BMJ Journals research highlights—20 December 2013

Research questionsBMJ Journals research highlights is a regular round-up of research papers appearing in the BMJ Journals.

Use of inhaled corticosteroids and the risk of tuberculosis
Chang-Hoon Lee,  Kyungjoo Kim,  Min Kyung Hyun,  Eun Jin Jang,  Na Rae Lee,  Jae-Joon Yim
Thorax 2013;68:1105-1113 Published online first: 8 June 2013 doi:10.1136/thoraxjnl-2012-203175

We have previously highlighted the worrying increase in a number of respiratory infections in patients treated with high dose inhaled corticosteroids (ICS). Here we publish a report that ICS increases TB risk in a moderate TB prevalence region. The authors did a nice job calculating dose equivalence of the various inhalers prescribed and used the data to show a dose response effect for both asthma and COPD. Unfortunately they were not able to report comparative safety related to the topical potency of the ICS prescribed. These are really worrying data, and underscore the need to be really sure your patient needs potent ICS before you prescribe them; potentially they divert money from more useful medications in developing world contexts, as well as actually doing harm.

Increased risk of breast cancer associated with long-term shift work in Canada
Anne Grundy,  Harriet Richardson,  Igor Burstyn,  Caroline Lohrisch,  Sandip K SenGupta, Agnes S Lai,  Derrick Lee,  John J Spinelli,  Kristan J Aronson
Occup Environ Med 2013;70:831-838 Published online first: 1 July 2013 doi:10.1136/oemed-2013-101482

Night shift work has been classified by the International Agency for Research on Cancer as a probable human carcinogen, although the mechanism remains unclear.  This Canadian study progresses our knowledge as it found an association between long term night shift work and breast cancer in a broader range of occupations than previously reported, but no interaction with eostrogen receptor status.