Would you start treatment for MAC in a patient with nodular bronchiectatic disease who has demonstrated radiographic progression but remains asymptomatic and smear-negative?

My default answer would be yes; this is a sign of progressive disease that will get worse without treatment. Having said that many things could be considered while making the decision, including patient preferences. First is there another cause? Does the patient have an exacerbation of bronchiectasi...

Before I consider treatment, I would ask the following:

1. Is the radiologic progression obvious and significant (as opposed to waxing-waning or minor changes)?
2. Even if the sputum cultures are smear-negative, are they culture-positive for MAC repeatedly (at least twice)?
3. Are alternative etiologies rule...

I agree with Dr. @Dr. First Last. I would speak with the patient and have an open conversation about treatment. At the end of the day, the patient is the one who is going to be taking a prolonged course of medication, and if asymptomatic, without any clinical benefit they can see. I would also weigh...