Ouch! I read this title and immediately got worried. Then I read the summary in the link, and didn't feel like it was very helpful.
It sounded like good science, reporting on a study of over 400,000 patients with asthma or COPD, but then it reported about 3000 infections among them. Is that a lot or a little for that population? What steroid? Who was at risk? So, I sat down and read the whole report (it is filled with footnotes and statistics - torturous reading, for me at least!) Find it here:
https://erj.ersjournals.com/content/50/3/1700037

Now, what does the full report say?
This study addressed ONLY the use of inhaled corticosteroids, not the other drugs commonly prescribed.
People with Asthma or COPD may get NTM/MAC with or without using inhaled corticosteroids (ICS.)
The highest risk is use of the ICS fluticasone by people with COPD or Asthma + COPD.
The higher the dose, the greater the risk of infection.
The increased risk of using fluticasone in Asthma only patients is not statistically significant.
Other ICS inhalers, including the next most commonly used, budosenide, did not demonstrably increase the risk of infection in any group. In fact, the number of infections among budosenide & other ICS users was less than the number in the population that did not use any ICS.
About 1/3 of patients who got NTM had also used oral steroids within one year of infection; 2/3 also used one or more asthma/COPD control medications. There was no analysis of whether these led to increased risk.
NTM/MAC risk is significantly lower for Asthma and COPD patients than risk of pneumonia. It is thought that ICS reduce pneumonia risks.
The report concludes that risks of fluticasone should be considered at part of the overall treatment plan,

What is the takeaway?
Each patient, with their medical provider, needs to evaluate both the risks associated with medication and the quality of life gained by using it.
The provider should recommend the safest available medication in the lowest possible dose.

Here is my story:
I have asthma, reactive airways and bronchiectasis. I have had MAC. I was reluctant to use my steroid inhaler because I was afraid the MAC would come back. I am using a rescue inhaler many times a day, and I walked around feeling like there was "an elephant on my chest."

My pulmonologist insisted she could improve my quality of life. With Symbicort (budosenide plus formoterol), that heavy feeling is almost absent, the rescue inhaler stays in my pocket, and I have the energy to get through my day.

I hope this helps you make sense of the complexity of life with MAC
Sue

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