ICS Use Associated With Non-TB Mycobacterial Lung Infections

The increasing prevalence of nontuberculous mycobacterial (NTM) lung disease prompted researchers to explore whether the use of inhaled corticosteroids (ICSs) is fueling the trend, and their findings call into question the widespread and increasing use of ICSs among people with asthma and other airway diseases.

Investigators at Kaiser Permanente in Oakland, California, conducted a case-control study of participants in Northern California with airway disease and both with and without NTM pulmonary infection between 2000 and 2010. After quantifying participants’ use of ICSs and other airway-disease medications and health care utilization within 6 months of their having received an NTM diagnosis, the researchers explored the association between NTM lung infections and the duration of ICS use and the cumulative dosage of the medication.

The findings showed that participants with an NTM infection were more likely to use airway-disease medications and were more likely to utilize health care than matched control participants. The use of an ICS between 120 days and 2 years before the study onset was associated with substantially increased risk of developing an NTM infection, as was increasing cumulative ICS dosage.

“ICS use, and particularly high dose ICS use, was associated with increased risk of NTM pulmonary infection,” the investigators concluded. “The magnitude of the effect revealed in this analysis and the very substantial clinical consequences of NTM pulmonary infection raise the important question of whether the broad and increasing use of ICS for [airway diseases] needs to be reconsidered,” they wrote.

—Michael Gerchufsky

Reference:

Liu VX, Winthrop KL, Lu Y, Sharifi H, Nasiri HU, Ruoss SJ. Association between inhaled corticosteroid use and pulmonary nontuberculous mycobacterial infection [published online September 14, 2018]. Ann Am Thorac Soc. https://doi.org/10.1513/AnnalsATS.201804-245OC.