Dr Kasperbaur from NJH-MAC Watchful Waiting talk

I was able to watch the presentation yesterday. Very informative. The Dr went into a great detail about microbiology which was interesting. She shared some real patient examples highlighting how each patient is different so there are many variables deciding if watchful waiting is appropriate. For her patients not treating, airway clearance and saline is of course part of the plan along with usually 4 month intervals for sputum testing. One thing she said which I might not be able to explain the context correctly but was that our lungs are like the Ritz Carlton. I used to think mine were wonky but have now flipped that. Ours our so welcoming the stuff wants to get all cozy and stuck around! Not quite sure if that’s how she meant it but I like the positive spin.

@rmoore901 I love your explanation!! I’m traveling so I didn’t get to watch it and this was informative and quite entertaining. 🙂 thank you again, Linda

I used AI to generate a summary of this webinar for the benefit of members of our group who were unable to attend or listen. The summary does not replace her presentation and informative slides, which provide much more detail and context.

NTM are organisms found in the environment that can cause chronic lung infections, particularly in individuals with underlying conditions like bronchiectasis. The diagnostic process involves collecting multiple sputum samples, which are analyzed via an AFB smear (microscopic exam) and a slow growing culture that takes up to eight weeks. A "smear positive" result indicates a high volume of bacteria and is a red flag for disease progression.

She explained that NTM lung disease is highly heterogeneous, meaning treatment decisions are not one-size-fits-all. While guidelines conditionally recommend treatment over "watchful waiting," this is based on low-certainty evidence. Key factors predicting progression include cavitary lung disease (holes in the lungs), a low Body Mass Index (BMI) below 18.5, and a positive sputum smear. For patients under watchful waiting, proactive management is crucial. This includes diligent airway clearance, for which hypertonic saline is effective due to its dual role in clearing mucus and its antimicrobial properties. Maintaining a healthy weight is also critical, as a low BMI is independently linked to disease progression, treatment failure, and mortality. Monitoring involves regular sputum cultures and low-dose CT scans without contrast to track the disease.

@becleartoday thank you. I have been vicariously enjoying your vacation and appreciate the reminder about algonates. I think I might have to plan a trip to the UK “for medical purposes” to try their version of Gaviscon. Maybe some English chocolate to work on my BMI would be medicinal too!

@scoop
Did they mention mucoid pseudomonas at all? Curious because my sputum has been coming back lately 1+ for mucoid pseudo, and my UNC Pulmo wants to treat it. Wondering what National Jewish would do. Since pseudo as can build resistance to so many drugs, it seems like watchful waiting would b good if possible

@sarahlynn1960
The main focus of that webinar was NTM. Tagging @irenea8 as she's very up to date on the latest treatments for pseudo and knows the questions to ask!

@sarahlynn1960
If you have mucoid that probably means you have had it for some time and it is there for good? If so then IV or oral treatment is usually reserved for when things get worse or exacerbated with your load and symptoms. Or you might be put on an inhaled antibiotic every month or every other month to keep it knocked back.
Finding a small amount (+1) can sometimes mean the bacteria is just sitting on a surface (colonization) rather than causing an active sickness. Lab vs. Symptoms: Lab reports must be matched with your physical signs, medical history, and other test results by a healthcare professional to see if treatment is needed.
One way or the other do not let it get too out of hand before treating it!
If mine were +1 and I felt ok I would not do IV or oral treatment but I would inquire about inhaled antibiotics to prevent it becoming worse. And of course airway clearance twice a day with saline etc.