Non-tuberculous Mycobacteria in Patients With Severe Eosinophilic Asthma Under Biological Treatment
Bibliographic record
Abstract
Abstract RATIONALE: The incidence and prevalence of pulmonary infections due to non-tuberculous mycobacteria (NTM) are rising globally. NTM can be found in the sputum of patients with severe eosinophilic asthma undergoing biological treatment. This study aims to determine whether blood eosinophilia and corticosteroid use correlates with pulmonary NTM colonization or infection. METHODS: This retrospective case-control study involves patients diagnosed with severe asthma undergoing biological treatment and follow-up by respirologists in Sherbrooke University Hospital, Canada. We included patients with mycobacterial sputum cultures and collected variables from their electronic health record. The primary outcome was the association between NTM culture positivity and blood eosinophil counts, while the secondary outcome examined the impact of oral (OCS) and inhaled (ICS) corticosteroids on culture positivity. Relative risk (RR) [95% confidence intervals (CI)] were computed using univariable modified Poisson regression. RESULTS: Out of the 47 patients recruited, 22 (47%) were women and the median age was 67 years [57-72]. The median FEV1% was 70 [49-86] and the median maximum lifetime eosinophilia was 0.66 [0.40-0.90]. Lifetime maximum eosinophilia was not significantly associated with positive NTM cultures (RR = 1.27 [0.71-2.27]; p = 0.4). Among our population, 20 (44%) patients were OCS dependent. We found that every 10 mg increase of long-term OCS therapy rises the risk of a positive NTM culture by 82% (RR = 1.82 [1.14-2.91]; p = 0.01). Stated differently, every 1 mg step-up increases the risk of NTM-positive status by 6% (RR = 1.06 [1.01-1.11]; p = 0.01). Patients with current or past corticosteroid dependence seemed to double their risk of NTM positivity (RR = 2.00 [0.81-4.94]; p = 0.1) but did not reach statistical significance. Interestingly, patients with positive bacterial airway cultures were over four times more likely to develop positive NTM cultures (RR =4.50 [1.15-17.57]; p = 0.03). Additionally, 9 out of 16 (56%) patients with initially positive mycobacterial cultures subsequentially tested negative, 7 out of 9 (78%) without treatment. There was no association between high-dose ICS and NTM-positive status (RR =0.65 [0.26-1.63]; p = 0.4). NTM-positive status did not significantly correlate with increased exacerbations (RR= 1.17 [0.72-1.87]; p = 0.5). CONCLUSION: Our findings confirm a trend between OCS dependence and positive NTM sputum cultures in severe asthma on biological therapy. The high rate of concomitant positive bacterial and NTM cultures highlights the need to minimize OCS use in severe asthma and follow current corticosteroid-sparing guidelines.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".