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Life sciences · Journal article
Respiratory Medicine · October 5, 2026
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BACKGROUND: Non-tuberculous mycobacterial pulmonary disease (NTM-PD) is increasingly recognised, yet initiating antimycobacterial therapy remains challenging. Following a three-year period of national educational activity in Italy, we re-assessed which factors Italian clinicians perceive as relevant to the decision to start treatment. METHODS: We conducted a repeated cross-sectional web-based survey. The second wave was administered between November 2023 and February 2024 to members of the Italian SITA and IRENE networks, using the instrument administered in 2020. Participants rated the relevance of 47 clinical, radiological and microbiological variables to the initiation of NTM-specific treatment on a scale from 0 (not relevant) to 5 (extremely relevant). Ratings were compared with those of the 2020 wave using the Mann-Whitney U test with Benjamini-Hochberg correction. A change was pre-specified as meaningful only if the median shifted by at least one point, the proportion rating the item 4-5 differed by at least 10 percentage points, and the comparison remained significant after correction. RESULTS: Sixty-two clinicians responded in 2023 and 58 had responded in 2020; as the invitation was circulated through network mailing lists, no response rate could be computed. In 2023 the median age was 39.5 years (IQR 33.3-50.8), 34/62 (54.8%) were women and 42/62 (67.7%) were infectious diseases specialists. The most highly rated factors were a worsening radiological picture (88.7% rated 4-5), multiple consecutive samples positive for NTM (82.3%), cavities on chest imaging (77.4%), transplant-related immunosuppression (75.8%) and isolation of NTM from multiple sputum samples (75.8%); sex and a single positive sputum sample were rated lowest. Across the 47 items common to both waves, the median rating was identical for 34 and differed by half a point for a further four; nine items differed significantly after correction, always with lower ratings in 2023, and only one, HIV infection (median 5 to 4; 81.0% to 64.5% rating 4-5; q = 0.009), met the pre-specified definition of a meaningful change. CONCLUSIONS: The factors perceived by clinicians in these networks as relevant to starting treatment for NTM-PD were substantially unchanged after three years. Because the two waves were completed largely by different respondents, these findings describe the state of clinical perception following a period of educational activity and cannot be attributed to that activity. Perceptions corresponded closely to guideline criteria in the microbiological, radiological and symptomatic domains, whereas host-related factors that are not guideline criteria for treatment initiation continued to carry considerable weight.