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

Journal of Thoracic Disease

article

Artmis Youssefnia¹  Alicia Pierre¹  Jeffrey M. Hoder²  Michelle MacDonald³  Monica J. B. Shaffer⁴  Jessica Friedman⁵  Philip S. Mehler⁶  Amanda Bontempo⁸  Francisco C. N. da Silva¹  Edward D. Chan⁹ 

[1] Department of Physical Therapy at Rusk Rehabilitation, New York University Langone Health;Doctor of Physical Therapy Program, Duke University;Department of Nutrition, National Jewish Health;Speech Therapy, National Jewish Health;University of Denver;Department of Medicine, University of Colorado Anschutz Medical Campus;ACUTE Center for Eating Disorders, Denver Health;Perlmutter Cancer Center at New York University Langone Health;Program in Cell Biology, National Jewish Health;Department of Academic Affairs, National Jewish Health;Pulmonary Section, Rocky Mountain Regional Veterans Affairs Medical Center;Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus

关键词: Airway clearance;    aspiration;    bronchiectasis;    gastroesophageal reflux;    nutrition;    vestibular dysfunction;   

DOI  :  10.21037/jtd-22-410

学科分类：呼吸医学

来源: Pioneer Bioscience Publishing Company

【 摘 要 】

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.

【 授权许可】

Unknown