Chest
Volume 150, Issue 6, December 2016, Pages 1222-1232
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Original Research: Chest Infections
Lung Function Decline According to Clinical Course in Nontuberculous Mycobacterial Lung Disease

https://doi.org/10.1016/j.chest.2016.06.005Get rights and content

Background

There are few data regarding the impact of nontuberculous mycobacterial lung disease (NTM-LD) on lung function during the clinical course of disease. This study aimed to assess the impact of NTM-LD on lung function decline.

Methods

Treatment outcomes and spirometry data at diagnosis and at least three years later were obtained from 358 patients who were diagnosed with NTM-LD between January 1999 and November 2011 using the prospective NTM registry cohort. For analysis, patients were divided into three groups: those observed without treatment, those who had treatment success, and those in whom treatment failed.

Results

The treatment-failure group (n = 68) had a significantly more rapid decline in FEV1 and FVC compared with the observation (n = 118) and treatment-success (n = 172) groups (–52.2, –30.8, and –28.2 mL/y, respectively; P = .023 for FEV1 decline; –50.4, –28.8, and –26.0 mL/y, respectively; P = .002 for FVC decline). After adjusting for confounding factors, patients with treatment failure had greater FEV1 and FVC declines than did those observed without treatment (adjusted P = .026 for FEV1 decline; adjusted P = .022 for FVC decline) or those treated successfully (adjusted P = .004 for FEV1 decline; adjusted P = .002 for FVC decline). Patients treated successfully had declines in FEV1 and FVC similar to those in the observation group.

Conclusions

The change of lung function was variable over a median 5-year follow-up period. Treatment failure was associated with a substantial decline in lung function in NTM-LD.

Section snippets

Study Population

Using the database of the prospective NTM Registry cohort of Samsung Medical Center (a 1,979-bed referral hospital in Seoul, South Korea), we identified 438 consecutive patients in whom NTM-LD was diagnosed between January 1999 and November 2011 and who underwent spirometry at the time of diagnosis of NTM-LD and again at least 3 years later. Fifty-three patients who underwent surgical resection for NTM-LD during the follow-up period, 22 patients who had other chronic LDs (interstitial LD,

Baseline Characteristics

Of 358 patients, there were 118 in the observation group, 172 in the treatment-success group, and 68 in the treatment-failure group (including 10 patients who discontinued antibiotic treatment within 12 months) (Table 1). Female patients were more common in the treatment-success group (73.3%) than in the observation and treatment-failure groups (56.8% and 50.0%, respectively; P = .001). Patients in the observation group were more likely to have higher body mass index (median, 21.4 kg/m2

Discussion

To our knowledge, this is the largest longitudinal study to evaluate the impact of NTM-LD on the change of lung function based on treatment status and treatment outcomes. We evaluated 358 patients over a median follow-up period of 5.6 years to access the impact of treatment on lung function decline seen on spirometry. We found that treatment failure in patients with NTM-LD was associated with greater declines in FEV1 and FVC than was seen in the group undergoing observation only or in the

Acknowledgments

Author contributions: H. Y. P., B-H. J., and W-J. K. were responsible for the conception and design. H. Y. P. and B-H. J. were responsible for data analysis. H. Y. P., B-H. J., H. R. C., and W-J. K. were responsible for data interpretation and writing the manuscript. H. Y. P., B-H. J., H. R. C., K. J., C. L. D., and W-J. K. were responsible for revision of the manuscript and contribution to intellectual content.

Financial/nonfinancial disclosures: The authors have reported to CHEST the

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  • Cited by (0)

    Drs Park and Jeong contributed equally to this work.

    FUNDING/SUPPORT: This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT and Future Planning (NRF-2015R1A2A1A01003959) and by a grant from the Korea Health Technology R & D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, South Korea (HI15C2778).

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