 Wouldn’t it be wonderful if there were only one way to do airway clearance? The truth is, there isn’t—and that’s okay. In fact, airway clearance is highly individualized, and as much an art as a science.
At every professional bronchiectasis conference I’ve attended, the message about airway clearance has been consistent: it should be taught by a respiratory professional and tailored to each person.Unfortunately, many people don’t have access to specialized education. While progress is being made, we’re not there yet. In the meantime, peer education and webinars have become invaluable resources. A frequent topic in these discussions is the use of devices like the Ombra compressor with AeroEclipse nebulizer cups. One advantage of this system is that the nebulizer cup can connect directly to an Aerobika OPEP (Oscillating Positive Expiratory Pressure) device. This combination is taught by National Jewish Health in Denver, Colorado—a leading lung hospital. Their method involves inhaling medicated mist and exhaling into the Aerobika, which creates lung vibrations. They believe this helps the saline mist penetrate deeper into the airways. Alternatively, specialists like Dr. Pamela McShane recommend a different sequence: nebulizing first to coat the airways with saline, followed by tools like the Aerobika, vibration vests, or breathing techniques to mobilize mucus. So, which method do I use? It depends. If I have plenty of time, I’ll nebulize first. If I’m in a hurry, I’ll attach the nebulizer cup to my Aerobika to save time. The key takeaway is that airway clearance isn’t one-size-fits-all. We shouldn’t compare ourselves to others or feel like we’re doing something wrong if one technique doesn’t work for us. One tip from experts: avoid exhaling too forcefully or coughing harshly to expel mucus. Doing so can cause floppy airways to collapse, making it harder to clear our lungs. Instead, aim for slow, steady breaths—easy does it. Do you have a preferred method? Share your experience below! (BE CLEAR has a consulting relationship with Monaghan Medical) #bronchiectasis #airwayclearance #removingmucus #phlegm #sputum #nebuliser #Aerobika
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 Keep your devices functioning properly, make de-scaling a monthly habit!
How to De-Scale Your Equipment: ✔️ Soak the disassembled device in a 50/50 solution of white vinegar and water for 1 hour ✔️ Wash and disinfect as usual Important: De-scaling is not the same as sterilizing—vinegar only provides low-level sterilization. ✅ Bonus Tip: Don’t forget to check your compressor filter—it may be time for a change! Check out my YouTube channel for helpful airway clearance videos: https://youtube.com/playlist?list=PLYv0bQel-IptGJS3KoAuOsyt7ia0_AkBW&si=jr5A0b1LvwkkDRmk Don’t forget to subscribe to my YouTube channel for more tips‼️ (Consulting relationship with Monaghan Medical) #Bronchiectasis #AirwayClearance #Aerobika #Acapella #Nebulizing #Nebuliser #Nebulizer  After my recent post about joining clinical trials, so many of you have shared your incredible experiences with me—it’s been truly inspiring!
Below is a summary of observations, highlighting a common consensus: a lot can be learned about a company by how they treat their patient advisors and clinical trial participants. Their approach reflects their values and commitment to patient-centric care. Key indicators of respect and care: ⭐️Responsiveness: How quickly and thoughtfully they respond to emails and address participant concerns. ⭐️Fair Compensation: Whether participants are compensated fairly, transparently, and without unnecessary delays. ⭐️Transparency in Adverse Situations: In cases where a clinical trial is terminated early—due to the drug not performing as expected or causing significant side effects—whether participants are promptly informed with honesty and clarity. Clinical trials are more than just data collection; they’re about building relationships. Participants should feel like valued members of a team—one that genuinely appreciates their contributions. When companies acknowledge the burden of living with a disease and treat participants with respect, it fosters trust, loyalty, and a shared sense of purpose. This patient-first approach not only encourages continuing participation but also creates a supportive environment where individuals feel hopeful about their future. It’s about demonstrating that every participant matters—not as a statistic, but as a person. #ClinicalTrials #PatientCare #Pharmaceuticals #PatientAdvocacy #ResearchEthics  Did you know there’s an association between bronchiectasis and gastric reflux, as well as between NTM pulmonary disease and reflux?
