Did you read my previous blog post about the connection between the lungs and the nose? How bronchiectasis (BE) and rhinosinusitis often occur together?
If so, you might have already deduced that just as reflux is associated with BE, it is also associated with Chronic Rhinosinusitis (CRS). The tricky thing with reflux is sometimes there are no clues. You don’t have heartburn and you are not belching. It is the sneaky kind of reflux often referred to as “silent.” But just like a stealth bomber, it can still do major damage. To compound matters, it is not always from acid. Non-acid refluxate (liquid, solid and gas) can also occur and according to Dr. Jeffrey King, chief of the Gastroenterology Division at National Jewish Health, when we take PPIs and other acid-lowering medications, non-acid reflux goes up! Geez… so what are we supposed to do to prevent reflux from being aspirated into our lungs or wreaking havoc in our sinuses? Certainly taking precautions like decreasing trigger foods such as alcohol, chocolate and greasy foods is helpful. Also not eating or drinking within several hours of lying down.Some research shows there is good reason to raise the head of your bed and if obese, shed some pounds. However, I can tell you from the 24 ph impedance test I had 6 years ago, that not all reflux occurs at night–mine was ALL during waking hours. Because when we bend at the waist, and unfortunately, even when we are standing tall, we can reflux. Earlier this summer I experimented with what might be a new idea for some of us–alginates. An alginate is what it sounds like, a treatment made with algae. When we take a spoonful after a meal it puts a lid or raft on top of our stomach contents. This physical barrier stops much of the refluxate from making its way into our lungs. There are familiar remedies like Gaviscon Advance that contain an alginate. Also, RefluxRaft and Reflux Gourmet that taste better and have other calming ingredients. What works for you might not for someone else. And, what works on a daily basis might not if you are having an attack. Have you tried alginates? Speak with your doctor before changing your current care. #Reflux #AcidReflux #Bronchiectasis #nasal #drippynose #postnasaldrio #stuffynose
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Are you tired of battling constant sinus infections and a stuffy nose? You're not alone.
Over 60% of people with bronchiectasis (BE) also experience Chronic Rhinosinusitis (CRS), according to Australian researcher and cardiopulmonary physiotherapist Annemarie Lee. There's even more to the story: Almost 100% of individuals who have BE with primary ciliary dyskinesia (PCD) and immunodeficiencies also have CRS. It makes perfect sense that upper and lower respiratory conditions often occur together. They share the same mucosal lining, allowing bacteria-filled secretions from the upper airways to drain into the lower airways (some suggest this movement might even be bi-directional). With this connection in mind, treating existing sinusitis becomes a crucial step in reducing inflammation and infection in the lungs. My personal journey with nasal issues began well before my bronchiectasis diagnosis. Twenty years ago, I sought help from an ENT doctor for my drippy nose and hoarseness. He ran a battery of allergy tests, but everything came back negative. He recommended a nasal wash and spray. The spray, ipratropium bromide, did the trick, and I still use it most mornings. I also rely on Simply Saline nasal spray by Arm and Hammer and occasionally perform a nasal wash with a NeilMed Squeezie. I favor this particular device over the standard NeilMed bottle because of its wide mouth, which allows for easy cleaning with a soft brush and more effective sterilization in my steam sterilizer. Do you struggle with chronic nasal problems? Who do you see for care – a specialist or your GP? How do these ongoing nasal issues impact your well-being?
#bronchiectasis #rhinosinusitis #nasalpolyps #nasalissues #sinusheadaches Why isn’t a cough enough? Why do people living with bronchiectasis need to do daily airway clearance?
