Abstract
BackgroundAn association between chronic obstructive pulmonary disease (COPD) and tuberculosis (TB) has been described, mainly due to smoking and corticosteroid use. Whether inhaled corticosteroid (ICS) therapy is associated with an increased risk of TB remains unclear.MethodsWe selected COPD cases by using six diagnostic scenarios and control subjects from a nationwide health insurance database, and applied time-dependent Cox regression analysis to identify the risk factors for TB.ResultsAmong 1,000,000 beneficiaries, 23,594 COPD cases and 47,188 non-COPD control subjects were selected. Cox regression analysis revealed that age, male gender, diabetes mellitus, end-stage renal disease, and cirrhosis, as well as COPD (hazard ratio = 2.468 [2.205–2.762]) were independent risk factors for TB. Among the COPD cases, those who developed TB received more oral corticosteroids and oral β-agonists. Time-dependent Cox regression analysis revealed that age, male gender, diabetes mellitus, low income, oral corticosteroid dose, and oral β-agonist dose, but not ICS dose, were independent risk factors for TB. The identified risk factors and their hazard ratios were similar among the COPD cases selected using different scenarios.ConclusionKeeping a high suspicion and regularly monitoring for the development of pulmonary TB in COPD patients are necessary, especially for those receiving higher doses of oral corticosteroids and other COPD medications. Although ICS therapy has been shown to predispose COPD patients to pneumonia in large randomized clinical trials, it does not increase the risk of TB in real world practice.
Highlights
An association between chronic obstructive pulmonary disease (COPD) and tuberculosis (TB) has been described, mainly due to smoking and corticosteroid use
Among the 1,000,000 beneficiaries in the Longitudinal Health Insurance Database (LHID) 2005, 23,594 COPD cases were identified, and 47,188 nonCOPD subjects matched for age, gender, and timing of entering the LHID 2005 were selected as the control group
We found that increased age, male gender, diabetes mellitus, end-stage renal disease, and liver cirrhosis significantly increased the risk of developing pulmonary TB
Summary
An association between chronic obstructive pulmonary disease (COPD) and tuberculosis (TB) has been described, mainly due to smoking and corticosteroid use. Whether inhaled corticosteroid (ICS) therapy is associated with an increased risk of TB remains unclear. COPD is an airway inflammatory disease with a high prevalence rate worldwide [8], ranging from 8.2% in China, 10.9% in Japan, 19.6% in USA, 23.8% in South Africa to 26.1% in Australia [9,10,11,12,13], It is a major health burden both in developed and developing countries. The systemic administration of corticosteroids is a known risk factor for TB [7], whether ICS therapy is associated with an increased risk of TB has yet to be elucidated
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