Now, more than ever, leading U.S. bronchiectasis centers are focusing on the role of gastric reflux. If your care team hasn’t evaluated you for reflux, it’s worth discussing. Why? Because managing reflux can be crucial to preventing disease progression. Airway clearance alone might not be enough to prevent inflammation and infection. Some individuals manage acid reflux with antacids, alginates, or medications like Pepcid. Others may need proton pump inhibitors (PPIs) such as Nexium or Prilosec to prevent precancerous conditions like erosive esophagitis or Barrett’s esophagus. However, the goal is often to minimize PPI use because stomach acid is needed to break down food and kill bacteria. Additionally, long-term use of these medications can cause nutrient malabsorption and bone loss. It’s important to note that while PPIs reduce acid production, they do not stop reflux. There is a condition called silent reflux, also known as laryngopharyngeal reflux (LPR), which involves the reflux of solids, liquids, and gases that can be both non-acidic and acidic. Substances like water, milk, or bile, which are alkaline, can also reflux into the throat and voice, causing symptoms such as a sore throat, drippy nose, and hoarseness. Despite not being acidic, these substances can still get into the lungs, potentially causing tissue damage, chronic inflammation, and impacting the lung microbiome. That’s why it’s important to take reflux seriously if you have it. Lifestyle modifications, such as not eating several hours before lying down, elevating the head of your bed, and weight loss if you’re obese, can help reduce reflux episodes. Always consult your medical team before making any changes to your treatment plan. ⭐️ Feel free to share! ⭐️ #Bronchiectasis #MACLungDisease #NTMLungDisease #ChronicCough #AcidReflux #Reflux #GastricReflux #ThroatClearing #Mucus #Phlegm #PostNasalDrip #Hoarseness  Treating someone empirically means providing medical treatment based on clinical judgment and educated guesses rather than waiting for definitive diagnostic evidence. This approach is often used when immediate intervention is important, such as starting broad-spectrum antibiotics for a suspected infection before identifying the exact pathogen. Once more diagnostic information is available, the treatment can be refined to target the confirmed cause more accurately. During a recent exacerbation, despite five days of increased airway clearance, I was still feverish and unwell. I saw a nurse practitioner at my pulmonologist’s office, provided a sputum sample on a Wednesday, and received the results the following Monday. Thankfully, I had already started antibiotics and was feeling much better by then. Interestingly, none of the major bronchiectasis pathogens were found in my sputum. This might seem puzzling, but it’s important to understand that a sputum analysis screens for a panel of bacteria. The absence of a major pathogen doesn’t rule out less virulent bacteria that could disrupt the lung microbiome and cause inflammation or infection. While reviewing my medical files, I found my 2018 bronchoscopy report identifying Neisseria as “non-pathogenic.” However, research by Dr. Sanjay Chotirmall, which I discussed in a September 2022 post, suggests Neisseria subflava can be a determinant of more severe bronchiectasis in some patients. I shared my bronchoscopy report discovery with Dr. Leopoldo Segal during the North American Bronchiectasis and NTM professional conference. He seemed very interested, as much of his research focuses on the interplay of bacteria, fungi, and viruses in the lung microbiome. I took the opportunity to invite myself to his laboratory at NYU Langone this spring. I look forward to my visit and sharing his exciting research with everyone!! #Bronchiectasis #LungHealth #EmpiricalTreatment #Microbiome #Antibiotics  We express a strong desire for new treatments for bronchiectasis and NTM Lung Disease, yet during a webinar with Dr. James Chalmers, a surprising revelation emerged. When patients were polled, only a small number said they had participated in research or would be willing to.
WOW! Is it just me, or does this seem like a disconnect? Certainly, there are good reasons why someone might not want to participate in a clinical trial. However, for those who meet the criteria, I ask that they remain open to discussing participation with their doctor. Dr. Anne O’Donnell at the recent North American BE/NTM Patient Conference, emphasized the importance of participation in research. (The following is a transcript and may contain minor errors): “Everything we did 10-15, years ago was …taken from the cystic fibrosis bronchiectasis knowledge. But it turned out that a lot of these that work in cystic fibrosis bronchiectasis actually don't translate well to non-CF disease. So, fortunately, now we're in the era of new development for bronchiectasis. Some of the drugs are truly novel. Some of them are actually repurposed drugs…old drugs that are being looked at specifically for this disease. It takes a lot of time to develop a drug and a lot of money, and generally, from the (inception) it takes about five years to bring it to a clinical trial, and then those clinical trials usually take up about six years and then if the drug has a positive trial, it has to be evaluated by the FDA and the regulatory agencies around the world and that can take several years. This all takes a lot of money and that's why it's not like we have late breaking drugs every year…(We) want to know that the drug is safe and effective, we want to know that the new therapeutic makes patients feel better, function better and survive better. So, it's a big hurdle to get a new drug and we're fortunate right now that things are in the pipeline and even close to completion.” With this in mind, the next time you have the chance to complete a trial survey or participate in a clinical trial, please consider it. Your involvement could be a crucial step toward discovering new treatments.✨✨ #bronchiectasis #clinicaltrials #MACLungDisease  I’m honored to serve as a patient ambassador for the incredible nonprofit organization, BE/NTM Info & Research. When I was diagnosed with these conditions seven years ago, their website became a vital source of information and support for me.
Now, their online global forum has been beautifully revamped and is easy to navigate. One of my favorite features is the search box which searches both the discussion threads and reference library. A standout aspect of the forum is the participation of our esteemed microbiologist, Dr. Joseph Falkinham from Virginia Tech, who regularly joins to answer questions about NTM (MAC) prevention. I also contribute frequently, sharing my experiences and insights alongside many others who have been managing bronchiectasis and related infections for years. I warmly invite you to explore the forum over your morning coffee or cuppa tea—there’s a vibrant global community waiting to connect! Consider joining a support group, many of which are listed on the site (including international groups). If you don’t find one in your area, don’t hesitate to reach out to me. I’ll gladly introduce you to Trisha, our Community Engagement Director, who will help you find the perfect group. Now settle in and explore the forum‼️ connect.ntminfo.org #PatientAmbassador #Bronchiectasis #MAClung #PatientAdvocacy #NTMCommunity #LungMatters #PulmonaryMatters  Over the years, recommendations for replacing nebulizer tubing have changed. Previously, the general guideline was to replace tubing every six months. However, with a growing emphasis on infection control and the recognition that tubing cannot be sterilized, many now recommend changing it monthly.
