Non-tuberculous mycobacteria pulmonary disease: an integrated approach beyond antibiotics

  1. Paola Faverio1,2⇑,
  2. Federica De Giacomi1,2,
  3. Bruno Dino Bodini3,
  4. Anna Stainer1,2,
  5. Alessia Fumagalli4,
  6. Francesco Bini5,
  7. Fabrizio Luppi1,2 and
  8. Stefano Aliberti6,7
  1. 1School of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
  2. 2Respiratory Unit, San Gerardo Hospital, ASST Monza, Monza, Italy
  3. 3Pulmonary Rehabilitation, ASST Rhodense, Casati Hospital, Garbagnate Milanese, Passirana (MI), Italy
  4. 4Pulmonary Rehabilitation Unit - Research Hospital of Casatenovo, Italian National Research Centre on Aging (INRCA), Casatenovo, LC, Italy
  5. 5Respiratory Unit, Internal Medicine Department, ASST Rhodense, G. Salvini Hospital, Garbagnate Milanese, MI, Italy
  6. 6Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy
  7. 7Università degli Studi di Milano, Department of Pathophysiology and Transplantation, Milan, Italy
  1. Dr Paola Faverio, MD, Department of Medicine and Surgery, Università degli Studi di Milano Bicocca, Respiratory Unit, San Gerardo Hospital, ASST di Monza, via Pergolesi 33, 20900, Monza, Italy. E-mail: paola.faverio{at}unimib.it

Abstract

Non-tuberculous mycobacteria pulmonary disease (NTM-PD) is an emerging condition with heterogeneous manifestations from both the microbiological and the clinical point of view. Diagnostic and therapeutic guidelines are available but unmet patients' and physicians' needs, including therapy-related adverse events, symptom control, management of comorbidities, risk of re-exposure to the pathogen and unfavourable outcomes are still relevant issues.

In the present review, we provide currently available evidence for an integrated approach to NTM-PD beyond antibiotic therapy. This includes: 1) Avoidance of exposure to environments where mycobacteria are present and careful evaluation of lifestyle and habits; 2) Implementation of a personalised pulmonary rehabilitation plan and airway clearance techniques to improve symptoms, exercise capacity, health related quality of life (HRQoL) and functional capacity in daily living activities; 3) A nutritional evaluation and intervention to improve HRQoL and to control gastrointestinal side effects during antimicrobial therapy, particularly in those with low body mass index and history of weight loss; and 4) Management of comorbidities that impact disease outcomes, including structural lung diseases, immune status evaluation and psychological support when appropriate.

Footnotes

This manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.

Conflict of interest: Dr. Faverio has nothing to disclose.

Conflict of interest: Dr. De Giacomi has nothing to disclose.

Conflict of interest: Dr. Bodini has nothing to disclose.

Conflict of interest: Dr. Stainer has nothing to disclose.

Conflict of interest: Dr. Fumagalli has nothing to disclose.

Conflict of interest: Dr. Bini has nothing to disclose.

Conflict of interest: Dr. Luppi has nothing to disclose.

Conflict of interest: Dr. Aliberti has nothing to disclose.

This is a PDF-only article. Please click on the PDF link above to read it.

  • Received August 12, 2020.
  • Accepted January 24, 2021.
http://creativecommons.org/licenses/by-nc/4.0/

This version is distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0. For commercial reproduction rights and permissions contact permissions{at}ersnet.org