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
We don’t laugh because we’re happy — we’re happy because we laugh — William James
Orange you glad I didn’t say banana?
You may not find this joke particularly funny, unlike my young grandsons who think it is hysterical. No matter how many times they tell it, it sends them into a fit of giggles. Then, their laughter becomes contagious and before long I am laughing along with them.
The old adage “laughter is the best medicine” was verified by Norman Cousins, editor of the Saturday Review, in his ground-breaking book Anatomy of an Illness published in 1979. The book details his painful experience with a degenerative disease. When Cousins was told that there was only a 1 in 500 chance of going into remission, he took matters into his own hands by creating a laughter therapy program for himself. He found that watching and laughing to comedic shows like Candid Camera, The Three Stooges and The Marx Brothers, eased his pain and was a large part of his recovery.
Although many in the medical community were skeptical of his claims, Cousins said that “We mustn’t regard any of this as a substitute for competent medical attention. But the doctor can only do half the job. The other half is the patient’s response to the illness. What we really mean by a patient’s responsibility is that we’ve got vast powers that are rarely used. It’s important to avoid defeatism and a sense of panic and despair.”(1)
Surprisingly, Cousins’ layman approach and self-experimentation was published in the New England Journal of Medicine. The medical profession started paying attention and, although many physicians had doubts and concerns about Cousins’ unscientific approach, he had laid down the gauntlet and the challenge was taken up by several researchers in the 1980’s, one of them being Dr. Lee Berk, a preventive care specialist in California.
Berk and his colleagues conducted many experiments involving laughter. In one study, they measured the participants’ stress hormones before and after watching an hour of comedy. The study found that after watching the show, the subjects had lower levels of stress hormones compared to those who did not watch it.(2)
In 1995, Dr. Matan Kataria, an Indian physician living in Mumbai started a laughing club. Dr. Kataria’s club was based on his research on the health benefits of laughter. His concept caught on and he formalized his method by calling it “Hasya Yoga” which means “Laughter Yoga.” Today, there are thousands of Laughter Yoga Clubs throughout the world.
Several years ago, I went to a Laughter Yoga class while on vacation. I hemmed and hawed about going to the class thinking that it sounded silly, but eventually I gave in. Following the teacher’s instructions, our group of about 20 women formed a circle and did some deep breathing, clapping and vocalizing of patterns such as “Hee Hee Ha Ha Ha”. Then we walked around the room and engaged one another with playful greetings and fake laughter. By the end of the hour we were all genuinely laughing and we left the class feeling relaxed and uplifted.
This type of program is not everyone’s cup of tea, yet for me the takeaway was that I should laugh more — I should lighten up. At times, the seriousness and daily grind of self-care can zap my sense of humor and I am sure you’ve felt the same way. But, if we think of laughter as part of healthy living, it seems less frivolous and more integral to our well-being.
The Mayo Clinic concurs that laughter has many salutary effects and recommends that we find ways to laugh regularly. They say that laughter can:
So, let’s try to benefit from laughter by looking for ways to let loose a guffaw or two during our day! Whether that means clicking over to an online joke site, watching a comedy hour or reminiscing with friends about something funny from the past, seek out opportunities to laugh.
Having grandchildren and watching them run around and be silly reminds me of how good it is to be present in the moment and enjoy life. My friends with pets have a similar experience watching the fun-loving antics of their cats and dogs. So, whatever our source of laughter, let’s remember that it nourishes the body and spirit.
#bronchiectasis #chronicdisease #positivethinking #laughter #laugh
1. Colburn, D. (October 21, 1986). Norman Cousins, Still Laughing. The Washington Post, https://www.washingtonpost.com/archive/lifestyle/wellness/1986/10/21/norman-cousins-still-laughing/e17f23cb-3e8c-4f58-b907-2dcd00326e22/
2. Body’s response to repetitive laughter is similar to the effect of repetitive exercise, study finds. (2010) ScienceDaily.com. sciencedaily.com/releases/2010/04/100426113058.htm
3. Mayo Clinic Staff. (2019). Stress Relief From Laughter? It’s No Joke. Healthy Lifestyle-Stress Management. mayoclinic.org/healthy-lifestyle/streLss-management/in-depth/stress-relief/art-20044456
Linda Cooper Esposito, MPH is a health educator with bronchiectasis. She developed the BE CLEAR Method (tm) to Living with Bronchiectasis and writes with compassion and humor about this chronic lung disease.