Inhaled Corticosteroids And Risk Of Tuberculosis In Patients With Obstructive Lung Diseases: A Systematic Review And Meta-Analysis Of Non-randomized Studies

Figures & data

Figure 1 PRISMA flowchart.

Table 1 Qualitative Analysis Of Studies Included In The Systematic Review

Author, Year	Country	Diagnosis	Age (years)	Sex (males, %)	Patients On ICS/Not On ICS	Any ICS Use Versus No ICS	Any ICS Use And No ICS With Or Without Simultaneous OCS	Current ICS Use Versus Prior Or No ICS	High-Dose ICS Use Versus No ICS	Moderate-Dose ICS Use Versus No ICS	Low-Dose ICS Use Versus No ICS
Retrospective cohort studies with medical record review (MRR)
Brassard, 2011^Citation23	Canada	Airways diseases	69	44	2361/3843	x	x	x	x	x
Brode, 2017^Citation30	Canada	Obstructive lung diseases	NR	NR	1031/604	x		x
Retrospective cohort study with a nested case-control analysis (NCC)
Chung, 2014^Citation24	Taiwan	Obstructive lung diseases	61	69	1153/39302	x	x		x	x	x
Jian, 2016^Citation25	Taiwan	Asthma	NR	58	10904/43616	x
Lee, 2013^Citation26	South Korea	Obstructive lung diseases	67	67	7410/17312	x	x	x
Wu, 2016^Citation27	Taiwan	COPD	NR	69	8813/35252	x
Yeh, 2016^Citation31	Taiwan	ACOS	65	55	4054/6697	x
Kim, 2013^Citation28	South Korea	COPD	65	87	309/307	x
Shu, 2010^Citation29	Taiwan	COPD	66	66	316/238	x	x		x	x	x

Notes: In NCCs, tuberculosis localization was derived from International Classification of Diseases and Related Health Problems codes. Age was expressed as mean, except for Lee, 2013, in which the median was reported.

Abbreviations: ACOS, asthma–chronic obstructive pulmonary disease overlap syndrome; COPD, chronic obstructive pulmonary disease; ICS, inhaled corticosteroids; NR, not reported; OCS, oral corticosteroids.

Figure 2 Forest plots of meta-analysis for difference in incident cases of TB between any ICS use and no ICS use.

Figure 3 Forest plots of meta-analysis for difference in incident cases of TB between any ICS use and no ICS with or without simultaneous OCS.

Brassard P, Suissa S, Kezouh A, Ernst P. Inhaled corticosteroids and risk of tuberculosis in patients with respiratory diseases. Am J Respir Crit Care Med. 2011;183(5):675–678. doi:10.1164/rccm.201007-1099OC20889902

 PubMed Web of Science ®Google Scholar

Brode SK, Campitelli MA, Kwong JC, et al. The risk of mycobacterial infections associated with inhaled corticosteroid use. Eur Respir J. 2017;50(3):1700037. doi:10.1183/13993003.00711-201728931659

 PubMed Web of Science ®Google Scholar

Chung WS, Chen YF, Hsu JC, Yang WT, Chen SC, Chiang JY. Inhaled corticosteroids and the increased risk of pulmonary tuberculosis: a population-based case-control study. Int J Clin Pract. 2014;68(10):1193–1199. doi:10.1111/ijcp.1245924838040

 PubMed Web of Science ®Google Scholar

Jian ZH, Huang JY, Lin FC, et al. Post-inhaled corticosteroid pulmonary tuberculosis increases lung cancer in patients with asthma. PLoS One. 2016;11(7):e0159683. doi:10.1371/journal.pone.015968327448321

 PubMed Web of Science ®Google Scholar

Lee CH, Kim K, Hyun MK, Jang EJ, Lee NR, Yim JJ. Use of inhaled corticosteroids and the risk of tuberculosis. Thorax. 2013;68(12):1105–1113. doi:10.1136/thoraxjnl-2012-20317523749841

 PubMed Web of Science ®Google Scholar

Wu MF, Jian ZH, Huang JY, et al. Post-inhaled corticosteroid pulmonary tuberculosis and pneumonia increases lung cancer in patients with COPD. BMC Cancer. 2016;16(1):778. doi:10.1186/s12885-016-2838-427724847

 PubMed Web of Science ®Google Scholar

Yeh JJ, Wang YC, Kao CH. Asthma-chronic obstructive pulmonary diseases overlap syndrome increases the risk of incident tuberculosis: a national cohort study. PLoS One. 2016;11(7):e0159012. doi:10.1371/journal.pone.015901227448309

 PubMed Web of Science ®Google Scholar

Kim JH, Park JS, Kim KH, Jeong HC, Kim EK, Lee JH. Inhaled corticosteroid is associated with an increased risk of TB in patients with COPD. Chest. 2013;143(4):1018–1024. doi:10.1378/chest.12-122523079688

 PubMed Web of Science ®Google Scholar

Shu CC, Wu HD, Yu MC, et al. Use of high-dose inhaled corticosteroids is associated with pulmonary tuberculosis in patients with chronic obstructive pulmonary disease. Medicine (Baltimore). 2010;89(1):53–61. doi:10.1097/MD.0b013e3181cafcd320075705

 PubMed Web of Science ®Google Scholar