{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T16:50:59Z","timestamp":1784739059901,"version":"3.55.0"},"reference-count":38,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T00:00:00Z","timestamp":1777334400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Research Committee and Copenhagen Respiratory Research at Herlev and Gentofte University Hospital"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Inhaled corticosteroids (ICS) increase the risk of pneumonia caused by various pathogens in patients with chronic obstructive pulmonary disease (COPD). Treatment may also increase the risk of infection with non-tuberculous mycobacteria (NTM), although evidence remains limited. The aim of this study was to assess the association between ICS treatment and the risk of NTM isolation among patients with COPD. Methods: This retrospective register-based cohort study included patients with a specialist-verified COPD diagnosis between 2008 and 2021. ICS exposure was based on redeemed prescriptions during the year preceding the index date. Exposure was calculated as the mean daily budesonide-equivalent dose and categorized as none, low, medium, or high. A cause-specific Cox proportional hazards regression model with death as a competing risk was applied, adjusted for potential confounders. Sensitivity analyses included, among others, an inverse probability of treatment weighted model, and a time-dependent Cox regression model. Results: A total of 120,006 patients were included, with a median follow-up time of 4.9 years. During follow-up, 378 (0.32%) patients reached the primary endpoint. Medium- and high-dose ICS were associated with an increased hazard of NTM isolation, with hazard ratios of 1.39 (95% CI 1.06\u20131.88, p = 0.020) and 1.52 (95% CI 1.14\u20132.04, p = 0.005), respectively. This association remained significant for high-dose ICS across all sensitivity analyses. Conclusions: In patients with COPD, ICS treatment was associated with an increased and dose-dependent hazard of NTM isolation, particularly at high doses. High-dose ICS should, therefore, be prescribed with caution.<\/jats:p>","DOI":"10.3390\/jcm15093352","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T09:55:39Z","timestamp":1777370139000},"page":"3352","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Inhaled Corticosteroids and Non-Tuberculous Mycobacteria Risk in Patients with COPD"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-7676-7069","authenticated-orcid":false,"given":"Emma Moerk","family":"Borremose","sequence":"first","affiliation":[{"name":"Copenhagen Respiratory Research, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2965-6348","authenticated-orcid":false,"given":"Victor Naestholt","family":"Dahl","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Aarhus University Hospital, 8200 Aarhus, Denmark"},{"name":"International Reference Laboratory of Mycobacteriology, Statens Serum Institut, 2300 Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Kubel","family":"Vognsen","sequence":"additional","affiliation":[{"name":"Copenhagen Respiratory Research, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2601-2718","authenticated-orcid":false,"given":"Troels","family":"Lillebaek","sequence":"additional","affiliation":[{"name":"International Reference Laboratory of Mycobacteriology, Statens Serum Institut, 2300 Copenhagen, Denmark"},{"name":"Global Health Section, Department of Public Health, University of Copenhagen, 1353 Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Fl\u00f8e","sequence":"additional","affiliation":[{"name":"Department of Respiratory Diseases and Allergy, Aarhus University Hospital, 8200 Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4209-2778","authenticated-orcid":false,"given":"Tor","family":"Biering-S\u00f8rensen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark"},{"name":"Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2900 Hellerup, Denmark"},{"name":"Department of Cardiology, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark"},{"name":"Steno Diabetes Center Copenhagen, 2730 Herlev, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Bonnesen","sequence":"additional","affiliation":[{"name":"Copenhagen Respiratory Research, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3739-7526","authenticated-orcid":false,"given":"Josefin","family":"Ekl\u00f6f","sequence":"additional","affiliation":[{"name":"Copenhagen Respiratory Research, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8620-3655","authenticated-orcid":false,"given":"Pradeesh","family":"Sivapalan","sequence":"additional","affiliation":[{"name":"Copenhagen Respiratory Research, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark"},{"name":"Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, 2200 Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4036-0521","authenticated-orcid":false,"given":"Jens-Ulrik St\u00e6hr","family":"Jensen","sequence":"additional","affiliation":[{"name":"Copenhagen Respiratory Research, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark"},{"name":"Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, 2200 Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.ijid.2022.10.013","article-title":"Global trends of pulmonary infections with nontuberculous mycobacteria: A systematic review","volume":"125","author":"Dahl","year":"2022","journal-title":"Int. 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