The Development of Pulmonary Tuberculosis in COPD: A Nationwide Population-Based Study

Abstract Background: Previous pulmonary tuberculosis is a significant risk factor for chronic obstructive pulmonary disease (COPD) and tuberculosis is one of the major COPD-related morbidities. Though inhaled corticosteroids (ICS) therapy has been shown to predispose COPD patients to pulmonary tuberculosis, the risk factors for tuberculosis in COPD have not been well studied. Hence, this study investigated the development of tuberculosis according to comorbidties and inhaler prescriptions in COPD. Methods: A retrospective cohort study was conducted based on the Korean Health Insurance Review and Assessment Service database from January 1, 2015 to December 31, 2020. This cohort included 139,589 COPD patients (≥ 40 years) with new prescription of inhalers. Patients with a previous history of any cancer or a switch of inhaler medication were excluded.Results: In the univariate analysis, ICS therapy, heart failure, diffuse interstitial lung disease, and gastroesophageal reflux disease were not associated with the development of pulmonary tuberculosis. Multivariate analysis, after adjusting for age, sex, and other significant factors identified in the univariate analysis, demonstrated that a previous history of tuberculosis infection (HR = 18.14; 95% CI = 16.44-20.02) and hospitalization during the screening period (HR of one hospitalization = 1.30; 95% CI = 1.17-1.44; HR of two or more hospitalizations = 1.55; 95% CI = 1.40-1.72), along with older age and male sex, were independently associated with the development of pulmonary tuberculosis.Conclusion: Our data suggest that a previous history of tuberculosis infection and hospitalization during screening period were independent risk factors for the development of pulmonary tuberculosis in COPD, whereas ICS prescription was not.