P37 Managing non tuberculous mycobacterial pulmonary disease – missed opportunities?

<h3>Introduction</h3> Non-tuberculous mycobacterium pulmonary disease (NTM-PD) can be a cause of significant pulmonary disease. Early diagnosis and treatment is important. In this review we studied the investigation, treatment and outcomes of patients who had microbiological confirmation of a non-tuberculous mycobacterium (NTM). <h3>Methods</h3> A review of all patients from 2017 - 2019 with a single sputum or bronchial wash culture of NTM was undertaken with notes, microbiology and radiology review. Further analysis was done to review whether patients were managed according to the BTS guidelines.¹ <h3>Results</h3> Data for 135 patients was analysed, epidemiological and clinico-radiological findings are shown in table 1. 30 patients were treated for NTM-PD. 21 met the criteria for treatment. 17/30 had repeat sputum cultures at the end of the treatment. 13/30 achieved showed sputum conversion. 12/30 of treated patients showed improved outcomes at treatment completion. 2 were unchanged; 4 died (unrelated to NTM). The remainder, 12/30, remain under follow up. 105/135 of patients with single sputum isolates for AAFB were not treated. 32/105 had evidence of NTM-PD. Reasons for not treating are as follows – 11/32 had mild symptoms only, 8/32 had other significant co-morbidities causing symptoms, 3/32 refused treatment, 3/32 reason unclear, 3/32 not followed up, 4/32 died. Of the patients who met the criteria for treatment for NTM-PD, 7/32 had repeat sputum of which 4 had persistent sputum AAFB positivity. 72/105 patients were followed up. 57% were unchanged, 24% showed improvement 2% deteriorated and 6% died(Unrelated). <h3>Conclusion</h3> This review of the NTM-PD patient cohort has demonstrated that a significant number of patients were over-treated, but also there were missed opportunities for patients with NTM-PD. Patients who are treated need to be managed more closely, aligned with sputum conversion and radiology to optimize outcomes. The need for a dedicated service for the management of NTM-PD and other host defence disease has been identified with clearly defined pathways to achieve the best clinical outcomes. <h3>Reference</h3> Haworth CS, Banks J, Capstick T, et al<i>.</i> British Thoracic Society guidelines for the management of non-tuberculous mycobacterial pulmonary disease (NTM-PD)<i>Thorax</i> 2017;<b>72</b>:ii1–ii64.