Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
Thorax. 2013 Mar;68(3):256-62. doi: 10.1136/thoraxjnl-2012-201772. Epub 2012 Jul 10.
Chronic respiratory disease and inhaled corticosteroid (ICS) therapy for chronic obstructive pulmonary disease (COPD) increase the risk of pneumonia. Few data are available on the association of these risk factors with non-tuberculous mycobacterial (NTM) pulmonary disease.
This study examined chronic respiratory diseases and ICS use as risk factors in a population-based case-control study encompassing all adults in Denmark with microbiologically confirmed NTM pulmonary disease between 1997 and 2008. The study included 10 matched population controls per case. Conditional logistic regression was used to compute adjusted ORs for NTM pulmonary disease with regard to chronic respiratory disease history.
Overall, chronic respiratory disease was associated with a 16.5-fold (95% CI 12.2 to 22.2) increased risk of NTM pulmonary disease. The adjusted OR for NTM disease was 15.7 (95% CI 11.4 to 21.5) for COPD, 7.8 (95% CI 5.2 to 11.6) for asthma, 9.8 (95% CI 2.03 to 52.8) for pneumoconiosis, 187.5 (95% CI 24.8 to 1417.4) for bronchiectasis, and 178.3 (95% CI 55.4 to 574.3) for tuberculosis history. ORs were 29.1 (95% CI 13.3 to 63.8) for patients with COPD on current ICS therapy and 7.6 (95% CI 3.4 to 16.8) for patients with COPD who had never received ICS therapy. Among patients with COPD, ORs increased according to ICS dose, from 28.1 for low-dose intake to 47.5 for high-dose intake (more than 800 μg/day). The OR was higher for fluticasone than for budesonide.
Chronic respiratory disease, particularly COPD treated with ICS therapy, is a strong risk factor for NTM pulmonary disease.
慢性呼吸道疾病和慢性阻塞性肺疾病（COPD）的吸入皮质类固醇（ICS）治疗会增加肺炎的风险。关于这些危险因素与非结核分枝杆菌（NTM）肺部疾病的关联，数据很少。
本研究在 1997 年至 2008 年间，对丹麦所有经微生物学证实患有 NTM 肺部疾病的成年人进行了一项基于人群的病例对照研究，研究了慢性呼吸道疾病和 ICS 使用作为危险因素。每个病例包括 10 名匹配的人群对照。使用条件逻辑回归计算了慢性呼吸道疾病史与 NTM 肺部疾病之间的调整比值比（OR）。
总体而言，慢性呼吸道疾病使 NTM 肺部疾病的风险增加了 16.5 倍（95%CI 12.2 至 22.2）。调整后的 COPD 患 NTM 疾病的 OR 为 15.7（95%CI 11.4 至 21.5），哮喘为 7.8（95%CI 5.2 至 11.6），尘肺为 9.8（95%CI 2.03 至 52.8），支气管扩张症为 187.5（95%CI 24.8 至 1417.4），肺结核病史为 178.3（95%CI 55.4 至 574.3）。目前正在接受 ICS 治疗的 COPD 患者的 OR 为 29.1（95%CI 13.3 至 63.8），从未接受过 ICS 治疗的 COPD 患者的 OR 为 7.6（95%CI 3.4 至 16.8）。在 COPD 患者中，OR 随着 ICS 剂量的增加而增加，从低剂量摄入的 28.1 增加到高剂量摄入（每天超过 800μg）的 47.5。氟替卡松的 OR 高于布地奈德。
慢性呼吸道疾病，特别是接受 ICS 治疗的 COPD，是 NTM 肺部疾病的一个强烈危险因素。
