Inhaled Corticosteroids Increase Risk of Nontuberculous Mycobacterial Lung Disease: A Nested Case-Control Study and Meta-analysis

Chin-Chung Shu; Yu-Feng Wei; Kuang-Hung Chen; Shulin Chuang; Ya-Hui Wang; Cheng-Yi Wang; Hao-Chien Wang

doi:10.1093/infdis/jiab428

Inhaled Corticosteroids Increase Risk of Nontuberculous Mycobacterial Lung Disease: A Nested Case-Control Study and Meta-analysis

J Infect Dis. 2022 Feb 15;225(4):627-636. doi: 10.1093/infdis/jiab428.

Authors

Chin-Chung Shu^{1

2}, Yu-Feng Wei^{3

4}, Kuang-Hung Chen¹, Shulin Chuang⁵, Ya-Hui Wang⁶, Cheng-Yi Wang⁷, Hao-Chien Wang^{1

2}

Affiliations

¹ Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
² National Taiwan University College of Medicine, Taipei, Taiwan.
³ Department of Internal Medicine, E-Da Cancer Hospital, Kaohsiung, Taiwan.
⁴ School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
⁵ Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan.
⁶ Medical Research Center, Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
⁷ Department of Internal Medicine, Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.

PMID: 34435631
DOI: 10.1093/infdis/jiab428

Abstract

Studies on use of inhaled corticosteroids (ICS) and the risk of nontuberculous mycobacterial lung disease (NTM-LD) are limited and have some conflicting results. We recruited 1235 NTM-LD patients and found that ICS use within 1 year was associated with increased NTM-LD, and the risk increased with elevated ICS dose and cumulative duration. Discontinuation of ICS use for more than 120 days could reduce the risk of NTM-LD to an insignificant level. For NTM species, the development of NTM-LD by ICS was highest for Mycobacterium kansasii lung disease. The pooled results of the meta-analysis showed that ICS use might increase the risk of NTM-LD with dose response in medium and high dose of daily ICS. In addition, budesonide had a smaller impact on the risk of NTM-LD than other ICS medications. The present study and meta-analysis provide evidence for ICS adjustment, including dose, discontinuation effect, and medications to possibly reduce the risk of NTM-LD.

Keywords: inhaled corticosteroid; meta-analysis; nested case-control; nontuberculous mycobacterial lung disease.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't

MeSH terms

Adrenal Cortex Hormones / adverse effects
Case-Control Studies
Humans
Lung Diseases*
Mycobacterium Infections, Nontuberculous* / drug therapy
Mycobacterium Infections, Nontuberculous* / epidemiology
Pneumonia* / complications
Risk Factors

Substances

Adrenal Cortex Hormones