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Facing The Challenges of NTM Lung Disease

Posted on November 29, 2022   |   
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This blog post was authored by Christina Hunt, BS, RRT.

Nontuberculous mycobacterial (NTM) lung disease is caused by common bacteria found in soil, freshwater, and natural water sources.1 You may not have heard of it because NTM lung disease is described as a rare disease. People who have NTM lung disease may have a cough (often bringing up mucus), fever, weight loss, tiredness, and sometimes bloody sputum (mucus).2 Often, NTM lung disease is found in people with weakened immune systems or who already have a lung disease like COPD, bronchiectasis, or a history of treated tuberculosis.2

If a doctor suspects NTM lung disease, they will first perform some tests to find out the type and how serious your infection could be. These include sputum testing, and a special x-ray called a CT scan. NTM lung disease is often slow to worsen. If NTM lung disease is diagnosed, the health care team will be careful to come up with a plan of care that will keep in mind the NTM’s ability to cause lung damage, risks and benefits of therapy, the person’s willingness to begin medicines for treatment, and the overall goals for therapy. Sometimes, “watchful waiting” may be chosen as the course of action.3 If symptoms or the NTM lung disease gets worse and starts to damage the lung, the care plan may be changed. Regardless of when treatment begins, health care teams will advise that those with NTM lung disease start a routine to help clear their mucus. This is called “airway clearance” and is an important part of treating NTM lung disease.4

Along with medicines, the care plan for NTM lung disease should include a wellness program. This can involve starting an exercise program, eating healthy, and avoiding losing weight.4 If the person with NTM lung disease has another lung condition (e.g., COPD, bronchiectasis, rheumatoid arthritis), they should take care of those conditions as well.1 Additionally, around a quarter (26%) of those with NTM lung disease also have acid reflux.5 Health care providers will often test for reflux disease and provide “lifestyle change” ideas to help reduce reflux and aspiration, a condition when food or fluids that should go into the stomach go into the lungs instead.5

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Categories: Awareness

The Home Sputum Collection Project

Posted on November 02, 2022   |   
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This article was reviewed by the Bronchiectasis and NTM Content Review and Evaluation Committee.

By Helen Ballard and John Torrence

Patients have reported that they often receive inconclusive or nonspecific results from NTM sputum tests, which can be incredibly frustrating.

Unfortunately, many laboratories do not possess the special testing equipment necessary to identify NTM subspecies. Far too often, we hear about patients’ “sputum chronicles”, where samples may be sent to various labs across the country, only for the patient to receive vague, sub-par test results in return. This inefficient process involving repeated, multi-laboratory sputum testing often creates diagnosis and treatment delays, generating unnecessary distress and frustration for patients and prescribers alike.

To combat these issues, the COPD Foundation has recently embarked on a pilot project with the goal of helping NTM patients receive more timely and accurate results on their sputum tests, free of cost!

With generous funding from Insmed, we partnered with NTMir and the full-service mycobacteriology lab at National Jewish Health to expand access to at-home sputum collection at no cost to the patient.

Through our website, physicians can sign up to participate and patients can access a variety of resources including FAQs, our Bronchiectasis and NTM info line, and a 3-D sputum collection instructional video.

Registration is simple!

  1. Let your doctor know you are interested in this program.
  2. The interested physician or prescriber completes a short online form located at www.homesputum.org.
  3. The prescriber receives an email from homesputum@copdfoundation.org containing a sputum kit order form.
  4. The prescriber completes the order form on behalf of their patient(s) and returns the completed form via email to National Jewish Health.
  5. The mycobacteriology lab at National Jewish Health sends a sputum collection kit directly to the patient.
  6. The patient follows the collection instructions and returns their specimen to the full-service mycobacteriology lab at National Jewish Health, where tests ordered by the prescriber are performed.
  7. Results are returned via email to the prescribing physician’s office.

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Categories: Research

How the “Teach Back” Method May Improve Education for Those with Chronic Lung Conditions

Posted on August 22, 2022   |   
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This blog post was authored by Katie Keating, RN, MS, and reviewed by the Bronchiectasis and NTM Content Review and Evaluation Committee.

Understanding and managing your health care plan as a person with bronchiectasis and/or NTM lung disease can be very challenging. In my experience, I have found that those that leave the hospital after a stay can be confused about the instructions they have been given. Often, patients do not recognize that they did not understand the instructions when they received them. As a result, a large amount of health care information is forgotten immediately after leaving a doctor’s appointment or being discharged from the hospital.

