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Approaches to reduce time to diagnosis and initiation of guideline-based treatment
The setting of individualized treatment goals in collaboration with patients
Improving efficacy and decreasing drug-related toxicity
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Airway and Lung Infection, Airway Disease, Bronchiectasis, Chronic Cough CE/CME accredited

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Management of patients with NTM-LD: Improving adherence for optimal outcomes

  • Downloads including slides are available for this activity in the Toolkit
Learning Objectives

After watching this activity, participants should be better able to:

  • Appraise strategies to reduce time to diagnosis for patients with NTM-LD
  • Utilize guideline recommendations when setting individualized treatment goals for patients with NTM-LD
  • Apply strategies to manage adverse events for improved outcomes and adherence in patients with NTM-LD
Overview

In this activity, expert pulmonologists respond to questions from the respiratory and infectious diseases community on reducing diagnostic delays for NTM-LD, setting individualized treatment goals and guideline-recommended treatment, and improving outcomes with effective monitoring and management of treatment-emergent side effects.

This activity is jointly provided by USF Health and touchIME. read more

Target Audience

This activity has been designed to meet the educational needs of pulmonologists, radiologists, infectious disease specialists, including specialist infectious disease nurses, and hospital pharmacists involved in the management of patients with NTM-LD.

Disclosures

USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

Faculty

Prof. Doreen Addrizzo-Harris discloses: Grants/research support from AN2 Therapeutics, Boehringer Ingelheim, HillRom and Insmed.

Dr Ashwin Basavaraj discloses: Advisory board/panel fees and consultancy fees from HillRom, Insmed, PhysioAssist and Zambon. Grants/research support from Hillrom.

Content reviewer

Angela M. Hill, Pharm.D., CRPh has no relevant financial relationships to disclose.

Touch Medical Director

Katrina Lester and Sola Neunie have no financial interests/relationships or affiliations in relation to this activity.

USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

If you have questions regarding credit please contact cpdsupport@usf.edu 

Accreditations

Physicians

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

USF Health designates this enduring material for a maximum of 0.75 AMA PRA Category 1 CreditTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 CreditTM into European CME credit (ECMEC) should contact the UEMS (www.uems.eu)

Advanced Practice Providers

Physician Assistants may claim a maximum of 0.75 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

Nurses

USF Health is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

A maximum of 0.75 contact hours may be earned by learners who successfully complete this continuing professional development activity. USF Health, the accredited provider, acknowledges touchIME as the joint provider in the planning and execution of this CNE activity.

This activity is awarded 0.75 ANCC pharmacotherapeutic contact hour.

Pharmacists

USF Health is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This knowledge-based program has been approved for 0.75 contact hours (0.75 CEUs).  Universal program number is as follows: 0230-0000-22-041-H01-P.

Date of original release: 30 November 2022. Date credits expire: 30 November 2024.

If you have any questions regarding credit please contact cpdsupport@usf.edu

This activity is CE/CME accredited

To obtain the CE credit(s) from this activity, please complete this post-activity test.

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  • Downloads including slides are available for this activity in the Toolkit

Topics covered in this activity

Airway and Lung Infection/ Airway Disease/ Bronchiectasis/ Chronic Cough
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touchIN CONVERSATION
Management of patients with NTM-LD: Improving adherence for optimal outcomes
0.75 CE/CME credit

Question 1/4
Your 60-year-old male patient fits the radiographic and clinical criteria for a diagnosis of NTM-LD. To confirm a diagnosis, you would like to obtain a sputum sample for laboratory assessment. Unfortunately, he is unable to produce sputum spontaneously. To avoid any diagnostic delays, which of the following actions would you take?

NTM-LD, nontuberculous mycobacterial lung disease.

The 2020 ATS/ERS/ESCMID/IDSA clinical practice guidelines recommend that sputum should be induced with hypertonic saline if spontaneous sputum specimens cannot be collected. Bronchoscopy should only be considered in exceptional circumstances and performed only in patients from whom sputum specimens cannot be obtained spontaneously or through induction.

Abbreviations

ATS, American Thoracic Society; ERS, European Respiratory Society; ESCMID, European Society of Clinical Microbiology and Infectious Diseases; IDSA, Infectious Disease Society of America.

Reference

Daley CL, et al. Eur Respir J. 2020;56:2000535.

Question 2/4
Your 70-year-old male patient is being treated for mild-to-moderate nodular-bronchiectatic MAC NTM-LD. He has been taking a three-drug macrolide-based regimen TIW for the last 6 months. Having obtained regular sputum cultures since treatment initiation, his most recent laboratory results show that the cultures remain positive. What do you do next?

ALIS, amikacin liposome inhalation suspension; MAC, Mycobacterium avium complex; NTM-LD, nontuberculous mycobacterial lung disease; TIW, three times a week.

The 2020 ATS/ERS/ESCMID/IDSA clinical practice guidelines recommend a three-drug macrolide-based regimen (GBT) for patients with macrolide-susceptible MAC NTM-LD, TIW in patients with nodular-bronchiectatic disease. Patients with severe/advanced disease should consider daily dosing.

ALIS is the only therapeutic agent approved by the FDA for treatment of refractory MAC NTM-LD, which is recommended as an add-on to the GBT regimen if sputum cultures remain positive after 6 months of GBT alone. Where ALIS is not yet available, guidelines recommend the addition of inhaled parenteral amikacin.

Abbreviations

ALIS, amikacin liposome inhalation suspension; ATS, American Thoracic Society; ERS, European Respiratory Society; ESCMID, European Society of Clinical Microbiology and Infectious Diseases; FDA, US Food and Drug Administration; GBT, guideline-based treatment; IDSA, Infectious Disease Society of America; MAC, Mycobacterium avium complex; NTM-LD, nontuberculous mycobacterial lung disease; TIW, three times a week.

Reference

Daley CL, et al. Eur Respir J. 2020;56:2000535.

Question 3/4
In your patients with cavitary macrolide-susceptible MAC NTM-LD taking a daily, three-drug, macrolide-based regimen and IV amikacin TIW, how would you determine whether the treatment regimen is working?

IV, intravenous; MAC, Mycobacterium avium complex; NTM-LD, nontuberculous mycobacterial lung disease; TIW, three times a week.

The 2020 ATS/ERS/ESCMID/IDSA clinical practice guidelines recommend obtaining sputum specimens every 1–2 months to monitor for culture conversion and thereby determine the duration of therapy. The recommendation is to continue treatment for at least 12 months after culture conversion.

Abbreviations:

ATS, American Thoracic Society; ERS, European Respiratory Society; ESCMID, European Society of Clinical Microbiology and Infectious Diseases; IDSA, Infectious Disease Society of America.

Reference

Daley CL, et al. Eur Respir J. 2020;56:2000535.

Question 4/4
How frequently should patients be monitored for side effects of anti-NTM drugs?

NTM, nontuberculous mycobacteria.

The 2020 ATS/ERS/ESCMID/IDSA clinical practice guidelines recommend that monitoring for side effects of anti-NTM drugs should be individualized based on age, comorbidities, concurrent drugs, overlapping drug toxicities and resources. The guidelines state that no studies, to date, have identified the optimum frequency or most cost-effective approach to monitoring for drug-related adverse reactions.

Abbreviations

ATS, American Thoracic Society; ERS, European Respiratory Society; ESCMID, European Society of Clinical Microbiology and Infectious Diseases; IDSA, Infectious Disease Society of America; NTM, nontuberculous mycobacteria.

Reference

Daley CL, et al. Eur Respir J. 2020;56:2000535.

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