pulmicort and Tuberculosis

There have been concerns about the risk of inhaled corticosteroid (ICS)-related tuberculosis (TB) development.. We investigated the occurrence of TB among ICS users according to underlying respiratory diseases and type of ICS.. A 12-year population cohort comprising approximately 1 million subjects collected from the Korean claims database were used. Adult ICS users (budesonide or fluticasone) were enrolled. The temporal relationship between TB development and the last ICS prescription before TB development was evaluated. A nested case-control study was performed with 1:4 matching for age, sex, and the initiation date of the ICS.. There were 17,991 ICS users, and 175 developed TB during the study period. Approximately 80% (140/175) of patients who developed TB were diagnosed within 3 years after the last ICS prescription. In the nested case-control study, the occurrence of TB was not related to the type of ICS, but was related to a higher annual admission rate and a higher comorbidity score. The risk of TB was higher in patients with chronic obstructive pulmonary disease (COPD) than in those with asthma (odds ratio: 2.31; CI 95%: 1.39-3.38; P = .0011) after adjusting for covariates. The subgroup analysis revealed no difference between budesonide and fluticasone with respect to the risk of developing TB in patients with asthma, COPD, or asthma-COPD overlap syndrome.. An increased risk of TB development may persist for 3 years after stopping the ICS and the risk is higher in patients with COPD regardless of the type of ICS used.

Topics: Administration, Inhalation; Adrenal Cortex Hormones; Adult; Aged; Asthma; Asthma-Chronic Obstructive Pulmonary Disease Overlap Syndrome; Budesonide; Case-Control Studies; Dose-Response Relationship, Drug; Female; Fluticasone; Humans; Logistic Models; Male; Middle Aged; Pulmonary Disease, Chronic Obstructive; Republic of Korea; Risk Factors; Tuberculosis; Tuberculosis, Pulmonary; Young Adult

Inhaled corticosteroid (ICS) use is associated with an increased risk of pneumonia. This study was performed to determine if ICS use is associated with an increased risk of nontuberculous mycobacterial pulmonary disease (NTM-PD) or tuberculosis (TB).We conducted a population-based nested case-control study using linked laboratory and health administrative databases in Ontario, Canada, including adults aged ≥66 years with treated obstructive lung disease (

Topics: Administration, Inhalation; Adrenal Cortex Hormones; Aged; Aged, 80 and over; Budesonide; Case-Control Studies; Female; Fluticasone; Humans; Logistic Models; Lung Diseases, Obstructive; Male; Mycobacterium Infections, Nontuberculous; Ontario; Risk Factors; Tuberculosis

Although treatment with oral corticosteroids can cause reactivation of latent Mycobacterium tuberculosis (TB) infection in purified protein derivative (PPD)-positive individuals with no evidence of clinical disease, little is known about the effects of inhaled corticosteroids in this respect.. This study was undertaken to assess whether inhaled corticosteroid (CS) therapy reactivates latent TB infection in PPD-positive asthmatic children.. We studied 32 PPD skin test-positive (> or =10 mm) children [age (mean +/- SD), 7.9 +/- 4.1 years] with no family history and no evidence of TB infection on chest radiograms who were receiving inhaled budesonide for the treatment of asthma. They were further evaluated with thorax computed tomography (CT) and erythrocyte sedimentation rate and closely observed for an additional 9 months.. At enrollment the mean diameter of PPD reaction was 12.8 +/- 2.7 mm. The mean duration of inhaled CS treatment and the mean cumulative CS dose were 9.8 +/- 7.6 months and 275 +/-199 mg, respectively. Thorax CT studies revealed mediastinal lymph nodes in 7 of the 32 patients. There was no significant difference between children with and without mediastinal lymph nodes according to age, gender, size of PPD skin testing, erythrocyte sedimentation rate and duration and cumulative CS dose of inhaled budesonide therapy before study. A second thorax CT was obtained 9 months later in those 7 patients with lymphadenopathy (additional mean cumulative CS dose, 222.57 mg). There was no change in the size of their lymph nodes.. Long term inhaled budesonide therapy appears to be safe in PPD-positive asthmatic children.

Topics: Administration, Inhalation; Adolescent; Adrenal Cortex Hormones; Asthma; Budesonide; Child; Child, Preschool; Female; Glucocorticoids; Humans; Male; Risk Factors; Tomography, X-Ray Computed; Tuberculin Test; Tuberculosis

Topics: Administration, Inhalation; Administration, Topical; Anti-Inflammatory Agents; Budesonide; Fever; Glucocorticoids; Humans; Nebulizers and Vaporizers; Powders; Treatment Outcome; Tuberculosis