This blog post was written by Katie Keating, RN, MS, patient advocate

Summary taken from presenter Rachel Thomson, PhD, MBBS, NTM/Bronchiectasis Patient Conference, May 2019, entitled Environmental Factors & Reducing Exposure

Awareness and prevention of NTMs has changed over the years. While it has been widely known that NTM is widespread in the environment, only more recently are physicians and researchers becoming more interested in where the bacteria actually live and thrive. Research has been conducted to determine this, but more studies are necessary. In addition, to further complicate this issue, not all NTM species have been associated with NTM lung disease. The question patients and their care team face daily is if these organisms are everywhere, how do we control our exposure and prevent new infections? To further complicate the issues, NTM organisms are ubiquitous and are resistant to chlorine, chloramine and chlorine dioxide, which are all used in the disinfection process. In fact, it NTM organisms can grow within the very small diameter within water pipes. Unfortunately, NTM is found in many places, some of which may surprise you. There is hope in preventing infection and precautions that can be taken to prevent contact and ultimately new infection. Rachel Thompson, PhD, MBBS spoke at the NTM/Bronchiectasis Patient Conference in May 2019, about the environmental factors of NTM and reducing exposure. Dr. Thompson's presentation is publicly available here.

Potential sources for NTM:

· Refrigerator —Especially water/ice systems filters. Some recommend that filters be changed frequently if you use ice or water from inset refrigerator door systems.

· Plastic drinking water filters — Some also recommend replacing granular activated carbon filter every two weeks, as NTM can attach to carbon filters.

· Mesh aerators— Also recommended to be replaced every couple of weeks

· Inhaled aerosols — Many patients avoid hot tubs, but especially those indoors, as bacteria tend to thrive in hot and humid environments.

· Showerhead— Another common source for NTM in the household is in showerheads. Biofilms and the steam during showers can transmit NTM. For this reason, many recommend cleaning showerheads regularly. One method for cleaning is to, hook your showerhead around a plastic bag and soak your showerhead with vinegar for 60 minutes; do not use bleach. Bleaching NTM over time may make them resistant. Some have also found it useful to replace showerheads periodically. It is also important to use adequate ventilation, such as a fan or an open window in the bathroom.

· Soil/planting, particularly peat rich soils —Since NTM are common in soil, many avoid contact with soils if possible. Others have not given up gardening but do use an N95 mask and gloves when exposed to soil. Wetting the potting soil or peat moss before transferring it also helps to limit dust from the soil.

· House dust —As with many chronic lung diseases, it may help to have others do the vacuuming, if possible.

· Stagnation of tap water —NTM can find homes in stagnant water. Some recommend flushing taps for five minutes in basement areas if the water has not been used overnight.

· Nebulizers —As with any medical equipment, it is important to keep it clean. Some use baby bottle sterilizers, or boil for five minutes. The dishwasher is also safe if it heats to over 158 degrees Fahrenheit/70 degrees Celsius.

· Humidifiers—Portable or in-home humidifiers have been known to create an environment for NTM; so many opt out of using humidifiers.

· Steam from an iron or steamer— Irons may aerosolize NTM, so some use distilled water and wear a mask to be extra cautious while ironing.

· Indoor pools— As mentioned previously, chlorine does not kill NTM, so many decide not to swim in indoor pools.

It is clear that there are quite a lot of possible ways to be exposed to NTM. This can be frightening and the likelihood is that the list above is not comprehensive and there may be other exposures that we need to be aware of and try to avoid. Anyone who has been challenged by NTM, who has experienced the fatigue associated and with NTM and the long-term side effects of medications, should take every single measure to avoid going down this exhausting path again. That said, we hope that the information provided here contributes to continued vigilance and awareness of possible sources of NTM infection.

The COPD Foundation advises that before you make any changes to your medication or therapies that you first consult with your doctor.