Comorbid respiratory diseases, including bronchiectasis, chronic obstructive pulmonary disease (COPD), and tuberculosis, are associated with an increased risk for nontuberculous mycobacterial pulmonary disease (NTM-PD), according to study findings published in Chest.
Researchers conducted a systematic review and meta-analysis to identify risk factors for NTM-PD. They performed a literature search in MEDLINE via PubMed and EMBASE in July 2021 of studies published in English between 2011 and 2021
that reported on risk factors associated with NTM-PD, comparing individuals with and without NTM-PD.
A total of 99 studies were identified; the 24 studies included in the meta-analysis all reported an association between potential risk factors and the presence of NTM-PD and used a control population for comparison.
The meta-analysis found that comorbid respiratory disease was associated with a significant increase in the odds ratio (OR) for NTM-PD, with ORs ranging from 4 to 21. The strongest association was with bronchiectasis (OR, 21.43; 95% CI, 5.90-77.82), which was followed by a history of tuberculosis (OR, 12.69; 95% CI, 2.39-67.26), interstitial lung disease (OR, 6.39; 95% CI, 2.65-15.37), COPD (OR, 6.63; 95% CI, 4.57-9.63), and asthma (OR, 4.15; 95% CI, 2.81-6.14).
“
These data suggest that, in line with current clinical thinking, comorbid respiratory disease is associated with a high risk for NTM-PD, but other factors such as cancer and immunosuppression also predispose patients to an increased risk of disease.
Other factors that had an association with a greater risk of NTM-PD were immunosuppression, including inhaled corticosteroids (OR, 4.46; 95% CI, 2.13-9.35), oral corticosteroids (OR, 3.37; CI, 0.82-13.75), and other immunosuppressants such as tacrolimus or mycophenolate mofetil (OR, 2.60; 95% CI, 0.69-9.79), in addition to anti-tumor necrosis factor-alpha treatment for rheumatoid arthritis (OR, 2.13; 95% CI, 1.24-3.65), solid tumors (OR, 4.66; 95% CI, 1.04-20.94), pneumonia (OR, 5.54; 95% CI, 2.72-11.26), cardiovascular disease (OR, 1.73; 95% CI, 1.01-2.97), and low body mass index (BMI; OR, 3.04; 95% CI, 1.95-4.73).
Increasing BMI (OR, 0.82; 95% CI, 0.71-0.95) or high BMI (OR, 0.73; 95% CI, 0.58- 0.97) were protective factors against NTM-PD, and long-term macrolide use for underlying disease was possibly protective against NTM-PD, although not statistically significant (OR, 0.80; 95% CI, 0.47-1.39). In addition, female sex was a nonsignificant risk factor (OR, 1.27; 95% CI, 0.95-1.69).
Study limitations include a high degree of heterogeneity across studies, a paucity of data regarding the attributable risk for NTM-PD, and lack of uniformity in the definitions of NTM-PD in the included publications.
“These data suggest that, in line with current clinical thinking, comorbid respiratory disease is associated with a high risk for NTM-PD, but other factors such as cancer and immunosuppression also predispose patients to an increased risk of disease,” stated the investigators. “Understanding the risk factors for NTM-PD, as explored in this meta-analysis, may help to identify patients who do not yet have notable symptoms and to initiate testing to diagnose NTM-PD early.”
Disclosure: The study was funded by Insmed B.V. Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
