Infection or Viral?Cold/Flu

Chest and lungs
1

Hi guys, I have a question for some of you more experienced Bronchiectasis sufferers, I have been diagnosed over a year or so ago with this condition which has knocked me for six but since am learning to adjust and cope, I just wondered, when you get a cold or virus and you are coughing up more mucus than usual, does this need antibiotic treatment? My G.p recently saw me as I have a cold or flu and said my chest is clear, I am coughing slightly more mucus up than I usually do but it does not appear to have changed colour. I can breathe okay now it's come off and the cold is on the mend, but as a rule of thumb should I be sending samples off?

Previous samples have shown bugs but my G.P says that everyone has bugs in there body so I am just a bit confused as to if my immune can fight them or if I 100 percent need antibiotics whenever something like this happens?

Kind regards

Simon

2

Hi Simon

​My consultant said if I start "feeling" unwell and the symptons last for more than one day, then start taking antibiotics.

3

Hi Simon

The short answer to your question is, in my case, undoubtedly antibiotics. Others will argue correctly that colds are viruses but that may or may not be a pre-cursor to a bacterial infection of the chest, susceptible to antibiotics. But my main purpose is to recommend azrythromycin not for bug killing per se but because it has a powerful anti inflammatory effect, unique to that drug and not to others in its class. B will always increase mucous if you get a cold and whilst A is not a miracle, it helps enormously. I have a rescue does always on hand, prescribed by my GP. There is much to be said to warding off a cold and it is possible. My recent post on that subject gives the formula of OTC drugs/ vitamins and zinc which achieves better than 50% success. To avoid repeating myself, I suggest a thorough read of this forum.

i hope this helps

4

Hi Simon

Firstly if you have bugs in yr mucus it's normally a sign of an infection. It actually sometimes doesn't show bugs but you can still have an infection (I was told this but the top consultant at Papworth ) your gp doesn't sound very sympathetic or helpful. I would ask what bugs are in the sample you sent off then look them up on the Internet.

Personally I would change yr GP . The trouble is many gp's don't know much about bronchiectasis so getting referred to a good chest clinic and building up a rapore with them helps. I'm lucky that my gp is now fully aware of bronchiectasis and all it brings an my consultant is always a text message away if I need her. This helps me deal with things so much better.

Hope this helps you Simon. Feel free to message me anytime.

Kind regards

Rachel ☺

5

Hi Simon

The rule of thumb is this...

Have you seen a change in the following

Production of mucus

Colour of mucus (clear -> cream -> green -> brown)

Drop in peak flow (more than 10% or so)

General feeling of malaise / tiredness

Worse sensation of breathlessness

Pain in chest

If yes to three of these, especially production and colour and if it has been going on for more than 3 days with no improvement / getting worse then you should give in a sample.

You should then start your emergency antibiotics, of which you should have a stash and which should treat whatever you tend to grow. For instance, I often get haemophilus influenza and moraxella catarhalis which are frequently immune to penicillin, so I have co-amoxiclav.

You can then change your drug depending on the test results.

In general a GP would insist on a week or ten days or more before going for antibiotics, and in general that is the right thing to do. However, with Bx the recommendation by NICE, BTS and everyone else is aggressive early treatment with antibiotics. If you need documentation to show to your GP then I / we can point you in the right way.

Finally it is very important to get vaccinated. Always get the flu vaccine as early in the season as you can. Also you should get Hib vaccine every couple of years.

Good luck!

Sam

6

Oh and if I can just echo broadsword- if you have a bit of a tendency for infections, and with many consultants even if not, then you should try azithromycin as a prophylactic. 

Taken every other day it both helps to see off the bugs  as well as this marvellous anti inflammatory effect. About,10% of people can't take it due to the side effects, but it might be worth a try.

Those who can take it, swear by it!

7

I agree with these other answers. A person with normal lungs, they have a cold/flu and get over it with bed rest and otc meds.

If we get a cold/flu, we'll end up in the hospital with pnuemonia.

So as soon as you see a change in the color of the mucus, energy level starts to decrease, more congested, see your gp as soon as possible.

