Patients at risk of NTM-PD who need testing evaluated using a modified Delphi process by European experts

Michael R. Loebinger, S. Aliberti, Charles Haworth, M. Janković Makek, Christoph Lange, N. Lorent, A. Papavasileiou, E. Polverino, Gernot Rohde, Nicolas Veziris, Dirk Wagner, J. van Ingen
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Abstract

Identifying patients at risk of nontuberculous mycobacterial pulmonary disease (NTM-PD) is challenging. Delays in NTM-PD identification and management are associated with declining lung function and increased morbidity and mortality.European NTM-PD experts (n=12) participated in a three-round modified Delphi process to score symptoms and comorbidities potentially associated with NTM-PD as reasons to test for NTM.Experts reached a consensus on the symptoms and comorbidities that should and should not prompt NTM testing. Requirements for testing were scored as high (mean ≥7), medium (mean 4–6), or low (mean ≤4). NTM testing should be undertaken when multiple suggestive symptoms are present simultaneously in all patients except those with cancer (7.3–8.8), or when radiology is indicative of NTM-PD (≥8.9). Symptoms of persistent sputum production, recurrent respiratory infection, and haemoptysis should prompt NTM testing, particularly in those with underlying respiratory diseases. Symptomatic patients with bronchiectasis or previous tuberculosis/NTM-PD or those being prescribed or undergoing long-term macrolide therapy for a respiratory condition should also be tested. Testing is not warranted in patients without an underlying respiratory disorder or in those without a history of respiratory disorders unless presenting with multiple symptoms.Assessing patients’ risk of NTM-PD is challenging. This Delphi consensus process provides insight into symptoms and clinical characteristics that should prompt NTM-PD assessment. Timely testing and diagnosis would enable initiation of appropriate management.
欧洲专家采用修改后的德尔菲程序,对需要检测的有 NTM-PD 风险的患者进行评估
识别非结核分枝杆菌肺病(NTM-PD)高危患者具有挑战性。欧洲非结核分枝杆菌肺病专家(n=12)参与了三轮改良德尔菲程序,对可能与非结核分枝杆菌肺病相关的症状和合并症进行评分,并将其作为检测非结核分枝杆菌的理由。检测要求分为高(平均值≥7)、中(平均值4-6)或低(平均值≤4)。除癌症患者(7.3-8.8 分)外,当所有患者同时出现多种提示症状时,或当放射学检查提示 NTM-PD(≥8.9 分)时,应进行 NTM 检测。出现持续痰量、反复呼吸道感染和咯血等症状时,应及时进行NTM检测,尤其是患有基础呼吸道疾病的患者。支气管扩张或曾患肺结核/NTM-PD 的无症状患者,或正在处方或因呼吸道疾病长期接受大环内酯类药物治疗的患者也应接受检测。对于没有潜在呼吸系统疾病或没有呼吸系统疾病史的患者,除非出现多种症状,否则不需要进行检测。本德尔菲共识程序提供了有关症状和临床特征的见解,这些症状和特征应促使对 NTM-PD 进行评估。及时检测和诊断将有助于启动适当的管理。
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