The Curbsiders Internal Medicine Podcast

#306 Bronchiectasis and NTM: You can’t get enough sputum!

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Nov 22, 2021
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ADVICE

Basic Immunologic Workup

  • Start initial workup with immunoglobulins (IgG, IgA, IgM) and Streptococcus pneumoniae serotypes.
  • If results are abnormal or recurrent infections persist, refer to an immunologist for deeper evaluation.
ADVICE

Get Sputum And Test For NTM

  • Collect sputum whenever possible and send for routine bacterial culture and acid-fast bacilli testing.
  • If sputum induction isn't available, try to bank any produced samples and request AFB culture to detect NTM.
INSIGHT

Inhaled Antibiotics: Limited Evidence

  • Inhaled antibiotics for Gram-negative pathogens have inconsistent trial results and are not universally FDA-approved for bronchiectasis.
  • Benefit likely exists for high-burden patients but practical obstacles (tolerability, compounding, insurance) limit use.
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