New Yale Program Addresses Rare Lung Infection

The new Yale Bronchiectasis and NTM Infections Program at the Winchester Center for Lung Disease specializes in treating patients with chronic respiratory tract infections, including one caused by nontuberculous mycobacteria (NTM).

NTM are organisms that can be found in soil and water sources, such as reservoirs, explains Ashley Losier, MD, assistant professor of medicine (pulmonary, critical care and sleep medicine), who directs the new program. Unlike tuberculosis, which is contagious, NTM infections are usually acquired from the environment rather than people, she said. Most NTM infections in the U.S. are caused by Mycobacterum avium complex (MAC), a slow-growing bacteria that is underdiagnosed. Everyone is exposed to NTM, but the bacteria generally causes disease in people with underlying conditions.

“There are host factors that put people at risk for these respiratory illnesses,” Losier said. “NTM typically impacts people with chronic lung diseases such as bronchiectasis, a structural condition in which the lungs have difficulty clearing mucus.”

Symptoms of the infection include chronic cough, fatigue, fever, night sweats, and weight loss. Patients with frequent chest infections or chronic cough are often referred to the program when imaging abnormalities lead to suspicion of the infection, Losier said.

“Then we are sent down a pathway of trying to obtain the diagnosis, which typically requires multiple sputum samples being positive or a bronchoscopy with a positive result,” Losier said, adding that the infection can be hard to identify due to its symptoms, which vary from person to person and can be similar to those of other conditions.

The new program allows Losier to work closely with Marjorie Golden, MD, associate professor of medicine (infectious diseases), James Shepherd, MD, PhD, associate professor of medicine (infectious diseases), and other colleagues across Yale to develop a streamlined approach to acquiring diagnoses and to developing optimal treatments, which often require extended periods of complex antibiotic regimens.

“We’re able to offer patient care that requires an involved approach from multiple disciplines,” she said.

To increase the chances of successful treatment, Losier and her colleagues counsel patients regarding multitiered strategies to combatting the disease—in addition to taking antibiotics, patients can maximize airway clearance and nutrition, and minimize aspects that contribute to their cough such as gastroesophageal reflux disease. Losier is also involved with patient advocate groups locally and nationally to collaborate on NTM patient education seminars.

“This cutting-edge program is more important now than ever, with the annual incidence and prevalence of NTM infections increasing, especially among women and older adults,” said Naftali Kaminski, MD, Boehringer Ingelheim Pharmaceuticals Inc. Professor of Medicine (Pulmonary) and chief of Pulmonary, Critical Care and Sleep Medicine.

Losier hopes the new program will positively impact her patients’ day-to-day living. “The symptoms of chronic cough can be debilitating, so we really strive to improve quality of life,” she said. “Developing a rapport with patients through long-term follow-up is the most rewarding part.”

As the program grows, Losier plans to increase clinical trials and education seminars at Yale to better serve patients. “We want to help people with these rare, underdiagnosed infections get access to new diagnostic techniques, therapies, and education that may not be available elsewhere,” she said.

The Section of Pulmonary, Critical Care and Sleep Medicine is one of the eleven sections within Yale School of Medicine’s Department of Internal Medicine. To learn more about Yale-PCCSM, visit PCCSM's website, or follow them on Facebook and Twitter.