NTM Northwest Support

A Pacific Northwest support group for sufferers of Nontuberculous Mycobacterial (NTM) Infections and Bronchiectasis

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#1 2016-06-19 14:13:16

Nancyr
Administrator
Registered: 2016-05-30
Posts: 37

New York NTM Meeting August 2014

NTM Notes from Meeting of Aug. 7, 2014

Dr. Dela Cruz-Guest Speaker
Yale Medical Center, New Haven, CT


Dr. Charles Dela Cruz is a noted pulmonary and critical care physician. Dr. Dela Cruz completed his research and training through an MD/PhD program in the area of immunology and virology from the University of Toronto and Yale University Medical School. He is presently an assistant professor at Yale University, specializing in pulmonary and critical care medicine. His clinical and research interest is in the studying of the role of respiratory infections in the pathogenesis of inflammation, injury and repair in the lung using cellular techniques, in vivo (within a living organism) modeling and human translational studies. He sees patients with respiratory infections and COPD in the West Haven Veteran’s Hospital and Yale’s Winchester Chest Clinic as well as acting as an attending critical physician in the Medical Intensive Care Unit at the Yale New Haven Hospital. Dr. Dela Cruz spent an elective session at National Jewish Health working with NTM under the directions of Drs. Daley and Huitt. He was recently presented with a Faculty Level award at Yale for his academic and leadership contribution.


Exactly What Does Pulmonary Function Testing Show?

Pulmonary function testing was explained. Dr. D. described how the test works. The PFT looked at the ability to breathe in, the size (capacity) of the lungs and the ability of the lung for gas exchange or diffusion. He explained that an x-ray showing black areas indicate air. White could indicate bone, scar tissue or something bad such as inflammation, infection or tumors.

What is Bronchiectasis?

Bronchiectasis is a series of dilated airways, which are larger than they are supposed to be. The airway becomes larger than a blood vessel. This is a condition of chronic bronchial inflammation. Tree in bud changes are non specific and not normal. Granulomas are the body’s response to something foreign. DNA probes are currently used to discover the type of mycobacteria and help with speciating the organism. They are often done in sophisticated institutions such as Yale and other places.

Hemoptysis Explained

Hemoptysis is bleeding from the lungs. If the bleeding is more than 2 Tbs., it needs to be taken seriously. The recommendation is for immediate medical care.  It is important to clear infection, as it can invade nearby blood vessels when the infection is severe If too much hemoptysis, the blood can clot, causing breathing issues. . This is an emergency situation and demands immediate medical attention. If the patient has cavities in the lungs, the patient is more likely to have hemoptysis. Out of 100 cases of bleeding, the statistics show that 5% go to the hospital. The initial treatment is antibiotics but if the bleeding worsens, additional procedures are needed to stop the breathing. An infection can cause more hemoptysis.  There is a strong likelihood of reinfection. A vicious cycle. Good airway clearance can help clear infection and possibly help in not getting sick.

Bronchiectasis can lead to NTM, but the reverse can also be true, meaning NTM growth in the lung can lead to more airway changes/bronchiectasis if not treated and considered a problem. The patient has a compromised immune system and produces excessive sputum, which creates more secretions. There is a point in which the infection becomes more difficult to clear.

Be sure to tell your physician not to use a single antibiotic to treat NTM as it can cause resistance. Likewise, if fighting a secondary infection, be sure your doc knows not to use a drug used to fight NTM (see Insights brochure for a list of NTM antibiotics, www. Ntminfo.org) as this can also cause resistance. They should consult with your doctor who treats your NTM.


How is Pseudomonas Dealt With?

Pseudomonas is another type of bacteria causing lung infections, which is not NTM. There is a high predisposition of these bacteria in bronchiectasis patients. If there are high numbers of pseudomonas bacteria, most doctors will treat the condition. There are drugs available that cover both pseudomonas and NTM, such as Cipro in combination with other drugs. The same symptoms are often seen with both conditions. He has found a correlation between aspiration and pseudomonas (also NTM). To prevent aspiration, use a wedge pillow or mechanical bed to raise the head of the bed while sleeping.

Fatigue

Chronic inflammation may be one of the reason for fatigue. The body tries to use energy to clear the infection, but it’s not working, so the body is working overtime.

Considerations in the  NTM/Bronchiectasis Patient Workup

The physician should look at family history; for example, does the Cystic Fibrosis gene mutation exist? If that is the case, genetic counseling may be recommended. The question becomes what to do with the information.

Recovering from Side Effects of Medication

Regarding hearing loss or decrease, it could take up to 6 months to recover. Some patients don’t recover.

Showerheads and NTM

Research has shown that showerheads can aerosolize NTM bacteria from the municipal water supply. It was suggested to soak the showerhead in vinegar on a periodic basis. Dr. D. recommended changing the showerhead frequently, maybe every several months.

How often should NTM patients be monitored?

For patients actively under treatment, Dr. D recommends monitoring with a CT scan and sputum culture at least every 6 months. He doesn’t use radiography  (an imaging technique that uses electromagnetic radiation other than visible light, especially X-rays, to view the internal structure of a non-uniformly composed and opaque object (i.e. a non-transparent object of varying density and composition) such as the human body) because they are not as sensitive in picking up changes in the lungs.

Alternative Treatments

Mucomist (Nacetylcystene), is an antioxidant in pill form. Dr. D. feels it is benign but does not routinely use this. Same for Glutathione. There have been no scientific evidence to prove they are effective.

Other Recommendations

Good nutrition-for weight loss or weight gain.
Pneumonia Vaccine-Every 5 years but need to check with CDC on their recommendation.
Shingles Vaccine
Exercise makes a big difference.

D. Breslawsky
Aug., 2014

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