M.R. Holt, S.H. Kasperbauer, C.L. Daley
European Respiratory Journal 2020; DOI: 10.1183/13993003.02196-2019
The recommended procedure for diagnosis of nontuberculous mycobacterial pulmonary disease (NTM-PD) is collection of three sputum samples on separate days . Sputum induction is suggested for patients unable to expectorate spontaneously. These recommendations align with evidence-based guidelines for pulmonary tuberculosis (TB)  but literature supporting their applicability to NTM-PD is lacking. In addition, the clinical utility of colony counts on solid media requires clarification. Early changes in semiquantitative colony counts are predictive of clinical and radiological improvement and treatment success  but the relationships of colony count with disease markers, such as smear status, have not been reported.
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Conflict of interest: Dr Holt has been an investigator in Insmed studies, outside the submitted work.
Conflict of interest: Dr Kasperbauer reports personal fees from Insmed, outside the submitted work.
Conflict of interest: Dr Daley has nothing to disclose.