Asthma–Chronic Obstructive Pulmonary Diseases Overlap Syndrome Increases the Risk of Incident Tuberculosis: A National Cohort Study

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Abstract

Purpose

The association between asthma–chronic obstructive pulmonary diseases (COPD) overlap syndrome (ACOS) and tuberculosis (TB) has yet to be studied.

Methods

The newly diagnosed TB patients (age > 20 y) treated from January 2000 to December 2008 were included (ACOS cohort, n = 10 751; non-ACOS cohort, n = 42 966). The non-ACOS cohort involved patients with confirmed absence of ACOS. We calculated incidence rate ratios (IRRs) for TB in the ACOS and non-ACOS cohorts by using poisson regression analysis. Cox proportional hazards regression models were used to determine the adjusted HR (aHR) for TB in the ACOS cohort compared with the non-ACOS cohort.

Results

The aHR for TB was 2.41 (95% confidence interval [CI], 2.19–2.66) in the ACOS cohort. The TB risk was significantly higher in the ACOS cohort than in the non-ACOS cohort when stratified by age, sex, comorbidities, and atopy. Within the ACOS cohort, the aHR was higher among patients receiving SABAs+SAMAs, LABAs+LAMAs, and ICSs (aHR [95% CI]: 3.06 [2.75–3.41], 3.68 [2.93–4.61], and 2.79 [1.25–6.22], respectively; all P < .05). Furthermore, patients with more than 15 outpatient visits and hospitalizations per year demonstrated the highest aHR (8.09; 95% CI, 6.85–9.56).

Conclusions

ACOS cohort potentially develop incident TB, regardless of the age,sex, comorbidities and atopy; even without receiving the inhalers.This risk is higher, especially in the ACOS cohort have a high frequency of medical services or receiving the inhalers such as SABAs+SAMAs, LABAs+LAMAs and ICSs.

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Most cited references 48

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The development of instruments to measure the work disability assessment behaviour of insurance physicians

Romy Steenbeek, Antonius JM Schellart, Henny PG Mulders … (2011)

Background Variation in assessments is a universal given, and work disability assessments by insurance physicians are no exception. Little is known about the considerations and views of insurance physicians that may partly explain such variation. On the basis of the Attitude - Social norm - self Efficacy (ASE) model, we have developed measurement instruments for assessment behaviour and its determinants. Methods Based on theory and interviews with insurance physicians the questionnaire included blocks of items concerning background variables, intentions, attitudes, social norms, self-efficacy, knowledge, barriers and behaviour of the insurance physicians in relation to work disability assessment issues. The responses of 231 insurance physicians were suitable for further analysis. Factor analysis and reliability analysis were used to form scale variables and homogeneity analysis was used to form dimension variables. Thus, we included 169 of the 177 original items. Results Factor analysis and reliability analysis yielded 29 scales with sufficient reliability. Homogeneity analysis yielded 19 dimensions. Scales and dimensions fitted with the concepts of the ASE model. We slightly modified the ASE model by dividing behaviour into two blocks: behaviour that reflects the assessment process and behaviour that reflects assessment behaviour. The picture that emerged from the descriptive results was of a group of physicians who were motivated in their job and positive about the Dutch social security system in general. However, only half of them had a positive opinion about the Dutch Work and Income (Capacity for Work) Act (WIA). They also reported serious barriers, the most common of which was work pressure. Finally, 73% of the insurance physicians described the majority of their cases as 'difficult'. Conclusions The scales and dimensions developed appear to be valid and offer a promising basis for future research. The results suggest that the underlying ASE model, in modified form, is suitable for describing the assessment behaviour of insurance physicians and the determinants of this behaviour. The next step in this line of research should be to validate the model using structural equation modelling. Finally, the predictive value should be tested in relation to outcome measurements of work disability assessments.

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Human TYK2 deficiency: Mycobacterial and viral infections without hyper-IgE syndrome

Alexandra Kreins, Michael Ciancanelli, Satoshi Okada … (2015)

Kreins et al. report the identification and immunological characterization of a group of TYK2-deficient patients.

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Asthma-COPD overlap. Clinical relevance of genomic signatures of type 2 inflammation in chronic obstructive pulmonary disease.

Stephanie Christenson, Katrina Steiling, Maarten van den Berge … (2015)

Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease and likely includes a subgroup that is biologically comparable to asthma. Studying asthma-associated gene expression changes in COPD could add insight into COPD pathogenesis and reveal biomarkers that predict a favorable response to corticosteroids.

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Author and article information

Contributors

Saeid Ghavami: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 22 July 2016

Publication date Collection: 2016

Volume: 11

Issue: 7

Electronic Location Identifier: e0159012

Affiliations

[1 ]Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan

[2 ]Chia Nan University of Pharmacy and Science, Tainan, Taiwan

[3 ]Meiho University, Pingtung, Taiwan

[4 ]Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan

[5 ]College of Medicine, China Medical University, Taichung, Taiwan

[6 ]Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan

[7 ]Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan

University of Manitoba, CANADA

Author notes

Competing Interests: The authors have declared that no competing interests exist.

Conceived and designed the experiments: JJY CHK. Performed the experiments: JJY YCW CHK. Analyzed the data: JJY YCW CHK. Contributed reagents/materials/analysis tools: CHK. Wrote the paper: JJY YCW CHK.

* E-mail: d10040@ 123456mail.cmuh.org.tw

Article

Publisher ID: PONE-D-16-10934

DOI: 10.1371/journal.pone.0159012

PMC ID: 4957791

PubMed ID: 27448309

SO-VID: f7dfa21f-d80a-49bc-9300-a5c6c47bb532

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 15 March 2016

Date accepted : 2 June 2016

Page count

Figures: 2, Tables: 5, Pages: 14

Funding

Funded by: funder-id http://dx.doi.org/10.13039/100008903, Ministry of Health and Welfare;

Award ID: MOHW105-TDU-B-212-133019

Award Recipient : Chia-Hung Kao

This study is supported in part by Taiwan Ministry of Health and Welfare Clinical Trial and Research Center of Excellence (MOHW105-TDU-B-212-133019), China Medical University Hospital, Academia Sinica Taiwan Biobank Stroke Biosignature Project (BM10501010037), NRPB Stroke Clinical Trial Consortium (MOST 104-2325-B-039 -005), Tseng-Lien Lin Foundation, Taichung, Taiwan, Taiwan Brain Disease Foundation, Taipei, Taiwan, and Katsuzo and Kiyo Aoshima Memorial Funds, Japan; and CMU under the Aim for Top University Plan of the Ministry of Education, Taiwan. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. No additional external funding was received for this study.

Custom metadata

Data Availability Data is available from the National Health Insurance Research Database (NHIRD): http://nhird.nhri.org.tw/en/index.html. The accession number is NHIRD-102-050.

Asthma–Chronic Obstructive Pulmonary Diseases Overlap Syndrome Increases the Risk of Incident Tuberculosis: A National Cohort Study

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Most cited references 48

The development of instruments to measure the work disability assessment behaviour of insurance physicians

Human TYK2 deficiency: Mycobacterial and viral infections without hyper-IgE syndrome

Asthma-COPD overlap. Clinical relevance of genomic signatures of type 2 inflammation in chronic obstructive pulmonary disease.

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