The risk of mycobacterial infections associated with inhaled corticosteroid use

Brode, Sarah K.; Campitelli, Michael A.; Kwong, Jeffrey C.; Lu, Hong; Marchand-Austin, Alex; Gershon, Andrea S.; Jamieson, Frances; Marras, Theodore K.

doi:10.1183/13993003.00037-2017

Cited by 144 publications

(137 citation statements)

References 44 publications

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“…This could be because they were seen more frequently by a physician or because there was concern over the known association between ICS and respiratory tract bacterial infections. [26][27][28][29] However, a past history of hospitalised pneumonia was not associated with ICS withdrawal and many resumed ICS use. Encouragingly, and as we have shown before in a different UK primary care patient cohort, 3 patients that were prescribed triple therapy, had more severe disease and were more likely to exacerbate than those prescribed dual therapy.…”

Section: Ics-containing Regimensmentioning

confidence: 99%

<p>Inhaled Corticosteroid Treatment Regimens and Health Outcomes in a UK COPD Population Study</p>

Bloom¹,

Douglas²,

Usmani³

et al. 2020

COPD

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Background: Inhaled corticosteroids (ICS) are a prevailing treatment option for COPD patients but recent guidelines have relegated their use predominantly to patients with frequent exacerbations. Yet large numbers of patients worldwide are currently treated with ICS-containing regimens. We wished to determine in routine clinical practice how common ICS withdrawal is and the differences in health outcomes between patients managed on ICScontaining and non-ICS containing regimens. Patients and Methods: COPD patients were identified from the UK primary care electronic healthcare records, between 2014 and 2018. Patients were grouped into three treatment regimens: long-acting beta-agonist (LABA) and inhaled corticosteroids (ICS), LABA and long-acting muscarinic antagonist (LAMA), and triple therapy (LABA, LAMA and ICS). Annual incidence of ICS withdrawal was measured. Multivariable logistic regression was used to identify patient factors associated with withdrawal. Multivariable Poisson regression was used to assess the association of exacerbations and hospitalised pneumonia between the ICS-containing regimens (LABA-ICS and triple therapy) and patients prescribed LABA-LAMA. Results: Of 117,046 patients, around three-quarters were prescribed ICS-containing inhalers but ICS withdrawal occurred annually in only approximately 2-3% of patients. Exacerbations in the past year, but not a past history of pneumonia, were associated with ICS withdrawal. A total of 31,034 patients using three treatment regimens (LABA-ICS, LABA-LAMA or triple therapy) were assessed for their relative risk of exacerbations and pneumonia; the exacerbation risk was slightly lower in LABA-ICS users but the same in triple therapy users, as compared to LABA-LAMA users (LABA-ICS adjusted IRR=0.82 (95% CI 0.73-0.93), triple adjusted IRR=0.99 (95% CI 0.88-1.11)). There was no difference in the pneumonia risk (LABA-ICS adjusted IRR=0.96 (95% CI 0.71-1.31), triple adjusted IRR=1.16 (95% CI 0.87-1.57)). Conclusion: Use of ICS-containing inhaled medication is prevalent across the UK while ICS withdrawal from established treatment was relatively uncommon. Exacerbations and pneumonia risk was similar between the ICS-containing and non-ICS containing treatment regimens.

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Section: Ics-containing Regimensmentioning

confidence: 99%

<p>Inhaled Corticosteroid Treatment Regimens and Health Outcomes in a UK COPD Population Study</p>

Bloom¹,

Douglas²,

Usmani³

et al. 2020

COPD

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“…GOLD 2019 recommends LAMA monotherapy as initial treatment in the majority of COPD patients; however, many patients remain symptomatic on monotherapy, and LABA/LAMA is recommended in these patients . On the other hand, use of ICS in COPD is associated with side effects—pneumonia, diabetes, osteoporosis and mycobacterial infections . Furthermore, as per GOLD 2019 update, initial treatment with LABA/ICS may be the first choice only for COPD patients with history of asthma or with blood eosinophil counts ≥300 cells/μL .…”

Section: Discussionmentioning

confidence: 99%

“…2,35,36 On the other hand, use of ICS in COPD is associated with side effects-pneumonia, diabetes, osteoporosis and mycobacterial infections. [37][38][39][40] Furthermore, as per GOLD 2019 update, initial treatment with LABA/ICS may be the first choice only for COPD patients with history of asthma or with blood eosinophil counts ≥300 cells/μL. 2 LABA/LAMA combinations, particularly IND/GLY, have shown improvements in lung function, PRO, rescue medication use and exacerbations versus monocomponents, placebo and well-established COPD treatments including LAB-A/ICS.…”

