Chest
Original ResearchUse of Inhaled Corticosteroids in Patients With COPD and the Risk of TB and Influenza: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Section snippets
Data Sources and Searches
We searched the databases of MEDLINE, EMBASE, CINAHL, Cochrane Library, and ClinicalTrials.gov from inception to July 2013. Full-text terms and specific thesaurus terms (eg, Medical Subject Headings for MEDLINE and EMTREE for EMBASE), including “COPD” and “ICS,” were used for the search strategy (see e-Appendix 1 for details). We examined the bibliographies of relevant articles for eligible trials. To identify complete trial information and unpublished trials, we searched the clinical study
Eligible Trials
We identified 32 studies that fulfilled the eligibility criteria8, 9, 20, 21, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53 and contacted 21 authors for outcome ascertainment.27, 30, 31, 32, 33, 34, 36, 38, 39, 40, 41, 42, 43, 44, 46, 47, 48, 49, 50, 51, 52 Nine authors (42.9%) provided outcome information; five (23.8%) did not respond, but information was confirmed by the clinical study registers of drug manufacturers. Seven
Discussion
This meta-analysis of data from randomized controlled trials demonstrated that patients with COPD receiving ICSs had an approximately twofold increased risk of TB, particularly in endemic areas such as Asia and Africa. Meanwhile, a marginally, but nonsignificantly increased risk of influenza associated with ICSs was observed. This study highlights the potential harm of ICSs in increasing respiratory infections. These findings should be weighed against benefits and risks of ICS in the management
Acknowledgments
Author contributions: Dr Lai had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Dr Dong: contributed to the study conception and design; study selection; assessment of risk of bias; extraction, analysis, and interpretation of the data; drafting of the manuscript; critical revision of the manuscript for important intellectual content; and final approval of the manuscript.
Dr Chang: contributed to the study
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Impact of chronic obstructive pulmonary disease, lung infection, and/or inhaled corticosteroids use on potential risk of lung cancer
2022, Life SciencesCitation Excerpt :A 2013, retrospective, cohort study further confirmed that ICS use not only increased the risk of pulmonary TB in COPD patients with at least one prior pulmonary TB episode (HR = 25, 95% CI 3.1–201), but also in patients with normal chest radiograph with no prior infection (HR = 9.1, 95% CI 1.01–81.43) [54]. A 2014 meta-analysis, that included 25 trials also concluded a greater likelihood of developing TB while using ICS (OR = 2.29, 95% CI 1.04–5.03) [55]. Castellana et al. conducted a systematic review and reported an odds ratio of 1.46 (95% CI 1.06–2.01) associated with TB infection and ICS use [56].
Inhaled corticosteroids and risk of tuberculosis—How bad is the risk?
2022, Indian Journal of TuberculosisCitation Excerpt :Realising that fluticasone at one tenth the dose of prednisolone produces similar adrenal suppression,10 it may be reasonable to postulate that TB reactivation risk is elevated in patients using 750 mcg of fluticasone or equivalent per day. The risk associated with systemic corticosteroid therapy and reactivation of LTBI is clearcut and dose related.9,11 A case–control study9 revealed an adjusted odds ratio (OR) for TB of 4.9 in patients on OCS, which rose to 7.0 when prednisolone at mean daily dose of 7.5 mg or more was consumed.
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Part of this article was presented in abstract form at the 29th International Conference on Pharmacoepidemiology & Therapeutic Risk Management, August 25-28, 2013, Montréal, QC, Canada.
Drs Dong and Chang contributed equally to the manuscript.
Funding/Support: This study was supported in part by the Taiwan Department of Health [Grant DOH101-TD-B-111-01].
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.