Asthma drug use and the development of Churg-Strauss syndrome (CSS)

Leslie R. Harrold, University of Massachusetts Medical School
M. Kay Patterson
Susan E. Andrade, University of Massachusetts Medical School
Timothy Dube
Alan S. Go, Kaiser Permanente
A. Sonia Buist, Oregon Health and Science University
K. Arnold Chan, Harvard School of Public Health
Peter F. Weller, Harvard Medical School
Michael E. Wechsler, Harvard Medical School
Robert A. Yood, University of Massachusetts Medical School
Kourtney J. Davis
Richard Platt, Harvard Medical School
Alexander M. Walker, Harvard School of Public Health

Abstract

PURPOSE: Case reports suggest that leukotriene modifier use may be associated with the onset of Churg-Strauss syndrome (CSS). Using pooled data from two nested case-control studies, we examined the association between asthma drug use and the development of CSS. METHODS: The study was performed in three US managed care organizations and a US national health plan with chart access and complete electronic pharmacy data, with a covered population of 13.9 million. There were 47 cases of possible or definite CSS and 4700 asthma drug user controls identified between January 1, 1995 and December 31, 2002. We examined exposure to asthma drugs in cases and controls, including leukotriene modifiers (6 cases and 202 controls), in the two to 6 months prior to the onset of adjudicated CSS. RESULTS: While the crude association between use of leukotriene modifiers and CSS was strong (odds ratio (OR) 4.00, 95% confidence interval (CI): 1.49-10.60), in a multivariable analysis controlling for use of oral corticosteroids, inhaled corticosteroids, and number of categories of asthma drugs dispensed, there was no significant association (OR 1.32, 95% CI: 0.44-3.96). Use of inhaled and oral corticosteroids, evaluated as markers of asthma severity, were associated with CSS (OR 3.07, 95% CI: 1.34-7.03 and OR 5.36, 95% CI: 2.51-11.45, respectively). CONCLUSIONS: No association was found between CSS and leukotriene modifiers after controlling for asthma drug use However, it is not possible to rule out modest associations with asthma treatments given CSS is so rare and so highly correlated with asthma severity, suggesting further investigation is warranted.