TY - JOUR
T1 - Association between inhaled corticosteroid use and pulmonary nontuberculous mycobacterial infection
AU - Liu, Vincent X.
AU - Winthrop, Kevin L.
AU - Lu, Yun
AU - Sharifi, Husham
AU - Nasiri, Hekmat U.
AU - Ruoss, Stephen J.
N1 - Publisher Copyright:
Copyright © 2018 by the American Thoracic Society.
PY - 2018/10
Y1 - 2018/10
N2 - Rationale: Nontuberculous mycobacterial (NTM) pulmonary disease prevalence is increasing. Objectives: To determine the association between the use of inhaled corticosteroids and the likelihood of NTM pulmonary infection among individuals with treated airway disease. Methods: We conducted a case–control study of subjects with airway disease with and without NTM pulmonary infection (based on mycobacterial respiratory cultures) between 2000 and 2010 in northern California. We quantified the use of inhaled corticosteroids, other airway disease medications, and healthcare use within 6 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 inhaled corticosteroid use and NTM pulmonary infection. Results: We identified 248 cases with NTM pulmonary infectio with an estimated rate of 16.4 cases per 10,000 subjects treated for airway disease. The median interval between treated airway disease cohort entry (defined as date of patient filling the third airway disease treatment prescription) and NTM case identification was 1,217 days. Compared with control subjects, subjects with NTM pulmonary infection were more likely to use airway disease medications including systemic steroids; they were also more likely to use health care. Any inhaled corticosteroids use between 120 days and 2 years before cohort entry was associated with substantially increased odds of NTM infection. For example, the adjusted odds ratio for NTM infection among inhaled corticosteroid users in a 2-year interval was 2.51 (95% confidence interval, 1.40–4.49; P, 0.01). Increasing cumulative inhaled corticosteroid dose was also associated with greater odds of NTM infection. Conclusions: Inhaled corticosteroid use, and particularly high-dose inhaled corticosteroid use, was associated with an increased risk of NTM pulmonary infection.
AB - Rationale: Nontuberculous mycobacterial (NTM) pulmonary disease prevalence is increasing. Objectives: To determine the association between the use of inhaled corticosteroids and the likelihood of NTM pulmonary infection among individuals with treated airway disease. Methods: We conducted a case–control study of subjects with airway disease with and without NTM pulmonary infection (based on mycobacterial respiratory cultures) between 2000 and 2010 in northern California. We quantified the use of inhaled corticosteroids, other airway disease medications, and healthcare use within 6 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 inhaled corticosteroid use and NTM pulmonary infection. Results: We identified 248 cases with NTM pulmonary infectio with an estimated rate of 16.4 cases per 10,000 subjects treated for airway disease. The median interval between treated airway disease cohort entry (defined as date of patient filling the third airway disease treatment prescription) and NTM case identification was 1,217 days. Compared with control subjects, subjects with NTM pulmonary infection were more likely to use airway disease medications including systemic steroids; they were also more likely to use health care. Any inhaled corticosteroids use between 120 days and 2 years before cohort entry was associated with substantially increased odds of NTM infection. For example, the adjusted odds ratio for NTM infection among inhaled corticosteroid users in a 2-year interval was 2.51 (95% confidence interval, 1.40–4.49; P, 0.01). Increasing cumulative inhaled corticosteroid dose was also associated with greater odds of NTM infection. Conclusions: Inhaled corticosteroid use, and particularly high-dose inhaled corticosteroid use, was associated with an increased risk of NTM pulmonary infection.
KW - Bronchiectasis
KW - Chronic obstructive pulmonary disease
KW - Infection
KW - Inhaled corticosteroid
KW - Nontuberculous mycobacteria
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U2 - 10.1513/AnnalsATS.201804-245OC
DO - 10.1513/AnnalsATS.201804-245OC
M3 - Article
C2 - 30213194
AN - SCOPUS:85054731773
SN - 2325-6621
VL - 15
SP - 1169
EP - 1176
JO - Annals of the American Thoracic Society
JF - Annals of the American Thoracic Society
IS - 10
ER -