title: Use of high-dose inhaled corticosteroids is associated with pulmonary tuberculosis in patients with chronic obstructive pulmonary disease.
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 microg/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.
authors.affiliation: From Department of Traumatology (CCS), Department of Internal Medicine (HDW, JTW, HCW, JYW, CJY, PCY), and Department of Laboratory Medicine (LNL), National Taiwan University Hospital, Taipei; Department of Internal Medicine (MCY), Taipei Medical University-Wan Fang Hospital, Taipei; Department of Internal Medicine (CHL), Buddhist Tzu Chi General Hospital, Taipei Branch, Taipei; and the TAMI group, Taiwan.
authors.forename: Chin-Chung
authors.initials: CC
authors.lastname: Shu
authors.forename: Huey-Dong
authors.initials: HD
authors.lastname: Wu
authors.forename: Ming-Chih
authors.initials: MC
authors.lastname: Yu
authors.forename: Jann-Tay
authors.initials: JT
authors.lastname: Wang
authors.forename: Chih-Hsin
authors.initials: CH
authors.lastname: Lee
authors.forename: Hao-Chien
authors.initials: HC
authors.lastname: Wang
authors.forename: Jann-Yuan
authors.initials: JY
authors.lastname: Wang
authors.forename: Li-Na
authors.initials: LN
authors.lastname: Lee
authors.forename: Chong-Jen
authors.initials: CJ
authors.lastname: Yu
authors.forename: Pan-Chyr
authors.initials: PC
authors.lastname: Yang
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D004305:Dose-Response Relationship, Drug; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D012189:Retrospective Studies; D013624:Taiwan; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000139:chemically induced*
chemical_list: D005938:Glucocorticoids