Division of Respirology, Dept of Medicine, University of Toronto, Toronto, ON, Canada
Dept of Medicine, University Health Network and Mount Sinai Hospital, Toronto, ON, Canada.
Eur Respir J. 2017 Sep 20;50(3). doi: 10.1183/13993003.00037-2017. Print 2017 Sep.
Inhaled corticosteroid (ICS) use is associated with an increased risk of pneumonia. This study was performed to determine if ICS use is associated with an increased risk of nontuberculous mycobacterial pulmonary disease (NTM-PD) or tuberculosis (TB).We conducted a population-based nested case-control study using linked laboratory and health administrative databases in Ontario, Canada, including adults aged ≥66 years with treated obstructive lung disease ( asthma, chronic obstructive pulmonary disease (COPD) or asthma-COPD overlap syndrome) between 2001 and 2013. We estimated odds ratios comparing ICS use with nonuse among NTM-PD and TB cases and controls using conditional logistic regression.Among 417 494 older adults with treated obstructive lung disease, we identified 2966 cases of NTM-PD and 327 cases of TB. Current ICS use was associated with NTM-PD compared with nonuse (adjusted OR (aOR) 1.86, 95% CI 1.60-2.15) and was statistically significant for fluticasone (aOR 2.09, 95% CI 1.80-2.43), but not for budesonide (aOR 1.19, 95% CI 0.97-1.45). There was a strong dose-response relationship between incident NTM-PD and cumulative ICS dose over 1 year. There was no significant association between current ICS use and TB (aOR 1.43, 95% CI 0.95-2.16).This study suggests that ICS use is associated with an increased risk of NTM-PD, but not TB.
吸入性皮质类固醇（ICS）的使用与肺炎风险增加有关。本研究旨在确定 ICS 的使用是否与非结核分枝杆菌肺病（NTM-PD）或结核病（TB）风险增加相关。我们在加拿大安大略省使用实验室和健康管理数据库进行了一项基于人群的巢式病例对照研究，包括 2001 年至 2013 年间年龄≥66 岁、有治疗的阻塞性肺病（哮喘、慢性阻塞性肺疾病（COPD）或哮喘-COPD 重叠综合征）的成年人。我们使用条件逻辑回归比较了 NTM-PD 和 TB 病例和对照中 ICS 使用与未使用的比值比。在 417494 名患有治疗性阻塞性肺病的老年人中，我们确定了 2966 例 NTM-PD 和 327 例 TB。与未使用相比，当前 ICS 使用与 NTM-PD 相关（调整后的比值比[aOR]1.86，95%置信区间[CI]1.60-2.15），并且在氟替卡松方面具有统计学意义[aOR 2.09，95%CI 1.80-2.43]，但布地奈德则不然[aOR 1.19，95%CI 0.97-1.45]。在 1 年内，NTM-PD 的发生率与累积 ICS 剂量之间存在很强的剂量反应关系。当前 ICS 使用与 TB 之间没有显著关联[aOR 1.43，95%CI 0.95-2.16]。本研究表明，ICS 的使用与 NTM-PD 风险增加相关，但与 TB 无关。
