Bronchiectasis in yellow nail syndrome

ABSTRACT Background and objective Yellow nail syndrome (YNS) is a rare and poorly described disease process. In this case–control study, clinical features and findings on HRCT were compared with idiopathic bronchiectasis (IBx). Methods A review of all patients attending an adult bronchiectasis clinic between 2007 and 2013 identified 25 YNS patients. IBx patients were matched in a 2:1 ratio for age, duration of symptoms and gender. Results Median age of onset was 53 years. There were 12 male and 23 Caucasian YNS patients. Respiratory manifestations included chronic productive cough (100%), chronic rhinosinusitis (88%), pleural effusions (20%) and lymphoedema (12%). Chest symptoms preceded yellow nails in the majority (68%). Abnormal nails persisted at follow‐up in 23 of 25 patients but improved in 14. In both disorders, there was symmetrical, predominantly lower lobe bronchiectasis on HRCT. Extent (P = 0.04), severity (P = 0.03) and bronchial wall thickness (P = 0.05) scores were lower in YNS, with less upper and middle lobe disease. Multivariate analysis showed an independent association with increased mucus plugging in YNS. There was a similar prevalence of Pseudomonas aeruginosa infection and mild lung function abnormalities. Conclusion Bronchiectasis in YNS is less severe than IBx but is associated with increased mucus plugging, onset is in middle age and there is no female predominance. Treatment targeted at improved secretion clearance may improve both chest and nail symptoms, with consideration of long‐term macrolide antibiotics. Bronchiectasis in yellow nail syndrome (YNS) has distinct features which influence clinical presentation and management. Bronchiectasis in YNS is milder than in idiopathic bronchiectasis, with less upper and middle lobe disease, but increased mucus plugging. A better understanding of aetiology may influence future research and management decisions.