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Respir Med. 2019 Apr;150:45-50. doi: 10.1016/j.rmed.2019.02.007. Epub 2019 Feb 12.

The natural history of non-cavitary nodular bronchiectatic Mycobacterium avium complex lung disease.

Author information

1
Division of Pulmonology and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Centre, 88 Olympic-ro 43-gil, Songpa-gu, 05505, Seoul, South Korea.
2
University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 05505, Seoul, South Korea.
3
Division of Pulmonology and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Centre, 88 Olympic-ro 43-gil, Songpa-gu, 05505, Seoul, South Korea. Electronic address: heathcliff6800@hanmail.net.

Abstract

PURPOSE:

We aimed to investigate the natural history of non-cavitary nodular bronchiectatic (NC-NB) Mycobacterium avium complex (MAC) lung disease (LD).

METHODS:

Among all patients diagnosed with NC-NB MAC LD between March 2000 and December 2013, 551 patients who were followed until December 2017 were enrolled at a tertiary referral center in South Korea. Patients were subdivided into progressive and stationary groups, depending on whether treatment was initiated within 3 years after diagnosis. We investigated the proportion of patients not receiving anti-MAC treatment within 3 years after the diagnosis. The rate for spontaneous sputum conversion in the untreated group was also calculated.

RESULTS:

The mean age of 551 patients was 61.1 years. During the median 5.8 years of follow-up, 323 (58.6%) patients received treatment within 3 years (progressive group), whereas the remaining 228 (41.4%) patients did not (stationary group). Multivariate analysis revealed that age ≤ 60 years, a positive sputum smear, the presence of systemic symptoms, body mass index >18.5 kg/m2, and the involvement of ≥ 4 lobes were predictors of receiving treatment. Additionally, during the median of 5.0 years follow-up, spontaneous sputum conversion occurred in 52.2% of patients who did not receive treatment.

CONCLUSIONS:

Among patients diagnosed with NC-NB MAC LD, approximately 40% did not receive antibiotic treatment within 3 years of diagnosis. Moreover, about 50% of untreated patients experienced spontaneous sputum conversion.

KEYWORDS:

Clinical course; Conversion; MAC; Treatment

PMID:
30961950
DOI:
10.1016/j.rmed.2019.02.007

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