Strategies to Improve Diagnosis and Treatment of Nontuberculous Mycobacterial Lung Disease

Strategies to Improve Diagnosis and Treatment of Nontuberculous Mycobacterial Lung Disease

Med-IQ Select
Continue to Course
Online Course | Specialties: Infectious Disease, Pulmonary Disease
Released: 3/18/2021
Expires: 3/16/2023
Max Credits: 0.75
Continue to Course Read Abstract

Charles L. Daley, MD
Chief, Division of Mycobacterial and Respiratory Infections
National Jewish Health
Denver, CO

Shannon Kasperbauer, MD
Division of Mycobacterial and Respiratory Infections
National Jewish Health
Denver, CO

Activity Planners
Christie Avraamides, PhD
Senior Clinical Content Manager
Baltimore, MD

Iwona Misiuta, PhD, MHA
Clinical Content Manager
Baltimore, MD

Samantha Gordon, MS
Accreditation Manager
Baltimore, MD

Amy Sison
Director of CME
Baltimore, MD

Learning Objectives
Upon completion, participants should be able to:

  • Summarize the diagnostic criteria and treatment recommendations for NTM-LD in the 2020 ATS/ERS/ESCMID/IDSA clinical practice guidelines
  • Individualize NTM-LD treatment plans based on the infecting species, disease extent, underlying comorbidities, initial treatment response, and adverse effect occurrence
  • Recognize the burden of NTM-LD and the importance of considering patient priorities and quality of life in treatment decisions

Target Audience
This activity is intended for pulmonologists, infectious disease (ID) specialists (MDs, NPs, PAs), ID pharmacists, and other clinicians who diagnose and treat patients with NTM-LD.

Statement of Need
Nontuberculous mycobacterial lung disease (NTM-LD) is often misdiagnosed or overlooked, leading to the belief that it is a rare disease. However, an estimated 50,000 to 90,000 Americans have NTM-LD with 12,000 to 18,000 new infections occurring each year, leading to decreased quality of life and impaired daily functioning. It is not uncommon for patients with NTM-LD to experience delays in diagnosis; they are also likely to be under- or over-treated due to a previous lack of clear guidance. Because the number of NTM-LD cases is expected to rise in the coming years, it is crucial that pulmonology and infectious disease clinicians stay up-to-date on new practice guidelines for the diagnosis and treatment of NTM-LD.

Providership Statement
Provided by Med-IQ.

Accreditation/Designation Statements
Med-IQ is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Med-IQ designates this enduring material for a maximum of 0.75 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ACPEMed-IQ is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. 0.75 contact hours (0.075 CEUs) of credit for pharmacists. ACPE #0476-0000-21-002-H01-P. This knowledge-based activity is designed for all pharmacists.

Medium/Method of Participation
This is a 0.75-credit CME/CE activity. To receive credit, read the introductory CME/CE material, complete all of the modules, and complete the evaluation, attestation, and post-test, answering at least 70% of the post-test questions correctly. Pharmacists will have credits uploaded directly to NABP.

Initial Release Date: March 18, 2021
Rerelease Date: March 17, 2022
Expiration Date: March 16, 2023
Estimated Time to Complete This Activity: 45 minutes

Disclosure Policy
Med-IQ requires any person in a position to control the content of an educational activity to disclose all financial relationships with any ineligible company over the past 24 months. The ACCME deems financial relationships as relevant if the educational content an individual can control is related to the business lines or products of the ineligible company. Individuals who refuse to disclose will not be permitted to contribute to this CME activity in any way. Med-IQ has policies in place that will identify and mitigate COIs prior to this educational activity. Med-IQ also requires faculty to disclose discussions of investigational products or unlabeled/unapproved uses of drugs or devices regulated by the US Food and Drug Administration.

Drug/Product Usage by Faculty
Off-label/unapproved drug uses or products are mentioned within this activity.

Disclosure Statement
The content of this activity has been peer reviewed and has been approved for compliance. The faculty and contributors have indicated the following financial relationships, which have been mitigated through an established COI mitigation process, and have stated that these reported relationships will not have any impact on their ability to give an unbiased presentation.

Charles L. Daley, MD
Consulting fees/advisory boards: AN2 Therapeutics, Genentech, Insmed, Lilly, Matinas BioPharma Holdings, Inc., Otsuka America Pharmaceutical, Inc., Paratek
Contracted research: AN2 Therapeutics, Beyond Air, Bugworks Research Inc., Insmed, Paratek Pharmaceuticals

Shannon Kasperbauer, MD
Consulting fees/advisory boards: AN2 Therapeutics, Insmed, NTMir, Paratek Pharmaceuticals

The peer reviewers and activity planners have no financial relationships to disclose.

