The following is a summary of “Inhaled nitric oxide for adults with pulmonary non-tuberculous mycobacterial infection,” published in the January 2023 issue of Pulmonology by Flume, et al.

Nontuberculous mycobacteria pulmonary disease (NTM-PD) was becoming more common in the US. Treatment for NTM-PD frequently involves many drugs, which could cause unpleasant morbidity and make infection eradication challenging. Therefore, there was a dire need for new effective, and well-tolerated medicines. Nitric oxide, breathed as a gas (gNO), had been indicated to have antibacterial action against NTM in recent in vitro research and case reports. In an open-label proof of concept experiment, researchers intended to examine the impact of gNO in patients with NTM-PD.

Participants who met the criteria had NTM-PD and consistently positive lung cultures for NTM while on antibiotic therapy. For 3 weeks, participants received treatment with gNO for 50 minutes, 5 days per week, for 3 weeks (total of 15 treatment days).

Ten subjects were enrolled, 9 of whom were receiving long-term NTM antibiotic treatment. Every participant finished the program without stopping or pausing. During therapy, there were only slight elevations in methemoglobin, which all returned to baseline in 2 hours. After 3 weeks of treatment, 4 patients (40%) achieved the primary outcome measure of negative sputum cultures. Three of these people were once again culture-positive during the post-therapy monitoring period of three months after treatment was stopped, albeit measurements indicated a low bacterial burden.

Despite having a highly resistant condition, patients tolerated a 3-week gNO treatment without any safety issues, and 4 of them finished the research with negative cultures, albeit 3 of them tested positive again in the following months. The findings encouraged more research into gNO as a possible treatment for NTM-PD.

Reference: resmedjournal.com/article/S0954-6111(22)00334-1/fulltext