Chronic Obstructive Pulmonary Disease (COPD) Expert Forum
Bronchiectasis and MAI
About This Forum:

This forum is for questions and support regarding COPD, coughing/wheezing, chronic bronchitis, emphysema, lung infections, pollution, smoking, treatment for COPD and what causes COPD.

Font Size:
A
A
A
Background:
Blank
Blank
Blank
This expert forum is not accepting new questions. Please post your question in one of our medical support communities.
Blank Blank

Bronchiectasis and MAI

My 54-year-old wife was diagnosed with bronchiectasis (BE) about 4 years ago but did not have symptoms until this year, when she's had walking pneumonia in the spring, difficulty walking up hills, then a bad double pneumonia in August. Since then, she coughs daily with sputum production, has not really felt well at all, gets quite fatigued daily, has had a few fevers, and been in bed for 3 - 4 days a few more times this fall. Recently, she has developed a lot of pain in her ribs, seemingly from a muscle pull from the coughing.

Her doctor, head of Pulmonary Medicine at Lenox Hill, has prescribed Rifampin (600 mgs daily) and Clarithromycin (1000 mgs daily) for 6 - 12 months to combat her MAI, which with her BE is in both lungs. She's been on the antibiotics now for 2 months. She uses her Albuterol inhaler 3x daily, and does postural drainage once daily. She is not doing exercise, because she doesn't feel well and has low stamina, though she doesn’t noticeably wheeze or anything, though her doctor hears wheezing. He says her BE is a combination of all 3 levels of severity, and that she has a lot of scarring.

We like her doctor a lot, but are adjusting to what seems like a new permanent reality, and can't seem to get a handle on precisely what's going on, I think perhaps because of the vicious and partly unpredictably cyclical nature of the disease.

1. Does it make sense that after 2 months on the antibiotics she would feel so lousy, and that her coughing has been worse lately? (Her doctor just prescribed 5 days of Leviquin, 750 mgs/daily.)
2. Is it likely that she will cough from now on, even if the MAI gets better?
3. Can the MAI disappear altogether, or just be held in check until it raises its ugly head again in the future?
4. We have no numbers to report, like % of lung function, etc. How important is it for us to get this?
5. Is there any predicting a short- or long-term prognosis?
6. Other recommendations?
THANKS SO MUCH!


Related Discussions
242588_tn?1224275300
1. Does it make sense that after 2 months on the antibiotics she would feel so lousy, and that her coughing has been worse lately? (Her doctor just prescribed 5 days of Leviquin, 750 mgs/daily.)
Possible reasons why your wife "would feel so lousy" are:  
a) the rifampin and clarithromycin are sub-optimally effective against the mycobacterium avium intracellulare (MAI); or
b) due to her bronchiectasis she may have an active bacterial infection, such as pseudomonas, which is not sensitive to these medicines.

2. Is it likely that she will cough from now on, even if the MAI gets better?
This is unpredictable, but, if the MAI is attenuated or eradicated, there is a good chance that the cough would diminish.

3. Can the MAI disappear altogether, or just be held in check until it raises its ugly head again in the future?
The MAI could be completely eradicated, but the more likely to become controlled or "in check".

4. We have no numbers to report, like % of lung function, etc. How important is it for us to get this?
It is important to obtain pulmonary function tests (PFTs) as a baseline, for comparison with future testing, to measure of disease progression.  However it has little or no value in guiding therapy.

5. Is there any predicting a short- or long-term prognosis?
A meaningful estimate of prognosis could only be provided by physicians with:  
a) extensive experience in the treatment of this disease;
b) intimate knowledge of your wife's present condition, including her PFTs;
c) degree of response to current therapy; and
d) rate of progression of her lung disease during the past 12 months or longer.
6. Other recommendations?
The infectious disease specialists at National Jewish Medical and Research Center in Denver, Colorado have, what is probably, the greatest experience in the U.S. in the evaluation and management of bronchiectasis with MAI.  You might want to seek a second opinion from them or at least ask your wife's doctor to consult.  Please read our nontuberculous mycobacteria (NTM) information at http://www.nationaljewish.org/disease-info/diseases/nts-mycobac/index.aspx and our bronchiectasis information at http://www.nationaljewish.org/disease-info/diseases/bronchiectasis/index.aspx to learn more.
Blank
This Forum's Experts
242587_tn?1355427710
David Tinkelman, M.D.Blank
National Jewish Health
Denver, CO
Blank
Request an Appointment
MedHelp Health Answers
Blank
Asthma Tracker
Asthma Tracker
Start Tracking Now
RSS Expert Activity
233488_tn?1310696703
Blank
New Cannabis Article from NORTH Mag...
Jul 20 by John C Hagan III, MD, FACS, FAAOBlank
242532_tn?1269553979
Blank
3 Reasons Why You are Still Binge E...
Jul 14 by Roger Gould, M.D.Blank
242532_tn?1269553979
Blank
Emotional Eating: What Your Closet ...
Jul 09 by Roger Gould, M.D.Blank