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Chronic respiratory disease, inhaled corticosteroids and risk of non-tuberculous mycobacteriosis
  1. Claire Andréjak1,2,3,4,
  2. Rikke Nielsen1,
  3. Vibeke Ø Thomsen5,
  4. Pierre Duhaut3,6,
  5. Henrik Toft Sørensen1,
  6. Reimar Wernich Thomsen1
  1. 1Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
  2. 2Department of Respiratory Diseases, Teaching Hospital Amiens, Picardie Jules Verne University, Amiens, France
  3. 3Reseau d'Epidémiologie International Francophone Unit, Amiens, France
  4. 4INSERM U 1088 Picardie Jules Verne University, Amiens, France
  5. 5International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
  6. 6Department of Internal Medicine, Teaching Hospital Amiens, Picardie Jules Verne University, Amiens, France
  1. Correspondence to Dr Claire Andréjak, Department of Respiratory Diseases, Teaching Hospital Amiens, Avenue Laënnec, Amiens 80054, Cedex 1, France; clandrejak{at}


Background Chronic respiratory disease and inhaled corticosteroid (ICS) therapy for chronic obstructive pulmonary disease (COPD) increase the risk of pneumonia. Few data are available on the association of these risk factors with non-tuberculous mycobacterial (NTM) pulmonary disease.

Methods This study examined chronic respiratory diseases and ICS use as risk factors in a population-based case-control study encompassing all adults in Denmark with microbiologically confirmed NTM pulmonary disease between 1997 and 2008. The study included 10 matched population controls per case. Conditional logistic regression was used to compute adjusted ORs for NTM pulmonary disease with regard to chronic respiratory disease history.

Results Overall, chronic respiratory disease was associated with a 16.5-fold (95% CI 12.2 to 22.2) increased risk of NTM pulmonary disease. The adjusted OR for NTM disease was 15.7 (95% CI 11.4 to 21.5) for COPD, 7.8 (95% CI 5.2 to 11.6) for asthma, 9.8 (95% CI 2.03 to 52.8) for pneumoconiosis, 187.5 (95% CI 24.8 to 1417.4) for bronchiectasis, and 178.3 (95% CI 55.4 to 574.3) for tuberculosis history. ORs were 29.1 (95% CI 13.3 to 63.8) for patients with COPD on current ICS therapy and 7.6 (95% CI 3.4 to 16.8) for patients with COPD who had never received ICS therapy. Among patients with COPD, ORs increased according to ICS dose, from 28.1 for low-dose intake to 47.5 for high-dose intake (more than 800 μg/day). The OR was higher for fluticasone than for budesonide.

Conclusion Chronic respiratory disease, particularly COPD treated with ICS therapy, is a strong risk factor for NTM pulmonary disease.

  • Atypical mycobacteria infections
  • chronic obstructive pulmonary disease
  • corticosteroids
  • case–control study
  • pneumonia
  • pulmonary embolism
  • respiratory infection
  • tuberculosis
  • bacterial infection
  • clinical epidemiology
  • respiratory infection

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  • Funding This study was supported by the Karen Elise Jensen Foundation, Denmark.

  • Competing interests None.

  • Patient consent This is a retrospective study. Data were obtained by Danish registries. This was approved by the Danish Data Protection Agency.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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