P113 Frequent co-detection of non-tuberculous mycobacteria with other microbes in a UK clinic population: what are the implications for treatment?

Abstract

Results 192 prescriptions corresponding to 112 patients were identified. 62 of 112 (56%) were prescribed long-term azithromycin. Bronchiectasis (60%), COPD(19%), asthma (8%), ILD (7%), Bronchiolitis and others (6%) were the variety of diseases for which Azithromycin was prescribed. 28% had pseudomonas colonisation.51(46%) patients were prescribed long-term azithromycin. Of these, 21 (25%) had been on azithromycin for less than 12 months.Sixty eight (82%) patients on long-term azithromycin had had LFTs and 3(3.5%) had audiology testing in the preceding 12 months.21(25%)had documented ECGs with Qtc interval.No patients tested had hearing loss and no documented QTc prolongation.The other common side effect noticed was GI upset in 6 patients (5.6%).The dosing was mostly 250mg three times a week 103(92%) There was also 500mg three times a week in 20(18%) H.influenzae (42%)Staphylococcus aureus (21%)Moraxella catarrhalis (11%)coliform sp (10%). We identified no new NTM in our Cohort. Conclusion Although formal monitoring in this cohort was patchy, Significant documented adverse effects in this cohort were rare and optimal practice for long-term management of azithromycin use remains to be established. Introduction and Objectives Non CF Bronchiectasis has diverse aetiologies. This includes idiopathic, systemic disease related and as a complication of asthma. Such diversity may be important in determining therapeutic strategies (personalised medicines) and may also be an important consideration in clinical trial design. This is increasingly relevant when neutrophil targeting or eosinophil targeted therapies are being developed. We hypothesised that patients could be phenotyped by sputum cytospins irrespective of suspected aetiology or disease severity. Methods Patients underwent a standardised clinical phenotyping protocol including HRCT chest (Anwar et al 2013). Baseline therapy was recorded. Spontaneous sputa were collected in stable state and spirometry was undertaken according to guidelines. Sputum cell counts were calculated using standard methods with data expressed as medians and ranges. P112 DEEPER PHENOTYPING OF NON CF BRONCHIECTASIS THROUGH SPUTUM DIFFERENTIAL COUNTSResults Fifty three patients' data are reported. The M:F ratio was 1:1.4. The mean FEV1 predicted was 62%, mean FEV1/VC ratio was 64%. Forty three (83%) were on inhaled corticosteroids and 24.5% had a historical diagnosis of asthma and /or ABPA. The predominant cell in sputa was neutrophils, median 94 (range 23-100%), macrophages were the 2nd most prevalent cell type median 2.6 (range 0-75%). Eosinophils showed a skewed distribution with median of 0.2 with a range of 0-24.8%. Four patients had sputum eosinophilia >3%. Of these, only 2 had a history of asthma and / or ABPA being diagnosed. Despite historical diagnoses of asthma and / or ABPA in 13 patients the eosinophil percentage was not statistically different to "non asthmatics". (P = 0.59 Chi Sq test) This group included features of ABPA in 2 patients and significant atopy in another.Conclusion...