Division of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan.
Respirology. 2012 Jan;17(1):185-90. doi: 10.1111/j.1440-1843.2011.02076.x.
The risk of pneumonia is increased among COPD patients using inhaled corticosteroids (ICS). However, there is uncertainty regarding the association between long-term use of ICS and exacerbations of respiratory tract infections among asthmatic patients.
A case-control nested cohort study was performed to assess the association of asthma with nontuberculous mycobacterium (NTM) infection.
Among this cohort of 464 asthmatic patients, 14 experienced complications due to NTM infections, of which eight were caused by Mycobacterium avium-intracellulare complex, three by M. kansasii, one by M.terrae and the remaining two by unclassifiable scotochromogens. Asthmatic patients with NTM infections were older (67.1 ± 8.6 vs 58.8 ± 12.3 years, P < 0.01) and had more severe airflow limitation (FEV(1) %, 60.6 ± 10.3 vs 72.3 ± 18.3, P < 0.03) than those without NTM infections. All except one had received ICS treatment for more than 5 years, and 12 of the 14 patients used inhaled fluticasone propionate daily (four patients at a dose of 400 µg/day and eight patients at a dose >800 µg/day).
These findings suggest that the risk of NTM infection may be greater in asthmatic patients who are older, have more severe airflow limitation and receive higher doses of ICS therapy.
慢性阻塞性肺疾病（COPD）患者使用吸入性皮质类固醇（ICS）会增加肺炎风险。然而，哮喘患者长期使用 ICS 与呼吸道感染恶化之间的关联仍存在不确定性。
进行了一项病例对照嵌套队列研究，以评估哮喘与非结核分枝杆菌（NTM）感染之间的关联。
在这 464 名哮喘患者队列中，有 14 名患者发生了 NTM 感染并发症，其中 8 名是由鸟分枝杆菌复合群引起的，3 名是由堪萨斯分枝杆菌引起的，1 名是由胞内分枝杆菌引起的，其余 2 名是由无法分类的光产色分枝杆菌引起的。发生 NTM 感染的哮喘患者年龄较大（67.1±8.6 岁 vs 58.8±12.3 岁，P<0.01），气流受限更严重（FEV(1) %，60.6±10.3 岁 vs 72.3±18.3 岁，P<0.03）。除 1 例患者外，所有患者均接受 ICS 治疗超过 5 年，14 例患者中有 12 例每天使用吸入性丙酸氟替卡松（400μg/天的剂量 4 例，剂量>800μg/天的剂量 8 例）。
这些发现表明，年龄较大、气流受限更严重且接受更高剂量 ICS 治疗的哮喘患者，NTM 感染的风险可能更高。
