Inhaled Corticosteroids Increase Risk for Pulmonary Nontuberculous Mycobacterial Infection

Patients with pulmonary nontuberculous mycobacterial (NTM) infections were more likely to have previously used inhaled corticosteroids within the previous 6 months compared with patients with other airway diseases, according to study results published in the Annals of the American Thoracic Society.

Use of inhaled corticosteroids, other airways disease medications, and healthcare resources were quantified from medical records of patients with airway disease from the Kaiser Permanente Northern California integrated healthcare delivery system. Data from patients with pulmonary NTM infections (n=549) were then compared with data from a group of case-control patients with airway disease. Mean patient age was 64.1 and 63.3% of patients were women.

Patients with NTM infection were more likely to have used inhaled corticosteroids in the previous 6 months (odds ratio [OR], 2.74; 95% CI, 1.83-4.09; P <.01). The same was true in patients who had used corticosteroids within the last year (adjusted OR, 2.80; 95% CI, 1.79-4.37; P <.01) and 2 years (adjusted OR, 2.51; 95% CI, 1.40-4.49; P <.01). Patients with NTM infection were also more likely to have used the most other medications compared with controls. (36.3% vs 14.2%). Higher levels of healthcare utilization based on ambulatory, emergency department, and hospital visits were also observed.

The researchers wrote, “Each month of high-dose [inhaled corticosteroid] use was independently associated with greatly increased odds of developing NTM pulmonary infection, even after adjusting for other airway disease treatments and healthcare utilization metrics.”

They also noted a possible mechanism, suggesting, “Corticosteroids can alter cellular immune function, critically important in host response and defense against pathogens, and this may contribute substantially to risk of pulmonary infections, including NTM infection.”

Reference

Liu V, Winthrop K, Lu Y, Sharifi H, Nasiri H, Ruoss SJ. Association between inhaled corticosteroid use and pulmonary nontuberculous mycobacterial infection. Ann Am Thorac Soc. 2018;15(10):1169-1176.