Current and future management of non-tuberculous mycobacterial pulmonary disease (NTM-PD) in the UK

Abstract

A rising number of non-tuberculous mycobacterial (NTM) isolates are being identified in UK clinical practice. There are many uncertainties around the management of non-tuberculous mycobacterial pulmonary disease (NTM-PD), including its epidemiology, diagnosis, treatment and prevention. Regional variations in how patients with NTM-PD are managed reflects the lack of standardised pathways in the UK. Service optimisation and multidisciplinary working can improve the quality of care for patients with NTM-PD, including (1) better identification of patients at risk of NTM-PD and modification of risk factors where applicable; (2) standardisation of reference laboratory testing to offer clinicians access to accurate and prompt information on NTM species and drug sensitivities; (3) development of recognised specialist NTM nursing care; (4) standardisation of NTM-PD imaging strategies for monitoring of treatment and disease progression; (5) establishment of a hub-and-spoke model of care, including clear referral and management pathways, dedicated NTM-PD multidisciplinary teams, and long-term patient follow-up; (6) formation of clinical networks to link experts who manage diseases associated with NTM; (7) enabling patients to access relevant support groups that can provide information and support for their condition; and (8) development of NTM research groups to allow patient participation in clinical trials and to facilitate professional education.

Impacts of Nontuberculous Mycobacteria Isolates in Non-cystic Fibrosis Bronchiectasis: A 16-Year Cohort Study in Taiwan

“…Nontuberculous mycobacteria (NTM) is often associated with bronchiectasis, but the role of NTM in bronchiectasis is unclear ( Bonaiti et al, 2015 ; Richardson et al, 2019 ). Elderly women with a low body mass index have been found to be susceptible to NTM isolates in non-cystic fibrosis ( CF ) bronchiectasis ( Aksamit et al, 2017 ; Lipman et al, 2020 ). Recently, Faverio et al (2016) revealed that patients with pulmonary NTM disease are more likely to experience body weight loss and have a lower number of pulmonary exacerbations than patients with chronic P. aeruginosa infection ( Faverio et al, 2016 ).…”

Case studies to illustrate good practice in the management of non-tuberculous mycobacterial pulmonary disease

“…NTM are found ubiquitously in the environment and >190 species have been identified to date [ 3 ]. Although most are clinically insignificant, several species of NTM can cause pulmonary disease in humans (NTM-PD), which remains a challenging condition for healthcare providers to diagnose and manage [ 4 ]. Several risk factors for NTM-PD have been identified, including demographic characteristics, medical conditions, structural lung diseases, an abnormal immune response, and drug treatments [ 1 , 2 , 4 , 5 ] ( Table 1 ).…”

“…Firstly, its presentation and ongoing symptoms are non-specific, and may be obscured by pre-existing lung conditions such as bronchiectasis, chronic obstructive pulmonary disease (COPD), and cystic fibrosis (CF). Secondly, NTM are ubiquitous in the environment and can transiently colonise the airways without causing disease [ 1 , 4 ]. Thirdly, chest X-rays may appear normal, near-normal or non-specifically abnormal [ 5 ] which can result in NTM-PD being missed or misdiagnosed ( Fig.…”

“…Treatment of NTM-PD is also challenging and there is a lack of standardisation in treatment and management pathways due to a limited evidence base [ 4 ]. A typical treatment course involves use of several antibiotics for 1–2 years, which can be associated with significant adverse effects and drug-drug interactions [ 2 , 3 , 8 ].…”

Improving the Drug Development Pipeline for Mycobacteria: Modelling Antibiotic Exposure in the Hollow Fibre Infection Model

“…NTM are opportunistic pathogens commonly known to cause chronic, pulmonary infections, which like M. tuberculosis , are notoriously hard to treat [ 10 ]. The perceived prevalence of NTM infections is increasing globally, and in recent years there has been a heightened awareness of the clinical relevance of NTM infections [ 11 ]. Currently, treatment of NTM infections involves at least three drugs (including one macrolide: clarithromycin or azithromycin) over an 18–24-month period.…”