Long-term natural history of non-cavitary nodular bronchiectatic nontuberculous mycobacterial pulmonary disease

Seong Mi Moon; Byung Woo Jhun; Sun Young Baek; Seonwoo Kim; Kyeongman Jeon; Ryoung Eun Ko; Sun Hye Shin; Hyun Lee; O. Jung Kwon; Hee Jae Huh; Chang Seok Ki; Nam Yong Lee; Myung Jin Chung; Kyung Soo Lee; Sung Jae Shin; Charles L. Daley; Won Jung Koh

doi:10.1016/j.rmed.2019.03.014

Long-term natural history of non-cavitary nodular bronchiectatic nontuberculous mycobacterial pulmonary disease

Seong Mi Moon, Byung Woo Jhun, Sun Young Baek, Seonwoo Kim, Kyeongman Jeon, Ryoung Eun Ko, Sun Hye Shin, Hyun Lee, O. Jung Kwon, Hee Jae Huh, Chang Seok Ki, Nam Yong Lee, Myung Jin Chung, Kyung Soo Lee, Sung Jae Shin, Charles L. Daley, Won Jung Koh

Department of Microbiology

Research output: Contribution to journal › Article › peer-review

22 Citations (Scopus)

Abstract

Background: Information about the natural history of nontuberculous mycobacterial pulmonary disease (NTM-PD) is limited. The purpose of this study was to evaluate the long-term natural history of non-cavitary nodular bronchiectatic NTM-PD and the factors associated with treatment initiation and the frequency of spontaneous sputum culture conversion after diagnosis of NTM-PD. Methods: We evaluated 1,021 patients with newly diagnosed non-cavitary nodular bronchiectatic NTM-PD caused by Mycobacterium avium complex or M. abscessus between 2003 and 2013. Results: Of 1,021 patients, 562 (55%) initiated antibiotic treatment and 459 (45%) did not. Young age (adjusted hazard ratio [aHR] = 0.99; 95% confidence interval [CI] = 0.98–0.99), low body mass index (aHR = 0.96; 95% CI = 0.93–0.99), previous history of tuberculosis (aHR = 1.23; 95% CI = 1.01–1.50), respiratory complaints such as cough (aHR = 1.36; 95% CI = 1.05–1.75) and sputum production (aHR = 1.47; 95% CI = 1.13–1.91), and high number of involved lobes on high-resolution computed tomography (aHR = 1.22; 95% CI = 1.14–1.31) were associated with treatment initiation. Of 459 patients who did not initiate treatment, 157 (34%) showed spontaneous sputum culture conversion. None of the clinical factors was associated with spontaneous conversion. After spontaneous culture conversion, 26 of 157 (17%) showed redeveloped NTM-PD caused by a species different from the original species. Conclusions: The natural history of non-cavitary nodular bronchiectatic NTM-PD is variable. After diagnosis, the decision to initiate antibiotic therapy should be individualized based on consideration of the risk factors for disease progression. However, for patients who do not start antibiotic therapy, continuous and lifetime follow-up is recommended to manage underlying bronchiectasis and the possibility of late progression of NTM-PD.

Original language	English
Pages (from-to)	1-7
Number of pages	7
Journal	Respiratory Medicine
Volume	151
DOIs	https://doi.org/10.1016/j.rmed.2019.03.014
Publication status	Published - 2019 May

Bibliographical note

Funding Information:
This research was supported by the National Research Foundation of Korea (NRF) founded by the Korea government (MSIT) ( NRF-2018R1A2A1A05018309 ). The sponsor had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript.

Funding Information:
Dr. Charles L. Daley has received grants from Insmed, Inc. and served on Advisory Boards for Insmed Inc., Johnson and Johnson, Spero, and Horizon, not associated with the submitted work. Dr. Won-Jung Koh has received a consultation fee from Insmed Inc. for the Insmed Advisory Board Meeting, not associated with the submitted work. Otherwise, we have no conflicts of interest to declare.This research was supported by the National Research Foundation of Korea (NRF) founded by the Korea government (MSIT) (NRF-2018R1A2A1A05018309). The sponsor had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript.

