Journal Article

Non-tuberculous mycobacteria (NTM) and COPD: a multicentre prospective study

Tabernero, Eva, Aramburu, Amaia, Garcia, Larraitz, Sobradillo, Patricia, Lopez de Calle, Ines, Sanchez, Raquel, Ortiz, Nerea, Urra, Elena, Santos, Borja

2025

Overview

IntroductionAn increase in airway isolates of non-tuberculous mycobacteria (NTM) has been observed, particularly in patients with previous lung damage. Inhaled corticosteroids may increase the risk of NTM lung disease. NTM isolation is of therapeutic importance, especially when macrolides are used. There are few data on the actual prevalence of NTM isolation in patients with chronic obstructive pulmonary disease (COPD).ObjectiveTo determine the prevalence of NTM isolation and NTM pulmonary disease according to the ATS/ERS/IDSA 2020 criteria in patients with high-risk COPD. As a secondary objective, we sought to identify risk factors for NTM isolation and developing NTM pulmonary disease in patients with COPD.MethodsProspective multicentre observational study based on the collection of three sputum samples in a year, for standard, mycobacteria and fungi cultures, in patients with high-risk COPD (postbronchodilator forced expiratory volume in 1 s<50% and/or ≥2 exacerbations in the previous year), with a 12-month follow-up. Patients with at least two good-quality samples were included.Results305 patients were initially selected, of which only 258 had at least two valid samples. NTM was isolated in 15% of patients (n=39), though only 8 (3%) met the ATS 2020 criteria for NTM disease. The most commonly isolated species was mycobacterium avium complex (MAC). Multivariate analysis identified the following risk factors for NTM isolation: low body weight, alpha-1 antitrypsin (AAT) deficiency, inhaled corticosteroids and cancer. NTM disease was only associated with body mass index <21.ConclusionsNTM isolation is more common than expected in patients with COPD and may have implications for treatment. It is associated with low body weight, AAT deficiency, inhaled corticosteroid use and cancer.

• Publisher: British Thoracic Society,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Adrenal Cortex Hormones - administration & dosage / Adrenal Cortex Hormones - adverse effects / Aged / Alpha1 Antitrypsin Deficiency / Asthma / Atypical Mycobacterial Infection / Body mass index / Bronchitis / Chronic Obstructive Pulmonary Disease / Clinical Epidemiology / COPD epidemiology / Dyspnea / Female / Humans / Male / Middle Aged / Mycobacterium Infections, Nontuberculous - epidemiology / Mycobacterium Infections, Nontuberculous - microbiology / Nontuberculous Mycobacteria - isolation & purification / Original Research / Patients / Prevalence / Prospective Studies / Pulmonary Disease, Chronic Obstructive - complications / Pulmonary Disease, Chronic Obstructive - drug therapy / Pulmonary Disease, Chronic Obstructive - epidemiology / Pulmonary Disease, Chronic Obstructive - microbiology / Pulmonary Disease, Chronic Obstructive - physiopathology / Quality of life / Risk Factors / Sample size / Sputum - microbiology / Steroids