For some of us with bronchiectasis, particularly those who also have MAC Lung Disease, going to the dentist can be stressful. Being inverted in a dentist’s chair, having the dental hygienist clean your teeth with an ultrasonic Cavitron spray and then using water from the spit bowl fountain to rinse, can expose us to harmful bacteria as well as cause coughing.
But, if you take some precautions and have good communication with your dental team, it makes all the difference!
Consider doing the following:
Good oral hygiene is important for everyone and especially for people with lung disease. There are hundreds of types of oral bacteria –some good, some not so good, and lots we are currently studying because their role is unknown. However, tartar build up and gum disease can be prevented by regular dentist visits.
#bronchiectasis #maclungdisease #ntmlungdisease #oralhygiene
The “mucociliary escalator” is a term used to describe a built-in mechanism to keep our airways clean. This clearing system is complex, but in the simplest terms, it uses mucus to trap dirt, air pollution particles and pathogens. Then cilia, small hairs that undulate in the moving mucus, sweep the unwanted matter towards our throat where it is expectorated or swallowed.
This cleansing system is ongoing in healthy lungs as they too produce daily mucus to clear the decks. However, in diseased lungs such as those in bronchiectasis (BE), the ciliated areas are damaged and therefore, we make more mucus to compensate. The body does its best to sweep the airways clean, but often it is a herculean task that cannot be automatically accomplished day after day.
For this reason, we need to help out our lungs with daily airway clearance. Airway clearance is a broad term describing the effort to help the mucociliary escalator function more effectively. With BE, there are damaged areas in our lungs with little or no cilia allowing mucus to pool. This mucus needs to be removed, otherwise bacteria, viruses and fungi can feed on it and multiply.
Whether we use exercise, breathing and coughing techniques, gravity, or medical devices will depend on availability and preferences. What is important is that we do our best to assist our lungs in clearing airways regardless of how often we cough or how much mucus annoys us throughout the day. Working together with our lungs is essential to maintaining overall health and well being.
#bronchiectasis #ntmlungdisease #maclungdisease #copd #asthma #lungdisease #lunghealth
When it comes to learning airway clearance, NOTHING is better than professional guidance. The problem is respiratory therapists (physios) who specialize in airway clearance techniques, are difficult to find, even where I live in New York City. But, when I found someone, that one session gave me the confidence to begin a daily habit that I will have for the rest of my life.
I’ve since had additional sessions as I continue to learn more and try different approaches. What might work for us today, might not yield the same results in a year or two. And sometimes we just need a tune-up.
There are many doctors around the world, both primary care and lung specialists who are not well-versed in airway clearance. But it is my hope that through online education and support groups, we will all understand the importance of keeping our airways clear and will seek out the care we need. It might mean having to raise the subject of services and equipment with your medical team, if they don’t offer those options.
Here’s a great analogy to use with your doctor regarding the importance of airway clearance. According to Dr. Pamela McShane, one of the top BE/NTM professionals in the US, we should think of removing mucus from our lungs the way we think of flossing our teeth. We floss even when there doesn’t appear to be anything there, but it breaks up any bacteria biofilm present and is a good habit to have. That is how we can think of trying to remove mucus. We are breaking up biofilm in our lungs.
Educate. Advocate. Stay committed.
#bronchiectasis #copd #maclungdisease #ntmlungdisease #airwayclearance
I have two diseases–bronchiectasis (BE) and a Mycobacterium Avium Complex (MAC-LD) lung infection. Both were considered rare, but with increased medical professional education and the use of High Resolution CT scans, BE is being diagnosed more frequently than in the past. However, a MAC infection is rare. These bacteria are everywhere in our environment and it is unusual for them to cause disease.
When people are diagnosed with both bronchiectasis and a MAC infection at the same time, which is my situation, doctors frequently say that it is a “chicken or the egg” situation. Did the bronchiectasis damage and inflammation allow the MAC to set up shop in the lungs or did the MAC infection cause the BE?
Some answers to this question can be found in a person’s medical and lifestyle history. For example, having pneumonia or bronchitis might have caused the scarring in the lungs, the bronchiectasis. A deeper dive might uncover genetic causes and in some cases, these underlying conditions might be treatable.
Although in my case nothing is certain, I probably got the BE from a bad pulmonary infection in my mid-50s that led to inflammation and a welcoming environment for MAC. As I said, MAC is ubiquitous–it is in the soil, water and air. At one point, my husband and I moved out of Manhattan to upstate New York. I had a huge flower garden during the eight years we lived there and spread heaps of mulch and soil. MAC loves mulch and because it is fluffy and easily airborne, it can find its way into the lungs and for some people, cause disease.
In my recently published book, “The BE CLEAR Method to Living with Bronchiectasis” https://amzn.to/333htls I mention my double-whammy diseases but focus on bronchiectasis. This was a deliberate choice as there are many people who have BE and will never get MAC or any Nontuberculous Mycobacterial (NTM) infections.
