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

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.