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Non-tuberculous mycobacterial lung disease in frailty — SCE Geriatric Medicine MCQ

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HardRespiratory medicineNon-tuberculous mycobacterial lung disease in frailtySCE Geriatric Medicine

An 82-year-old woman with bronchiectasis and frailty is admitted with productive cough, weight loss and haemoptysis. CT chest shows tree-in-bud nodularity and sputum cultures repeatedly grow non-tuberculous mycobacteria. She has hearing impairment, CKD3 and takes amiodarone. What is the most appropriate management?

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Correct answer: E — Refer to respiratory infection specialists to confirm disease and weigh multidrug treatment risks against symptoms and goals

NTM pulmonary disease requires compatible symptoms, radiology and microbiology, but treatment is prolonged, toxic and should be specialist-led. Frailty, hearing impairment, CKD and drug interactions materially affect risk-benefit decisions. Macrolide monotherapy risks resistance. The pearl is that in older adults, microbiological diagnosis does not automatically mandate burdensome treatment without goals-of-care discussion.

Reference: BTS NTM guideline; NICE NG56; BNF