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

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.

Chronic Pulmonary Aspergillosis as a Considerable Complication in Post-Tuberculosis Lung Disease

“…While bronchodilators are widely recommended, the use of systemic and inhaled glucocorticoids is controversial, given the potentially increased risk of chronic pulmonary infection such as NTM, TB, and CPA. 103 A similar situation is found for large airway involvement, where treatment as bronchiectasis according to the corresponding guidelines is recommended due to lack of reliable data. 16,94 Bacterial (co-)infections are common in exacerbations of PTLD, yet general recommendations for antibiotic treatment are difficult to make.…”

“…While bronchodilators are widely recommended, the use of systemic and inhaled glucocorticoids is controversial, given the potentially increased risk of chronic pulmonary infection such as NTM, TB, and CPA. 103…”

Post-TB health and wellbeing

“…Inhaled corticosteroids: The safety and efficacy of inhaled corticosteroids in the management PTLD are not yet known. There are concerns about their potential to increase the risk of NTM infection 132 , 133 or reactivation of TB. 134 , 135 In the absence of PTLD-specific safety data, we recommend caution in the use of inhaled corticosteroids in individuals with PTLD, with frequent reassessment after starting treatment, unless otherwise indicated (for example, in the treatment of asthma)…”

The association between inhaled corticosteroid and the risks of SARS-COV-2 infection: A systematic review and meta-analysis

“…Add-on ICS to mono or duo-bronchodilator, LABA and/or long-acting muscarinic-antagonist (LAMA), is also recommended for COPD patients with high eosinophil or at risk of exacerbation [6] . In contrast, ICS could be associated with the local adverse events - oral candidiasis and dysphonia, and systemic complications, such as diabetes mellitus, osteoporotic fractures, glaucoma, and mycobacterial infection [7] , [8] , [9] , [10] , [11] , [12] . In addition, solid evidences have demonstrated a significant association between the use of ICS and the increasing risk of pneumonia [12] , [13] , [14] , which implied this serious concern about the safety issue of ICS prescription in those patients.…”