Do all pulmonologists encourage their patients to submit sputum test?

My husband Bruce's ID/Pulmonologist at Johns Hopkins in Bayview, Maryland (east of Baltimore) has requested multiple sputum cultures for different reasons. He does a monthly submission to our local Quest lab which involves two tests; one for non-MAC bacteria which takes about 2 weeks for results, and one for MAC which takes 6 weeks. He has also provided sputum for pseudomonas testing and for various fungi.
His doctor told him at the start of his MAC treatment in September 2021 that regular sputum cultures were part of the Hopkins' MAC protocol.
Earlier in the year Bruce's immunologist, also at Hopkins, added to the mix by having him submit sputum cultures and bloodwork through Quest for testing at a specialized lab in Utah.
All of the results to date have given the doctors, and us, a pretty good indication of whether the treatment is working or not. A lot of changes have been made along the way with substituting and adding antibiotics both to deal with negative side effects or new infection issues.
It seems from the discussions among this group that what we are experiencing - all of the cultures and testing - is pretty much the norm.
Perhaps your suggestion that smaller labs or additional costs are a factor. It seems curious especially since MAC, Pseudomonas, Bronchiectasis and other types of lung diseases and infections are becoming more prevalent.

Are you asking about people who are MAC/NTM positive? Being treated? Symptomatic?

The reason for my question is that my pulmonologist & ID doc had me doing sputum samples every 3 months while I was MAC positive & being treated. The last culture, done after I stopped antibiotics, was still positive but I was largely asymptomatic - no fever, green/yellow sputum, etc. (All my samples being tested for MAC were sent from Minnesota to NJH.)

At that point, sputum samples were stopped, it was explained that the assumption is I am still positive, and likely to remain so. I was told the only reason to test would be if I became ill again & was considering treatment, and it would be for sensitivities & strain. The doctor explained a CT is a better indication of what is going on inside my lungs. In 2 1/2 years, I have had 2 CT scans which showed no progression from the day I stopped antibiotics. I continue to neb & do airway clearance. 2 exacerbations were treated by increased nebs and short courses of steroids.

I will see my pulmonologist next week, and ask again if I need to submit samples. I am guessing we will instead do a repeat CT to look for any changes or progression.

It will be interesting to see what others report. How are your doctors handling testing? Are you presently taking antibiotics?
Sue

I see my pulmonologist every 6 months and that’s when I submit sputum samples. I have a CT once a year. Since being diagnosed with bronchiectasis, I haven’t had any progression. I do not have MAC, but it is possible that my bronchiectisis started with a past MAC infection that I never knew about. Who knows how it started, but I take necessary precautions, do my airway clearance, and exercise. I try to eat healthy, but I do love sweets in moderation!

I am not taking antibiotics. Many doctors like regular sputum samples to check for possible Pseudomonas or NTM. The current consensus regarding Pseudomonas is an attempt at eradication.

I have been looking periodically since your post, to see if there are any clinically recommended intervals for sputum cultures in the absence of evidence of infection. Do you know of any recent studies?
So far I have not found anything, so I will ask my pulmo next week at my regular appointment if there are new recommendations. She & the ID doc have told me that if there is no symptomatic indication of infection they do not test. Those symptoms would include yellow or green sputum, increased sputum and cough, fever, fatigue, general feeling of being unwell.
Sue

Nothing new that I know of. The British Thoracic Society recommends for those with significant bronchiectasis to have regular monitoring. I guess it would depend on whether your doc believes in early pseudomonas eradication.

I hope Bruce is feeling well. Do you know I’d Quest automatically sends cultures to their Utah reference lab or if your doctor had to specifically request it? Did you ever discuss your doctor’s approach to pseudomonas? Does he/she believe in early eradication?

Hi there.
Thanks for your good thoughts for Bruce. He is battling a lot but we are keeping our fingers crossed that all of the doctors and the various treatment protocols will get him back to a healthier place.
To your questions. Quest lab does not automatically send cultures to the lab in Utah. That very time sensitive testing process was ordered by Bruce’s immunologist. It is a piece of extensive and ongoing testing and research being done to get a whole body sense of the potential relationship between his various lung issues and the multiple other health conditions he has.
On the subject of pseudomonas, both our primary care and Bruce’s ID/Pulmonologist believe in early eradication. They have each prescribed a course of Cipro which has been effective. They also coordinate his care with our PC actively pursuing treatment options and recommending specialists when different illnesses like pseudomonas have been diagnosed. She’s a wonder.
Melissa

I was diagnosed with Bronchiectasis after I got CT scans for Covid pneumonia. No one noticed it but me, all they told me was my Covid groundglass was gone. I have had pneumonia more times than I can remember, which I suspect is the cause of my disease. I brought it up with my doctor after reading the results as I was concern because my Mother died of it.
I had a pulmonary test, but they did not test sputum. I don't have mucus production unless after heavy exercise, partially due to asthma as well. I guess they can do some invasive stuff to get a sample, but pulmonologist said they wouldn't do anything now as not symptomatic. I had a little lung function loss but not much. I am athletic and do a lot of sports. Doctor just said keep exercising and no other preventative measures. Do people nebulize with mild cases?

My Pulmomolgist does. At least once a year or sometimes six months depending on how I am doing. I also have an Infectious Disease doctor. I was coughing a lot recently so she ordered a sputum test and CT scan. However, I have been nebulizing every day and drinking a lot of water and my coughing is not as bad.