title: Asthma-Chronic Obstructive Pulmonary Diseases Overlap Syndrome Increases the Risk of Incident Tuberculosis: A National Cohort Study.
abstract: OBJECTIVE
  The association between asthma-chronic obstructive pulmonary diseases (COPD) overlap syndrome (ACOS) and tuberculosis (TB) has yet to be studied.
  
  
  METHODS
  The newly diagnosed TB patients (age > 20 y) treated from January 2000 to December 2008 were included (ACOS cohort, n = 10 751; non-ACOS cohort, n = 42 966). The non-ACOS cohort involved patients with confirmed absence of ACOS. We calculated incidence rate ratios (IRRs) for TB in the ACOS and non-ACOS cohorts by using poisson regression analysis. Cox proportional hazards regression models were used to determine the adjusted HR (aHR) for TB in the ACOS cohort compared with the non-ACOS cohort.
  
  
  RESULTS
  The aHR for TB was 2.41 (95% confidence interval [CI], 2.19-2.66) in the ACOS cohort. The TB risk was significantly higher in the ACOS cohort than in the non-ACOS cohort when stratified by age, sex, comorbidities, and atopy. Within the ACOS cohort, the aHR was higher among patients receiving SABAs+SAMAs, LABAs+LAMAs, and ICSs (aHR [95% CI]: 3.06 [2.75-3.41], 3.68 [2.93-4.61], and 2.79 [1.25-6.22], respectively; all P < .05). Furthermore, patients with more than 15 outpatient visits and hospitalizations per year demonstrated the highest aHR (8.09; 95% CI, 6.85-9.56).
  
  
  CONCLUSIONS
  ACOS cohort potentially develop incident TB, regardless of the age,sex, comorbidities and atopy; even without receiving the inhalers.This risk is higher, especially in the ACOS cohort have a high frequency of medical services or receiving the inhalers such as SABAs+SAMAs, LABAs+LAMAs and ICSs.
authors.affiliation: Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan.|Chia Nan University of Pharmacy and Science, Tainan, Taiwan.|Meiho University, Pingtung, Taiwan.
authors.forename: Jun-Jun
authors.initials: JJ
authors.lastname: Yeh
authors.affiliation: Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.|College of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: Yu-Chiao
authors.initials: YC
authors.lastname: Wang
authors.affiliation: Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan.|Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Kao
mesh_terms: D000328:Adult; D000368:Aged; D001249:Asthma / Q000150:complications* / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000453:epidemiology; D018570:Risk Assessment; D013624:Taiwan / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000453:epidemiology; D055815:Young Adult