What is the treatment for lung exacerbation in yellow nail syndrome?

From the Guidelines

Treatment of yellow nail syndrome lung exacerbations should prioritize a 14-day course of appropriate antibiotics, with the choice based on airway cultures and history of antibiotic hypersensitivity reactions, as recommended by the European Respiratory Society guidelines 1. For acute exacerbations, the empiric antibiotic of choice is amoxicillin-clavulanate, but the type of antibiotics chosen should be based on the patient’s airway cultures and history of antibiotic hypersensitivity reactions. Some key considerations in managing these exacerbations include:

• Using broad-spectrum antibiotics such as amoxicillin-clavulanate (875/125 mg twice daily for 7-14 days) based on sputum culture results, as supported by guidelines for managing bronchiectasis 1.
• Providing respiratory support, including chest physiotherapy, postural drainage, and mucolytics like N-acetylcysteine (600 mg twice daily) to help clear secretions.
• Utilizing bronchodilators such as albuterol (2 puffs every 4-6 hours as needed) for symptomatic relief.
• Administering supplemental oxygen to maintain oxygen saturation above 92% in patients with significant hypoxemia.
• Considering long-term macrolide therapy (azithromycin 250 mg three times weekly) in severe cases with bronchiectasis to reduce exacerbation frequency, as suggested by the management of adult bronchiectasis guidelines 1.
• Addressing underlying conditions like lymphedema or pleural effusions that contribute to respiratory compromise.
• Regular follow-up is essential to monitor disease progression and adjust treatment accordingly, taking into consideration the most recent guidelines for managing bronchiectasis in both adults and children/adolescents 1.

From the Research

Treatment of Yellow Nail Syndrome Lung Exacerbation

• The treatment of yellow nail syndrome (YNS) is symptomatic and not codified, with a focus on managing the individual symptoms of the disease 2.
• For lung exacerbations, treatment options may include:
  • Antibiotic prophylaxis for bronchiectasia with chronic sputum production 2.
  • Treatment targeted at improved secretion clearance, such as long-term macrolide antibiotics, may improve both chest and nail symptoms 3.
• In some cases, pleural effusion can be treated surgically, with decortication/pleurectomy or pleurodesis 2, 4, 5.
• Octreotide, a medication that regulates the release of growth hormone and thyrotropin, has been used to treat pleural effusions in YNS, with some success 4.
• Conservative therapy, including vitamin E, antibiotics, and compression stockings, may be recommended before pursuing more aggressive or invasive modalities 6.

Management of Associated Symptoms

• Lymphedema treatment is based on low-stretch bandages and the wearing of elastic compression garments combined with skin care, exercises, and, as needed, manual lymph drainage 2.
• Yellow nail discoloration may be treated with oral vitamin E alone or in combination with triazole antifungals, which may achieve partial or total disappearance of nail discoloration 2.
• Chronic sinusitis is frequently associated with YNS and may require separate treatment 2.