Elizabeth

8

Thankyou guys, My G.p's is so useless, they think I am just being anxious all the time, which I am, but my condition is real, especially when I am ill with a cold like now. I have had the vacines and take relvar. I told them two weeks ago my peak flow had dropped and they did nothing, then I got flu like symptoms, the dr saw me and said my chest was clear and that my immune would kick in and fight it, she said what so many drs have said before to me, anti biotics don't work on virus's. But surely to escape the circle of more damage I should be treated slightly different to the average patient. I am considering a new G.P practice aswell as a new specialist as even he does not seem to be very caring neither. I

I am doing all I can including trying to stay positive, attending the gym and doing clearence, but I am so fatiuge and tired a lot of the time aswell as bloated which dosn't help at all. My specialist hasn't given me a stash of antibiotics for emergencys so I can't do that, and when I initially started with it, they over treated me with antibiotic which caused me to develop asspirigillus (which was not affecting me apparently) so they left it be as my body wasn't reacting. The specialist simply said he was not suprised I had developed that after a lot of antibiotic which was to kill the bug hamaphelius influenza I think. So after that I kind of stopped doing the samples and have tried to be tuffer about it and only see my G.p when I feel really bad. I guess with a cold your gonna feel bad though, right?

What a complicated condition. The specialist says I have it (mild) if this is mild I would not like to have it severely. My peakflow remains at 500, a drop from 540 I use to get 4 or 5 years ago. I have damage apparently on both of my lungs but not badly. I am just scared the damage will increase. I just wish I had a good care plan. I will follow things up with the specialist asap.

Thanks again guys.

Simon

9

Where do you live Simon? It seems yr GP doesn't want to help you. I think finding out what bugs you grow will help you also your body can't fight chest infections if you have bronchiectasis. I'm not saying yr GP is wrong but one minute hes saying you have a virus (but it seems odd that yr showing symptoms of an infection) and then he's tells you that you have grown bugs but your able to fight them off. Keep chipping away and try an find a gp that understands you better & can point you in the right direction.

10

Blimey, where to start...

Well you've got the thin end of it  for sure. And I'm very sorry to hear it. 

I am surprised that you were  massively treated for haemophilus influenza. It's one of my frequent fliers and I know the little bugger well. Often resistant to penicillin but usually sensitive to co-amoxiclav and - as far as I know - always sensitive to the flouro-quinolones like ciprofloxacin or moxifloxicin. A week and it's done.

What bugs to you tend to grow? If you're not sure, ask your doctors receptionist to print them out. Just say it's for your consultant and they'll usually be fine with that.

Getting aspergillosis is a bit of a bind, but steroid inhaler should keep it under control. The relvar should sort you out nicely there.

I have a little sympathy for the doctor - if he can't hear the typical sounds of lower lung infection he may, with some justification, feel that is likely to be a virus. Therefore no antibiotics.

However, the way to be sure is a sputum sample. And you should persist even if the first sample shows nothing. If you're still unwell a few weeks later, do or again . Sputum sample microbiological tests can miss a bug  20% of the time.

Consultant: if you have Bx (by the way 'mild' just refers to the damage they can see in the ct scan, not the frequency of infections or anything else) you need a respiratory consultant who knows what they're doing. There are specialist teams at the Royal Brompton in London, at Papworth in Cambridge (i think Rachel is with them). Where do you live - someone here will know a decent consultant and you can use NHS Choice to go to them.

Also, if you don't mind answering, how old are you? With age and height you can work out what your peak flow should look like and then what is a trigger level for action.

Your point in your last paragraph is the key one - an action plan. We don't get cured, we manage Bx. Hence the barrage of instructions in these responses.

And the primary objective is to break the vicious cycle of infection -> damage -> inflammation -> mucus -> infection. So don't tough it out, get all informed patient on your GP, tell him what for, hand in the samples, take the antibiotics (given the protocol mentioned above), get a specialist consultant.

For  information, a good place to start is to Google 'bronchiectasis chest heart stroke Scotland'. Very very good pamphlet. It's the second result at the moment, and is at chss dot org.

Good luck

S

11

Hi Sam

Yes I'm with Papworth buy was with Brompton prior to that. Both excellent hospitals but my preference is Papworth.

Your spot on saying you need to be on the ball with managing bronchiectasis. As soon as you start to notice any changes its best to start an oral anti biotic because you can cast iron guarantee it will progress on the weekend & no doctors are open. I always got ciprofloxin on hand as my main bug is pseudomonus and it's sensitive to that. I recently had a Ct scan in Papworth, my last one was 2009, an my lungs have only moderately deterioted since then so I'm pleased with that. I think years of running has helped me maintain that.

It's so nice to hear from other people who have this condition there's so much great advice and help!

Rachel

12

*but not buy lol

13

Thank you so much for all your advice. In reply i am 33 years old, 5,9 ish peakflow is about 500 510 520 when well, i live in west yorkshire and my specialist is called dr thomas of calderdale royal hospital which is in west yorkshire (halifax area)

I have just seen my g.p again this morning. She said my chest sounds clear and is convinced i have a virus that my body off fighting off and that it's upper respitory and only lower causes scarring. I will get a sample in also as you have advised so they can take a look. It's so annoying,you go on a good run of no infections a while building your immune back up and then it has to be wiped away with lengthly antibiotics : ( i remain positive though and xmas is iust around the corner so i am hoping to be well by then. Thankyou again for all your great advice.

