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Around 7% of NTM-LD patients develop CPA, especially older male smokers with COPD and low BMI

April 16 2018

Non-tuberculous mycobacterial lung disease (NTM-LD) is a predisposing factor for chronic pulmonary aspergillosis (CPA), but the overlap in symptoms and drug-drug interactions (e.g. itraconazole with rifamycin) make it difficult to treat both conditions in the same patient.

Dr Byung Woo Jhun and colleagues in Seoul retrospectively reviewed the medical records of 1,334 consecutive Korean patients with NTM-LD, spanning a period of 5 years. Of 566 who fulfilled the inclusion criteria, 41 (7.2%) went on to develop CPA at a median time of 18 months and 17 (3%) of these died. These patients were more likely to be older male smokers with a low BMI and a history of COPD and/or steroid treatment.

What can I do?

  •  When treating patients with NTM-LD, watch for progression of clinical and radiological signs despite antibiotic treatment, especially among patients with some of the following characteristics: older; male; smoker; low BMI; COPD; history of steroid treatment. Confirm with serum antibody testing (Aspergillus IgG) and/or culture from respiratory samples.

 

Read the paper: Jhun et al (2018) Risk factors for the development of chronic pulmonary aspergillosis in patients with nontuberculous mycobacterial lung disease. PLoS ONE 12(11): e0188716.