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Inhaled corticosteroids linked to higher infection risk

People using ICS at much greater risk of developing non-TB mycobacteria lung infections

Louise Prime

Friday, 14 September 2018

People who use inhaled corticosteroids (ICS) to treat asthma or other breathing problems might be more likely to develop non-tuberculous mycobacteria (NTM) lung infections, US research has suggested. The authors of the study*, published today in the Annals of the American Thoracic Society, urged doctors to be alert to the increased risk for infections and monitor for routine and mycobacteria infections. And, given the uncertainty regarding possible benefits of ICS in chronic obstructive pulmonary disease (COPD), they called for a reanalysis of the broad use of ICS in chronic airways diseases.

The researchers noted that two recent studies have investigated the potentially increased risk of NTM disease in patients with COPD, in different populations. Because of emerging support for the hypothesis that ICS use can increase the risk of NTM disease in patients with chronic airways disease, they sought to determine whether this potential causative association could be confirmed in a separate and large patient population.

A research team analysed the health records of 549 people who had been diagnosed with a lung infection between 2000 and 2010 in northern California. They quantified the use of inhaled corticosteroids, other airways disease medications, and healthcare utilisation within six months of NTM pulmonary infection identification, and using these data conducted a case-control study of airway disease subjects with and without NTM pulmonary infection (based on mycobacterial respiratory cultures).

They found that people with NTM pulmonary infection were more likely than controls to use airway disease medications including systemic steroids – the odds of developing NTM pulmonary infection were 2.7 times greater in those patients who had filled three or more prescriptions for an inhaled steroid – and they were also more likely to utilise healthcare. Although any ICS use between 120 days and two years prior to cohort entry was associated with substantially increased odds of NTM infection there was a dose-response association between ICS use and risk of NTM infection – the longer the patient was on an inhaled steroid and the higher the dose, the more likely they were to develop an NTM lung infection.

The authors pointed out that as theirs was a retrospective study it could not show cause and effect. But they concluded: “In summary, our study found that ICS use was associated with a substantial increased risk of NTM pulmonary infection. In the face of uncertainty regarding possible benefits of ICS in COPD, these data argue for a reanalysis of the broad use of ICS in chronic airways diseases.”

*Liu VX, Winthrop KL, Lu Y, et al. Association between inhaled corticosteroid use and pulmonary nontuberculous mycobacterial infection. Annals of the American Thoracic Society Published online: September 14, 2018. DOI:10.1513/AnnalsATS.201804-245OC

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