Physician Update on Respiratory Disease Treatment: Inhaled Corticosteroids vs. Oral Antibiotics

Posted on September 12, 2018   |   
Like 10 Likes

This blog post was written by Beth McKnight, Patient Advocate, with the help of a Patient Advisory Panel.

Researchers at Oregon Health and Science University have found that long-term treatment of respiratory diseases with inhaled corticosteroid drugs actually increases the risk of serious lung infections.

The study, presented at the 2018 American Thoracic Society International Conference, focused on adult patients with bronchiectasis, whose bronchial tubes are thickened from inflammation and infection, preventing the clearing of mucus. Bronchiectasis, most accurately diagnosed by a CT scan, is on the rise in the U.S.

Dr. Emily Henkle, presenting author, said the team found that inhaled corticosteroid use increased the risk of hospitalized infections, and no evidence exists that they prevent exacerbations or progression of the disease. The study examined Medicare data from 90,000 patients who used either inhaled corticosteroids or the oral antibiotics azithromycin and erythromycin. The study found an increased 39% risk in the corticosteroid group as compared the group taking the oral antibiotics.

However, Dr. Henkle cautioned, potential risks exists with taking just one antibiotic long-term, such as the development of antibiotic resistant bacterial lung diseases like Mycobacterium aviumcomplex (MAC or MAI) and other nontuberculous mycobacterial infections.

What does this mean for physicians who treat patients with bronchiectasis and other lung diseases?

Since bronchiectasis patients often can have other lung diseases, a patient committee involved in the Oregon study recommends that physicians:

  1. Broaden their knowledge base of bronchiectasis and mycobacterial lung diseases like MAC and MAI.
  2. Take a second, thorough look at all of a patient’s medications and medication history before beginning any treatment.
  3. Use caution when prescribing corticosteroids long-term for any respiratory disease.
  4. Test for nontuberculous mycobacteria before long-term use of oral antibiotic azithromycin.
  5. Help patients understand the complexity of their disease and treatment, and empower them to manage their disease.
  6. Refer these patients, as appropriate, to medical centers specializing in the treatment of bronchiectasis and mycobacterial lung diseases.