I recently attended the virtual 4th World Bronchiectasis & NTM Conference. Leading clinicians from across the globe presented in their areas of interest and research. One topic that many were concerned about is the overuse of inhaled corticosteroids (ICSs) for bronchiectasis. Although inhalers, also known as puffers, are frequently needed by those who have asthma and COPD, there is less supportive data when it comes to bronchiectasis. In fact, there is worry that ICSs could very well be doing more harm than good by lowering an individual’s immunity and encouraging the growth of bacteria such as Nontuberculous Mycobacteria as well as viruses and fungi.
This overprescribing of inhalers issue was also discussed by Dr. Colin Swenson and Dr. Wendi Drummond in their NTMTalk.com podcast on bronchiectasis and NTM Lung Disease. “Up until recently, we thought that these were very benign medications that really did not have very many side effects”, stated Dr. Swenson. “We now know however that it looks as though there is an association, not necessarily causation…between inhaling corticosteroids and development of NTM Lung Disease”.
They both voiced concern that some individuals with BE might be taking ICSs needlessly and at higher doses than necessary. Dr. Swenson said that what often happens is patients are prescribed ICSs at a very high dose to bring their COPD or asthma under control. Then, because the patient doesn’t want to have another exacerbation, they are left on that higher dose indefinitely and not stepped down to the lowest effective dose. Dr. Swenson strongly suggested that patients advocate for themselves by asking their doctors “Am I at the lowest optimal dose for me to keep my underlying condition under control…but will not put me at risk for developing NTM pulmonary disease?”
So, please think about this issue, do your research and then if you feel it is appropriate, have a conversation with your doctor. It goes without saying, do not decrease or stop your medication without your doctor's approval.
#bronchiectasis #COPD #asthma #cysticfibrosis #ntmlungdisease #maclungdisease #ntmtalk @ntmtalk #lungdisease #advocate
When I say we need to “be clear” with bronchiectasis, what exactly am I talking about?
For me, being clear means:
Firstly, keeping our lungs clear is critical to living with bronchiectasis. We need to have a daily commitment to removing mucus from our airways through breathing, exercise and using clearance devices. This powerful trio is key to a better quality of life.
In addition to keeping our lungs clear, we can also benefit from clearing our minds of misconceptions about bronchiectasis. Anecdotes, like the ones posted on social media, are personal stories and may or may not be fact-based. If you go online to share and support others, that is great. If you go online to learn about BE, then know your source. Online support forums are global and this translates into a broad spectrum of therapies, outcomes and levels of patient education. For current information, you should visit the websites of the top institutions that specialize in bronchiectasis and organizational support sites dedicated to our disease. I reference reliable evidence-based studies and information on this website on both the "Bronchiectasis Information" and "Bronchiectasis Research" pages.
Lastly, we must clear our thoughts of debilitating anger and fear. Maybe you were shocked by your diagnosis. I know I was. After a while, you might become resentful and perhaps angry about it. Angry that it took so long for you to be diagnosed resulting in unnecessary pulmonary scarring. Angry that you now have to spend hours caring for yourself when you would rather be doing other things. And, for those in the advanced stages of this disease, angry that your quality of life has been diminished.
These emotions are to be expected, but if they stay with us over time, they will not serve us well. The hormones and other chemicals that are released in response to negative emotions are harmful to our health. If we are to achieve and maintain a nurturing environment in our bodies, one that is conducive to maximal healing and health, we need to clear negative thoughts quickly.
This attention to being clear in body, mind and spirit can create a healing framework for living with bronchiectasis. It can support us in our efforts to minimize additional damage to our lungs and to thrive.
#bronchiectasis #ntmlungdisease #airwayclearance #trudellmed #positiveattitude
Linda 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.