Mum first started having haemoptysis around 8 years ago. A referral to University College Hospital followed and, eventually she was diagnosed with bronchiectasis over the right lower part of her lung and Mycobacterium Avium Intracellulare (MAI). It was thought that the bronchiectasis was caused by childhood infection(s), most likely Tuberculosis, even though mum was not aware of ever having it.  MAI is an organism which is found commonly in soil and water and has a predilection to grown in damaged lung tissue. Mum underwent a year-long treatment with combinations of antibiotics, which had unpalatable side effects. The haemoptysis settled down initially. However, in the last few years, they happened regularly in small amounts. Lots of things might precipitate it, from moving her body in a certain way, to having intercurrent chest infections, to eating certain foods such as grapefruit (which had an effect on haemostats generally). She had a significant episode of bleeding at the end of 2016 for which she was admitted to hospital. Things settled down after a day or two and no significant change was made to her long- term management plan. In the intervening year, mum often felt tired and looked visibly thinner. Despite this, she gave us enormous help with looking after the twins: cooking for them, reading to them and cutting their hair! Unfortunately, she caught the flu over the Christmas period and the physical trauma of coughing badly and the secondary chest infection/inflammation probably led to the acute injury to blood vessel(s) which then caused her to have a fatal haemorrhage on New Year's eve. 

Talking to mum's usual respiratory consultant afterwards, I learnt that it is common for patients with bronchiectasis to have frequent small volumes of haemoptysis. However, it was very rare for such fatal haemorrhage to occur. He speculated that the MAI might have recurred since the initial treatment. This might have contributed to her weight loss, fatigue and recurrent chest infections as well as the massive haemorrhage in the end.

I hope that donations to the British Lung Foundation in my mum's memory would go to research to better understand the management of bronchiectasis and MAI. Mum was also a firm advocate for better air quality and I know that she would support the ongoing campaign against air pollution that the BLF has.