Association between Inhaled Corticosteroid Use and Pulmonary Nontuberculous Mycobacterial Infection.
Ann Am Thorac Soc. 2018 Sep 14;:
Authors: Liu VX, Winthrop KL, Lu Y, Sharifi H, Nasiri HU, Ruoss SJ
RATIONALE: Nontuberculous mycobacterial (NTM) pulmonary disease prevalence is increasing.
OBJECTIVES: To determine the association between the use of inhaled corticosteroids (ICS) and the likelihood of NTM pulmonary infection among individuals with treated airways disease.
METHODS: We conducted a case-control study of airway disease subjects with and without NTM pulmonary infection (based on mycobacterial respiratory cultures) between 2000 and 2010 in Northern California. We quantified the use of ICS, other airways disease medications, and healthcare utilization within six months of NTM pulmonary infection identification. We used 1:10 case:control matching and conditional logistic regression to evaluate the association between the duration and cumulative dosage of ICS use and NTM pulmonary infection.
RESULTS: We identified 248 cases with NTM pulmonary infection with an estimated rate of 16.4 cases per 10,000 airway disease-treated subjects. The median interval between treated airway disease cohort entry (defined as date of patient filling the third airways disease treatment prescription) and NTM case identification was 1,217 days. Compared with controls, subjects with NTM pulmonary infection were more likely to use airway disease medications including systemic steroids; they were also more likely to utilize healthcare. Any ICS use between 120 days and two years prior to cohort entry was associated with substantially increased odds of NTM infection. For example, the adjusted odds ratio for NTM infection among ICS users in a two year interval was 2.51 (95% confidence interval: 1.40-4.49; p<0.01). Increasing cumulative ICS dose was also associated with greater odds of NTM infection.
CONCLUSIONS: ICS use, and particularly high dose ICS use, was associated with increased risk of NTM pulmonary infection.
PMID: 30213194 [PubMed - as supplied by publisher]