Asthma, sinonasal disease, and the risk of active tuberculosis

Publication date: Available online 18 August 2018

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Anthony C. Yii, Avril Z. Soh, Cynthia B.E Chee, Yee T. Wang, Jian-Min Yuan, Woon-Puay Koh

Abstract

Background

Although asthma is associated with impaired lung immunity, it is unclear whether asthma affects risk of active tuberculosis (TB). Since the upper and lower airways are immunologically related, sinonasal disease may also modify susceptibility to TB disease.

Objectives

To evaluate whether asthma and sinonasal disease prospectively modulate the risk of active TB in the Singapore Chinese Health Study.

Methods

In this population-based prospective cohort, we recruited 63,257 Chinese adults aged 45-74 years from 1993-1998 in Singapore, and conducted follow-up I interviews among 52,325 surviving participants from 1999-2004. Data on self-reported history of physician-diagnosed sinonasal disease was collected at baseline, and data on asthma and chronic bronchitis were collected at follow-up I interviews. Active TB cases were identified by linkage with the national TB notification registry through December 2014. Multivariable Cox proportional hazards regression models were used to estimate risk of active TB.

Results

During a mean follow-up of 17 years from recruitment, there were 1249 cases of active TB, and among them, 678 cases were diagnosed in the 12-year period from follow-up I interviews. We observed reduced risk of active TB in those with a history of asthma at follow-up I [hazard ratio (HR) 0.55, 95% confidence interval (CI) 0.32-0.93] or sinonasal disease at baseline (HR 0.59, 95% CI 0.36-0.95). Conversely, history of chronic bronchitis was not associated with risk of TB (HR 0.95, 95% CI 0.68-1.31).

Conclusions

A history of asthma or sinonasal disease may modulate immunological response to reduce incidence of active TB in the adult population.