Health literacy is the “ability to find, process, and understand basic health information and services needed to make appropriate health care decisions.”1 When people with lung conditions do not understand the health information they have been given, it can lead to an increased burden of your lung condition, worsening outcomes, and increased health system use and costs.1

Health literacy is an important goal of patient education. It can be defined as having the skills and understanding to apply information to make valuable decisions about your health and healthcare.

How health care teams give information to those with lung conditions, like bronchiectasis and NTM lung disease, can make a big difference in how much someone understands their diagnosis.It may also help someone who has a lung condition manage it better. “Teach-back” can be a wonderful patient education tool to help patients understand information about their health. It can help those with health conditions become involved in their care and may lead to better quality and safer care.1

Good communication between health care practitioners (HCPs) and patients is important for safe, quality care. There is a high cost to misunderstanding. The cost of a lack of education and patient misunderstanding of medical information is estimated at $73 billion a year.2 This means that many people leave doctors’ offices without fully understanding their diagnosis and the necessary treatments to lessen their symptoms.

Crowded areas in health care facilities, noise, and lack of privacy are often barriers to effective learning. Interruptions, lack of time, and poor HCP teaching skills may contribute to a patient’s difficulty understanding health information.2

A possible solution

“Teach-back” helps HCPs test whether their teaching methods are working by allowing them to find out whether their patients understand. Open-ended questions enable the health care professional to see whether a person understands what she/ he has just been taught.

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Categories: Awareness

Research Opportunity for People with Non-CF Bronchiectasis

Posted on June 15, 2022   |   
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This article was reviewed by the Bronchiectasis and NTM Content Review and Evaluation Committee.

Non-cystic fibrosis bronchiectasis (NCFBE) is a chronic lung disease that affects the lungs by causing widening, irritation, and scarring of the airways due to increased mucus production. Mucus tends to pool in the airways because the cilia (tiny hair-like structures that help to sweep mucus out the lungs) do not function well. This causes NCFBE patients to have repeated lung infections.1 Bronchiectasis can be diagnosed using a CT scan of the chest although further testing like PFT (pulmonary function tests) and bloodwork may be requested by your health care team.1

The goals of treating NCFBE are to reduce exacerbations (flare-ups), maintain lung function, and improve a person’s quality of life.1 This may be done by stressing the importance of airway clearing methods, healthy eating, exercise, and avoiding illness. Those with bronchiectasis may be referred to a pulmonary rehab (rehabilitation) center to get advice and education on clearing the airways of mucus and to help create an exercise routine that will be beneficial.2

Researchers are currently studying a drug that may have an effect on lung inflammation, breathlessness, and pulmonary exacerbations due to NCFBE:

ASPEN is a clinical study for NCFBE patients being conducted by Insmed Incorporated. The results of this study will help researchers gain a better understanding of an oral study drug that is being evaluated for its effects on flare-ups and other NCFBE symptoms.

To participate in this study to must meet the following criteria:

  • Be between 12 and 85 years of age
  • Be a non-smoker
  • Have a clinical history consistent with non-cystic fibrosis bronchiectasis
  • Have had at least 2 pulmonary exacerbations in the last 12 months (Adolescent participants are required to have had at least 1 pulmonary exacerbation in the prior 12 months.)
  • Have no history of COPD or Asthma
  • Cannot be on active treatment for nontuberculous mycobacterial (NTM) lung infection, allergic bronchopulmonary aspergillosis (ABPA), or tuberculosis (TB)

Click here to learn more about the study and to see if you may qualify.

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Categories: Research

Summer Precautions for People with Bronchiectasis and NTM Lung Disease

Posted on June 13, 2022   |   
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This blog post was authored by Katie Keating, RN, MS, and reviewed by the Bronchiectasis and NTM Content Review and Evaluation Committee.

Summer fun and great outdoor weather are approaching. Sunshine is uplifting to most of us after being indoors through a long and challenging winter. By taking specific precautions throughout the summer, you may lessen your chance of getting an NTM infection or experiencing a flare-up. Educating yourself on these suggestions may enable you to truly enjoy your summer and avoid infection.

