title: Inhaled corticosteroids (ICS) and risk of mycobacterium in patients with chronic respiratory diseases: a meta-analysis.
abstract: BACKGROUND
  Studies have indicated that therapy with inhaled corticosteroids (ICS) can be associated with a higher risk of pneumonia. However, it is not known whether ICS increases the risk of mycobacterium. Most of these published studies were small, and the conclusions were inconsistent.
  
  
  METHODS
  A meta-analysis was conducted into whether ICS increases the risk of mycobacterium in patients with chronic respiratory diseases. PubMed, OVID, EMBASE and Cochrane Library databases were searched.
  
  
  RESULTS
  Five studies involving 4,851 cases and 28,477 controls were considered in the meta-analysis. From the pooled analyses, there was significant association between ICS and risk of mycobacterium in all patients with chronic respiratory diseases [risk ratio (RR) =1.81; 95% confidence interval (CI), 1.23-2.68; P=0.003]. Among patients with chronic respiratory diseases, the relationship between ICS and risk of tuberculosis (TB) was also significant (RR =1.34; 95% CI, 1.15-1.55; P=0.0001). And meta-analysis of four studies in patients with chronic obstructive pulmonary disease (COPD) (RR =1.42; 95% CI, 1.18-1.72; P=0.0003) or two studies in patients who have prior pulmonary TB (RR =1.61; 95% CI, 1.35-1.92; P<0.00001) or three studies in patients with high-dose ICS (RR =1.60; 95% CI, 1.28-1.99; P<0.0001) showed a relationship between ICS and risk of mycobacterium.
  
  
  CONCLUSIONS
  Significant relationship has been shown between ICS use and risk of mycobacterium in all patients with chronic respiratory diseases. ICS use also increases the risk of TB among the patients with chronic respiratory diseases. Use of ICS increases the risk of mycobacterium in patients with COPD or patients with prior pulmonary TB or patients inhaling high-dose corticosteroids. Further research is required to establish the potential adverse effect of ICS as a therapy for chronic respiratory diseases.
authors.affiliation: Department of Respiratory Medicine, Affiliated Hospital of Nantong University, Nantong 226001, China.
authors.forename: Songshi
authors.initials: S
authors.lastname: Ni
authors.affiliation: Department of Respiratory Medicine, Affiliated Hospital of Nantong University, Nantong 226001, China.
authors.forename: Zhenxue
authors.initials: Z
authors.lastname: Fu
authors.affiliation: Department of Respiratory Medicine, Affiliated Hospital of Nantong University, Nantong 226001, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Zhao
authors.affiliation: Department of Respiratory Medicine, Affiliated Hospital of Nantong University, Nantong 226001, China.
authors.forename: Hua
authors.initials: H
authors.lastname: Liu
keywords: Inhaled corticosteroids (ICS); meta-analysis; mycobacterium; risk
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