Patrick A Flume, MD

Professor of Medicine and Pediatrics
Medical University of South Carolina
Powers-Huggins Endowed Chair for Cystic Fibrosis
University of South Carolina
Charleston, South Carolina

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Given the complexity, increasing recognition/prevalence and suboptimal understanding of MAC lung disease, can you summarize for us the disease burden, epidemiology, risk factors, and unmet needs for this infectious condition?

Patrick Flume, MD

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Which geographical regions of the U.S. is MAC lung disease particularly prevalent and what are the recognized risk factors? And why do some people acquire the infection while others do not?

Patrick A Flume, MD

Patrick Flume, MD

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Why is MAC lung disease, as a general rule, under-diagnosed and how can clinicians improve recognition of NTM pulmonary infection?

Patrick Flume, MD

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Based on the ATS and IDSA guidelines for ATM lung disease, what clinical symptomatology, microbiologic evidence, and/or radiographic findings should alert the clinician that the diagnosis of MAC lung disease should be considered?

Patrick Flume, MD

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In a patient in whom you suspect MAC lung infection, what is the preponderance of evidence and symptomatology you require to initiate antimicrobial therapy for NTM lung disease? Do all patients with MAC lung disease require treatment?

Patrick Flume, MD

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What is your protocol for establishing microbiological confirmation of MAC lung disease? How do you obtain samples and evaluate their quality? And what kind of samples do you obtain? How do you interpret the culture results?

Patrick Flume, MD

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What other conditions do you need to consider in patients referred to you for evaluation of NTM pulmonary disease? And what is the indication for bronchoscopy?

Patrick Flume, MD

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Do all patients with radiographic and microbiological confirmation of MAC lung infection receive and/or require antimicrobial therapy? Based on what clinical and/or radiographic and/or microbiological criteria should treatment be initiated?

Patrick Flume, MD

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What percentage of your patients with culture-proven MAC lung disease are treated? And why do you withhold treatment in some cases?

Patrick Flume, MD

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Are there specific radiographic findings—cavities, diffuse nodules, or expansion of pulmonary nodules—or other triggers in patients with culture-positive MAC lung disease that indicate a need for initiation of antimicrobial therapy?

Patrick Flume, MD

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What are the current expert- and consensus-based guidelines for initial anti-infective treatment of MAC lung infection? Are they current and are there variations that are accepted by pulmonary or infectious disease experts?

Patrick Flume, MD

$How do you intensify therapy in patients with MAC lung disease who have more advanced disease or disease that is demonstrated to be refractory to the initial three-drug regimen? What is the role of amikacin?$ Video

How do you intensify therapy in patients with MAC lung disease who have more advanced disease or disease that is demonstrated to be refractory to the initial three-drug regimen? What is the role of amikacin?

Patrick Flume, MD

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What strategies do you use to optimize tolerability of anti-MAC regimens? Do you ever deploy agents sequentially, or at lower doses, or reduced frequency, and if so, why? And for how long? How successful is this approach?

Patrick Flume, MD

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How do you monitor patients with MAC lung disease over the long term, and how do you make modifications to address poor drug tolerability? And how do you monitor the success, or lack thereof, of the antimicrobial treatment regimen?

Patrick Flume, MD

$How do you approach patients with MAC lung disease who are “treatment refractory” to their initial drug regimen?$ Video

How do you approach patients with MAC lung disease who are “treatment refractory” to their initial drug regimen?

Patrick Flume, MD

$When the patient shows progressive, symptomatic or radiographic disease, or the lack of antimicrobial conversion confirms treatment refractoriness with oral therapy, how do you decide between systemic IV amikacin and the liposome inhaled suspension?$ Video

When the patient shows progressive, symptomatic or radiographic disease, or the lack of antimicrobial conversion confirms treatment refractoriness with oral therapy, how do you decide between systemic IV amikacin and the liposome inhaled suspension?

Patrick Flume, MD

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What is the role of “adjunctive therapy”—that is, methods that should be used in addition to antibiotic-based treatment for MAC lung disease?

Patrick Flume, MD

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Once you have determined that amikacin is appropriate, what formulation of this antimicrobial do you consider? How do MOA and side effects differ between these options and does the MOA of liposome inhaled suspension confer advantages?

Patrick Flume, MD

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What is the evidence that the MOA—tissue penetration, intracellular tropism, concentration in macrophages—of amikacin liposome inhalation suspension translates into improved clinical outcomes in patients with MAC lung disease?

Patrick Flume, MD

$If we know that MAC-associated cavitary lung disease is a marker of poor outcomes and/or refractory disease at the time of initial presentation, what is the rationale for waiting before deploying the amikacin liposome inhalation suspension?$ Video

If we know that MAC-associated cavitary lung disease is a marker of poor outcomes and/or refractory disease at the time of initial presentation, what is the rationale for waiting before deploying the amikacin liposome inhalation suspension?

Patrick Flume, MD

$Given your experience with amikacin liposome inhalation suspension in the setting of early severe and/or treatment refractory MAC lung disease, can you discuss the design, efficacy, safety, results, and clinical applications of the CONVERT trial?$ Video

Given your experience with amikacin liposome inhalation suspension in the setting of early severe and/or treatment refractory MAC lung disease, can you discuss the design, efficacy, safety, results, and clinical applications of the CONVERT trial?

Patrick Flume, MD

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What new advances in treatment—including the availability of amikacin liposome inhalation suspension—and other innovations are positively reshaping our approach to managing MAC lung disease and helping reduce its considerable burden?

Patrick Flume, MD

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How do we optimize the clinical benefit of our current treatment regimens and what strategies do you recommend for making patients more adherent and improving tolerability of medications used for MAC lung disease?

Patrick Flume, MD

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Given the efficacy and need for effective therapies such as amikacin liposome inhalation suspension for MAC lung disease, what clinical strategies do you recommend for optimizing adherence, patient satisfaction, and tolerability for this formulation?

Patrick Flume, MD