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Correspondence |

Nontubercular Mycobacterial Pulmonary Infection in Severe Asthma FREE TO VIEW

Parameswaran Nair, MD, PhD
Author and Funding Information

From the Firestone Institute for Respiratory Health, McMaster University and St. Joseph’s Healthcare.

Correspondence to: Parameswaran Nair, MD, PhD, Firestone Institute for Respiratory Health, McMaster University and St. Joseph’s Healthcare, 50 Charlton Ave E, Hamilton, ON, L8N 4A6, Canada.


Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(3):721. doi:10.1378/chest.10-2364
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Published online

To the Editor:

In a recent article in CHEST (January 2011), Fritscher and colleagues1 identified a group of patients with severe asthma who also had pulmonary infection with nontubercular mycobacterial infection. They suggested that this be considered in older patients with more severe airflow obstruction who are on high doses of corticosteroids.

I have a cohort of 84 patients with severe asthma who require daily prednisone to control their eosinophilic bronchitis. The doses of corticosteroids are titrated to maintain sputum eosinophils < 1%.2 If they have increased total cell count (TCC) and neutrophils (N) in their sputum, they are investigated according to a protocol that includes a detailed microbiologic survey.3 I have identified two patients with Mycobacterium avium complex (one man [FEV1, 72% predicted; sputum TCC, 52 × 106/g; N, 82%] and one woman [FEV1, 62% predicted; sputum TCC, 34 × 106/g; N, 84%]); one patient with Mycobacterium xenopi (woman; FEV1, 70% predicted; sputum TCC, 70 × 106/g; N, 90%); and one patient with Mycobacterium abscessus (woman, FEV1, 67% predicted; sputum TCC, 29 × 106/g; N, 92%).

All four patients had intense neutrophilic bronchitis that persisted after the eosinophilic bronchitis was controlled with an optimal dose of corticosteroids. One patient had mild bronchial wall thickening. There were no other causes of airway neutrophilia. The median time from presentation to diagnosis was 5 months. I suggest that, in addition to the clinical criteria suggested by Fritscher and colleagues, persistent sputum neutrophilia should alert physicians to examine for intracellular pathogens such as nontubercular mycobacteria in steroid-dependent asthmatic patients.

Fritscher LG, Marras TK, Bradi AC, Fritscher CC, Balter MS, Chapman KR. Nontuberculous mycobacterial infection as a cause of difficult-to-control asthma: a case-control study. Chest. 2011;1391:23-27. [CrossRef] [PubMed]
 
Nair P, Hargreave FE. Measuring bronchitis in airway diseases: clinical implementation and application: airway hyperresponsiveness in asthma: its measurement and clinical significance. Chest. 2010;1382Suppl:38S-43S. [CrossRef] [PubMed]
 
Pallan S, Mahony JB, O’Byrne PM, Nair P. Asthma management by monitoring sputum neutrophil count. Chest. 2008;1343:628-630. [CrossRef] [PubMed]
 

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References

Fritscher LG, Marras TK, Bradi AC, Fritscher CC, Balter MS, Chapman KR. Nontuberculous mycobacterial infection as a cause of difficult-to-control asthma: a case-control study. Chest. 2011;1391:23-27. [CrossRef] [PubMed]
 
Nair P, Hargreave FE. Measuring bronchitis in airway diseases: clinical implementation and application: airway hyperresponsiveness in asthma: its measurement and clinical significance. Chest. 2010;1382Suppl:38S-43S. [CrossRef] [PubMed]
 
Pallan S, Mahony JB, O’Byrne PM, Nair P. Asthma management by monitoring sputum neutrophil count. Chest. 2008;1343:628-630. [CrossRef] [PubMed]
 
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