Use of high-dose inhaled corticosteroids is associated with pulmonary tuberculosis in patients with chronic obstructive pulmonary disease
Journal
Medicine
Journal Volume
89
Journal Issue
1
Pages
53-61
Date Issued
2010
Author(s)
Yu M.-C.
Lee C.-H.
Abstract
The use of high-dose inhaled corticosteroids (ICS) in patients with chronic obstructive pulmonary disease (COPD) has recently been shown to increase the incidence of pneumonia. However, to our knowledge, the impact of high-dose ICS on pulmonary tuberculosis (TB) has never been investigated. To study that impact, we conducted a retrospective study including patients aged more than 40 years old with irreversible airflow limitation between August 2000 and July 2008 in a medical center in Taiwan.Of the 36,684 patients who underwent pulmonary function testing, we included 554 patients. Among them, patients using high-dose ICS (equivalent to >500 μg/d of fluticasone) were more likely to have more severe COPD and receive oral corticosteroids than those using medium-dose, low-dose, or no ICS. Sixteen (3%) patients developed active pulmonary TB within a follow-up of 25,544 person-months. Multivariate Cox regression analysis revealed that the use of high-dose ICS, the use of 10 mg or more of prednisolone per day, and prior pulmonary TB were independent risk factors for the development of active pulmonary TB. Chest radiography and sputum smear/culture for Mycobacterium tuberculosis should be performed before initiating high-dose ICS and regularly thereafter. Copyright ? 2010 by Lippincott Williams & Wilkins.
SDGs
Other Subjects
corticosteroid; fluticasone; isoniazid; prednisolone; rifampicin; salbutamol; adult; aged; airflow; article; chronic obstructive lung disease; controlled study; disease association; disease duration; disease exacerbation; disease severity; drug efficacy; drug megadose; drug safety; female; follow up; forced expiratory volume; human; low drug dose; lung function test; lung tuberculosis; major clinical study; male; Mycobacterium tuberculosis; priority journal; retrospective study; risk factor; sputum culture; sputum smear; Taiwan; thorax radiography; treatment duration; treatment outcome; Administration, Inhalation; Adult; Dose-Response Relationship, Drug; Female; Glucocorticoids; Humans; Male; Middle Aged; Pulmonary Disease, Chronic Obstructive; Retrospective Studies; Taiwan; Treatment Outcome; Tuberculosis, Pulmonary
Type
journal article