Disclosures: Tobias Welte receives honarium for lectures and participation in an advisory board from Insmed.
FILMED AT THE EUROPEAN RESPIRATORY SOCIETY (ERS) INTERNATIONAL CONGRESS, SEPTEMBER 2016
What are the main challenges in the diagnosis of nontuberculous mycobacteria (NTM)?
00:11 – NTM is more and more diagnosed in patients with bronchiectasis. This could have two reasons, diagnosis of NTM from a technical point of view had been more difficult in the past, and now diagnostic procedure is much better. But on the other hand side, bronchiectasis is a disease with an increasing prevalence and it could be that really the number of NTM patients increases. The two main problems are we have to take NTM into account in the primarily diagnosis of bronchiectasis patients, we have to start the right diagnostic procedures. And on the other hand side, it is very difficult to distinguish between NTM colonisation and NTM disease. Normally, a CT scan is necessary to show that there is an active disease, and this is something which does not happen often enough at the moment.
How have new molecular methods improved diagnostic techniques?
01:30 – So, PCR techniques improve the diagnosis. However, there is a risk that in some circumstances PCR is hypersensitive and find pathogens which are not present. Nevertheless, the main issue still is to initiate the diagnostic procedure and to have NTM in mind as I said before.
What are the limitations of multiple drug therapy for NTM?
02:07 – The main limitation of the current therapy is the high rate of side effects. So, because of these side effects, mainly gastrointestinal side effects, patients are not very adherent to the current treatment. And it’s well known that non-adherence is followed by adverse outcome and by resistance development.
Could you describe the latest advances in antibiotic therapy for refractory cases?
02:41 – As systemic therapy in every circumstance is associated with an increase in side effects, we are looking for administration routes which has less systemic effects. And the most impressive one in respiratory disease is to deliver the drug by inhalation, on an inhaled route. So, there are now inhaled antibiotics available, and one of them inhaled liposomal amikacin, which are studied in the most severe and the treatment refractory cases. And we have a lot of expectation that this is a treatment option which will solve some of the problems which are present.