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Bacteria belonging to the genus Mycobacterium are predominantly responsible for pulmonary diseases; most notably Mycobacterium tuberculosis causes granulomatous pulmonary infections. Here we describe a novel slow growing mycobacterial species isolated from respiratory samples from five patients, four with underlying pulmonary disease. The isolates were characterized by biochemical and molecular techniques, including whole genome sequencing. Biochemical characteristics generally match those of M. marinum and M. ulcerans; however, the most striking difference of the new species is its ability to grow at 37°C. The new species was found to grow in human macrophages, but not amoebae, suggesting a pathogenic rather than an environmental lifestyle. Phylogenetic analysis reveals a deep-rooting relationship to M. marinum and M. ulcerans. A complete genome sequence was obtained through combining short and long-read sequencing, providing a genome of 5.6 Mb. The genome appears to be highly intact, syntenic with that of M. marinum, with very few insertion sequences. A vast array of virulence factors includes 283 PE/PPE surface-associated proteins, making up 10% of the coding capacity, and 22 non-ribosomal peptide synthase clusters. A comparison of six clinical isolates from the five patients shows that they differ by up to two single nucleotide polymorphisms, suggesting a common source of infection. Our findings are in accordance with the recognition of a new taxonomic entity. We propose the name M. basiliense, as all isolates were found in patients from the Basel area of Switzerland.

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Zusammenfassung. Die inhalative Therapie ist nach wie vor sowohl bei der COPD als auch beim Asthma eine wichtige Säule der Behandlung. Bei Asthma Patienten stehen primär die inhalativen Kortikosteroide im Vordergrund der Behandlung, während bei COPD Patienten vor allem Bronchodilatatoren eingesetzt werden. In den letzten Jahren änderte sich der Stellenwert der inhalativen Kortikosteroide in der COPD- Therapie immer wieder und aktuell scheinen sie für eine Subgruppe von Patienten wieder mehr an Bedeutung zu gewinnen. Auch bei den inhalativen Therapien wird man sich in Zukunft zunehmend an Biomarkern orientieren. Neu auf dem Markt sind die «Triple Therapien als Fixkombinationen», deren Erfolg sich in den nächsten Jahren zeigen wird. Trotz der grossen Vielfalt an neuen Wirkstoffen, neuen Kombinationen und neuen Inhalationssystemen, ist es wichtig eine gute Übersicht zu behalten und den individuellen Nutzen des Patienten in den Mittelpunkt zu stellen. Ziel ist es aus der Fülle der Angebote, die für den individuellen Patienten geeigneten Präparate in einer für ihn ideal anwendbaren Darreichungsform zu finden. Eine korrekte Inhalationstechnik und Adhärenz zum verschriebenen Therapieplan ist für den Erfolg der inhalativen Therapie entscheidend.

Objective: The aims of the survey were to assess first experiences of Swiss COPD patients switching from the disposable to the new reusable Respimat inhaler, and to evaluate physicians and patients views of the new training material. Methods: Patients with a confirmed diagnosis of COPD using a disposable Respimat inhaler for at least three months were included. Patients demographics, COPD stage, current treatment, and comorbidities relevant for the handling of the device were assessed. Further, patients were trained on the reusable Respimat by placebo inhaler, patient brochure, video cards/demo films and SMS reminder service. After at least one cartridge change, patients gave comprehensive feedback on their satisfaction with the reusable Respimat and physicians evaluated the need for re-training. Results: 235 patients participated in the survey. Of these, 37% suffered from comorbidities restricting the handling of the Respimat. 216 (92%) patients had a better overall satisfaction with the reusable than with the disposable Respimat. Dose counter (86%), monthly preparation (81%) and daily handling (77%) were also assessed as better by most of the patients. In 80% of cases, the user ability was stated as better than for the disposable Respimat. Less than 15% of the patients required further training. Placebo inhaler was the mostly preferred training material by both, physicians (in 86% of the patients) and patients (75%). In patients with comorbidities affecting inhaler handling, overall satisfaction was also better in 86% of the patients. Conclusion:The majority of patients were satisfied with the new reusable Respimat device and proper handling could be attained using the provided training material, even in patients with restricting comorbidities.