Bronchiectasis, Nontuberculosis Mycobacteria (NTM), and Exercise

Isabelle LeClerc

Isabelle LeClerc


Isabelle LeClerc, RN leads a chronic disease self-management program in an Academic Primary Care Center in Ottawa. Her main areas of interest are Bronchiectasis and Chronic Non-Cancer Pain self-management education. Her passion for helping patients manage their health has taken her around the world, to the World Bronchiectasis Conferences in Germany, Italy and the USA, including participating in the panel discussion during the patient session at the 3rd World Bronchiectasis Conference, in Washington DC in 2018.

Bronchiectasis, Nontuberculosis Mycobacteria (NTM), and Exercise


For someone experiencing symptoms of bronchiectasis or NTM, finding the drive to exercise may require some inspiration; but understanding the disease and the benefits of exercise should help to get you moving.

What is Bronchiectasis?


Bronchiectasis is a chronic lung disease where the main airways of the lungs (the bronchi) become dilated or inflamed. This causes mucous to build-up in the lungs which in turn starts a vicious cycle of lung infections, more inflammation, and more infections. Bronchiectasis is not curable, but it is manageable.


What is Nontuberculosis Mycobacteria (NTM)?


NTM are a group of environmental bacteria found in soil, tap water, and dust. NTM can be found in most water sources in the home such as water heaters which transport NTM to showers and taps like the kitchen and bathrooms sinks. NTM can also be found in outside soil as well as soil in indoor plants.


There are many species of NTM, and these bacteria are difficult to treat. Some people are more susceptible to these infections. Thankfully, NTM is NOT contagious and cannot be transmitted from person to person.


Since NTM is not contagious, you may be wondering how someone might come into contact with it and become infected.

Because NTM is found in our environment, some people will come into contact with it when inhaling the aerosolized bacteria while gardening by turning over soil. Others might contract it by inhaling it when water is vaporized from showers, swimming pools, hot tubs, humidifiers, or simply when using the kitchen sink sprayer.

Bronchiectasis and NTM

    People who already have bronchiectasis have mucous in their lungs and this is an ideal home for bacteria to grow. Studies show that people with bronchiectasis in the right middle lobe and lingula, who have a low body weight, are more at risk from getting NTM; this is called Lady Windermere Syndrome. (5)

    Bronchiectasis can have many aetiologies, but most people with an NTM infection have idiopathic bronchiectasis (generally of an unknown cause) or they already have an immune disorder that has caused their bronchiectasis.



    • Daily cough with thick, sticky mucous
    • Fatigue or lack of energy
    • Shortness of breath, wheezing, chest pain around the ribs
    • Weight loss, loss of appetite and usually a low body mass index (BMI)
    • Night sweats or fever
    • Recurrent lung infections
    • Sometimes presence of hemoptysis (coughing up blood)

    Can we successfully treat or eradicate NTM?


    The goal of treating NTM is culture conversion vs culture eradication. The treatment consists of taking three antibiotics daily for a period of 12-18 months. People may show a negative sputum culture during the treatment or after treatment.

    Relapse or reinfection can occur with NTM same species or new species in the future. There are specific guidelines as to who will need treatment for NTM Pulmonary Disease (1)

    Not everyone with NTM-PD needs to start treatment, sometimes the decision will be made for “watchful waiting” for people with mild symptoms, or who have a higher potential for medication intolerance and NTM species that are less responsive to treatment. (1)


    Side effect of treatment


    • There can be many side effects to the treatment for NTM. Some people can experience vision loss, tinnitus, hearing loss and for this reason, partnering with a pulmonologist is key.
    • The decision to start antibiotic therapy should be individualized on the basis of risk for progression and the patient priorities.


    Airway Clearance Technique


    Clearing the lungs can be done with airway clearance techniques (ACT). Done daily, this will help remove bacteria that settles in the mucous.  Getting the mucous out of the lungs should decrease coughing during the day and in turn can reduce shortness of breath, fatigue and reduce the NTM load.


    There are many airway clearance techniques such as:

    • Breathing exercises like active cycle of breathing technique (ACBT), and autogenic drainage (AD).
    • Postural drainage, which is done by lying in a specific position to let the mucous drain by gravity. This can be done with another technique at the same time. Postural drainage is not recommended for certain people; those with reflux should not practice lying down flat to prevent aspirating food content and NTM into their lungs.
    • There are also specific devices called Oscillating Positive Expiratory Pressure devices (OPEP devices), that can help get the mucous out of the lungs. When breathing through an OPEP device, it will help keep airways open and the vibrations from the device will loosen up the mucous and move it up the airways so it can be coughed out.
    • Breathing a specific salt solution called hypertonic saline or normal saline with a nebulizer can also assist with thinning out the thick mucus. In one study using hypertonic saline inhalation appeared to be beneficial; it may even enhance sputum conversion in patients with NTM. (3)


    Exercise: Barriers & Benefits


    Exercise helps loosen up the infected mucous from the lungs and can help reduce infections when that mucous is coughed out. While this seems like an ideal way to clear the airways, coughing in public can be embarrassing and some people prefer to exercise at home so they can feel comfortable with mucous clearance.

    Muscle weakness including respiratory muscles, and reduced exercise tolerance are common with bronchiectasis. (4) (5) Sometimes fatigue, shortness of breath, and a daily cough can hinder the motivation to participate in an exercise program or plan an exercise routine.

    An exercise program of activities that involves physical exertion and muscle contractions, lower and upper limb endurance exercise and strength training can improve physical function, exercise tolerance, and reduce respiratory symptoms. (4)(5) For someone who has never exercised in the past, it can be daunting to start without knowing how to perform certain exercises. For those who don’t have recent experience exercising regularly, focus should be on starting a regimen at the right level, with a plan to increase strength and endurance over time.


    What You Need to Remember


    Although NTM is in the environment, in tap water and soil, not everyone with NTM needs to undergo treatment with antibiotics. While Airway Clearance is the mainstay of treatment for Bronchiectasis and NTM, exercise provides several positive outcomes specific to the condition. Endurance and strength exercise training can improve muscle strength and aerobic capacity, reduce shortness of breath, fatigue and improve quality of life. (4) An exercise programme combined with education sessions will promote positive changes in health behaviours. Together they show the most benefit to the self-management of bronchiectasis and NTM.


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