Drinking Water and Aspiration

Traveling with Bronchiectasis: How I Minimize MAC Exposure from Water

When I travel, I take extra precautions to reduce my risk of exposure to Mycobacterium avium complex (MAC).

Mycobacterium avium complex (MAC)—are a group of bacteria commonly found in water and soil that can be inhaled or aspirated into the lungs.

To stay safe, I either:

• Bring bottled spring water or
• Bring my LARQ UV self-cleaning water bottle, which uses UV-C light to help neutralize potential pathogens.
  
  

But you may be wondering…what is the connection between drinking water, reflux, and MAC Infection...

The answer lies in two common mechanisms:

• Inefficient swallowing and micro-aspiration​
• Gastroesophageal reflux disease (GERD)

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We all occasionally micro-aspirate fluids—especially when something “goes down the wrong pipe.” For most healthy people, the lungs can clear these small amounts without issue. But for those of us with bronchiectasis, compromised mucociliary clearance makes it harder to remove aspirated material, which can lead to inflammation and chronic infection.
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Another risk factor is gastric reflux. Both acid and non-acid reflux can move from the stomach up into the esophagus and airways—especially during sleep. If this reflux contains MAC bacteria from drinking water that wasn’t neutralized by stomach acid, the lungs may be vulnerable to colonization.

GERD Precautions to Lower Aspiration Risk

If you’re managing GERD or concerned about silent reflux, here are some practical tips that may help:

• Raise the head of your bed by 6–8 inches
• Avoid eating 2–3 hours before lying down
• Maintain a healthy weight
• Limit trigger foods (spicy, fatty, caffeinated)
• Consider an alginate product like RefluxRaft to reduce nighttime reflux
  
  
  

Learn more: American College of Gastroenterology on GERD

To lower my exposure to environmental MAC bacteria, I avoid:

• Water coolers (biofilm can form inside the tank or spout)
• Refrigerator water dispensers and ice makers
• Charcoal-based filters like Brita, which don’t sterilize water
• Unboiled tap water, especially when traveling
  
  

If I use spring water, I choose sealed bottled brands and avoid sources that are refilled or shared.

According to Dr. Joseph Falkinham, a leading microbiologist and expert on NTM exposure, “MAC thrives in biofilms in household water systems and is resistant to chlorine disinfection.”

Finding Balance in Prevention

Some bronchiectasis and MAC specialists take a more relaxed view on environmental exposure, suggesting patients avoid “bacteria fixation” and focus on quality of life. Others recommend more proactive strategies, especially for patients with recurrent infections or risk factors like GERD.
Your care should be tailored. Talk to your pulmonologist or infectious disease specialist about what’s best for your health and lifestyle.

Find support: NTM Info & Research – Find a Doctor

💙 A Reminder
Bronchiectasis is a lifelong condition, but it doesn’t mean you need to overhaul everything at once. Even small steps—like changing your water source or elevating your bed—can make a meaningful difference in reducing risk and preserving lung health.

📌 Helpful Resources:

• U.S. CDC on NTM Infections
• American College of Gastroenterology
• Dr. Falkinham’s NTM Research via NIH
  
  

🚫 What to Avoid:

• ❌ Water coolers (biofilm risk)
• ❌ Refrigerator water dispensers
• ❌ Ice from unknown sources
• ❌ Charcoal-only filters (e.g. Brita)
• ❌ Tap water for drinking, brushing teeth, or CPAP humidifiers

💡 Pro Tips:

• ✔️ Let hot water run for 30–60 seconds before showering
• ✔️ Use bottled or sterilized water when taking pills
• ✔️ Elevate your bed to prevent nighttime reflux
• ✔️ Talk to your doctor about your travel plans and symptom management​