title: Bronchiectasis in yellow nail syndrome.
abstract: 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).
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Host Defence Unit, Royal Brompton Hospital, London, UK.
authors.forename: Georgia
authors.initials: G
authors.lastname: Woodfield
authors.affiliation: Host Defence Unit, Royal Brompton Hospital, London, UK.
authors.forename: Mitzi
authors.initials: M
authors.lastname: Nisbet
authors.affiliation: Radiology Department, Royal Brompton Hospital, London, UK.
authors.forename: Joe
authors.initials: J
authors.lastname: Jacob
authors.affiliation: Radiology Department, Royal Brompton Hospital, London, UK.
authors.forename: Wing
authors.initials: W
authors.lastname: Mok
authors.affiliation: Host Defence Unit, Royal Brompton Hospital, London, UK.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Loebinger
authors.affiliation: Radiology Department, Royal Brompton Hospital, London, UK.
authors.forename: David M
authors.initials: DM
authors.lastname: Hansell
authors.affiliation: Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK.
authors.forename: Athol U
authors.initials: AU
authors.lastname: Wells
authors.affiliation: Host Defence Unit, Royal Brompton Hospital, London, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Wilson
mesh_terms: D017668:Age of Onset; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001987:Bronchiectasis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D018942:Macrolides / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009079:Mucociliary Clearance / Q000502:physiology; D009093:Mucus / Q000378:metabolism; D012129:Respiratory Function Tests / Q000379:methods; D012720:Severity of Illness Index; D012737:Sex Factors; D006113:United Kingdom / Q000453:epidemiology; D056684:Yellow Nail Syndrome / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy
chemical_list: D000900:Anti-Bacterial Agents; D018942:Macrolides
keywords: 
  Pseudomonas aeruginosa
  ; idiopathic bronchiectasis; lymphoedema; pleural effusion; yellow nail syndrome