Use of high-dose inhaled corticosteroids is associated with pulmonary tuberculosis in patients with chronic obstructive pulmonary disease

Chin Chung Shu, Huey Dong Wu, Ming Chih Yu, Jann Tay Wang, Chih Hsin Lee, Hao Chien Wang, Jann Yuan Wang, Li Na Lee, Chong Jen Yu, Pan Chyr Yang

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Abstract

The use of high-dose inhaled corticosteroids (ICS) in patients with chronic obstructive pulmonary disease (COPD) has recently been shown to increase the incidence of pneumonia. However, to our knowledge, the impact of high-dose ICS on pulmonary tuberculosis (TB) has never been investigated. To study that impact, we conducted a retrospective study including patients aged more than 40 years old with irreversible airflow limitation between August 2000 and July 2008 in a medical center in Taiwan.Of the 36,684 patients who underwent pulmonary function testing, we included 554 patients. Among them, patients using high-dose ICS (equivalent to >500 μg/d of fluticasone) were more likely to have more severe COPD and receive oral corticosteroids than those using medium-dose, low-dose, or no ICS. Sixteen (3%) patients developed active pulmonary TB within a follow-up of 25,544 person-months. Multivariate Cox regression analysis revealed that the use of high-dose ICS, the use of 10 mg or more of prednisolone per day, and prior pulmonary TB were independent risk factors for the development of active pulmonary TB. Chest radiography and sputum smear/culture for Mycobacterium tuberculosis should be performed before initiating high-dose ICS and regularly thereafter.

Original languageEnglish
Pages (from-to)53-61
Number of pages9
JournalMedicine (United States)
Volume89
Issue number1
DOIs
Publication statusPublished - Jan 2010

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Pulmonary Tuberculosis
Chronic Obstructive Pulmonary Disease
Adrenal Cortex Hormones
Prednisolone
Sputum
Taiwan
Mycobacterium tuberculosis
Radiography
Pneumonia
Thorax
Retrospective Studies
Regression Analysis
Lung
Incidence

ASJC Scopus subject areas

  • Medicine(all)

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Use of high-dose inhaled corticosteroids is associated with pulmonary tuberculosis in patients with chronic obstructive pulmonary disease. / Shu, Chin Chung; Wu, Huey Dong; Yu, Ming Chih; Wang, Jann Tay; Lee, Chih Hsin; Wang, Hao Chien; Wang, Jann Yuan; Lee, Li Na; Yu, Chong Jen; Yang, Pan Chyr.

In: Medicine (United States), Vol. 89, No. 1, 01.2010, p. 53-61.

Research output: Contribution to journalArticle

Shu, Chin Chung ; Wu, Huey Dong ; Yu, Ming Chih ; Wang, Jann Tay ; Lee, Chih Hsin ; Wang, Hao Chien ; Wang, Jann Yuan ; Lee, Li Na ; Yu, Chong Jen ; Yang, Pan Chyr. / Use of high-dose inhaled corticosteroids is associated with pulmonary tuberculosis in patients with chronic obstructive pulmonary disease. In: Medicine (United States). 2010 ; Vol. 89, No. 1. pp. 53-61.
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