Ancillary treatment of patients with lung disease due to non-tuberculous mycobacteria: a narrative review

Artmis Youssefnia; Alicia Pierre; Jeffrey M Hoder; Michelle MacDonald; Monica J B Shaffer; Jessica Friedman; Philip S Mehler; Amanda Bontempo; Francisco C N da Silva; Edward D Chan

doi:10.21037/jtd-22-410

Ancillary treatment of patients with lung disease due to non-tuberculous mycobacteria: a narrative review

J Thorac Dis. 2022 Sep;14(9):3575-3597. doi: 10.21037/jtd-22-410.

Authors

Affiliations

¹ Department of Physical Therapy at Rusk Rehabilitation, New York University Langone Health, New York, NY, USA.
² Doctor of Physical Therapy Program, Duke University, Durham, NC, USA.
³ Department of Nutrition, National Jewish Health, Denver, CO, USA.
⁴ Speech Therapy, National Jewish Health, Denver, CO, USA.
⁵ University of Denver, Denver, CO, USA.
⁶ Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
⁷ ACUTE Center for Eating Disorders, Denver Health, Denver, CO, USA.
⁸ Perlmutter Cancer Center at New York University Langone Health, New York, NY, USA.
⁹ Program in Cell Biology, National Jewish Health, Denver, CO, USA.
¹⁰ Department of Academic Affairs, National Jewish Health, Denver, CO, USA.
¹¹ Pulmonary Section, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA.
¹² Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.

Abstract

Background and objective: Non-tuberculous mycobacterial lung disease (NTM-LD) manifests with bronchiectasis, inflammatory bronchiolitis, nodules, and/or cavitation. Bronchiectasis is characterized by permanently dilated airways wherein mucus accumulates, creating a vicious cycle of chronic injurious inflammation and recurrent infections. While antibiotics are an important part of the treatment of NTM-LD, airway clearance techniques to mitigate this pathogenic mechanism of bronchiectasis as well as other ancillary measures are also important components of NTM-LD treatment. The objective of this contemporaneous Narrative Review is to emphasize the importance of such ancillary measures.

Methods: We searched PubMed for the key words of "airway clearance", "pulmonary rehabilitation", "nutrition", "swallowing dysfunction", "gastroesophageal reflux", "vestibular dysfunction", or "cochlear dysfunction" with that of "non-tuberculous mycobacterial lung disease", "bronchiectasis", or "respiratory disease". The bibliographies of identified articles were further searched for relevant articles not previously identified. Each relevant article was reviewed by one or more of the authors and a narrative review was composed.

Key content and findings: Herein, we discuss five ancillary treatment measures that are pertinent to patients with bronchiectasis and NTM-LD: (I) airway clearance; (II) physical and pulmonary rehabilitation; (III) nutrition; (IV) diagnosis and mitigation of swallowing dysfunction and of gastroesophageal reflux disease (GERD); and (V) minimization of vestibular and cochlear dysfunction associated with some anti-NTM drugs.

Conclusions: While antibiotics is often the central focus of treatment of NTM-LD, given its propensity for recurrent and recalcitrant infection, other ancillary measures to break the vicious cycle of injurious inflammation and infection should also be emphasized to optimize treatment success.

Keywords: Airway clearance; aspiration; bronchiectasis; gastroesophageal reflux; nutrition; vestibular dysfunction.

Publication types

Review