During a cough, air is expelled from the lungs at high speed, clearing the airways of irritants, mucus, or foreign particles. This forceful action can also bring up mucus from the lungs. Unfortunately, individuals who are underweight or frail may lack the necessary strength to cough effectively. Furthermore, coughing relies on the elasticity of the airways to manage the increased pressure. But, in conditions like bronchiectasis, the airways lose their elasticity and do not respond normally to the pressures exerted during a cough. According to Dr. PJ McShane, “This is why you can cough your head off to the point that you’re exhausted and nothing’s coming out and you don’t feel like it’s effective, and instead you’re just getting tired. So that’s where airway clearance comes in. And that’s why it’s so important to learn techniques you can do, other than just a simple cough.” #ChronicCough #airwayclearance #Bronchiectasis #lunghealth #RespiratoryCare #PulmonaryRehab #ChestPhysiotherapy #LungFunction #copd Mucus plays a vital role in lung health. It contains mucins, which act like a sponge, absorbing water and creating a gel-like substance. This gel traps dust, germs, and toxins, protecting the airways. However, in bronchiectasis, the balance is disrupted.
The excess mucins in bronchiectasis make the mucus thicker and heavier. This overwhelms tiny hairs called cilia lining the airways. Normally, cilia act like miniature brooms, sweeping mucus upwards to be coughed out. But burdened by the dense mucus, they struggle to function effectively. This leads to mucus buildup, creating a breeding ground for infections and further inflammation. Dr. McShane offers a reassuring message in her recent webinar sponsored by NTM IR. “Scientists are working on fixing this problem based on drugs that target those receptors and target the mucin. We cannot fix that by our diet, so you’re not doing anything wrong. Keep living your life. And stay tuned because science is moving forward.” In the meantime, we can do our best to help our ineffective cilia clear out mucus by using various airway clearance devices and modalities. #AirwayClearance #Mucus #cilia #Bronchiectasis “I want you to understand that this is nothing that you’re doing wrong and you can’t fix this by drinking water.
With bronchiectasis mucus becomes heavy and weighs down the epithelial cells and the cilia. So now the mucus becomes stagnant.. Don’t go rushing to your refrigerator and grab a bottle of water and start drinking. I want you to understand that if this is nothing that you’re doing wrong and you can’t fix this by drinking your water. In fact, if you do drink more water, you’re going to lower your sodium in your blood and then you’re going to have symptoms and have to go to the ER and it’s going to be a nightmare. So, just drink if you’re thirsty. You can’t fix these abnormal abnormalities in your mucus by your diet. Many of my patients will say that (they) shouldn’t have dairy products because it increases the mucus. And I’m not sure that’s 100% scientifically based. I would rather my patients, get the dairy, get the protein, get the calcium from the dairy in their diet, and understand that the abnormalities of their mucus are coming from something different than just what they eat in their diet.” Interested in hearing more? Check out Dr. PJ McShane’s webinar!! youtu.be/VEYK67nld_o #Bronchiectasis ##Breathing #Exercise #AirwayClearance #Nutrition HAPPY WORLD BRONCHIECTASIS DAY!!
To celebrate this event, we've spent the past 2 weeks focusing on what BE experts consider essential for living well with bronchiectasis: excellent nutrition. We discussed ways to add calories and protein. But remember, IT'S ALL IMPORTANT! Healthy fats, carbs (including starchy carbs), and the rainbow of fruits and vegetables! My favorite way of eating is following the ancient Japanese practice of including all five tastes - salty, sweet, sour, bitter,and umami - in a meal. When I eat this way, I enjoy my food more and nourish my spirit. We still have lots to discuss about nourishing ourselves to build immunity and a strong body, a crucial element of self-care. Perhaps the most challenging aspect is body image. Many of us, especially women in the US, are steeped in "Thin is In" culture from a young age. Some view the weight loss that often accompanies bronchiectasis as a perk, especially those of us who were overweight children. It can be difficult to move from that mindset to eating more food without worrying about calories (I know‼️). Now, I come along to say let's all be able to "Pinch an Inch." Let's not only get over the 18.5 BMI redline, but let's add some padding, too. Because when we get sick, our body will try to convert not only fat into disease-fighting energy, but also lean muscle mass. Lean muscle mass includes all body components that are not fat: muscles, tissues, organs, bones, and blood. And, of course, we want to preserve all of the above because, when you lose some of it, like bone, it's not likely to come back. So consider this: What is most important to you - creating a stronger body or having a flatter stomach? Are you willing to create a "muffin top" like me? I did it by moving from a weight of around 130 to around 135. I can "pinch an inch" at this weight and am proud of it. Try to meet with a registered dietitian, preferably one who specializes in lung health. Getting expert guidance can make all the difference. Do not change your current care without first speaking to your medical team. #WorldBronchiectasisDay #BetterNutrition #Bronchiectasis #COPD #ThinIsNotIn TIRED ALL THE TIME? No energy for airway clearance? READ THIS!!
