P9 Outcomes of non-tuberculous pulmonary disease in an east london referral centre

<h3>Introduction</h3> Non-tuberculous mycobacterial pulmonary disease (NTM-PD) is increasingly prevalent and presents significant disability burden and cost. The diagnosis and treatment of NTM-PD is challenging as clinical and radiological presentation is diverse. Prolonged treatment with multiple agents frequently induces intolerable side effects in the older and frailer populations more often affected by NTM-PD. We present clinical and radiological features and outcome data on 60 individuals with NTM-PD at a tertiary referral centre over six years. <h3>Methods</h3> This retrospective observational study was endorsed by the trust local authority. We included individuals aged 18 or over with NTM-PD defined according to the ATS definition. This comprises clinically or radiologically suggestive features, plus two or more positive and consistent sputum isolates, a bronchoalveolar lavage sample or biopsy. Individuals with Cystic Fibrosis were excluded. Outcomes are defined according to the 2018 NTM-NET consensus statement. <h3>Results</h3> The cohort was 53% female with a median age of 67 and median BMI of 21.9. COPD was an underlying diagnosis in 32% and 58% were current or ex-smokers. The commonest symptoms were cough, weight loss and haemoptysis, recorded in 87%, 36% and 33% respectively. Mycobacterium avium was the predominant species occurring in 43% followed by M. chimerae in 23% and M. abscessus and M. Kansasii in 15% each. The commonest CT finding was nodularity occurring in 72%, with bronchiectasis, tree-in-bud opacity and cavitation occurring in 58%, 35% and 28% respectively. Treatment was attempted in 82% of cases overall, with culture conversion or cure having occurred in 41% of these to date (treatment continues in 35% of patients commenced). Treatment was halted in 18%, with nausea and vomiting being the commonest reasons. Two previously cured individuals experienced relapse and six of the cohort died, with NTM-PD being the cause in four of these. The rate of cure or culture conversion among those treated was similar in individuals with M. avium (42%) compared to other species (37%). <h3>Conclusions</h3> Our outcomes are comparable to those reported in an Italian cohort and reflect the challenges of NTM-PD treatment. The standardisation of outcome terminology is essential for clinical trials and observational studies into NTM-PD.