Statement of Evidence-Based Content
Educational activities that assist physicians in carrying out their professional responsibilities more effectively and efficiently are consistent with the ACCME definition of continuing medical education (CME). As an ACCME-accredited provider of CME, it is the policy of Med-IQ to review and ensure that all the content and any recommendations, treatments, and manners of practicing medicine in CME activities are scientifically based, valid, and relevant to the practice of medicine. Med-IQ is responsible for validating the content of the CME activities it provides. Specifically, (1) all recommendations addressing the medical care of patients must be based on evidence that is scientifically sound and recognized as such within the profession; (2) all scientific research referred to, reported, or used in CME in support or justification of a patient care recommendation must conform to generally accepted standards of experimental design, data collection, and analysis.

Med-IQ is not liable for any decision made or action taken in reliance upon the information provided through this activity.

Contact Information
For questions or comments about this activity, please contact Med-IQ. Call (toll-free) 866 858 7434 or email

System Requirements



  • Operating system - Med-IQ supports the current operating system, plus two prior releases:
    • Android (eg, Samsung Galaxy)
    • Apple (eg, iPhone/iPad)
  • Browsers - Med-IQ supports the default browser for the applicable operating system release, plus two prior releases:
    • Android (Chrome)
    • Apple (Safari)

Applications & Software

For technical assistance, please refer to our Support Manual.

The information provided through this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient’s medical condition.

Privacy & Confidentiality
Med-IQ is committed to honoring your privacy and protecting any personal information you choose to share with us. For detailed information about our privacy policy, please visit:

This activity is available free of charge to participants.

Acknowledgment of Commercial Support
This activity is supported by an educational grant from Insmed.



Here are some key takeaways from this activity. Deeper insights and evidence, plus an opportunity to receive credit, are available by clicking the "Continue" button below.

  • More than 200 species of nontuberculous mycobacteria exist that produce both pulmonary and extrapulmonary disease
  • According to the National Managed Care Claims Database (Optum), the prevalence of NTM-LD is increasing, and approximately 27 million individuals have the disease
  • Risk factors for NTM-LD include underlying conditions (eg, CF/CFTR anomalies, AAT anomalies, COPD, pneumoconiosis, collagen vascular disease, bronchiectasis, TNF alpha antagonists, alveolar proteinosis, chronic aspiration), significant environmental exposures (eg, aerosolized soil and water, endemic areas), and innate host issues (eg, postmenopausal women, thin women with distinct body habitus, predisposition to hypersensitivity)
  • Different clinical phenotypes for nodular/bronchiectatic and fibrocavitary NTM-LD disease include age, sex, body type, and smoking status
  • Median time from symptom onset to diagnosis is 10 months with a range of 1 month to 6 years
  • According to the 2020 ATS/ERS/ESCMID/IDSA clinical practice guidelines for NTM-LD, a 3-drug, macrolide-containing regimen is recommended and can be administered intermittently (noncavitary) or daily (cavitary); parenteral amikacin (including amikacin liposome inhalation solution) or streptomycin is suggested in patients with cavitary, extensive bronchiectatic, or macrolide-resistant disease
  • In patients who meet the diagnostic criteria for NTM-LD, treatment should be started (ie, rather than watchful waiting), especially in the context of positive acid-fast bacilli sputum smears and/or cavitary lung disease
  • Factors related to disease progression include bacterial load (ie, smear positive) and radiographic extent of disease; other predictors are older age, low BMI (< 18.5), comorbidities, low albumin, anemia, and elevated inflammatory indices
  • Patients face many challenges with NTM-LD and experience real fears and struggles and losses in quality of life; it is important to share goals, set expectations, and provide education on adverse event management

View reference list.

Click "Continue" to proceed through this activity and/or receive credit. To receive credit and a certificate, you must complete all of the modules in this activity.

By clicking "Continue," you confirm that you have reviewed the CME information.


Unless otherwise indicated, photographed subjects who appear within the content of this activity or on artwork associated with this activity are models; they are not actual patients or doctors.

The information provided through this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient’s medical condition.

COPYRIGHTED. Republication or redistribution of Med‑IQ content, including by framing, is prohibited without prior written consent. Med‑IQ shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon.