Effects of Chest Physical Therapy in Patients with Non-Tuberculous Mycobacteria.

Ashwin Basavaraj

doi:10.23937/2378-3516/1410065

Abstract

Antibiotic therapy against non-tuberculous mycobacteria (NTM) is prolonged and can be associated with toxicity. We sought to evaluate whether chest physical therapy (PT) was associated with clinical improvement in patients with NTM not receiving anti-mycobacterial pharmacotherapy.A retrospective review of 77 subjects that were followed from June 2006 to September 2014 was performed. Baseline time point was defined as the first positive sputum culture for NTM; symptoms, pulmonary function, and radiology reports were studied. Subjects were followed for up to 24 months and results analyzed at specified time points.Half of the subjects received chest PT at baseline. Cough improved at 12 (p = 0.001) and 24 months (p = 0.003) in the overall cohort when compared with baseline, despite lack of NTM antibiotic treatment. Cough decreased at 6 (p = 0.01), 9 (p = 0.02), 12 (p = 0.02) and 24 months (p = 0.002) in subjects that received chest PT. Sputum production also improved at 24 months in the overall cohort (p = 0.01). There was an increase in the percent change of total lung capacity in subjects that received chest PT (p = 0.005).Select patients with NTM may have clinical improvement with chest PT, without being subjected to prolonged antibiotic therapy. Future studies are warranted to prospectively evaluate outcomes in the setting of non-pharmacologic treatment and aid with the decision of antibiotic initiation.

Highlights

Non-tuberculous mycobacteria (NTM) infection is not a reportable disease in the United States, recent data suggest that the prevalence of the disease is increasing in the United States [1,2], mainly due to increased clinical suspicion, improving diagnostic capability, and the aging of the general population [3]
We performed a retrospective review of consecutive subjects with non-tuberculous mycobacteria (NTM) seen during a period of 8 years who did not receive NTM antibiotic therapy, to evaluate whether chest physical therapy (PT) was associated with a change in the natural history of their disease
Only 25% of subjects had heartburn symptoms at baseline, 52% had a diagnostic study that suggested the presence of gastroesophageal reflux disease (GERD)

Summary

Introduction

Non-tuberculous mycobacteria (NTM) infection is not a reportable disease in the United States, recent data suggest that the prevalence of the disease is increasing in the United States [1,2], mainly due to increased clinical suspicion, improving diagnostic capability, and the aging of the general population [3]. Except for cases with advanced and progressive disease, the statement does not provide clear recommendations about when treatment of NTM should be initiated, stating that the decision to start antibiotics should be based on potential risks and benefits of therapy for individual patients [4]. Large studies are lacking, non-pharmacological treatments have been utilized in the management of non-cystic fibrosis bronchiectasis [7,8]. Recent data shows that oscillatory devices improve symptoms, exercise capacity [9], quality of life [10], pulmonary function and inflammatory markers in the non-cystic fibrosis bronchiectasis population [11]. Data on the utility of non-pharmacological treatments in NTM pulmonary disease is sparse. We performed a retrospective review of consecutive subjects with NTM seen during a period of 8 years who did not receive NTM antibiotic therapy, to evaluate whether chest PT was associated with a change in the natural history of their disease

Methods

Results

Conclusion