At the same time, I feel I should talk about it so that people, if they so choose, can minimize their risk with simple solutions such as wetting soil to prevent dust and wearing a mask while gardening.
#bronchiectasis #NTMLungDisease #maclungdisease
How does the water we drink that goes into our stomach cause a MAC infection in our lungs?
The answer is two-fold: by inefficient swallowing and gastric reflux.
All of us micro-aspirate liquid into our lungs throughout the day. This might be from liquid “going down the wrong pipe” as can happen with swallowing issues, coughing, or “just because.” Although a certain number of aspirations is considered normal and not a concern for those with healthy immune systems and lungs, this may not be the case for people with impaired airways.
Gastroesophogeal Reflux is another way bacteria can enter the lungs. Both acid and non-acid gastric refluxate can come up from the stomach and enter the lungs. This liquid can contain bacteria that have not been killed off by our stomach acid and possibly cause infection.
One way to help prevent reflux is to take GERD precautions. These precautions might include:
In addition to reducing swallowing issues and GERD, we can also reduce the MAC in our drinking water. Boiling water for 10 minutes or drinking spring water will greatly reduce this exposure and is something I do.
If you choose to drink spring water, do not drink from a water cooler as a MAC biofilm might be lining the inside of the machine. The same is true for refrigerator filtered water and ice and Brita-like charcoal pitchers.
Not everyone with bronchiectasis will get a MAC infection. However, there is about a 10-20% chance you will and the precautions I have laid out can reduce that probability.
Some BE and MAC specialists tell their patients to just live their lives and to not try to control bacteria that is everywhere in our environment. Others suggest taking preventive measures. So it is best to have this conversation with your doctors and see what they recommend.
Remember, we have a life-long condition so you can always make changes gradually over time.
#bronchiectasis #maclungdisease #ntmlungdisease #GERD
The “B” in my book, “The BE CLEAR Method to Living with Bronchiectasis,” stands for “Breathing.” To breathe our best we need to create space in our body by lengthening our spine. In other words, by improving our posture.
During a 2021 patient bronchiectasis conference, Dr. Jonathan Whiteson, Medical Director of the NYU Langone Cardiopulmonary Rehabilitation department, repeatedly mentioned the connection between good posture and lung health.
Improving posture begins with believing it is critical to your well-being. It means that you too believe that sitting, standing and walking more upright will lead to better breathing and many other benefits including:
* More confidence
* Less coughing
* Less feeling short of breath
* Better digestion including less gastric reflux
* More stability while walking
* Fewer joint issues
Like any new habit, improving your posture will require daily practice. For example, write the phrase “lengthen your spine” or “sit with better posture” on a slip of paper and put it on the table when you eat, or when you are at your desk or watching TV.
Observe what might be getting in your way of sitting, standing and walking more upright. See what you can do to address these challenges.
In my book, “The BE CLEAR Method,” I demonstrate 10 exercises to improve your strength and alignment. Some people with BE have spinal issues such as scoliosis and kyphosis, but understanding the importance of posture and making small changes to better align the spine, will make a difference over time.
As your body begins to elongate you will feel the difference. Your breath will have more room to naturally flow more evenly and deeply.
#bronchiectasis #copd #breathing #posture
Let’s talk about our backsides. Those of us with bronchiectasis tend to be thin. This could mean a loss of fat but also a loss of muscle. As you can imagine, losing muscle is not a good thing especially for the buttocks. The gluteal muscle is big for a reason. It does the heavy lifting in a lot of everyday activities like climbing the stairs and getting us up from a chair or the floor.
The great news is that strengthening your backside is simple. All you have to do is lower your body down as if you were going to sit in a chair,( you don’t need to drop too far), and then stand back up again! Watch your form so that your upper spine is not curved forward. Only go as far as you are able to maintain a relatively straight spine position.
You can do these mini-squats when you have a few free minutes during your day. Or, you can set aside time several days a week to practice them. If you have a joint issue and mini-squats are difficult, you might want to work with a physical therapist or personal trainer to isolate and strengthen that particular joint. Then, daily activities will be easier and so will exercise.
Over time, you’ll be better able to squat down to pick something up from the floor or while gardening instead of having to bend at the waist. This is especially important if you have gastric reflux. Controlling reflux is critical to controlling aspiration of harmful liquids into the lungs that can increase lung tissue damage and exacerbate bronchiectasis. Whatever your situation, strengthening your gluteal muscle is good for you, no ifs, ands or butts about it!
Before you start or change an exercise program, be sure to get your doctor’s medical clearance.
#Bronchiectasis #COPD #Asthma #cysticfibrosis #GERD #GORD #GastricReflux #Reflux #exercise
Lung disease nutritionist Michelle MacDonald says, “You wouldn’t skip taking your medication, so why would you miss a meal?” and this resonates with me. Even when I am not hungry or have an upset stomach, I do my best to eat. Sometimes, my attitude is just “get it down the hatch,” in other words, don’t overthink it, just eat.
