Diagnosing and Treating NTM Pulmonary Disease
Diagnosis of NTM lung disease is often delayed, because the symptoms are similar to other lung diseases like COPD, bronchitis or bronchiectasis. However, once NTM infection is suspected, diagnosis is not difficult. When a specimen is sent to the lab, it can easily be identified whether or not the person has NTM and what species is causing the disease. This will influence the type of treatment you receive.
What to Expect
If you are diagnosed with NTM pulmonary disease, you may never have symptoms or have them only after many years. However, once symptoms develop, it may be difficult to completely relieve all symptoms with treatment. Therefore, early diagnosis and treatment are essential for good outcomes.
How It's Diagnosed
A typical diagnostic evaluation by your healthcare provider will include:
- Detailed medical history
- Physical examination
- Computed tomography (CT) scan
- Sputum culture
A chest X-ray may provide the first hint that NTM are present. However, a CT scan is often required to show more detail that can help confirm NTM. The CT scan can show the presence of small nodules (sometimes referred to as "tree-in-bud" because of their branch like appearance). The CT scan can also identify cavities or holes in the lung, which represent a more destructive form of infection.
A definitive diagnosis of NTM infection is through culture of a respiratory specimen, usually mucus you cough up (sputum). In some cases, where sputum cannot be not produced, a bronchoscopy is performed to obtain the specimen.
How It's Treated
NTM are relatively resistant to antibiotics and can become more resistant if only one antibiotic is used to treat the infection. Effective treatment requires two to three drugs: the exact drug and combination of drugs depending on the NTM species involved, how bad the infection is, and results of drug susceptibility testing. Treatment should continue until the respiratory culture results have been negative for at least 12 months.
- Treatment of MAC and M kansasii, the most common causes of pulmonary NTM disease, requires three drugs given either 3 days a week or daily, depending on the severity of disease.
- Treatment of M abscessus is more complicated and associated with poorer treatment outcomes compared with MAC and M kansasii. Patients require several months of treatment with one to two intravenous (IV) drugs in combination with oral and sometimes inhaled antibiotics.
Some patients will need surgery to remove the most damaged areas of the lung. However, this should only be considered after consultation with experts in NTM and surgery. In most cases, surgery can be performed using VATS (video-assisted thoracoscopic surgery).
Side effects of drug treatment are common, but most people can complete treatment as prescribed. You may need to get your blood tested regularly to make sure you are taking the right levels of drugs and to make sure your body is handling the drugs well. You may also need to have a vision and hearing test before and during treatment to make sure the drugs are not affecting your sight or hearing.
This content was developed in partnership with the CHEST Foundation, the philanthropic arm of the American College of Chest Physicians.