Abstract
INTRODUCTION: Treatment of non-tuberculous mycobacterial pulmonary disease (NTM-PD) is often complex, relying on long treatment courses with multiple antibiotics, which are associated with treatment intolerance and failure. Current guidelines provide limited insight into non-pharmacological treatment, which is believed to be an important component of symptom control and is related to treatment outcomes with an established evidence base in other chronic respiratory diseases. METHODS: The authors conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify studies on non-pharmacological interventions for NTM-PD, focusing on airway clearance techniques, pulmonary rehabilitation, nutritional support and psychological care. RESULTS: There was little evidence regarding the impact of non-pharmacological interventions in NTM-PD. We identified three studies that described a positive impact of airway clearance techniques, including oscillating positive expiratory pressure, chest physical therapy with devices such as Acapella and Flutter, as well as chest oscillatory techniques (e.g. Vest) and hypertonic saline nebulisation. We found no relevant studies in NTM-PD reporting the use of nutrition, pulmonary rehabilitation or psychological care as interventions in this group of patients. CONCLUSIONS: Non-pharmacological interventions show potential in managing NTM-PD, although significant evidence gaps remain. This review highlights the importance of expanding high-quality studies on the use of these interventions to people with NTM-PD.