Have You Heard of Refractory NTM?

Posted on May 03, 2023   |   
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This post was authored by Christina Hunt, BS, RRT, Director of Bronchiectasis and NTM Research and Education.

The occurrence of nontuberculous mycobacteria (NTM) lung disease rises each year1, yet many have never heard of this condition. NTM are common bacteria found in soil and water sources (both residential and naturally occurring). The most common type of NTM is called Mycobacterium avium complex, or MAC for short. These bacteria can be inhaled into the lungs and cause an infection. Most people can inhale the bacteria without getting an infection, but if you have a pre-existing lung condition like COPD or bronchiectasis, you may be more likely to develop an NTM lung disease.2

When someone is diagnosed with an NTM lung infection that requires treatment, they are typically treated with multiple antibiotics at the same time. NTM are hard to kill, so it is expected that those who are being treated with medications stay on them for 12 months after their sputum cultures are clear of the bacteria.3 While on treatment, sputum will be collected regularly as part of routine monitoring. If, after 6 months of initial treatment, sputum samples remain positive, the patient is considered to have refractory NTM lung disease. When this happens, health care teams may choose to change and/or add to the type of medication that a person is taking.4 Health care teams hope that this treatment change will kill the NTM and that the sputum culture will show less NTM in the lung.

If NTM lung disease is left untreated, further damage can occur to the lungs. This may lead to the person with NTM lung disease having worsening lung function and quality of life. In select cases of refractory NTM lung disease, doctors may choose to surgically remove sections of the lung that seem to be extremely damaged.5 This procedure, also known as lung resection, is only done by highly qualified, skilled surgeons.

Currently, research studies are being conducted on NTM, including refractory NTM lung disease. You can learn more about these studies by visiting the Ongoing/Actively Recruiting Studies page. Have you ever been diagnosed with refractory NTM lung disease? Tell us more about your experience below.


  1. Winthrop KL, Marras TK, Adjemian J, Zhang H, Wang P, Zhang Q. Incidence and Prevalence of Nontuberculous Mycobacterial Lung Disease in a Large U.S. Managed Care Health Plan, 2008-2015. Ann Am Thorac Soc. 2020;17(2):178-185. doi:10.1513/AnnalsATS.201804-236OC
  2. Szturmowicz M, Oniszh K, Wyrostkiewicz D, Radwan-Rohrenschef P, Filipczak D, Zabost A. Non-Tuberculous Mycobacteria in Respiratory Specimens of Patients with Obstructive Lung Diseases-Colonization or Disease?. Antibiotics (Basel). 2020;9(7):424. Published 2020 Jul 20. doi:10.3390/antibiotics9070424
  3. Daley CL, Iaccarino JM, Lange C, et al. Treatment of nontuberculous mycobacterial pulmonary disease: an official ATS/ERS/ESCMID/IDSA clinical practice guideline. Eur Respir J. 2020;56(1):2000535. Published 2020 Jul 7. doi:10.1183/13993003.00535-2020
  4. Cowman S, van Ingen J, Griffith DE, Loebinger MR. Non-tuberculous mycobacterial pulmonary disease. Eur Respir J. 2019;54(1):1900250. Published 2019 Jul 11. doi:10.1183/13993003.00250-2019
  5. Kim JY, Park S, Park IK, et al. Outcomes of adjunctive surgery for nontuberculous mycobacterial pulmonary disease. BMC Pulm Med. 2021;21(1):312. Published 2021 Oct 6. doi:10.1186/s12890-021-01679-0