Our bodies are constantly in a state of flux, with tissues breaking down and being rebuilt. To maintain this process, a steady supply of building materials - amino acids derived from protein - is essential. Think of protein as the body’s spackling material. Just like patching holes in a wall requires putty, our bodies rely on protein to repair damaged tissues. For individuals with chronic inflammation and frequent infections, the need for repair is even greater. Without sufficient protein, the body resorts to breaking down existing tissues for its amino acid needs. Beyond muscle building, protein plays a vital role in numerous bodily functions. It supports tissue and cell repair, produces immunoglobulins and antibodies to fight infection, and fuels metabolic reactions like digestion for energy production. Additionally, protein forms the building blocks of hormones (like insulin), provides structure (bones, collagen), balances fluids and pH levels, and even transports nutrients (blood sugar, cholesterol) throughout the body. If your diet regularly includes meat, fish and eggs, you may not need to significantly increase your protein intake. However, during the day it’s crucial to spread out your protein consumption to ensure a continuous supply for optimal body function. Fasting or restrictive diets are not recommended when dealing with chronic inflammation and infections. Skipping meals or relying primarily on fruits, vegetables, and grains won’t provide the necessary protein for repair. A certified dietician nutritionist can help you determine your optimal daily protein intake. Ideally, seek out someone specializing in lung disease who understands the extra burden on your body from compromised respiration and recurrent lung infections. Research local nutritionists within your health plan network. Virtual consultations are also an option with specialists like Michelle MacDonald, @winknutrition (Instagram) who is a supervisor at National Jewish Health and also has a consulting business. Do not change your current practices without first consulting your medical team. #bronchiectasis #chroniclungdisease #protein #lunghealth #COPD #cysticfibrosis #immunity #stayhealthy #wellness #betterlunghealth #chronicillness ⭐️Why Maintaining a Healthy Weight is Crucial for Successfully Managing Bronchiectasis⭐️
In this coming week we’ll delve into how to add protein to our diet. But first, let’s revisit why staying in a healthy weight zone is critical for those with bronchiectasis (BE). A BMI below 18.5: This is considered underweight and linked to a poorer prognosis for BE patients. For example,someone who’s 5’4” and weighs 108 lbs has a BMI of 18.5. Underweight Risks: People with BE who are underweight are more prone to: *Frequent acute exacerbations (flare-ups) *Reduced lung function *Increased systemic inflammation *Higher rates of chronic infections This means restrictive diets lacking dairy, low in carbs, and devoid of sweets, might be counterproductive, causing inflammation instead of fighting it. The Importance of Proper Nutrition When our body lacks the calories and nutrients needed for strong immunity, it can’t function optimally. It’s like asking for overtime work without additional pay (food)! As nutritionist Michelle MacDonald emphasizes, “if we don’t eat, our body will eat us.” This can lead to: *Muscle breakdown (including breathing and heart muscles) *Shortness of breath *Difficulty pumping blood, leading to fatigue and hindering daily activities *Malnourishment impacts all organs, tissues, and bones. It can cause: * Brain fog * Severe constipation and bowel impaction * Increased risk of bone fractures ⭐️Low BMI and Hospitalization: A low BMI is linked to a higher risk of hospitalization. ⭐️Eligibility for Treatment: Being underweight can exclude you from potentially life-saving surgeries or clinical trials. For instance, the ARINA-1 Phase 2 trial (nebulizing a solution with glutathione) required a BMI exceeding 18 for participation. Has this information shed light on the importance of maintaining a healthy weight? Take Action: Discuss a weight-gain plan with your medical team. Don’t delay – it’s crucial for your well-being. #bronchiectasis #NTM #NTMlung #DisorderedEating #EatingDisorder Silvia was my friend even though we never met in person. She contacted me years ago when she had a misunderstanding with someone online. What this person didn’t know about Silvia was that English was not her first language and writing was a challenge for her.
