Inhaled corticosteroids increase risk of nontuberculous mycobacterial lung disease: a nested case control study and meta-analysis.

Studies on using inhaled corticosteroids (ICS) and the risk of nontuberculous mycobacterial lung disease (NTM-LD) are limited and have some conflict results. We recruited 1,235 NTM-LD patients and found that the ICS use within 1 year was associated with increased NTM-LD, and the risk increased by elevating ICS dose and cumulative duration. Discontinuation of ICS use for more than 120 days could reduce the risk of NTM-LD to an insignificant level. For NTM species, the development of NTM-LD by ICS was highest for M. kansasii lung disease. The pooled results of the meta-analysis echoed that ICS use might increase risk of NTM-LD with dose response since medium daily ICS dose. In addition, budesonide had a smaller impact on the risk of NTM-LD than other ICS medications. The present study and meta-analysis provided evidence for ICS adjustment including dose, discontinuation effect and medications to possibly reduce the risk of NTM-LD.