Publisher Copyright:
© 2019 Elsevier Ltd

All Science Journal Classification (ASJC) codes

Pulmonary and Respiratory Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.rmed.2019.03.014

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Moon, S. M., Jhun, B. W., Baek, S. Y., Kim, S., Jeon, K., Ko, R. E., Shin, S. H., Lee, H., Kwon, O. J., Huh, H. J., Ki, C. S., Lee, N. Y., Chung, M. J., Lee, K. S., Shin, S. J., Daley, C. L., & Koh, W. J. (2019). Long-term natural history of non-cavitary nodular bronchiectatic nontuberculous mycobacterial pulmonary disease. Respiratory Medicine, 151, 1-7. https://doi.org/10.1016/j.rmed.2019.03.014

@article{aa1ae0cfedaa47fe893f15204c2ea85b,

title = "Long-term natural history of non-cavitary nodular bronchiectatic nontuberculous mycobacterial pulmonary disease",

abstract = "Background: Information about the natural history of nontuberculous mycobacterial pulmonary disease (NTM-PD) is limited. The purpose of this study was to evaluate the long-term natural history of non-cavitary nodular bronchiectatic NTM-PD and the factors associated with treatment initiation and the frequency of spontaneous sputum culture conversion after diagnosis of NTM-PD. Methods: We evaluated 1,021 patients with newly diagnosed non-cavitary nodular bronchiectatic NTM-PD caused by Mycobacterium avium complex or M. abscessus between 2003 and 2013. Results: Of 1,021 patients, 562 (55%) initiated antibiotic treatment and 459 (45%) did not. Young age (adjusted hazard ratio [aHR] = 0.99; 95% confidence interval [CI] = 0.98–0.99), low body mass index (aHR = 0.96; 95% CI = 0.93–0.99), previous history of tuberculosis (aHR = 1.23; 95% CI = 1.01–1.50), respiratory complaints such as cough (aHR = 1.36; 95% CI = 1.05–1.75) and sputum production (aHR = 1.47; 95% CI = 1.13–1.91), and high number of involved lobes on high-resolution computed tomography (aHR = 1.22; 95% CI = 1.14–1.31) were associated with treatment initiation. Of 459 patients who did not initiate treatment, 157 (34%) showed spontaneous sputum culture conversion. None of the clinical factors was associated with spontaneous conversion. After spontaneous culture conversion, 26 of 157 (17%) showed redeveloped NTM-PD caused by a species different from the original species. Conclusions: The natural history of non-cavitary nodular bronchiectatic NTM-PD is variable. After diagnosis, the decision to initiate antibiotic therapy should be individualized based on consideration of the risk factors for disease progression. However, for patients who do not start antibiotic therapy, continuous and lifetime follow-up is recommended to manage underlying bronchiectasis and the possibility of late progression of NTM-PD.",

author = "Moon, {Seong Mi} and Jhun, {Byung Woo} and Baek, {Sun Young} and Seonwoo Kim and Kyeongman Jeon and Ko, {Ryoung Eun} and Shin, {Sun Hye} and Hyun Lee and Kwon, {O. Jung} and Huh, {Hee Jae} and Ki, {Chang Seok} and Lee, {Nam Yong} and Chung, {Myung Jin} and Lee, {Kyung Soo} and Shin, {Sung Jae} and Daley, {Charles L.} and Koh, {Won Jung}",

note = "Funding Information: This research was supported by the National Research Foundation of Korea (NRF) founded by the Korea government (MSIT) ( NRF-2018R1A2A1A05018309 ). The sponsor had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript. Funding Information: Dr. Charles L. Daley has received grants from Insmed, Inc. and served on Advisory Boards for Insmed Inc., Johnson and Johnson, Spero, and Horizon, not associated with the submitted work. Dr. Won-Jung Koh has received a consultation fee from Insmed Inc. for the Insmed Advisory Board Meeting, not associated with the submitted work. Otherwise, we have no conflicts of interest to declare.This research was supported by the National Research Foundation of Korea (NRF) founded by the Korea government (MSIT) (NRF-2018R1A2A1A05018309). The sponsor had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript. Publisher Copyright: {\textcopyright} 2019 Elsevier Ltd",

year = "2019",

month = may,

doi = "10.1016/j.rmed.2019.03.014",

language = "English",

volume = "151",

pages = "1--7",

journal = "British Journal of Tuberculosis and Diseases of the Chest",

issn = "0954-6111",

publisher = "W.B. Saunders Ltd",

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TY - JOUR

T1 - Long-term natural history of non-cavitary nodular bronchiectatic nontuberculous mycobacterial pulmonary disease

AU - Moon, Seong Mi

AU - Jhun, Byung Woo

AU - Baek, Sun Young

AU - Kim, Seonwoo

AU - Jeon, Kyeongman

AU - Ko, Ryoung Eun

AU - Shin, Sun Hye

AU - Lee, Hyun

AU - Kwon, O. Jung

AU - Huh, Hee Jae

AU - Ki, Chang Seok

AU - Lee, Nam Yong

AU - Chung, Myung Jin

AU - Lee, Kyung Soo

AU - Shin, Sung Jae

AU - Daley, Charles L.

