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

研究成果: 雜誌貢獻文章

42 引文 (Scopus)

摘要

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.

原文英語
文章編號194
期刊BMC Infectious Diseases
13
發行號1
DOIs
出版狀態已發佈 - 四月 30 2013
對外發佈Yes

指紋

Taiwan
Pulmonary Tuberculosis
Chronic Obstructive Pulmonary Disease
Cohort Studies
Adrenal Cortex Hormones
Tuberculosis
Regression Analysis
Diabetes Mellitus
Obstructive Lung Diseases
Health Insurance
Chronic Kidney Failure
Pneumonia
Fibrosis
Randomized Controlled Trials
Smoking
Databases
Therapeutics

ASJC Scopus subject areas

  • Infectious Diseases

引用此文

Risk factors for pulmonary tuberculosis in patients with chronic obstructive airway disease in Taiwan : A nationwide cohort study. / Lee, Chih Hsin; Lee, Ming Chia; Shu, Chin Chung; Lim, Chor Shen; Wang, Jann Yuan; Lee, Li Na; Chao, Kun Mao.

於: BMC Infectious Diseases, 卷 13, 編號 1, 194, 30.04.2013.

研究成果: 雜誌貢獻文章

Lee, Chih Hsin ; Lee, Ming Chia ; Shu, Chin Chung ; Lim, Chor Shen ; Wang, Jann Yuan ; Lee, Li Na ; Chao, Kun Mao. / Risk factors for pulmonary tuberculosis in patients with chronic obstructive airway disease in Taiwan : A nationwide cohort study. 於: BMC Infectious Diseases. 2013 ; 卷 13, 編號 1.
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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.",
keywords = "Chronic obstructive pulmonary disease, Inhaled corticosteroid, Oral corticosteroid, Time-dependent cox regression, Tuberculosis",
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AB - 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.

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