Risk factors for pulmonary tuberculosis in patients with chronic obstructive airway disease in Taiwan: A nationwide cohort study

Chih Hsin Lee, Ming Chia Lee, Chin Chung Shu, Chor Shen Lim, Jann Yuan Wang, Li Na Lee, Kun Mao Chao

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

Background: An association between chronic obstructive pulmonary disease (COPD) and tuberculosis (TB) has been described, mainly due to smoking and corticosteroid use. Whether inhaled corticosteroid (ICS) therapy is associated with an increased risk of TB remains unclear.Methods: We selected COPD cases by using six diagnostic scenarios and control subjects from a nationwide health insurance database, and applied time-dependent Cox regression analysis to identify the risk factors for TB.Results: Among 1,000,000 beneficiaries, 23,594 COPD cases and 47,188 non-COPD control subjects were selected. Cox regression analysis revealed that age, male gender, diabetes mellitus, end-stage renal disease, and cirrhosis, as well as COPD (hazard ratio = 2.468 [2.205-2.762]) were independent risk factors for TB. Among the COPD cases, those who developed TB received more oral corticosteroids and oral β-agonists. Time-dependent Cox regression analysis revealed that age, male gender, diabetes mellitus, low income, oral corticosteroid dose, and oral β-agonist dose, but not ICS dose, were independent risk factors for TB. The identified risk factors and their hazard ratios were similar among the COPD cases selected using different scenarios.Conclusion: Keeping a high suspicion and regularly monitoring for the development of pulmonary TB in COPD patients are necessary, especially for those receiving higher doses of oral corticosteroids and other COPD medications. Although ICS therapy has been shown to predispose COPD patients to pneumonia in large randomized clinical trials, it does not increase the risk of TB in real world practice.

Original languageEnglish
Article number194
JournalBMC Infectious Diseases
Volume13
Issue number1
DOIs
Publication statusPublished - Apr 30 2013
Externally publishedYes

Keywords

  • Chronic obstructive pulmonary disease
  • Inhaled corticosteroid
  • Oral corticosteroid
  • Time-dependent cox regression
  • Tuberculosis

ASJC Scopus subject areas

  • Infectious Diseases

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