Nail Clubbing

[yaf_user681_26872]

Hi all i'm back again after 3 lovely admission including spending all easter weekend in ITU then contracting hospital contracted pneumonia and ending up back in on IV abx.

Anyway back to the question my nails have some nail clubbing and I was wondering if thats normal with asthma. I do use home o2 and have done for about 8 yrs now i've been under RBH and my diagnosis has been down a few routes but they say its brittle asthma so nothing else causing the clubbing, drs always comment on it saying its unheard of in asthma.

Anyone?

Ps we're getting there i'm 27 weeks preg now we're hoping to get to 34 then i'll have c-section am having steroid injections at 28 weeks to mature babies lungs but i'm determind to hang on longer!!

[Hidden]

Hi Charlotte,

Sorry to hear you've had another admission, I hope you are recovering well now. Congratulations for getting to 27 weeks - hope you continue to do well and make it to the magic 34 weeks!

For those who don't know what it is, nail clubbing is a change in the appearance of the fingernails. The end of the finger widens, the nail becomes more curved and the angle between the base of the nail and the finger is lost.

Nail clubbing is seen in a variety of conditions, but your doctors are right that asthma is not usually one of them. It's quite a complex condition and it's difficult to really suggest why you might have it with any certainty, this is just guess-work really.

Conditions that it is seen in include:

Lung conditions:

Lung cancer (vanishingly rare in someone your age, and would have been picked up on chest X ray anyway, so don't worry about that one).

Supperative (infective) conditions such as bronchiectasis or lung abscess.

Interstitial lung disease such as fibrotic lung disease

Pulmonary hypertension

Heart conditions:

Congenital heart disease (heart disease you are born with - would have probably been picked up before now)

Subacute bacterial endocarditis (infection on a heart valve)

Gut conditions:

Inflammatory bowel disease (Crohn's disease or ulcerative colitis)

Cirrhosis of the liver

Malabsorption syndromes

Clubbing *can* be seen in any condition where there is chronic hypoxia, so if your sats are low a lot of the time, it is possible that this is the explanation. However, if this is the case, you should really be using enough home O2 to bring your sats back up, especially as you are pregnant! Have you had 24 hour oximetry (sats recording) done recently?

Otherwise, it is possible that you could have developed a bit of bronchiectasis (scarring, widening and thickening of the airways, usually after getting an infection) or that you are developing secondary pulmonary hypertension (thickening of the blood vessels in the lungs in response to hypoxia). Both of these conditions can be seen in brittle asthma. They can be managed if they do occur.

Do you know if your medical team have any plans to investigate the cause of your clubbing? Most of the investigations, such as CT scans, would be best avoided in pregnancy, so it may be that they are waiting until after you have the baby to complete their investigations!

Hope this helps - as I said, it is just guesswork, so please don't be too concerned by it. If your doctors are aware of the problem, I am sure they will do any investigation that they feel is appropriate.

Take care

Em H

[KateMoss]

Hi Charlie,

sorry you have been in costa Del NHS again! Hope someone saved you some chocolate at Easter. Glad you have got to 27 weeks!

I have heard of nail clubbing but as Em has so expertly explained it I can't really add anything , that it is caused by Chronic Hypoxia. Are you still under RBH?

anyway, please take care, all of you!

Will call sometime

Kate

XXXX

[yaf_user681_26872]

Hi thanks for your replies unforunately Kate I seem to spend more time on B8 than at home at the mo i'm also at wed clinic every 2 weeks!

Thanks for your reply em, Im still under RBH but only got to annual review there, my choice as they'd exhausted every route and its a long ol trip up there which was v tiring. I'm under an excellent cons at my local hosp who has known me for years. I was mistakenly diagnosed cf when i first went to brompton. I get horrendous chest infections which almost always need Ivs and abx neb gent/tobi or colomycin normally. I think i am due another ct scan but like you say they won't do that while Im pregnant. My cons is aware of it but doesnt seem that concerned its just when i go in via A&E or the medical emergnacy ward the docs always comment on it.

I haven't had a 24 hour sats reading for a long time (talking years and years) I have the concentrator mainly for night time use and when I go off big time till the paramedics get there but use it after admissions sometimes like when I came out after having pneumonia. We've been told its the most important thing for the baby to keep my sats above 90, but I don't have a sats meter at home so makes it tricky! I know the normal signs for me though my finger and toe nails go blue first.

Anyway i've rambled enough thanks again for your help and good wishes - I was hoping someone else might have clubbing too but i'm obviously a loner on this one!!

[danisales1989 in reply to yaf_user681_26872]

I actually have clubbing on both my index fingers - only the nail - the fingers are normal. And I have asthma but as far as I'm aware nothing else

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