Asthma and Nontuberculous Mycobacterial (NTM) Lung Disease

As of 2021, more than 86,000 people in the United States are likely living with nontuberculous mycobacterial (NTM) lung disease. Plus, the number of people diagnosed with NTM – especially among women and older adults – is increasing each year.¹

What is NTM lung disease?

NTM lung disease is an infection that is caused by bacteria that are commonly found in the environment. The bacteria that cause NTM are invisible to the naked eye and aerosolized. This means the bacteria are commonly found in dust, water, and soil particles in the air.²

In most cases, these bacteria particles do not cause illness. In fact, people come into contact with this bacteria on a daily basis through everyday activities like gardening, using tap water, and showering. For most people, coming into contact with this bacteria does not affect them. Their lungs are healthy enough to clear the bacteria on their own.^2,3

But for those with underlying lung conditions or compromised immune systems, clearing NTM from the lungs is more difficult. The bacteria, when breathed in, can cause damage to the lungs.²

Symptoms of NTM include:^2,3

• Chronic cough
• Shortness of breath
• Excessive mucus
• Fatigue
• Respiratory infections that do not go away
• Weight loss
• Fever

NTM lung disease is a progressive disease. If symptoms are ignored or left untreated, NTM can worsen and may cause permanent damage to lungs over time. This could lead to scarring of the lungs and, eventually, respiratory failure.^1,2,3

How does NTM develop?

When a person with an underlying lung condition inhales NTM bacteria, the bacteria can infect the already damaged areas of the lungs and hide in the macrophages (the body’s immune cells) of the lungs. After disabling the macrophages’ defenses, the NTM bacteria multiply and spread, leading to an infection. NTM can also develop after a person has had severe pneumonia.²

People most at risk of developing NTM are those with underlying lung conditions and compromised immune systems. Women and people over the age of 65 seem to be more at risk as well.^1,2

Interestingly, a 2018 study found that inhaled corticosteroid (ICS) use – often a first defense against asthma symptoms – was linked to an increased risk of NTM infection.⁴

How are asthma and NTM lung disease related?

People with asthma and other lung conditions like chronic obstructive pulmonary disease (COPD) and bronchiectasis are more at risk of developing NTM lung disease. That is because these conditions make it easier for NTM bacteria to infect the lungs.²

Because NTM symptoms are so similar to these other lung conditions, it often goes undiagnosed or misdiagnosed for months and sometimes even years. Pay close attention to your symptoms and take note if anything feels different.²

One key sign of a possible NTM lung infection is if symptoms get worse. For example, you may have more flare-ups of excessive coughing or feel shortness of breath more often. Or, your persistent cough only gets worse despite medicine.⁵

What do you do if you are concerned that you have NTM lung disease?

If you are experiencing symptoms like coughing that does not go away, shortness of breath, fatigue, weight loss, or symptoms that do not get better with medicine, tell your doctor. Ask if getting tested for NTM lung disease is right for you.²

Your doctor may refer you to a pulmonologist or infectious disease specialist to get tested. This may involve a physical exam, a chest scan, and a mucus analysis. And, if you use an inhaler for your asthma, ask your doctor if the dosage is right for you and how often you should use it.

The sooner you are diagnosed, the sooner you can start getting proper treatment and on the road to feeling better.