Because it is unreasonable to expect my body to heal if I am depriving it of nutrients. It would be like expecting a wood-burning stove to burn brightly without putting wood in it!
Generally speaking, I like foods that have texture and crunch. I prefer eating fruit and vegetables to a smoothie and cookies over tiramisu. But, when I am not feeling well or am excitedly busy with a project, all of the crunching and munching loses its appeal. To prevent a decline in my nutrition, I make sure that I have my “baby food soup” on hand.
I call the soup that because when my daughters were young and we were living in Italy, that’s what I fed them. It was nearly impossible to find baby food in jars, so like the Italians, I made a vegetable and pastina puree. Che buono!
Now when I need a little TLC, I make it for myself. Sometimes I saute vegetables in olive oil and then add water, tomatoes, broth and beans or lentils. Other times when I don’t want to fuss, I just chop up vegetables and throw them in a pot with the other ingredients. I vary spices and flavoring, but I always cook the soup for an hour or more. Then I use my immersion blender and puree everything to a silky texture. If I didn’t use olive oil, I’ll add that too and sometimes a little quinoa to thicken the soup. Then I freeze the soup in portion-size containers so that it is available on days when munching and crunching aren’t appealing.
Because food is medicine. Not just in a sound-bite sort of way, but in an inherently true and deeply meaningful way.
As a fitness and health educator since 2001, I’ve spent a lot of time in gyms. One thing that never ceases to concern me is seeing exercisers going through their workouts using poor form. Watching them perform dangerous, spine-crunching exercises including neck-pulls while doing sit-ups, squatting with rounded spines and heavy weights, and stretching in deep yoga poses makes me want to set off the fire alarm to get them to stop!!!
I know that these gym-goers are there to improve their health and look their best (who doesn’t want abs of steel???) but unfortunately because they or their fitness instructors are not well-informed, they are setting themselves up for the possibility of fractured back bones and chronic pain.
If you regularly follow me, you know that I stay away from “the sky is falling down” posts. I much prefer to uplift my readers. But as mostly thin, small-boned women over 50 who might have taken steroids or currently take them, we are at risk for osteoporosis. That’s not to say that younger women shouldn’t be concerned, too. I once had a client in her twenties who due to an eating disorder had advanced osteoporosis.
I am hoping that after reading this post, you might approach exercising with bone health in mind. Osteoporosis is a silent disease. Even if we fracture a vertebra, we probably won’t feel it. Then we go for our annual check-up and we see that we are shorter. A little loss of height is expected as we age and the cushy discs between our spine bones lose some of their fullness, but fracturing bones can often be prevented.
A fantastic site for educating ourselves about protective ways to exercise is the U.S. National Osteoporosis Foundation (www.nof.org). They give lots of recommendations for exercise modifications as well as the proper approach to activities of daily living such as lifting objects, sitting at the computer and even washing dishes!
The best suggestion is that we can become more aware of our posture. There is the likelihood that over time our back has become a little rounded and our head is not centered on our spine. The weight of our forward-positioned head can cause vertebrae compression. We can offset this by checking our posture throughout the day and doing back strengthening exercises.
The good news is we can slow or stop the progression of osteoporosis through education, awareness and new habits. Be sure to discuss your concerns with your doctor and get medical clearance before stopping or starting a new exercise program.
It is never too late for us to educate ourselves, improve our posture and protect our bones!
Check out the videos and yoga modifications on the National Osteoporosis Foundation website: www.nof.org.
#bronchiectasis #osteoporosis #bonehealth #copd #exercise
I frequently post on social media about upcoming webinars from a non-profit organization, NTM Info & Research. People have repeatedly asked me what NTM is and what it has to do with bronchiectasis, so I thought I would share this information.
There are over 180 species of Nontuberculous Mycobacteria (NTM) and they are present in water, including drinking and showering water as well as in soil. Many people who have bronchiectasis (BE) will eventually get an NTM infection. Why? Because when our airways are inflamed and dilated from BE, mucus pools and provides a welcoming environment for them to grow.
NTM infections are challenging to cure and even when we manage to get rid of them, in 50% of the cases, the same bacteria will reappear or we will get infected by a different NTM organism. This is why some of us, including me, take precautions against acquiring other infections.
With that said, many people with bronchiectasis who do not have an infection, choose to lead their lives without changes to their showering habits, drinking water, use of hot tubs, humidifiers and indoor pools. Additionally, some who already have an infection also choose not to restrict NTM exposure because these bacteria are everywhere in the environment and trying to prevent an infection can seem like a futile undertaking. What you decide to do, how you choose to go about your life is entirely your decision. But I do think it is important to understand NTM infections, how you can, if you so choose, minimize exposure and to discuss these issues with your health care team.
Fantastic article on the most common NTM bacteria--
Reducing Human Exposure to Mycobacterium Avium---- https://www.atsjournals.org/doi/pdf/10.1513/AnnalsATS.201301-013FR
#bronchiectasis #NTMlungdisease #MAClungdisease
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.