Section: Discussionmentioning

confidence: 99%

Indacaterol/glycopyrronium versus tiotropium or glycopyrronium in long‐acting bronchodilator‐naïve COPD patients: A pooled analysis

et al. 2019

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Background and objective Indacaterol/glycopyrronium (IND/GLY) 110/50 μg once daily (q.d.) has demonstrated greater improvements in lung function, patient‐reported outcomes and lower exacerbation rates versus mono long‐acting muscarinic antagonists (LAMA) in chronic obstructive pulmonary disease (COPD) patients. However, data are limited on initial treatment with IND/GLY 110/50 μg q.d. versus mono LAMA in COPD patients, not previously on maintenance treatment with long‐acting bronchodilators (LABD). Methods A pooled analysis of ARISE, SHINE and SPARK trials was conducted to evaluate the efficacy of IND/GLY 110/50 μg q.d. versus open‐label (OL) tiotropium (TIO) 18 μg q.d. and GLY 50 μg q.d. in COPD patients, not on maintenance treatment with LABD at study entry (LABD‐naïve). Efficacy was assessed after 24/26 weeks of treatment. Results In total, 998 LABD‐naïve patients were included (IND/GLY: 353; OL TIO: 328; GLY: 317). Patients treated with IND/GLY 110/50 μg q.d. experienced greater improvements in trough forced expiratory volume in 1 s (FEV1) versus OL TIO 18 μg q.d. (least squares mean treatment difference (Δ): 0.086 L) and GLY 50 μg q.d. (Δ: 0.080 L) after 24/26 weeks. Improvements in electronic diary (eDiary) symptom scores, transition dyspnoea index (TDI) focal score, St George's Respiratory Questionnaire (SGRQ) total score and rescue medication use were also greater with IND/GLY versus OL TIO and GLY. Greater proportion of patients achieved minimal clinically important difference in trough FEV1, TDI and SGRQ with IND/GLY versus OL TIO and GLY. Conclusion LABD‐naïve patients treated with IND/GLY 110/50 μg q.d. achieved improvements in lung function, daily symptoms, dyspnoea, health‐related quality of life and rescue medication use versus those who received single LAMA.

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“…The increased risk of NTMLD in COPD subjects may be partly associated with inhaled steroids use and dosage [26,27]. Diel et al [28] found an increased mortality rate among COPD individuals infected with NTM, comparing to those not infected.…”

Section: Discussionmentioning

confidence: 99%

Factors Predisposing to Non-Tuberculous Mycobacterial Lung Disease in the Patients with Respiratory Isolates of Non-Tuberculous Mycobacteria

Szturmowicz¹,

Siemion-Szcześniak²,

Wyrostkiewicz³

et al. 2018

Advances in Respiratory Medicine

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Introduction: An increasing incidence rate of respiratory isolates of non-tuberculous mycobacteria (NTM) has been noted recently in most European countries as well as in the US. Despite many publications, there is no consensus concerning the importance of different factors in promoting NTM lung disease (NTMLD). The aim of the present retrospective study was to analyse patients with positive NTM respiratory isolates in search of factors predisposing to NTMLD. Material and methods: 73 patients, 23 males, 50 females, median age 62.2 years, in whom NTM have been cultured from respiratory specimen (sputum and/or bronchial washings), in the period 2010-2015, entered the study. Results: NTMLD (according to ATS/IDSA) has been recognised in 36 patients, airways colonisation by NTM-in 37 patients. NTMLD was diagnosed more often in the patients infected with M. kansasii, M. abscessus and M. avium/M. intracellulare comparing to those infected with M. xenopi, M. gordonae and M. fortuitum (p < 0.0001). The proportion of females to males was significantly higher in the NTMLD group comparing to the colonisation group (p < 0.007). Previous tuberculosis or mycobacteriosis were noted significantly more frequently in the group of patients with NTMLD comparing to the colonisation group (28% vs 8%, p = 0.038). Univariate regression analysis revealed M. kansasii, female gender, and previous tuberculosis or mycobacteriosis as significant predictors of NTMLD. Conclusions: The risk factors of NTMLD recognition in the presented group of patients were the following: female gender, M. kansasii isolation, as well as past tuberculosis or mycobacteriosis.

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The risk of mycobacterial infections associated with inhaled corticosteroid use

Cited by 144 publications

References 44 publications

<p>Inhaled Corticosteroid Treatment Regimens and Health Outcomes in a UK COPD Population Study</p>

<p>Inhaled Corticosteroid Treatment Regimens and Health Outcomes in a UK COPD Population Study</p>

Indacaterol/glycopyrronium versus tiotropium or glycopyrronium in long‐acting bronchodilator‐naïve COPD patients: A pooled analysis

Factors Predisposing to Non-Tuberculous Mycobacterial Lung Disease in the Patients with Respiratory Isolates of Non-Tuberculous Mycobacteria

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