title: Post-inhaled corticosteroid pulmonary tuberculosis and pneumonia increases lung cancer in patients with COPD.
abstract: Inhaled corticosteroids (ICS) have been associated with decreased lung cancer risk. However, they have been associated with pulmonary infections (tuberculosis [TB] and pneumonia) in patients with chronic obstructive pulmonary disease (COPD). TB and pneumonia have increased lung cancer risk. The association between post-ICS pulmonary infections and lung cancer remains unclear.
  
  
  
  We conducted a retrospective cohort study from 2003 to 2010 using the Taiwan National Health Insurance Research Database. Among the 1,089,955 patients with COPD, we identified 8813 new users of ICS prescribed for a period of 3 months or more and 35,252 non-ICS users who were randomly matched for sex, age and date of ICS use from 2003 to 2005. Cox proportional hazard regression was used to estimate the hazard ratio (HR) of pulmonary infections in patients with/without ICS use.
  
  
  
  The HRs for lung cancer in ICS users with sequential lung infections were as follows; 2.42 (95 % confidence interval [CI], 1.28-4.58) for individuals with TB, 2.37 (95 % CI, 1.01-5.54) for TB and pneumonia, and 1.17(95 % CI, 0.69-1.98) for those with pneumonia. For non-ICS users with pulmonary infections, the HRs were 1.68 (95 % CI, 0.78-3.65) for individual with TB and pneumonia, 1.42 (95 % CI, 0.89-2.26) for TB, and 0.95 (95 % CI, 0.62-1.46) for individuals with pneumonia.
  
  
  
  COPD patients with TB /or pneumonia who used ICS had increased risk of lung cancer. Because the overall prognosis of lung cancer remains poor, screening tests are recommended for patients with these conditions.
authors.affiliation: School of Medicine, Chung Shan Medical University, Taichung City, Taiwan.|Divisions of Medical Oncology and Pulmonary Medicine, Chung Shan Medical University Hospital, Taichung City, Taiwan.
authors.forename: Ming-Fang
authors.initials: MF
authors.lastname: Wu
authors.affiliation: Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung City, Taiwan.
authors.forename: Zhi-Hong
authors.initials: ZH
authors.lastname: Jian
authors.affiliation: Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung City, Taiwan.
authors.forename: Jing-Yang
authors.initials: JY
authors.lastname: Huang
authors.affiliation: Office of Physical Education, Chung Yuan Christian University, Taoyuan City, Taiwan.
authors.forename: Cheng-Feng
authors.initials: CF
authors.lastname: Jan
authors.affiliation: Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung City, Taiwan.
authors.forename: Oswald Ndi
authors.initials: ON
authors.lastname: Nfor
authors.affiliation: Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung City, Taiwan.|Department of Neurology, Lu-Tung Christian Hospital, Changhua, Taiwan.
authors.forename: Kai-Ming
authors.initials: KM
authors.lastname: Jhang
authors.affiliation: Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung City, Taiwan.
authors.forename: Wen-Yuan
authors.initials: WY
authors.lastname: Ku
authors.affiliation: Department of Physical Education, Fu Jen Catholic University, New Taipei City, Taiwan.
authors.forename: Chien-Chang
authors.initials: CC
authors.lastname: Ho
authors.affiliation: Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung City, Taiwan.|Department of Family and Community Medicine, Chung Shan Medical University Hospital, No. 110, Sec. 1 Jianguo N. Rd., Taichung City, 40201, Taiwan.
authors.forename: Chia-Chi
authors.initials: CC
authors.lastname: Lung
authors.affiliation: School of Medicine, Chung Shan Medical University, Taichung City, Taiwan.|Department of Pediatrics, Chung Shan Medical University Hospital, Taichung City, Taiwan.
authors.forename: Hui-Hsien
authors.initials: HH
authors.lastname: Pan
authors.affiliation: Office of Physical Education, Chung Yuan Christian University, Taoyuan City, Taiwan.
authors.forename: Min-Chen
authors.initials: MC
authors.lastname: Wu
authors.affiliation: Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung City, Taiwan. Liawyp@csmu.edu.tw.|Department of Family and Community Medicine, Chung Shan Medical University Hospital, No. 110, Sec. 1 Jianguo N. Rd., Taichung City, 40201, Taiwan. Liawyp@csmu.edu.tw.
authors.forename: Yung-Po
authors.identifier: 0000-0003-2046-4964
authors.initials: YP
authors.lastname: Liaw
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000150:complications* / Q000453:epidemiology / Q000209:etiology*; D011159:Population Surveillance; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D012042:Registries; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000453:epidemiology / Q000209:etiology*; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones
keywords: Chronic obstructive pulmonary disease; Inhaled corticosteroid; Pneumonia; Tuberculosis