Below are some excerpts that are taken from the paper Reducing Exposure to Nontuberculous Mycobacteria (NTM), by Joseph O. Falkinham, III, Ph.D. (revised June 11, 2020). Other relevant publications also are referenced.

Flush and run water in unused lines to reduce water age. Water age refers to the time water stays in pipes in houses. The average water age in household plumbing is one to three days. When water stays in your pipes for more than three days it can lead to a loss of disinfectant and may cause NTM and other waterborne germs to grow. Increased water age can occur in plumbing in unused areas of a house (e.g., in an unused bathroom or unoccupied wing of a house). The solution is simple: have someone unlikely to be at risk for NTM disease flush commodes and run water (5 minutes) in taps in unused bathrooms and seldom-used laundry tubs, half baths, and outside faucets.1

Blogger’s note: Many of us will be traveling over the summer months and it is good to remember the above statement. Rental homes may not have flushed the systems for days before your arrival. Let others who do not have NTM lung disease or sensitive immune systems flush the infrequently used faucets, outdoor faucets, gardening hoses, etc. Doing something as simple as this can save you from getting an infection or reinfection while traveling.

Don’t drink water or use ice from a refrigerator. Many refrigerators come with outside taps for chilled water and ice. Do not use them as high numbers of NTM may be collecting in the refrigerator tap water and ice. The tap water coming into the refrigerator collects in a large reservoir and the warmth of the machinery raises the temperature of the water (before cooling), so the reservoir may contain lots of NTM. Use ice trays and bottles that are filled with boiled (10 min) or 0.2 micrometer-filtered water if you want cold water.1

Blogger’s note: My refrigerator water filter was tested years ago by the lab at Virginia Tech — the mycobacterium matched what was in my recent sputum sample.

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Categories: Quality of Life

Beginning the Journey of NTM Lung Disease

Posted on May 16, 2022   |   
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This post was authored by Christina Hunt, BS, RRT.

For many people, the diagnosis of a lung condition can be a very uncertain time. Feelings of worry, fear, and confusion can weigh greatly on those trying to decide their next steps for treatment, adjust to major lifestyle changes, and answer the all-important question of “Why me?” These challenges may seem more difficult for those diagnosed with a rare disease, such as Nontuberculous mycobacterial (NTM) lung disease. For those who have an NTM lung disease diagnosis, there is plenty to unpack in the beginning to understand the disease itself, why they may have been susceptible to this infection, and how they can make lifestyle changes to best manage their condition.

This diagnosis can be a complex one, so let’s start with the basics. There are 190 different types of NTM, but the most common is called Mycobacterium avium complex (MAC).1,2 This type of bacteria is found in soil and different fresh and natural water sources. NTM lung infections are thought to develop when a susceptible person comes in contact with these bacteria and breathes them into the lungs doing normal daily activities. These daily activities may include showering, bathing, drinking, hand washing, dishwashing, gardening, or just sleeping.3 While the healthy lung can remove NTM and stop these usually harmless bacteria from taking hold and finding “a home” in the lungs, people who have damaged lungs, weakened immune systems, and other predisposing conditions are more likely to become infected and be diagnosed with NTM lung disease.2 These lung conditions can include COPD, bronchiectasis, and prior tuberculosis.2,3 Women who have gone through menopause and people over the age of 65 are also more likely to have NTM lung disease.2,3 It’s important to note that NTM lung disease is not spread from person to person like its more well-known relative, tuberculosis.2

While NTM lung disease is considered a rare disease, rates have been increasing throughout the world. The increasing rate is likely due to more patients developing the infection, as well as due to improved testing methods and increased awareness of the condition.2 Patient symptoms can often be subtle, leading to delays in diagnosis, and may include long-lasting cough with or without mucus, also known as sputum, shortness of breath, weakness, fatigue, weight loss, and at times coughing up blood.2

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Categories: Quality of Life

Preventing Spring Flare-ups for those with Bronchiectasis

Posted on May 12, 2022   |   
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This post was authored by Christina Hunt, BS, RRT.

Those with bronchiectasis (a lung disease with enlarged airways that are thickened and/or scarred) frequently have a lot of mucus. If a person has normal lungs, they can clear the excess mucus. However, in bronchiectasis, the cilia (tiny hair-like fibers that help to sweep mucus out of the lungs) don’t work well. This causes the mucus to pool and stick to the sides of the airways. When mucus stays in the lungs too long, it can lead to repeated infections causing lung damage.

