Inhaled Corticosteroids May Increase the Risk of Serious Lung Infection

Inhaled corticosteroids (ICS) use is associated with an increased risk of nontuberculous mycobacterial pulmonary disease (NTM PD), according to a new study.


While ICS are widely used for the treatment of asthma and COPD, they also inhibit immune function and have been associated with increased risk of pneumonia.



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To determine whether ICS could also be associated with NTM PD, the researchers conducted a population-based, nested, case-control study using linked laboratory and health administrative databases in Ontario, Canada. The cohort included adults aged ≥66 years with obstructive lung disease (OLD)—asthma, COPD, or asthma-COPD overlap syndrome (ACOS)—prescribed at least 1 medication for OLD from 2001-2013.

They identified NTM PD among cohort members microbiologically and identified drug exposures using outpatient prescription medication claims. The investigators defined cases of NTM PD using microbiologic criteria, and each case was matched with up to 4 controls. They estimated odds ratios comparing ICS current and prior use with non-use among NTM cases and controls using conditional logistic regression, adjusting for age, sex, income, rurality, comorbidities, and medications associated with NTM. They also adjusted for markers of severity of OLD, including use of OLD medications, spirometry, and home oxygen, and hospitalization for OLD.

Among 417,494 older adults with treated OLD, they identified 2964 cases of NTM PD. Current ICS use was associated with significantly increased risk of NTM PD compared with non-use (adjusted OR [aOR] 1.84; 95% CI, 1.59-2.13). Prior ICS use was not significantly associated with NTM PD. The association between NTM PD and current ICS use was greatest for patients with COPD only (aOR=2.10; 95% CI, 1.73-2.54), intermediate for those with ACOS (aOR=1.55; 95% CI, 1.17-2.04), and not statistically significant for patients with asthma only (aOR=1.42; 95%CI, 0.85-2.36).

The association was statistically significant for fluticasone use (aOR=2.08; 95%CI, 1.79-2.42) but not for budesonide use (aOR=1.17; 95%CI, 0.96-1.43). There was a strong dose-response relationship between incident NTM PD and cumulative ICS dose over 1 year. The association between current ICS use and NTM PD remained significant when including only cases of NTM PD who received antimicrobial treatment (aOR=1.89; 95% CI, 1.32-2.71).

“Physicians should consider this risk when prescribing ICS, particularly for patients with COPD, who appear most vulnerable,” the researchers concluded.

—Mike Bederka


Brode SK, Campitelli MA, Kwong JC, et al. The risk of pulmonary nontuberculous mycobacterial disease associated with inhaled corticosteroid use. Presented at: ATS 2016 International Conference; May 18, 2016; San Francisco, California.