Exposure to Inhaled Corticosteroids Increases Risk for Nontuberculous Mycobacterial Lung Disease

Pulmonary Tuberculosis . Chest X-ray : interstitial infiltration at left upper lung due to Mycobacterium Tuberculosis infection
Researchers conducted a meta-analysis to assess the risk for nontuberculous mycobacterial lung disease in patients who use inhaled corticosteroids.

Nontuberculous mycobacterial lung disease (NTM-LD) was associated with use, dose, and duration of exposure to inhaled corticosteroids (ICS); however, discontinuation of ICS for 120 days or more may significantly decrease the risk for NTM-LD, according to study results published in the Journal of Infectious Disease.

Between 2008 and 2016, researchers retrospectively reviewed electronic health records from National Taiwan University Hospital to identify patients (n=1235) who had 2 or more sputum samples that were positive for NTM within a period of 12 months. Patients (n=4932) whose sputum samples were negative for NTM within the same time period were compared against those in the positive NTM group.. In addition, the researchers conducted a systematic review and meta-analysis pooling data from 3 studies with their data.

Among patients in both the NTM-LD and non-NTM groups, mean ages were 66 ± 15.3 and 65.9 ± 15.3 years, 53.8% and 53.8% were men, BMI was 21.3 ± 4.0 and 23 ± 4.2 kg/m2 (P <.001), and 10.4% and 2.2% had used ICS within the past year (P <.001), respectively. Compared with patients in the non-NTM group, those with NTM-LD had significantly increased incidence rates of chronic obstructive pulmonary disease, asthma, bronchiectasis, and pneumoconiosis (all P <.001).

The researchers found that ICS use increased the risk for NTM-LD within 1 year (adjusted odds ratio [aOR], 2.48; 95% CI, 1.73-3.55). Other factors of ICS use found to be associated with an even greater increased risk for NTM-LD were more recent use (<30 days; aOR, 3.38; 95% CI, 2.18-5.23), longer exposure (³1 year; aOR, 1.84; 95% CI, 1.09-3.11), and increased dosing (aOR, 3.52; 95% CI, 2.06-6.01).

Of note, ICS use was associated with an increased risk for NTM infections caused by Mycobacterium kansasii (aOR, 4.88; 95% CI, 1.16-20.48), M chelonae (aOR, 3.87; 95% CI, 1.05-14.23), M avium complex (aOR, 2.79; 95% CI, 1.66-4.68), and M abscessus (aOR, 2.28; 95% CI, 1.08-4.85); but not for NTM infections caused by M fortuitum (aOR, 3.33; 95% CI, 0.61-18.33).

The meta-analysis also showed an increased risk for NTM-LD among patients who used ICS during the previous year (OR, 2.02; 95% CI, 1.41-2.90; P =.000), and there was significant heterogeneity among the included studies (I2, 76.5%; P =.005). In addition, low- (OR, 1.61), moderate- (OR, 1.85), and high-dose (OR, 3.49) ICS were all found to be associated with an increased risk for NTM-LD. The comparisons between low- and high-dose ICS included significant study heterogeneity (both P £.003).

After Stratification by ICS medication, the risk for NTM-LD was decreased with budesonide use (OR, 0.69; 95% CI, 0.52-0.92; P =.012) and increased with fluticasone (OR, 1.60; 95% CI, 1.40-1.82; P =0.000), though neither comparison included significant study heterogeneity.

This study may have been limited as sputum examination and treatment protocols were not standardized.

The researchers noted that data from their center and those available in the literature indicated that use of ICS increased the risk for NTM-LD. “Given this information on ICS use, clinicians need to be alert for NTM-LD and may need to manipulate the dose, duration, and ICS medication [type] to reduce the risk for NTM-LD,” the researchers concluded.


Shu C-C, Wei Y-F, Chen K-H, et al. Inhaled corticosteroids increase risk of nontuberculous mycobacterial lung disease: a nested case control study and meta-analysis. J Infect Dis. 2021;jiab428. doi:10.1093/infdis/jiab428

This article originally appeared on Infectious Disease Advisor