Non-tuberculous mycobacterial disease & aspergillus- related lung disease in bronchiectasis

Objective: To determine if patients with bronchiectasis and non-tuberculous mycobacteria (NTM) have a higher prevalence of aspergillus-related lung disease. Methods: A series of 30 consecutive patients with bronchiectasis and NTM (cases) were compared with 61 patients with bronchiectasis and no evidence of NTM (controls). Aspergillus serology and computerised tomography (CT) of thorax were used to identify aspergillus-related lung diseases including aspergilloma, allergic bronchopulmonary aspergillosis (ABPA) and chronic necrotizing pulmonary aspergillosis (CNPA). Results: The rate of positive aspergillus serology was higher in cases with NTM disease compared to controls (10/30 v 4/61, p=0.005). The radiological features of aspergillus-related lung disease were also commoner among patients with NTM disease than in controls (6/30 v 0/61, p=0.003). This association between NTM disease and aspergillus-related lung disease remained significant after adjustment for confounding effects of age and lung function (adjusted odds ratio 5.1, 95% confidence interval 1.5-17.0, p=0.008). Conclusion: Patients with bronchiectasis and NTM disease have a higher prevalence of coexisting aspergillus-related lung disease than patients with bronchiectasis without NTM. Identification of aspergillus-related lung disease is important as prognosis amongst undetected cases is invariably poor.