Oakland, CA—Regular use of inhaled steroids can more than double the risk of developing a type of lung infection that sometimes is more difficult to treat than multi-drug resistant tuberculosis.

That’s according to a report in the Annals of the American Thoracic Society, which notes that nontuberculous mycobacteria (NTM) lung infections—which can cause serious illness and death, although not contagious—appear to be on the upswing because increased use of inhaled steroid therapy.

Kaiser Permanente and Stanford University researchers came to those conclusions after analyzing medical records of 549 patients with and without NTM pulmonary infection diagnosed in northern California over the decade between 2000 and 2010. Ultimately, they identified 248 cases with NTM pulmonary infection, with an estimated rate of 16.4 cases per 10,000 airway disease-treated subjects.

The study team determined that the odds of developing NTM pulmonary infection were 2.7 times greater in those patients who had filled three or more prescriptions for an inhaled steroid and that the risk was dose- and duration-dependent, i.e., the longer inhaled steroids were used and the higher the dosage, the greater the risk of an NTM lung infection.

“The increasing prevalence of NTMs is disconcerting because some of the most common types of NTM are harder to treat than multidrug-resistant TB,” explained corresponding author Stephen J. Ruoss, MD, a pulmonologist and intensivist at Stanford University Medical Center. “The rapidly growing number of NTM infections has occurred during a time when inhaled steroid use has increased, and we wanted to see if there was a potential connection.”

While the prevalence of NTM infection in the early 1980s was estimated as 1.8 cases per 100,000 persons, it has risen to more than 40 cases per 100,00 in some areas, according to more recent research.

The articles points out that this trend has coincided with greater use of inhaled steroids, which were first used in the 1980s to treat asthma but are now frequently prescribed for chronic obstructive pulmonary disease (COPD) and bronchiectasis, a chronic inflammatory condition that scars the airways.

The concern, according to the researchers, is whether the benefits are outweighing the risks.

“There have been some big studies that have shown a very modest, but statistically significant, benefit of inhaled steroid use in COPD patients,” Ruoss said. “These studies have also shown that COPD patients who use these drugs are at a slightly greater risk of developing routine bacterial infections.”

Ruoss added, “Inhaled steroids are standard therapy for those with asthma because the benefits have proven in studies and clinical practice to outweigh the risks. But as physicians, we should be careful using this class of drugs broadly in patients with COPD.” He also urged that patients receive the lowest effective dose with proven need for the therapy.

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