NTM Lung Disease

NTM lung disease is a nontuberculous mycobacteria (NTM) infection in your lungs. NTM are different types of bacteria that live in the soil and water around us.

We all breathe in NTM, but most people don’t get sick from them. NTM lung disease is more common in people with long-term lung conditions, like bronchiectasis and cystic fibrosis. It can be hard to treat — you may have to be on antibiotics for a long time to manage it. It can be fatal.

Symptoms of NTM lung disease

NTM lung disease symptoms include:

• Cough
• Coughing up blood
• Chest pain
• Extreme tiredness (fatigue)
• Frequent respiratory illnesses
• Loss of appetite
• Low fever
• Night sweats
• Shortness of breath
• Unexplained weight loss
• Swollen lymph nodes
• Wheezing

Nontuberculous mycobacterial infection causes

Many kinds of nontuberculous mycobacteria can cause NTM lung disease. M. avium complex (MAC), M. kansasii and M. abscessus bacteria are the most likely to make you sick. You can get them in your lungs from:

• Drinking, bathing or showering in water containing NTM
• Inhaling mycobacteria from dirt and dust
• Medical devices that go into your body (like an intubation tube)

Is it contagious?

No, NTM lung disease isn’t usually contagious. But sometimes, it can spread between two people who have cystic fibrosis.

Risk factors

You might be at higher risk for NTM lung disease if you have an ongoing condition that affects your lungs. These include:

• Bronchiectasis
• COPD (chronic obstructive pulmonary disease)
• Cystic fibrosis
• Lung cancer
• Tuberculosis

You might also be at higher risk if you:

• Are over 65
• Have a weakened immune system (from HIV, cancer or certain medications)
• Are female with a low BMI

Complications of NTM lung disease

Inflammation from NTM infections can cause scarring (fibrosis). The scarring can get worse over time and lead to pits or cavities in your lung tissue. This can eventually lead to respiratory failure.

How doctors diagnose NTM lung disease

Healthcare providers diagnose NTM lung disease by trying to grow (culture) NTM bacteria from a sputum sample. Sputum is mucus from your lungs. Your provider may get a sample by having you cough up sputum. Or they might get a sample using a lighted tube with a camera on the end (bronchoscopy).

But just because they find bacteria in your lungs doesn’t mean you have the disease. Providers usually need at least two positive cultures to diagnose an NTM infection. They may also do imaging, like chest X-rays or CT scans, to help with diagnosis.

How is NTM lung disease treated?

Providers treat NTM lung disease with antibiotics. These might be:

• A pill or liquid you swallow
• IV medication a provider gives you with a needle in your vein
• A liquid you breathe in as a mist with a nebulizer
• A powder you breathe in with an inhaler
• A combination of these

They might also have you use airway clearance techniques or chest physiotherapy if you aren’t already.

When should I see my healthcare provider?

Talk to your healthcare provider if you have new or long-lasting symptoms, like a cough, unexplained weight loss or shortness of breath. If you have an ongoing lung condition, check with your provider if you notice any changes in your breathing or other symptoms.

What is the life expectancy of someone with NTM lung disease?

The outlook for someone with an NTM lung infection depends on many factors. These include:

• The specific type of mycobacteria causing the infection
• Other health conditions you have (comorbidities)
• How well antibiotics and other treatments work

Even after finishing treatment, an NTM infection can come back. It can sometimes be fatal.

What can I expect if I have NTM lung disease?

Many people find their symptoms improve after starting medication. But NTM infections can be hard to get rid of. Treatment can last a long time — sometimes years — and your provider will have to take into consideration any other health conditions you have.

Sometimes, they may decide it’s best to delay treatment. They’ll work with you on a treatment plan for your specific situation.

Can it be prevented?

If you have a condition that increases your risk for an NTM infection, here are steps you can take to reduce your risk:

• Wear a mask that filters particles when working outdoors or with dirt.
• Avoid using hot tubs and sprayers that create a fine mist.
• Avoid working with soil (especially potting soil).
• Wash your hands regularly.
• Don’t smoke or vape.

If you have cystic fibrosis, your provider may recommend not being in close contact with others who also have CF. This can reduce the risk of spreading bacteria that can cause infections.