A recent review of the National Jewish Health website even suggests replacing it every two weeks. Given the cost is around $8 and the critical importance of preventing infections, especially for those prone to them, some people opt to change nebulizer tubing weekly. It’s a simple and inexpensive step to enhance health and peace of mind. This brings up a related concern: the use of NeilMed Sinus Rinse bottles. The manufacturer recommends replacing these bottles every three months. Unlike nebulizer tubing, the bottles can be cleaned with detergent and water. However, the bottles cannot be sterilized. For individuals dealing with sinus infections, this raises potential risks. The bottle, being used to prevent infections, could become colonized with a bacterial biofilm and contribute to infections. Some nasal wash users opt for boilable syringes for better sterilization. However, for serious sinus conditions requiring large-volume rinses, syringes can be impractical. Personally, I prefer NeilMed’s Squeezie. Its flexible plastic and wide mouth allow for thorough cleaning of the inside with a soft brush. And, I have sterilized it in my Bololo baby bottle sterilizer without any issues. Still, its 8-ounce capacity may not suit those regularly using the large 16 ounce bottle, often with an antibiotic added. Another option might be to replace sinus rinse bottles more frequently. These bottles are similarly priced to nebulizer tubing and could be replaced weekly if budget permits. Currently, NeilMed sells the bottles with solution packets and I’ve reached out to them to suggest offering standalone bottles, potentially at a discount for bulk purchases. Share with us what you do. What makes you feel confident rinsing your sinuses daily? Before making any changes to your current practices, first consult with your medical team. #NasalRinse #NeilMed #SinusInfection #NasalIrrigation #Rhinosinusitis #SinusInfections #Mucus  I’m always surprised by the number of people booking consultations with me with the primary concern of whether or not they should have a bronchoscopy.
Their often-mentioned concern about bronchoscopy is the potential risk of infection from introducing a scope into the lungs. While I am not a clinician and do not provide medical advice, I educate individuals on what they might want to consider in their decision-making and to help them engage their medical team in discussion. On a personal note, early in my disease, I underwent a bronchoscopy after three sputum samples tested negative for bacteria but my CT scan showed bronchiectasis progression. The procedure revealed that I had a MAC (Mycobacterium avium complex) infection. This information was crucial, as it enabled me to commit to airway clearance even though I was initially unable to produce sputum and my chronic cough had stopped. Fortunately, with practice and creativity, I eventually learned how to produce enough sputum for analysis. As highlighted at many professional conferences I’ve attended, a certain proportion of individuals with bronchiectasis are classified as “dry bronchiectatic.” This means that despite mastering airway clearance techniques, they may not cough up mucus unless they have a respiratory infection. For those on multiple antibiotics for infections like MAC, bronchoscopy can be essential to determine whether the drugs are effective. Without it, people might continue taking harsh medications that are unnecessary or ineffective. It’s important to emphasize that bronchoscopy should not replace airway clearance. I’ve heard from several clients that their doctors prioritized bronchoscopies without addressing airway clearance. This raises an important question: if patients were properly educated on airway clearance techniques, could some invasive procedures be avoided? Like many decisions in life, this ultimately becomes a risk-reward calculation. It’s a discussion that should involve your family and medical team. If you lack confidence in your current medical team, do your best to seek out more expert care. #Bronchoscopies #Bronchiectasis #Pseudomonas #BEWarrior  If you’ve been part of this journey with me over the years, you might remember the incredible airway clearance cart masterpiece created by the ever-clever Kate. It’s one of those gems worth revisiting and I’ll be sharing her brilliant work with you soon as we dive into clearing and organizing our spaces to kick off the year.
But for now, I want to focus on something deeper—the sacrifices, efforts, and joys we experience just to be with the people we love. At the end of the day, there’s nothing more important than loving and being loved.💖 Kate’s New Year’s Day post: After 5 years, we were finally able to do Christmas together! It took lots of medical preparation and precautions to make sure everyone was illness-free before and during travel due to my immunosuppression and lung disease, but we got ourselves to a cozy cabin and huddled and it was good! It was hard, but it was so good to be together! If you have family/friends who have chronic illness, check on them. The holidays are hard. Chronic means always, so chronic illness doesn’t take a vacation, and managing day-to-day treatments, medications, and symptoms is always more complicated when away from home. Add immunosuppression to the puzzle, and it requires a group project approach to keep us safe from infection. This effort is what love looks like. #LovedOnes #Family #HappyNewYear |
AuthorLinda Cooper Esposito, MPH is a health educator with bronchiectasis. She developed the BE CLEAR Method to Living with Bronchiectasis and writes with compassion and humor about this chronic lung disease. Archives
February 2025
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