Nontuberculous Mycobacterial Lung Disease: Current State of Knowledge and Future Directions

The two symposia reviewed here took place on 11th and 12th September 2017, as part of the European Respiratory Society (ERS) International Congress in Milan, Italy

Chairpersons: James Chalmers,1 Charles Haworth,2 David Griffith3
Speakers: Felix C. Ringshausen,4 Jakko van Ingen,5 Stefano Aliberti,6 Timothy Aksamit,7 David Griffith,3 Michael Loebinger,8 Won-Jung Koh9

1. Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, Dundee, UK
2. Cambridge Centre for Lung Infection, Cambridge, UK
3. University of Texas, Health Science Center Tyler, Tyler, Texas, USA
4. Department of Respiratory Medicine, Hannover Medical School; German Center for Lung Research (DZL), Hannover, Germany
5. Radboud University Medical Centre, Nijmegen, Netherlands
6. University of Milan, Milan, Italy
7. Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
8. Royal Brompton Hospital, London, UK
9. Division of Pulmonary and Critical Care, Department of Medicine, Samsung Medical Center, Seoul, South Korea

Disclosure: Dr Chalmers has received research grants from the European Union IMI, European Respiratory Society, Boehringer Ingelheim, GlaxoSmithKline, AstraZeneca, Insmed, Pfizer, and Bayer Healthcare; and honoraria for speaking or consultancy from Boehringer Ingelheim, GlaxoSmithKline, AstraZeneca, Insmed, Napp, Grifols, Pfizer, Bayer Healthcare, and Chiesi. Dr Haworth has declared no conflicts of interest. Dr Ringshausen has received clinical trial support from Algipharma, Basilea, Bayer Healthcare, Celtaxsys, EU/EFPIA, Insmed, Novartis, Parion, Vertex, and Zambon; grants and research support from Bayer Healthcare, EU/EFPIA, Griffols, Horizon, InfectoPharma, and Insmed; consultancy and speaking honoraria from AstraZeneca, Bayer Healthcare, Brahms/Thermo Fisher Scientific, Cellestis/Qiagen, Chiesi, Forest, Gilead, Griffols, and Insmed; and patient education/scientific event support from Abbott, Aposan, Basilea, Bayer Healthcare, Berlin Chemie, Boehringer Ingelheim, Chiesi, Gilead, Griffols, GlaxoSmithKline, Heinen & Löwenstein, Forest, InfectoPharm, Insmed, MSD, Novartis, Oxycare, Pari, Pfizer, Raptor, Trudell Medical, and Zambon. Dr van Ingen has received consultancy and speaking honoraria from Insmed, Janssen Pharmaceuticals, and Spero Therapeutics. Dr Aliberti has received clinical trial support from Aradigm Corporation, Zambon, Novartis, and Insmed; research grants from EU Innovative Medicines Initiative, European Respiratory Society, Bayer Healthcare, Aradigm Corporation, Griffols, Regione Lombardia, and Insmed; and consultancy honoraria from Bayer Healthcare, AstraZeneca, Griffols, Aradigm Corporation, Basilea, Zambon, Novartis, Horizon, and Actavis. Dr Aksamit has declared no conflicts of interest. Dr Griffith has received clinical trial support from Aradigm, Grifols, Insmed, and Bayer, and received research grants, research support, and consultancy and speaking honoraria from Insmed. Dr Loebinger has received consultancy or lecture fees from Insmed, Raptor, Bayer, Chiesi, and Actavis. Dr Koh has no relevant financial relationships to disclose.
Acknowledgements: Writing assistance was provided by Mia Cahill, ApotheCom, London, UK.
Support: The publication of this article was funded by Insmed. The views and opinions expressed are those of the authors and not necessarily Insmed.
Citation: EMJ Respir. 2017;5[1]:41-52.

Meeting Summary

The main objectives of the two symposia were to raise awareness of nontuberculous mycobacterial lung disease (NTM-LD); evaluate the key microbiological and clinical aspects of the disease, including its association with other conditions, such as bronchiectasis and common coinfections; outline the current treatment and management strategies; and review data from clinical trials of new therapies and how these could shape future management strategies. Dr Chalmers, Dr Griffith, and Dr Haworth opened the symposia by introducing NTM-LD and providing a brief overview of the key topics. Dr Ringshausen focussed on the epidemiology, prevalence, and burden of NTM-LD, and briefly discussed pathophysiology. Dr van Ingen outlined the microbiological diagnosis of NTM-LD, in particular the importance of molecular identification and drug susceptibility testing (DST). Dr Aliberti introduced bronchiectasis, outlined the relationship between the two diseases, and discussed the clinical relevance of comorbid disease. Dr Aksamit addressed the assessment and management of co-isolated NTM and other respiratory pathogens. Dr Griffith and Dr Loebinger each summarised the current treatment and management strategies, and reviewed the latest research regarding new therapies and what this could mean for the future. Dr Koh closed the symposium by outlining the latest clinical research on the natural history of NTM-LD from a global perspective.

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