Yoon Eun Chong, Lee Hyewon, Yoon Hee-Young
Department of Health Administration and Management, College of Medical Science, Soonchunhyang University, Asan, Republic of Korea.
Department of Software Convergence, Soonchunhyang University Graduate School, Asan, Republic of Korea.
Tuberc Respir Dis (Seoul). 2024 Oct;87(4):473-482. doi: 10.4046/trd.2024.0038. Epub 2024 Jun 5.
Chronic airway diseases, such as asthma and chronic obstructive pulmonary disease (COPD), are increasingly being treated with inhaled corticosteroid (ICS). However, ICSs carry potential infection risks, particularly nontuberculous mycobacteria (NTM). This study investigated the association between ICS use and NTM infection risk using national insurance data, particularly for individuals with chronic airway diseases.
We conducted a nationwide population-based study using data from the National Health Insurance Service-National Sample Cohort in South Korea from 2002 to 2019. The cohort included 57,553 patients diagnosed with COPD or asthma. To assess the risk of NTM infection, we used Cox proportional hazards models and propensity score-based inverse probability of treatment weighting (IPTW) to ensure a balanced analysis of covariates.
Of the 57,553 patients (mean age 56.0 years, 43.2% male), 16.5% used ICS and 83.5% did not. We identified 63 NTM infection cases, including nine among ICS users and 54 among non-users. Before and after IPTW, ICS use was associated with a higher risk of NTM infection (adjusted hazard ratio [HR], 4.01; 95% confidence interval [CI], 1.48 to 15.58). Higher risks were significant for patients ≥65 years (adjusted HR, 6.40; 95% CI, 1.28 to 31.94), females (adjusted HR, 10.91; 95% CI, 2.24 to 53.20), never-smokers (adjusted HR, 6.31; 95% CI, 1.49 to 26.64), systemic steroid users (adjusted HR, 50.19; 95% CI, 8.07 to 312.19), and those with higher comorbidity scores (adjusted HR, 6.64; 95% CI, 1.19 to 37.03).
ICS use in patients with chronic airway diseases might increase the risk of NTM infection, particularly in older females, never-smokers, and systemic steroid users.
慢性气道疾病，如哮喘和慢性阻塞性肺疾病（COPD），越来越多地采用吸入性糖皮质激素（ICS）进行治疗。然而，ICS存在潜在的感染风险，尤其是非结核分枝杆菌（NTM）。本研究利用国民保险数据，特别是针对慢性气道疾病患者，调查了ICS使用与NTM感染风险之间的关联。
我们利用韩国国民健康保险服务-全国样本队列2002年至2019年的数据进行了一项全国性的基于人群的研究。该队列包括57553例被诊断为COPD或哮喘的患者。为了评估NTM感染风险，我们使用Cox比例风险模型和基于倾向评分的逆概率处理加权（IPTW）来确保对协变量进行平衡分析。
在57553例患者（平均年龄56.0岁，43.2%为男性）中，16.5%使用ICS，83.5%未使用。我们确定了63例NTM感染病例，其中ICS使用者中有9例，非使用者中有54例。在IPTW前后，使用ICS与NTM感染风险较高相关（调整后的风险比[HR]，4.01；95%置信区间[CI]，1.48至15.58）。对于≥65岁的患者（调整后的HR，6.40；95%CI，1.28至31.94）、女性（调整后的HR，10.91；95%CI，2.24至53.20）、从不吸烟者（调整后的HR，6.31；95%CI，1.49至26.64）、全身使用类固醇的患者（调整后的HR，50.19；95%CI，8.07至312.19）以及合并症评分较高的患者（调整后的HR，6.64；95%CI，1.19至37.03），风险更高。
慢性气道疾病患者使用ICS可能会增加NTM感染风险，尤其是在老年女性、从不吸烟者和全身使用类固醇的患者中。
