Yield of systematic screening for tuberculosis among patients with obstructive airway disease using inhalational corticosteroids.

Abstract

Introduction: The increased risk of tuberculosis associated with inhalation corticosteroids has been demonstrated in various studies. However, the specific risk factors for developing tuberculosis in this context are less studied. So, this study was planned.

Methods: This cross-sectional study was carried out in the Department of Pulmonary Medicine of a tertiary care centre in Puducherry, India. Those patients who were on inhalational corticosteroid for more than 1 year and having presumptive TB symptom were included in the study. Sputum smears, chest radiography, and CBNAAT were done in all cases of presumptive tb cases, and bronchoscopies and BAL where necessary were used to diagnose patients. The patient was diagnosed with tuberculosis diagnosis upon microbiologic confirmation.

Results: 1550 patients had symptoms of presumptive tuberculosis and were thus included in the study. The mean age of our study population was 50.97 ± 19.25. Male gender, use of higher doses of steroids, coronary artery disease, smoking, and alcohol use were the risk factors for the development of tuberculosis. On multivariate regression analysis, diabetes (OR: 6.4, 95% CI: 2.275-18.121, P value: 0.001) and higher doses of steroid use (OR: 7, 95% CI: 2.485-20.026, P value: 0.001) were identified as independent risk factors for the development of tuberculosis among patients using inhalational corticosteroids. The number indeed to screen was 262.

Conclusion: Patients who were on higher doses of inhalational corticosteroids and diabetic patients should be advised to undergo targeted screening and testing for tuberculosis. In order to get one case tuberculosis patient, we have to screen 262 cases of OAD patients.