Use of inhaled corticosteroids and the risk of tuberculosis

Lee, Chang‐Hoon; Kim, Kyungjoo; Hyun, Min Kyung; Jang, Eun Jin; Lee, Na Rae; Yim, Jae Joon

doi:10.1136/thoraxjnl-2012-203175

Cited by 159 publications

(146 citation statements)

References 26 publications

(21 reference statements)

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“…Current use of ICS is also associated with an increase in the risk of active tuberculosis in a low-prevalence setting (RR 1.33, 95% CI 1.04-1.71), although there is no added risk in patients who already experience an increase in risk from having received oral corticosteroids in the prior year [72]. A similar increase in the risk of tuberculosis was observed in an area with higher prevalence (RR 1.20, 95% CI 1.08-1.34), again limited to subjects without concomitant use of oral corticosteroids [73]. COPD is also a risk factor for infection with nontuberculous mycobacteria and there is a further dose-related increased risk with ICS [74].…”

Section: Safety Of Ics and Laba/ics In Copdsupporting

confidence: 52%

Inhaled corticosteroids in COPD: the clinical evidence

2014

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In this article, we focus on the scientific evidence from randomised trials supporting treatment with inhaled corticosteroids (ICS) in chronic obstructive pulmonary disease (COPD), including treatment with combinations of long-acting β-agonist (LABA) bronchodilators and ICS. Our emphasis is on the methodological strengths and limitations that guide the conclusions that may be drawn.The evidence of benefit of ICS and, therefore, of the LABA/ICS combinations in COPD is limited by major methodological problems. From the data reviewed herein, we conclude that there is no survival benefit independent of the effect of long-acting bronchodilation and no effect on FEV1 decline, and that the possible benefit on reducing severe exacerbations is unclear. Our interpretation of the data is that there are substantial adverse effects from the use of ICS in patients with COPD, most notably severe pneumonia resulting in excess deaths.Currently, the most reliable predictor of response to ICS in COPD is the presence of eosinophilic inflammation in the sputum. There is an urgent need for better markers of benefit and risk that can be tested in randomised trials for use in routine specialist practice. Given the overall safety and effectiveness of long-acting bronchodilators in subjects without an asthma component to their COPD, we believe use of such agents without an associated ICS should be favoured. @ERSpublicationsThe benefits of ICS in COPD are limited. Better tools are needed to identify which patients might benefit.

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Section: Safety Of Ics and Laba/ics In Copdsupporting

confidence: 52%

Inhaled corticosteroids in COPD: the clinical evidence

2014

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“…1 Even otherwise, the use of inhaled steroids in higher doses and oral steroids for treatment of advanced stages of asthma may be a factor for the development of tuberculosis.…”

Section: Introductionmentioning

confidence: 99%

Association between tuberculosis and bronchial asthma

Garg

Karahyla

2017

Int J Res Med Sci

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Background: Everything that wheezes is not asthma. In patients of tuberculosis (TB), wheezing can be because of bronchial asthma, or many other causes. Asthma and other causes of wheezing need to be differentiated, as the treatment should be planned accordingly.Methods: Patients of active/quiescent tuberculosis who presented to Department of Tuberculosis and Chest Diseases, Government Medical College, Patiala, Punjab, India, with complaints of breathlessness and had rhonchi on examination were subjected to bronchodilator reversibility testing to prove if they were suffering from concomitant asthma. Patients thus found to have tuberculosis along with asthma were analyzed with respect to age, sex, rural urban differences and timing of diagnosis of either disease. Patients who developed asthma after tuberculosis were further analyzed for duration between completion of anti-tubercular treatment (ATT) and onset of asthma, family history of asthma and correlation of radiological manifestations and lung function measurements. Aim was to find association, if any, between tuberculosis and asthma.Results: Over 6 months, 69 patients of tuberculosis along with asthma were found. Only 21/69 (30.4%) patients developed tuberculosis after asthma. 48/69 (69.6%) patients developed asthma after tuberculosis. Majority (25/48=52.1%) of them developed asthma within 5 years of completion of ATT (p=0.020). Only 2/48 (2.9%) patients had a positive family history for asthma. Lung function abnormalities correlated with the extent of radiological involvement in these patients who developed asthma after tuberculosis (p ≤0.0001).Conclusions: Patients of active/quiescent tuberculosis who present with breathlessness and have rhonchi on examination should be treated for asthma only after confirmation of the diagnosis, as there can be other reasons for the same.

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“…A meta-analysis found that ICS therapy is associated with an increased risk of serious pneumonia in COPD patients when compared with placebo (RR of 1.81 [95% CI: 1.44-2.29]) [49]. In a study conducted in Quebec on 163,514 patients with COPD, current use of ICS was associated with a 69% increase in the rate of a serious pneumonia event during a 5.4 year follow-up period (RR of 1.69 [95% CI: 1.63-1.75]) [48]. The risk was maintained with long-term use but declined following cessation of ICS use and eventually disappeared after 6 months (RR of 1.08 [95% CI: 0.99-1.17]) [48].…”

Section: Chronic Airway Disease As a Risk Factor For The Development mentioning

confidence: 99%

“…The use of immunosuppressant corticosteroid based therapy in COPD patients has also been linked to pneumonia development [48]. A meta-analysis found that ICS therapy is associated with an increased risk of serious pneumonia in COPD patients when compared with placebo (RR of 1.81 [95% CI: 1.44-2.29]) [49].…”

Section: Chronic Airway Disease As a Risk Factor For The Development mentioning

confidence: 99%

“…In a study conducted in Quebec on 163,514 patients with COPD, current use of ICS was associated with a 69% increase in the rate of a serious pneumonia event during a 5.4 year follow-up period (RR of 1.69 [95% CI: 1.63-1.75]) [48]. The risk was maintained with long-term use but declined following cessation of ICS use and eventually disappeared after 6 months (RR of 1.08 [95% CI: 0.99-1.17]) [48]. A study performed in the USA on 145,586 newly-diagnosed COPD patients found that subjects on ICS treatment were 1.38 [95% CI: 1.31-1.45] times more likely to have a hospitalization for pneumonia than non-ICS users [50].…”

Section: Chronic Airway Disease As a Risk Factor For The Development mentioning

confidence: 99%

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