has made me want more.
Keep talking to your doctor, keep active on the Internet, and know that there are many of out here pulling for you all.
Helen

[Trudy]

Thanks so very much, Helen! I am learning so much from you. You explain things thoroughly, yet simply, and I can tell you care so very much. It's been a blessing to me to have you here this week.

Maybe this is a crazy question, but sometimes I wonder what would happen if all my meds were taken away. Do they ever do that and start from ground zero? Over the years more and more meds have gotten added. I have a great pulmonary doc, so caring and understanding, and one who values my suggestions. I once asked him if any of my meds could be done without, but he didn't feel comfortable with it. He did change my Duoneb to albuterol neb treatments when he added Spiriva as he said Spiriva carries the same ingredient as Duoneb has in it. Anyway, I don't like to believe I really NEED all these meds. Maybe it's denial, but it does bother me. I always wonder what would happen if they started over, you know? Sorry if this sounds silly...

This reminds me of more questions, Helen. My last two breathing tests have stabilized and been in the normal range. And I'm thankful for it! But if this test shows normal, why do I feel more and more like I'm breathing through small holes? Why do I experience a worsening progression, especially in the last few years? I used to have to take Prednisone only occasionally, but gradually it gets more often in order for me to get on top of an exacerbation. It's either that or land in the hospital again. It really worries me. Will you be open and honest with me? I know I have to keep positive and keep doing things that will better my life and always keep HOPE, but I also want to be prepared for the future. What happens if my bronchial tubes get so scarred, they close? My DH says if he had lots of money, he'd buy me bronchial tubes. I told him I don't think this is possible. I know there are lung transplants, but not just bronchial tubes, right? I have read the tubes can be stretched though, can't they? How would this work if they are already floppy with pockets from the bronchiectasis? Sorry so many questions! Can you tell how much I'm really pouring out my heart to you? Thanks so much again for caring and understanding, Helen!

[Helen RRT]

Trudy, on Feb 28 2008, 06:34 PM, said:

Thanks so very much, Helen! I am learning so much from you. You explain things thoroughly, yet simply, and I can tell you care so very much. It's been a blessing to me to have you here this week.

Maybe this is a crazy question, but sometimes I wonder what would happen if all my meds were taken away. Do they ever do that and start from ground zero? Over the years more and more meds have gotten added. I have a great pulmonary doc, so caring and understanding, and one who values my suggestions. I once asked him if any of my meds could be done without, but he didn't feel comfortable with it. He did change my Duoneb to albuterol neb treatments when he added Spiriva as he said Spiriva carries the same ingredient as Duoneb has in it. Anyway, I don't like to believe I really NEED all these meds. Maybe it's denial, but it does bother me. I always wonder what would happen if they started over, you know? Sorry if this sounds silly...

This reminds me of more questions, Helen. My last two breathing tests have stabilized and been in the normal range. And I'm thankful for it! But if this test shows normal, why do I feel more and more like I'm breathing through small holes? Why do I experience a worsening progression, especially in the last few years? I used to have to take Prednisone only occasionally, but gradually it gets more often in order for me to get on top of an exacerbation. It's either that or land in the hospital again. It really worries me. Will you be open and honest with me? I know I have to keep positive and keep doing things that will better my life and always keep HOPE, but I also want to be prepared for the future. What happens if my bronchial tubes get so scarred, they close? My DH says if he had lots of money, he'd buy me bronchial tubes. I told him I don't think this is possible. I know there are lung transplants, but not just bronchial tubes, right? I have read the tubes can be stretched though, can't they? How would this work if they are already floppy with pockets from the bronchiectasis? Sorry so many questions! Can you tell how much I'm really pouring out my heart to you? Thanks so much again for caring and understanding, Helen!

There are no silly questions Trudy...I have only had one patient over the years that the physician simply said "start over" with the meds - took all of them away and added only what was needed. However, he did hospitalize the patient the whole time so he could see how the patient reacted. It never hurts to ask why you are on each and every medication.....and could any of them be stopped at least for a little while - but that is still a little frightening. I am glad your pulmonary tests have stabilized...do they check your heart on a regular basis? CArdiac problems can also cause shortness of breath. A few years ago there was a small device called a pulmonary stent that they inserted into patients bronchial tubes to open them up. It is very similar to the stents that they put in people with poor circulation to their hearts. I have not heard recently of the pulmonary stents being put in - but another good question for your physician. The stents won't change the disease but will help you breathe easier. It has been a priviledge visiting with all of you over the past 4 days - and I hope Jane invites me back again.
Helen
Helen