Inhaled Steroids Linked to Non-TB Mycobacterial Lung Disease in Elderly

By Anne Harding

September 27, 2017

NEW YORK (Reuters Health) – Inhaled corticosteroids (ICS) have a strong dose-response relationship with non-tuberculous mycobacterial pulmonary disease (NTM-PD) in older adults with obstructive lung disease, according to a population-based case-control study from Canada.

While ICS have been recommended as a first-line treatment for chronic obstructive pulmonary disease (COPD), “that’s probably not appropriate as more and more data come out about the potential harms of inhaled corticosteroids,” Dr. Sarah K. Brode of the University of Toronto, the study’s first author, told Reuters Health in a telephone interview. The findings were published September 20 in European Respiratory Journal.

Dr. Brode and her team analyzed linked laboratory and health administrative data from 417,494 adults age 66 or older in Ontario. All had been treated for obstructive lung disease - COPD, asthma, or mixed COPD and asthma – from 2001 to 2013. In all, 2,966 NTM-PD cases and 327 TB cases were matched with up to four controls.

Adjusted odds ratios for NTM-PD were statistically significant for current ICS use overall (AOR, 1.86) and specifically for fluticasone (AOR, 2.09), but not for budenoside. Incident NTM-PD had a dose-response relationship with ICS cumulative dose within one year.

Current ICS use was not significantly associated with tuberculosis.

Fluticasone, but not budenoside, has also been linked to increased pneumonia risk, Dr. Brode and her colleagues note. The difference “is likely due to differences in pharmacokinetic and pharmacodynamic properties,” they add. “Fluticasone has a greater effect on glucocorticoid receptors, is more lipophilic and has a longer half-life than budenoside.”

Non-tuberculous mycobacteria are found in the environment and are not spread from human to human, Dr. Brode said. A few of the 160-plus types can make people sick, typically infecting the lungs. While these infections tend to be less pathogenic than TB, she added, they are less likely to be treated successfully. “Patients with these infections have to be treated with multiple antibiotics for a long time, and that’s not even a guarantee of a cure,” she said.

“The research community is still trying to figure out which COPD patients should be treated with inhaled corticosteroids and which shouldn’t, and I don’t think that’s really clear yet,” Brode noted.

“There are definitely COPD patients who need inhaled steroids, and almost all asthma patients will need them," she observed. Her recommendation: "Try to give the lowest effective dose. Don’t always give the highest dose.”


Eur Respir J 2017.