The next iteration of CHEST’s Bridging Specialties® program will be targeting two often misdiagnosed lung conditions: nontuberculous mycobacterial (NTM) disease and bronchiectasis. It was created because the problem with both disease states is they can easily look like something else, especially to primary care physicians (PCPs).
“These patients are often [people who don’t smoke and] who won’t have other pulmonary diseases, and we want [providers] to understand these conditions so they’re not routinely misdiagnosing asthma, COPD, or bronchitis,” said Doreen J. Addrizzo-Harris, MD, FCCP, Professor of Medicine at NYU Grossman School of Medicine, Chair of the Steering Committee, and CHEST Past President.
Common symptoms, common misdiagnosis
Some patients with NTM pulmonary disease can carry an infection for years—or decades—and not be symptomatic, while others suffer gravely with symptoms that can include fatigue, night sweats, shortness of breath, weight loss, and cough. Similarly, bronchiectasis can be a symptom of more than 20 different conditions, including antibody deficiencies, autoimmune disorders, childhood infections, or genetics. Because these symptoms can be chalked up to other common maladies, including asthma, COPD, or recurring bronchitis, Dr. Addrizzo-Harris said that it can take as long as 10 years for someone to get a correct diagnosis.
NTM pulmonary disease and bronchiectasis are commonly diagnosed by sputum culture or by a CT scan, neither of which are routine tests ordered by PCPs. “If a patient is coughing for years and gets a chest [radiograph], it will often miss the diagnosis,” Dr. Addrizzo-Harris said.
Getting a correct diagnosis early can be life-altering. “Many of the patients have been to many physicians over the years, and by the time they come to us, they have lost a significant portion of lung function,” she said. “Early diagnosis can help preserve that lung function and help patients resolve symptoms more quickly, and both improve and preserve their quality of life.”
Expanding the Bridging Specialties series
To address the gaps in diagnosis of both conditions, CHEST launched a new addition to its Bridging Specialties series: Timely Diagnosis for NTM Pulmonary Disease and Bronchiectasis. The goal of each Bridging Specialties program is to connect specialists to PCPs to reduce time to diagnosis and improve patient care.
“It’s important to educate our primary care physicians so they know that bronchiectasis is one of the causes of cough, especially in patients who have recurring episodes,” Dr. Addrizzo-Harris said. The goal of the program is for more people within health care to remember NTM pulmonary disease and bronchiectasis as possible diagnoses. Perhaps this will encourage PCPs to order a CT scan or sputum culture or refer patients to a pulmonologist as soon as they present symptoms.
The program also addresses important questions such as what to do if a physician inadvertently finds nonsymptomatic NTM pulmonary disease through a patient’s unrelated CT scan or sputum culture: Do you treat the patient now (often through a multiantibiotic drug course) or track them through regular check-ins until the condition turns symptomatic?
Dr. Addrizzo-Harris added that this Bridging Specialties installation is a “novel way” to get NTM pulmonary disease and bronchiectasis on the mind of health care professionals “with many different tools for learning, whether it’s a podcast—which you can listen to in your car—whether it’s a webinar, [or] whether it’s a patient case that you do online,” she said. “I really think it makes it very easy for the learner to get this information.”
Keeping NTM and bronchiectasis top of mind
In addition to PCPs, Dr. Addrizzo-Harris also hopes that this Bridging Specialties program will be used by the entire care team, including advanced practice providers, respiratory therapists, nutritionists, and research staff. And because bronchiectasis can be caused by so many different conditions, she hopes it’s taken up by immunology, gastroenterology, and rheumatology professionals too.
The ability to be picked up by so many people outside of pulmonology “really makes it phenomenal,” she said.
CHEST gratefully acknowledges the following supporters of Bridging Specialties: Timely Diagnosis for NTM Pulmonary Disease and Bronchiectasis.
Supported by Insmed Incorporated
