Bronchiectasis and the Lung Microbiome

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