1. < MAC & Bronchiectasis

Do all pulmonologists encourage their patients to submit sputum test?

Posted by becleartoday @becleartoday, Jul 6, 2022

I am trying to get a better understanding of why some pulmonologists do not encourage their patients to submit regular sputum samples. I am not sure if this occurs mostly in smaller towns that might have limited lab services. Also, whether the additional step in some cases of needing to send some of the sample to a more sophisticated reference laboratory plays into the decision-making. Also, perhaps there is an added cost when samples are sent out.

Does anyone have insight into this?

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extracare808 | @extracare808 | Jul 20, 2022
In reply to @gbsue "I was diagnosed with Bronchiectasis after I got CT scans for Covid pneumonia. No one noticed..." + (show)
@gbsue

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?

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Yes, per NJH, bronchiectasis patients should be doing airway clearance and nebulizing with saline on a daily basis. This is regardless of how mild your case is. The purpose is to stop the cycle of infection, inflammation, and further lung damage.

Sputum induction is done by nebulizing with saline (typically between 3% and 10%). You may not be able to get out more than small cloudy specimens, but this should be enough for testing purposes.

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woot | @woot | Jul 21, 2022
In reply to @sueinmn "Are you asking about people who are MAC/NTM positive? Being treated? Symptomatic? The reason for my..." + (show)
@sueinmn

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

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I delivered a sputum sample yesterday to UNC specialty lab, a 40 minute drive, the sample in a refrigerated bag. I have increased SOB, etc. bypassing a ct scan for now to get quick Id. Of other bugs that could be immediately treated, no matter what the status of my Mac is.

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