People with bronchiectasis can be at risk for developing fungal, viral, and bacterial infections. Recent studies suggest that those with bronchiectasis can have high allergen sensitivity rates.1 In particular, fungi and dust seem to be common allergens in the spring. Learning a person’s sensitivities and preventing exposure to allergens could impact how those with bronchiectasis feel. It may also help them to manage their condition. Now that spring has arrived, let’s explore some ways in which people with bronchiectasis can prevent problems caused by common allergens.

Wear a mask when outdoors and exposed to environmental allergens like dust, pollen, or mold. By wearing a facemask, you may be able to filter allergens and reduce the risk of an allergic response.2 Your local weather channel as well as most weather apps will notify you when the air quality is poor. Consider pollen and mold counts before spending extended time outdoors.

Change the filters in your home. Consider purchasing asthma and allergy friendly® filters that can filter out 98% of allergens in the air. Air conditioners can help to lower humidity thereby lowering the chance for mold and fungus to grow. In addition, portable air purifiers may also be helpful to cleanse the air indoors. Keep your windows closed to avoid outside allergens from entering your home.

Declutter. Most of us are familiar with “spring cleaning.” Getting rid of items that you do not need or use may help to make it easier to clean and dust your home. Vacuum frequently to keep dust and other allergens low indoors. Consider wearing a mask when cleaning and dusting your home.

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Categories: Quality of Life

Wheezing and the Bronchiectasis/NTM Patient

Posted on April 19, 2022   |   
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This blog post was authored by Katie Keating, RN, MS, and reviewed by the Bronchiectasis and NTM Content Review and Evaluation Committee.

Do you occasionally wheeze? Do you become concerned and sometimes confused about the causes of your wheezing? Ongoing wheezing can cause stress and worry to occur. Getting to the root cause of your wheezing may relieve worry and help you to breathe easier.

What is wheezing?

Wheezing is a high-pitched, coarse whistle-like sound made when you breathe. It is the result of air moving through narrowed or partially blocked airways. The breath does not easily move in and out of the lungs.

Many people with respiratory allergies know that wheezing often comes with allergy season. It may also happen because of lung infections like acute bronchitis. But chronic obstructive pulmonary disease (COPD) and asthma are the most common causes.1

Wheezing is never normal. If you notice it when you inhale or exhale, and particularly if it persists or worsens, you should consult a doctor to find out what is restricting your airway.2

Wheezing is more obvious when you breathe out (exhale) but can also be heard when you breathe in (inhale). The tone of the wheeze can vary depending on which part of the respiratory system is blocked or narrowed. Narrowing in the upper respiratory system may make for a hoarser wheeze.3

What causes wheezing?

Many health problems can cause wheezing, some of the most common include the following4:

  • Asthma (a lung condition where the airways narrow, swell, and produce extra mucus, making it hard to breathe)
  • Allergic reactions often to pollen, chemicals, pet dander, dust, foods, or insect stings
  • Bronchitis
  • Bronchiectasis (an abnormal widening of bronchial tubes which inhibits mucus clearing)
  • COPD exacerbation (a worsening of symptoms)
  • Pneumonia (an infection that inflames the air sacs in the lungs and they fill with fluid or pus)
  • Obstruction of an airway by an inhaled object or food particle
  • Bronchiolitis (a lung infection that inflames airways and causes congestion)
  • GERD-related asthma. (Gastroesophageal reflux disease or GERD occurs when acid from the stomach comes back into the esophagus, the tube that connects the stomach to the throat. Chronic GERD is also often associated with asthma, causing wheezing. The two diagnoses often coexist, with each one contributing to the other. Acid reflux can trigger an asthma attack in patients with the condition.5)

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Categories: Quality of Life

Postnasal Drip in the Bronchiectasis Patient

Posted on March 15, 2022   |   
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This blog post was authored by Katie Keating, RN, MS, and reviewed by the Bronchiectasis and NTM Content Review and Evaluation Committee.