AU - Koh, Won Jung

N1 - Funding Information: This research was supported by the National Research Foundation of Korea (NRF) founded by the Korea government (MSIT) ( NRF-2018R1A2A1A05018309 ). The sponsor had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript. Funding Information: Dr. Charles L. Daley has received grants from Insmed, Inc. and served on Advisory Boards for Insmed Inc., Johnson and Johnson, Spero, and Horizon, not associated with the submitted work. Dr. Won-Jung Koh has received a consultation fee from Insmed Inc. for the Insmed Advisory Board Meeting, not associated with the submitted work. Otherwise, we have no conflicts of interest to declare.This research was supported by the National Research Foundation of Korea (NRF) founded by the Korea government (MSIT) (NRF-2018R1A2A1A05018309). The sponsor had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript. Publisher Copyright: © 2019 Elsevier Ltd

PY - 2019/5

Y1 - 2019/5

N2 - Background: Information about the natural history of nontuberculous mycobacterial pulmonary disease (NTM-PD) is limited. The purpose of this study was to evaluate the long-term natural history of non-cavitary nodular bronchiectatic NTM-PD and the factors associated with treatment initiation and the frequency of spontaneous sputum culture conversion after diagnosis of NTM-PD. Methods: We evaluated 1,021 patients with newly diagnosed non-cavitary nodular bronchiectatic NTM-PD caused by Mycobacterium avium complex or M. abscessus between 2003 and 2013. Results: Of 1,021 patients, 562 (55%) initiated antibiotic treatment and 459 (45%) did not. Young age (adjusted hazard ratio [aHR] = 0.99; 95% confidence interval [CI] = 0.98–0.99), low body mass index (aHR = 0.96; 95% CI = 0.93–0.99), previous history of tuberculosis (aHR = 1.23; 95% CI = 1.01–1.50), respiratory complaints such as cough (aHR = 1.36; 95% CI = 1.05–1.75) and sputum production (aHR = 1.47; 95% CI = 1.13–1.91), and high number of involved lobes on high-resolution computed tomography (aHR = 1.22; 95% CI = 1.14–1.31) were associated with treatment initiation. Of 459 patients who did not initiate treatment, 157 (34%) showed spontaneous sputum culture conversion. None of the clinical factors was associated with spontaneous conversion. After spontaneous culture conversion, 26 of 157 (17%) showed redeveloped NTM-PD caused by a species different from the original species. Conclusions: The natural history of non-cavitary nodular bronchiectatic NTM-PD is variable. After diagnosis, the decision to initiate antibiotic therapy should be individualized based on consideration of the risk factors for disease progression. However, for patients who do not start antibiotic therapy, continuous and lifetime follow-up is recommended to manage underlying bronchiectasis and the possibility of late progression of NTM-PD.

AB - Background: Information about the natural history of nontuberculous mycobacterial pulmonary disease (NTM-PD) is limited. The purpose of this study was to evaluate the long-term natural history of non-cavitary nodular bronchiectatic NTM-PD and the factors associated with treatment initiation and the frequency of spontaneous sputum culture conversion after diagnosis of NTM-PD. Methods: We evaluated 1,021 patients with newly diagnosed non-cavitary nodular bronchiectatic NTM-PD caused by Mycobacterium avium complex or M. abscessus between 2003 and 2013. Results: Of 1,021 patients, 562 (55%) initiated antibiotic treatment and 459 (45%) did not. Young age (adjusted hazard ratio [aHR] = 0.99; 95% confidence interval [CI] = 0.98–0.99), low body mass index (aHR = 0.96; 95% CI = 0.93–0.99), previous history of tuberculosis (aHR = 1.23; 95% CI = 1.01–1.50), respiratory complaints such as cough (aHR = 1.36; 95% CI = 1.05–1.75) and sputum production (aHR = 1.47; 95% CI = 1.13–1.91), and high number of involved lobes on high-resolution computed tomography (aHR = 1.22; 95% CI = 1.14–1.31) were associated with treatment initiation. Of 459 patients who did not initiate treatment, 157 (34%) showed spontaneous sputum culture conversion. None of the clinical factors was associated with spontaneous conversion. After spontaneous culture conversion, 26 of 157 (17%) showed redeveloped NTM-PD caused by a species different from the original species. Conclusions: The natural history of non-cavitary nodular bronchiectatic NTM-PD is variable. After diagnosis, the decision to initiate antibiotic therapy should be individualized based on consideration of the risk factors for disease progression. However, for patients who do not start antibiotic therapy, continuous and lifetime follow-up is recommended to manage underlying bronchiectasis and the possibility of late progression of NTM-PD.

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Long-term natural history of non-cavitary nodular bronchiectatic nontuberculous mycobacterial pulmonary disease

Abstract

Bibliographical note

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UN SDGs

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