Chronic respiratory disease, inhaled corticosteroids and risk of non-tuberculous mycobacteriosis

Background Chronic respiratory disease and inhaled corticosteroid (ICS) therapy for chronic obstructive pulmonary disease (COPD) increase the risk of pneumonia. Few data are available on the association of these risk factors with non-tuberculous mycobacterial (NTM) pulmonary disease. Methods This st...

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Bibliographic Details
Published in:Thorax Vol. 68; no. 3; pp. 256 - 262
Main Authors: Andréjak, Claire, Nielsen, Rikke, Thomsen, Vibeke Ø, Duhaut, Pierre, Sørensen, Henrik Toft, Thomsen, Reimar Wernich
Format: Journal Article
Language:English
Published: England BMJ Publishing Group Ltd and British Thoracic Society 01.03.2013
BMJ Publishing Group LTD
Subjects:
Administration, Inhalation
Aged
Androstadienes - therapeutic use
Anti-Inflammatory Agents - administration & dosage
Anti-Inflammatory Agents - adverse effects
Anti-Inflammatory Agents - therapeutic use
Asthma - drug therapy
Asthma - epidemiology
Atypical mycobacteria infections
bacterial infection
Bronchiectasis - drug therapy
Bronchiectasis - epidemiology
Budesonide - therapeutic use
Case-Control Studies
case–control study
Chronic Disease
Chronic obstructive pulmonary disease
clinical epidemiology
Comorbidity
Confidence Intervals
corticosteroids
Denmark - epidemiology
Female
Fluticasone
Humans
Male
Middle Aged
Mycobacterium
Mycobacterium Infections, Nontuberculous - chemically induced
Mycobacterium Infections, Nontuberculous - epidemiology
Odds Ratio
Pneumoconiosis - drug therapy
Pneumoconiosis - epidemiology
pneumonia
Pulmonary Disease, Chronic Obstructive - drug therapy
Pulmonary Disease, Chronic Obstructive - epidemiology
pulmonary embolism
respiratory infection
Respiratory Tract Diseases - drug therapy
Respiratory Tract Diseases - epidemiology
Risk Factors
Steroids
tuberculosis
Tuberculosis, Pulmonary - drug therapy
Tuberculosis, Pulmonary - epidemiology
Denmark
ISSN:0040-6376, 1468-3296, 1468-3296
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Summary:Background Chronic respiratory disease and inhaled corticosteroid (ICS) therapy for chronic obstructive pulmonary disease (COPD) increase the risk of pneumonia. Few data are available on the association of these risk factors with non-tuberculous mycobacterial (NTM) pulmonary disease. Methods This study examined chronic respiratory diseases and ICS use as risk factors in a population-based case-control study encompassing all adults in Denmark with microbiologically confirmed NTM pulmonary disease between 1997 and 2008. The study included 10 matched population controls per case. Conditional logistic regression was used to compute adjusted ORs for NTM pulmonary disease with regard to chronic respiratory disease history. Results Overall, chronic respiratory disease was associated with a 16.5-fold (95% CI 12.2 to 22.2) increased risk of NTM pulmonary disease. The adjusted OR for NTM disease was 15.7 (95% CI 11.4 to 21.5) for COPD, 7.8 (95% CI 5.2 to 11.6) for asthma, 9.8 (95% CI 2.03 to 52.8) for pneumoconiosis, 187.5 (95% CI 24.8 to 1417.4) for bronchiectasis, and 178.3 (95% CI 55.4 to 574.3) for tuberculosis history. ORs were 29.1 (95% CI 13.3 to 63.8) for patients with COPD on current ICS therapy and 7.6 (95% CI 3.4 to 16.8) for patients with COPD who had never received ICS therapy. Among patients with COPD, ORs increased according to ICS dose, from 28.1 for low-dose intake to 47.5 for high-dose intake (more than 800 μg/day). The OR was higher for fluticasone than for budesonide. Conclusion Chronic respiratory disease, particularly COPD treated with ICS therapy, is a strong risk factor for NTM pulmonary disease.
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ArticleID:thoraxjnl-2012-201772
PMID:22781123
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ISSN:0040-6376
1468-3296
1468-3296
DOI:10.1136/thoraxjnl-2012-201772