According to a recent study, people who have asthma and bronchiectasis are more likely to have persistent swelling of the nasal passages (51%) than people without bronchiectasis (36%).1 This swelling often leads to postnasal drip and coughing that will not go away. Discovering whether a person with bronchiectasis has sinus swelling and/or postnasal drip, will help to improve care.1

Mucus is important to health. Glands in the nose and throat produce about 1-2 quarts of it throughout the day. Mucus moistens and cleans the nasal lining, adds moisture to the air, filters the air, and helps to fight infection. When too much mucus is produced, it can gather in the throat or drip from the back of the nose. This is called postnasal drip.2

Too much mucus may make your voice hoarse. It can also give you a sore, irritated, scratchy throat.In addition, postnasal drip can make you feel like you need to constantly clear your throat. It also can trigger a cough that will not go away and can be worse at night.3

What Causes Postnasal Drip?

Excess mucus that triggers postnasal drip has many possible causes, including:

  • Colds, flu, allergies, and sinus infections
  • Certain medications (including some for blood pressure)
  • Changing weather, cold temperatures, or very dry air
  • Certain foods (e.g., spicy foods may trigger mucus flow)
  • Fumes from chemicals, perfumes, cleaning products, smoke, or other irritants
  • A deviated septum (the crooked placement of the wall that separates the two nostrils) or some other problem with the structure of the nose that affects the sinuses

Sometimes postnasal drip may not be related to producing too much mucus. It may happen if the mucus is not cleared properly. Swallowing problems can cause a buildup of liquids in the throat, which can feel like a postnasal drip. These problems can occur with age, a blockage, or reflux (also known as GERD).

Treatment Options

Treatment of postnasal drip depends on what is causing it. Antibiotics may be used if your doctor thinks that there is an infection.

Antihistamines and decongestants can often help with postnasal drip caused by sinus and viral infections. They can also work with steroid nasal sprays for postnasal drip caused by allergies. It is a good idea to check with your doctor before taking any over-the-counter antihistamines. Many of them can have side effects that range from dizziness, drowsiness, to dry mouth.4

In addition to antihistamines, other treatment options may include an oral decongestant or guaifenesin (a medication that can thin the mucus to help prevent blockages in the ears and sinuses).

Avoid nasal decongestants that constrict blood vessels in the nasal passages unless used under the direction of your doctor.

Be aware that many of these medications are a combination of over-the-counter products. It is important to read the label and avoid taking too much of any active ingredient.

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Categories: Awareness

Overcoming Barriers for Individuals Diagnosed with Bronchiectasis and/or NTM

Posted on February 09, 2022   |   
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This blog post was authored by Katie Keating, RN, MS, and reviewed by the Bronchiectasis and NTM Content Review and Evaluation Committee.

Have you included goals to manage your health in your annual resolutions? Are you having difficulty working towards your new goals? Sticking to goals regarding your health can be hard at times, but the benefits of feeling your best throughout the year will be worth it!

The first step in reaching any goal that follows your care plan is to identify any barriers to setting your goals or self-management. Common barriers include gaps in what you know about your diagnosis; low motivation; lack of time, finances, or support; and expectation of immediate results.1

Below is a summary of important points gathered from an article entitled, Self-management in Bronchiectasis: The Patients’ Perspective.2 While it was originally written for health care providers, I have changed the point of view to give you some valuable insight and ideas for achieving your own goals regarding your health.

You may question if the therapy you are doing is working. Some patients don’t see immediate results and distrust that the treatment is working. However, research has shown that treatments such as airway clearance techniques can help over time. Being consistent and sticking to the care plan recommended by your health care team will help you to feel better and avoid flare-ups over time.

You may wonder whether you are doing the treatment correctly. If you are questioning whether you are performing your therapies correctly; my suggestion is that you consult your health care team. Good communication with your care team can help to answer questions and relieve worries. You may want to ask your health care team about starting a pulmonary rehab program. Although pulmonary rehab is known for increasing your strength and endurance, it can be a valuable tool for education on topics such as airway clearance and nutrition.

Are you struggling to prioritize treatment due to a lack of time? I encourage you to put therapies on your “to do” list daily. It may be helpful to write out a schedule so that you have your medicines and therapies accounted for. Compare your treatment to the safety instructions that they give on an airplane; you must put your mask on first before taking care of anyone else. Taking the time today may lessen the time it could take in the future to go to a doctor’s appointment, get medicines for necessary treatments, rest days, and healing days.

Do you struggle with (or would you like to improve) communication with your healthcare provider?

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Categories: Quality of Life

Living with Bronchiectasis – An Opportunity to Tell Your Story

Posted on January 11, 2022   |   
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* Recruitment for this study is closed. Check BronchandNTM360social regularly for other potential research opportunities.

