Inhaled corticosteroid therapy is safe in tuberculin-positive asthmatic children

Background. Although treatment with oral corticosteroids can cause reactiva tion of latent Mycobacterium tuberculosis (TB) infection in purified protei n derivative (PPD)-positive individuals with no evidence of clinical diseas e, little is known about the effects of inhaled corticosteroids in this res pect. Objective. This study was undertaken to assess whether inhaled corticostero id (CS) therapy reactivates latent TB infection in PPD-positive asthmatic c hildren. Method. We studied 32 PPD skin test-positive (greater than or equal to 10 m m) children [age (mean +/- SD), 7.9 +/- 4.1 years] with no family history a nd no evidence of TB infection on chest radiograms who were receiving inhal ed budesonide for the treatment of asthma. They were further evaluated with thorax computed tomography (CT) and erythrocyte sedimentation rate and clo sely observed for an additional 9 months. Results. At enrollment the mean diameter of PPD reaction was 12.8 +/- 2.7 m m, The mean duration of inhaled CS treatment and the mean cumulative CS dos e were 9.8 +/- 7.6 months and 275 +/- 199 mg, respectively. Thorax CT studi es revealed mediastinal lymph nodes in 7 of the 32 patients. There was no s ignificant difference between children with and without mediastinal lymph n odes according to age, gender, size of PPD skin testing, erythrocyte sedime ntation rate and duration and cumulative CS dose of inhaled budesonide ther apy before study. A second thorax CT was obtained 9 months later in those 7 patients with lymphadenopathy (additional mean cumulative CS dose, 222.57 mg), There was no change in the size of their lymph nodes. Conclusion. Long term inhaled budesonide therapy appears to be safe in PPD- positive asthmatic children.