Much gratitude and respect.

Simon

14

Hi Simon

For peak flow you are set the bottom edge of normal given age and height. The normal curve would be at about 600 ish, and anything within 100 of that is considered normal. It's about the same as me. So if you drift down to consistently below 500, say 470 and below, that should be a red flag.

The consultant you're seeing is not a specialist in Bx. That group looks more like a lung cancer specialist group with  some general medicine thrown in.

I note however that the Leeds Centre for Respiratory Medicine has  a specialist bronchiectasis service headed by Dr Daniel Peckham and Dr Ian Clifton. It is based at Seacroft Hospital. Google for Leeds specialist bronchiectasis service and you'll get to their website.

 I don't know anything about them, maybe someone else here does, but it is explicitly set up to provide secondary and tertiary care for bronchiectasis for west Yorkshire, so I would give it a go.

Hope that helps

Sam

15

Thanks Sam, I actually saw dr peckham when they checked me their for Cystic Firbosis which thank goodness I did not have. He did say I could see him if i wanted, that's really helpfull to know. I assumed dr thomas was a specialist in bronciectisis. I will try get transferred, would I need to ask my G.P to do that do you know?

Thanks again

Sy

16

Hi Simon

Check out NHS e-Referral. This is the new system that had replaced Choose and Book (what I erroneously called NHS Choice). But the same system applies - talk to  GP, get a referral to the place of your choice.

It looks like the best option to me - I know you'll have to go through your GP, and this may dissuade you. But trust me, seeing a specialist that actually knows about Bx is liberating. Battle the bureaucracy get to the specialist clinic- you won't regret it, I'm sure.

Good luck - let us know how it goes

S

17

thankyou guys, I have sent a sputumn sample off today, it really effects me psycolically the worry of a cold turning into something worse, had the worse panic attack ever today (don't get them often) but I guess after 12 days of cold/f/flu and coughing up more mucus than usual it got the better of me. It was just panic as I can breathe fine now but it's like sometimes when I am trying to free the mucus off and it feels stuck, I get so scared. It's kind of like your breathing is being repressed or your choking. I can handle it once, or twice or even three times, but a life time of this with the realization that it will get worse is kind of grim.

I often think, how could a woman ever put up with this if/when I find a relationship as it sounds so nasty, really gets me down, wish there was a cure for this terrible thing. Anyway, I have asked to be referred to Dr Peckham in leeds as he is the bx specialist closest to me. Thanks again for all the sound advice, I am hoping things will get easier and that 2016 Is the year I can resume a more normal life without this dominating my world.

18

Hi Simon.

Just read your last comments. It can sometimes get me down especially when I have a bad run of infections but I think to myself your not going to control me & my life & I'm in control of you! (As in the bronchiectasis ☺) Being as positive as you can be is crucial & this will keep you up beat, somedays your going to feel better than others but if you have a day where your feeling poorly or low try an think that tomorrow will be a better day, that's how I think anyway.

As for worrying that there's mucus left in your lungs just try an do the breathing cycles (I'm guessing you know what that it?) Make sure you have taken your inhalers before hand, also try & do some physio on yourself to loosen the mucus. I got an acapella which I find extremely helpful. (Not sure if you have one if you haven't try & find out where you can get one from when you see your consultant).

I'm sure plenty of people will give you good advice on here but the main one is don't panic as this won't help with your breathing.

Take care

Rachel ☺

19

Hi, yes I have an accapella, it does really help me, but keeping up to the cycles is so hard, the specialist I am under says I should be able to handle a 9 5 full time no problem, but it's so tiring just keeping my chest clear, i'm 33 now so imagine in 10 years. I honestly have a bad preminition of how this is all going to end for me.

20

Don't put so much pressure on yrself if you can only do 5 breathing cycles or even 3 what matters is your going them. Maybe it's better if you break the cycles up I get the feeling that your panicking & over thinking things. I'm only 47 and I've been managing this condition since I was a young girl and yes I'm not as fit as I used to be but it's hard for everyone as they get older with or without an illness. There are plenty of things you can do to stay fit & well but stressing will only make things worse. There is plenty of research being done into bronchiectasis and they are trialing stem cell research in America so I'm sure one day in the future there will be more help with either that or new drugs that will be more effective. You have to live in hope. I always think there's people out there far worse than me, so I enjoy life to the full & if I'm poorly I rest up have ivs & get back on track.

Hope this helps

Rach