Post-tuberculosis lung disease: a comparison of Brazilian, Italian, and Mexican cohorts

Abstract

Objective: To evaluate lung function in a cohort of patients with a history of pulmonary tuberculosis in Brazil, as well as to evaluate the decline in lung function over time and compare it with that observed in similar cohorts in Mexico and Italy. Methods: The three cohorts were compared in terms of age, smoking status, pulmonary function test results, six-minute walk test results, and arterial blood gas results. In the Brazilian cohort, pulmonary function test results, six-minute walk test results, and arterial blood gas results right after the end of tuberculosis treatment were compared with those obtained at the end of the follow-up period. Results: The three cohorts were very different regarding pulmonary function test results. The most common ventilatory patterns in the Brazilian, Italian, and Mexican cohorts were an obstructive pattern, a mixed pattern, and a normal pattern (in 58 patients [50.9%], in 18 patients [41.9%], and in 26 patients [44.1%], respectively). Only 2 multidrug-resistant tuberculosis cases were included in the Brazilian cohort, whereas, in the Mexican cohort, 27 cases were included (45.8%). Mean PaO2 and mean SaO2 were lower in the Mexican cohort than in the Brazilian cohort (p < 0.0001 and p < 0.002 for PaO2 and SaO2, respectively). In the Brazilian cohort, almost all functional parameters deteriorated over time. Conclusions: This study reinforces the importance of early and effective treatment of drug-susceptible tuberculosis patients, because multidrug-resistant tuberculosis increases lung damage. When patients complete their tuberculosis treatment, they should be evaluated as early as possible, and, if post-tuberculosis lung disease is diagnosed, they should be managed and offered pulmonary rehabilitation because there is evidence that it is effective in these patients.

Residual respiratory disability after successful treatment of pulmonary tuberculosis: a systematic review and meta-analysis

“…We included 60 studies and identified three additional studies from reference lists of the included studies. In total, 63 studies with 41,014 patients with PTB were included 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 . Of the 63 studies, 61 were unique study populations (two pairs of studies reported different post-TB assessments in the same study population 52 , 53 , 73 , 99 ).…”

Brazilian Thoracic Association recommendations for the management of post-tuberculosis lung disease

“…In a recent comparison of three different cohort studies involving PTLD patients in Brazil, Italy, and Mexico, pulmonary function tests showed different results, the majority of which showed obstructive, mixed, and normal patterns, respectively. 23 …”

“…Therefore, whenever plethysmography or lung volume measurements are feasible, they should complement spirometry to confirm obstructive, restrictive, or even mixed patterns of pulmonary disease since the type of ventilatory defect can be heterogeneous and vary in different populations. 23 …”

Diagnosis and management of post-tuberculosis lung disease

“…Eles podem ter déficits de função pulmonar (obstrução, restrição ou padrões mistos), tendo um risco duas vezes maior de apresentar anormalidades espirométricas do que a população em geral, e aproximadamente 10% desses pacientes podem ter perdido mais da metade de sua função pulmonar. (2,4,5) Além disso, esses pacientes podem apresentar sintomas respiratórios persistentes, como tosse residual e dispneia, além de redução da capacidade de exercício e da qualidade de vida. (2,6) Além disso, foi demonstrado que sobreviventes da tuberculose têm uma taxa de mortalidade pós-tratamento de longo prazo quase três vezes maior do que a população geral, com a maioria das mortes ocorrendo no primeiro ano após o término do tratamento.…”

“…They may have lung function deficits (obstruction, restriction, or mixed patterns), having a two-fold greater risk of presenting with spirometric abnormalities than the general population, and approximately 10% of these patients may have lost more than half of their lung function. 2 , 4 , 5 In addition, these patients may have persistent respiratory symptoms, such as residual cough and dyspnea, in addition to reduced exercise capacity and quality of life. 2 , 6 Furthermore, it has been shown that tuberculosis survivors have a long-term post-treatment mortality rate almost three times higher than the general population, with most deaths occurring in the first year after the end of treatment.…”