Risk factors for pulmonary tuberculosis in patients with chronic obstructive airway disease in Taiwan: A nationwide cohort study
Journal
BMC Infectious Diseases
Journal Volume
13
Journal Issue
1
Pages
194
Date Issued
2013
Author(s)
Abstract
Background: An association between chronic obstructive pulmonary disease (COPD) and tuberculosis (TB) has been described, mainly due to smoking and corticosteroid use. Whether inhaled corticosteroid (ICS) therapy is associated with an increased risk of TB remains unclear.Methods: We selected COPD cases by using six diagnostic scenarios and control subjects from a nationwide health insurance database, and applied time-dependent Cox regression analysis to identify the risk factors for TB.Results: Among 1,000,000 beneficiaries, 23,594 COPD cases and 47,188 non-COPD control subjects were selected. Cox regression analysis revealed that age, male gender, diabetes mellitus, end-stage renal disease, and cirrhosis, as well as COPD (hazard ratio = 2.468 [2.205-2.762]) were independent risk factors for TB. Among the COPD cases, those who developed TB received more oral corticosteroids and oral β-agonists. Time-dependent Cox regression analysis revealed that age, male gender, diabetes mellitus, low income, oral corticosteroid dose, and oral β-agonist dose, but not ICS dose, were independent risk factors for TB. The identified risk factors and their hazard ratios were similar among the COPD cases selected using different scenarios.Conclusion: Keeping a high suspicion and regularly monitoring for the development of pulmonary TB in COPD patients are necessary, especially for those receiving higher doses of oral corticosteroids and other COPD medications. Although ICS therapy has been shown to predispose COPD patients to pneumonia in large randomized clinical trials, it does not increase the risk of TB in real world practice. ? 2013 Lee et al.; licensee BioMed Central Ltd.
Other Subjects
aminophylline; beta adrenergic receptor stimulating agent; cholinergic receptor blocking agent; corticosteroid; ipratropium bromide; muscarinic receptor blocking agent; theophylline; tiotropium bromide; adult; age; aged; article; chronic obstructive lung disease; cohort analysis; controlled study; diabetes mellitus; drug megadose; female; human; kidney failure; liver cirrhosis; lowest income group; lung tuberculosis; major clinical study; male; pneumonia; sex difference; Taiwan; Administration, Inhalation; Administration, Oral; Adrenal Cortex Hormones; Adult; Aged; Aged, 80 and over; Case-Control Studies; Cohort Studies; Female; Humans; Immunosuppressive Agents; Male; Middle Aged; Pulmonary Disease, Chronic Obstructive; Risk Factors; Taiwan; Tuberculosis, Pulmonary
Type
journal article