NTM Lung Disease

What is nontuberculous mycobacteria (NTM) lung disease?

This rare condition occurs when nontuberculous mycobacteria (NTM) causes a lung infection.

There are two types of NTM lung disease:

• Nodular bronchiectasis: This is the most common form and can be a milder form of the disease. It’s seen slightly more in people assigned female at birth who’ve completed menopause and are nonsmokers.
• Cavitary NTM lung disease: This type is a marker of more severe infection and can lead to respiratory failure. It slowly creates holes within your lung tissue and is slightly more common in people who smoke or have smoked and have an underlying lung disease like emphysema.

What is NTM?

Nontuberculous mycobacteria are a family of slow-growing bacteria that exist in soil, water and dust, making them impossible to avoid. They can be resistant to disinfectants. They can also survive high temperatures that typically destroy other types of bacteria.

The severity of infection, treatment approach and prognosis depend on which bacteria strain is causing the infection and whether the disease is nodular bronchiectatic or cavitary. They include:

• Mycobacterium avium complex (most NTM lung disease in the U.S. is typically from this strain).
• Mycobacterium abscessus.
• Mycobacterium kansasii.

Who gets NTM lung disease?

You're more likely to experience an NTM lung infection if you're living with certain types of predisposing conditions like other types of lung disease. These include:

• Recurring pneumonia, including aspirate pneumonia that occurs when something you breathe in infects your lungs.
• Asthma.
• Bronchiectasis. This is the most common predisposing risk factor.
• Chronic obstructive pulmonary disease (COPD).
• Cystic fibrosis.
• Lung cancer.
• Tuberculosis.

You may also be at risk if you’re over age 65, have conditions that weaken your immune system or take medications that suppress your immune system. These include:

• Human immunodeficiency virus (HIV).
• Rheumatoid arthritis.
• Sjögren’s syndrome.
• Chemotherapy.
• Inhaled corticosteroids.

What are NTM lung disease symptoms?

The most common sign is a cough. It may:

• Be chronic.
• Bring up blood (hemoptysis).
• Keep you up at night.
• Produce mucus.

Other NTM infection symptoms include:

• Chest pain.
• Extreme tiredness (fatigue).
• Loss of appetite.
• Low-grade fever.
• Night sweats.
• Recurring respiratory infections.
• Shortness of breath (dyspnea).
• Unexpected weight loss.
• Wheezing.

Is NTM lung disease contagious?

NTM bacteria don’t pass from person to person, so it isn’t contagious. However, infections in people with cystic fibrosis have spread to other people with cystic fibrosis although this is rare. Researchers are still determining whether NTM lung infections are among these.

How is NTM lung disease diagnosed?

NTM lung disease is challenging to diagnose because its symptoms aren't specific and are like many other, more common conditions. Diagnosis is made by the presence of symptoms, changes in your chest X-ray or CT scan and the growth of NTM in a sputum (the saliva and mucus you cough up) sample. If you have an infection, it’s essential to determine which strain of bacteria is causing it.

Evaluations may include:

• Physical exam to learn more about your symptoms.
• Imaging studies, such as a chest X-ray or CT scan to assess changes in lung tissue.
• Mucus and saliva (sputum) culture, which may come from coughing. To reduce the likelihood of testing errors, you'll need to provide cultures on several days. Healthcare providers may also take a sample from smaller airways in your lungs. Experts then examine the culture under a microscope.
• Lung biopsy, a procedure to take a sample of tissue from your lungs. This test also involves examining tissue under a microscope.

What else is important to know about NTM testing?

Many people have NTM lung disease for years before receiving a diagnosis. The longer you have it, the higher your risk of complications. If you're undergoing lung disease treatment and your symptoms continue to worsen, you might benefit from NTM infection testing.

The best care comes from healthcare providers who have experience treating this disease. These include pulmonologists and infectious disease doctors.

What is NTM lung disease treatment like?

The treatment that’s right for you depends on the bacteria strain, type of NTM lung disease and your health history. Care typically includes taking antibiotics for several months.

For more severe forms of the disease, surgery is sometimes necessary to remove infected lung tissue. Your providers are more likely to consider surgery if your disease doesn’t respond to antibiotics or if you can’t tolerate treatment. People with Mycobacterium avium complex sometimes need surgery to stop the bleeding that the infection sometimes causes.

Are NTM treatment side effects bothersome?

Being on long-term antibiotics can cause side effects like vomiting, diarrhea and loss of appetite. Some antibiotics can cause hearing or vision changes and your healthcare provider will monitor these during treatment. These issues can make it difficult to go about your day. If you're struggling to keep up treatment, tell your healthcare provider. You shouldn't stop taking antibiotics without first talking to your provider.

How can I prevent NTM lung disease?

It’s nearly impossible to avoid NTM exposure. But there are steps you can take to lower the risk of an NTM lung infection.

These include:

• Good hygiene: Regular hand washing slows the spread of germs like NTM bacteria. It also lowers the likelihood of an exposure turning into an infection.
• Immunizations: It’s essential to receive an annual flu shot and follow pneumonia vaccine guidelines. These conditions can complicate NTM lung disease recovery.
• Quit smoking and using tobacco products: Using tobacco increases your risk of lung disease and NTM infections.

What is the outlook for people with NTM lung disease?

The outlook varies, but many people make a full recovery, especially if you have non-cavitary disease. Your chances of getting better depend on:

• The type of NTM lung disease you have.
• Your health history.
• Whether you can tolerate long-term antibiotics.
• If you’re taking the correct antibiotics.
• Your ability to do airway clearance treatments if you have bronchiectasis.

Even with successful treatment, some people experience NTM lung disease more than once.

What’s important to know about living with NTM lung disease?

Airway infections from NTM bacteria can make everyday life challenging. But there are steps you can take to feel your best. These include:

• Avoid moisture: Don’t use hot tubs or spas. If you are in a kitchen or bathroom, turn on the ventilation fan.
• Eat a nutritious diet: Optimizing your diet helps you get more of the nutrients your body needs to fight infection. This includes getting plenty of protein, fluids and vegetables.
• Exercise: Gentle physical activity can loosen mucus, making it easier to clear. It also improves strength and endurance.
• Wear a mask: Limit ongoing NTM exposure by wearing a mask in areas with recently cut grass, new landscaping or farmland.

A note from Cleveland Clinic

NTM lung disease is an infection caused by slow-growing bacteria found in soil and water. People living with other lung conditions are more likely to experience this condition. It can be challenging to detect and treat, but many people make a full recovery. If you have or are at risk for this disease, it’s helpful to avoid moisture and wear a mask when outdoors.