Many in our community know first-hand the complexities of living with bronchiectasis. Bronchiectasis is characterized by thickened or scarred airways which leads to excessive mucus pooling. When the mucus gathers in the airways, it can lead to frequent, burdensome infections. Due to the difficulties in moving mucus out of the airways and the importance to avoid illness, a “day in the life” of a patient with bronchiectasis can often be centered around activities that assist with airway clearance.

When it comes to clearing mucus from the airways, many patients first think about airway clearance techniques and devices. A “normal day” is typically planned around, critical mucus clearance sessions that can involve inhaled medications, the use of a mucus clearing device, and purposeful coughing. These sessions are typically scheduled 2-3 times a day and can last anywhere from twenty to forty-five minutes. Factors like daily exercise and nutrition can also play a key role in assisting with mucus clearance and avoiding illness. Exercise causes rapid, deep breathing which can help to “jiggle” the mucus away from the airways, making it easier to clear. Eating a well-balanced, nutritious diet helps to support a healthy immune system and adequate hydration assists in thinning mucus.

Preventing illness is a priority for individuals living with bronchiectasis. As mentioned previously, fighting infection takes on an essential role. Efforts are made by those diagnosed with bronchiectasis to stay well and avoid catching viruses. Good hand hygiene along with up-to-date vaccinations are recommended. Mask wearing is encouraged to reduce triggers that may cause airway irritation or the chance to become ill.

Living with bronchiectasis is unique from person to person. Whether your diagnosis prevents you from working or whether you hardly notice that you have bronchiectasis at all, making sure you feel your best is of great importance.

LaGrippe Research is looking for individuals who have been diagnosed with non-cystic fibrosis related bronchiectasis and are willing to share their experiences with the condition during a 90-minute interview. LaGrippe is interested in learning about patients’ journey to diagnosis, relationships with their care team, family, and friends and how bronchiectasis affects their life on a day-to-day basis. All responses are completely confidential, and if you are eligible and selected to participate, you will be compensated for your time.

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Categories: Research

Goal Setting and the NTM/Bronchiectasis Patient

Posted on December 03, 2021   |   
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This blog post was written by Katie Keating, RN, MS, patient advocate and reviewed by the Bronchiectasis and NTM Content Review and Evaluation Committee.

Tis that time of year when we are setting goals and preparing for the year ahead. I hope and pray that this new year will be a turning point for the coronavirus and other aspects of our lives. We are surviving the pandemic and must acknowledge that we all have a purpose, whether big or small. So, here’s to setting goals for 2022.

Goals are measurable milestones that are established to indicate the success of a plan. Short-term goals are actionable. They can be accomplished in a limited period of time, and frequently lead to achievement of a long-term goal. Long-term goals are the ultimate results desired when a plan is established or revised.

When setting goals, consider what do you treasure in life? What are you really trying to change? What are the pros of making a change? What are the pros and cons of staying the same?


Set SMART goals

The SMART acronym makes it easy to remember the ideal characteristics of a goal.

Specific — You have a better chance of meeting a goal when you can answer the following six “W” questions about the goal: who, what, where, when, which, and why.

Measurable — A goal is measurable when you can answer questions to show progress and know when it is accomplished. For example, if you have a goal of being more active you could measure your activity by steps with a pedometer.

Attainable — Goals should have small, doable steps planned out that will allow you to attain the goal.

Realistic – Determine if the goal is in alignment with what you value in your life. Unrealistic goals may set you up to feel like a failure.

Timely — Be realistic in setting your timeframes. Some goals may take a week; others can take months or a year or more.

It is important to review your goals frequently. Be prepared to modify them as you achieve or encounter barriers along the way. Think of your list of goals as a care plan that can be adjusted as needed. Never look at the adjustments as failures, but necessary changes at the time.


Know why you are setting a goal

It helps to remember “the why” behind your goals. Focusing on what is meaningful to you can help you stay the course. Consider the following goals and examples of “the why”:

Nutrition Goal: To eat a nutritious, lung-healthy diet.
The Why: Eating right gives you energy for all your activities of daily living — even breathing! If you’re underweight, your body might have a harder time fighting illness. Eating smaller, more frequent (4-5) meals during the day gives your diaphragm more room to move, enabling you to breathe better.

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Categories: Quality of Life

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