Over the years we exchanged dozens of texts. Often, Silvia would send me gifs with a bunny or bird saying “Good Morning” or “Nitey Nite.” A deeply religious woman, Silvia drew strength from her faith and her many hospitalizations never made her angry. I learned how to be a more patient person from her grace. Unfortunately, Silvia had difficulty gaining weight. She weighed 95 pounds and over the years, with new infections and a surgery, continued to lose weight. She showed some concern, but rather than focus on eating more, she preferred to discuss supplements and air purifiers. When my book came out I sent her a copy and reviewed the chapters on nutrition and airway clearance with her. She admitted to having a sweet tooth and loving a traditional cake from her culture, but she had stopped eating anything with sugar. Looking back over the years of texts, I wondered whether I could have done more to encourage her to gain weight. I took some solace when I finally came across a text I sent that read, “EAT THE CAKE!!” During Silvia’s last months, her weight had plummeted to 68 pounds. She was hospitalized and started to receive supplemental nutrition through a feeding tube. My last text from her was right before Thanksgiving in 2022. It was a gif of a cup of coffee on a balcony railing surrounded by flowers saying “Good morning, have a nice day.” After months of sending her texts and not hearing back, I contacted several people on her Facebook page. Her daughter got back to me and told me of Silvia’s unexpected death. She was 56 years old. I think about Silvia when I tell people to do everything possible to gain weight, even if they have always been thin. You need to take every measure early on to prevent more disease. With bronchiectasis, you need to be in fighting condition. Thank you, Silvia, for being by my side. You are a constant presence, encouraging me to lead people to better health. #bronchiectasis #lungdisease #lunginfections Hold the Boil! Wash Your Airway Clearance Equipment First
I’ve heard some of us are sterilizing our airway clearance devices by skipping the soapy warm water soak and jumping straight to boiling or steaming. But wait! ✨Soap and water are essential for the first cleaning step.✨ This physically removes bacteria, mucus, and medication residue that can build up on your equipment. Dr Falkinham, a microbiologist with a NTM laboratory at Virginia Tech, recommends using Dawn dish detergent. Manufacturers of nebulizers and OPEP devices, like the Aerobika, recommend a 15 minute soak in warm soapy water as the first cleaning step. I often leave mine in for longer. Even overnight! Soap helps loosen and remove contaminants, making rinsing and sterilization more effective. Remember to agitate! Swish the soapy water around your equipment to dislodge any stuck-on material. Then, follow the manufacturer’s instructions for sterilization. This might involve boiling, steam sterilization, or a disinfectant solution. Many devices should also be soaked monthly in one part water and one part vinegar for one hour to remove scale buildup. By following these steps, you can ensure your airway clearance equipment is clean and functioning properly. For more information on cleaning, sterilizing and de-scaling go to my YouTube channel and please subscribe! (And check out my very bad hair day!😂) https://youtube.com/playlist?list=PLYv0bQel-IptGJS3KoAuOsyt7ia0_AkBW&si=A2aQxYvWkYIuA0NL #nebulizer #Nebulizing #Nebuliser #nebulising #airwayclearance #BestPractices #Soap #UseSoap #UseSoapAndWater #Bronchiectasis |
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
July 2024
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