A Novel Scoring System to Measure Radiographic Abnormalities and Related Spirometric Values in Cured Pulmonary Tuberculosis

Abstract

BackgroundDespite chemotherapy, patients with cured pulmonary tuberculosis may result in lung functional impairment.ObjectiveTo evaluate a novel scoring system based on the degree of radiographic abnormalities and related spirometric values in patients with cured pulmonary tuberculosis.MethodsOne hundred and twenty seven patients with cured pulmonary tuberculosis were prospectively enrolled in a referral hospital specializing in respiratory diseases. Spirometry was performed and the extent of radiographic abnormalities was evaluated twice by each of two readers to generate a novel quantitative score. Scoring reproducibility was analyzed by the intra-class correlation coefficient (ICC) and the Bland-Altman method. Multiple linear regression models were performed to assess the association of the extent of radiographic abnormalities with spirometric values.ResultsThe intra-observer agreement for scoring of radiographic abnormalities (SRA) showed an ICC of 0.81 (CI:95%, 0.67–0.95) and 0.78 (CI:95%, 0.65–0.92), for reader 1 and 2, respectively. Inter-observer reproducibility for the first measurement was 0.83 (CI:95%, 0.71–0.95), and for the second measurement was 0.74 (CI:95%, 0.58–0.90). The Bland-Altman analysis of the intra-observer agreement showed a mean bias of 0.87% and -0.55% and an inter-observer agreement of -0.35% and -1.78%, indicating a minor average systematic variability.After adjustment for age, gender, height, smoking status, pack-years of smoking, and degree of dyspnea, the scoring degree of radiographic abnormalities was significantly and negatively associated with absolute and percent predicted values of FVC: -0.07 (CI:95%, -0.01 to -0.04); -2.48 (CI:95%, -3.45 to -1.50); and FEV1 -0.07 (CI:95%, -0.10 to -0.05); -2.92 (CI:95%, -3.87 to -1.97) respectively, in the patients studied. ConclusionThe extent of radiographic abnormalities, as evaluated through our novel scoring system, was inversely associated with spirometric values, and exhibited good reliability and reproducibility. As intra-observer and inter-observer agreement of the SRA varied from good to excellent, the use of SRA in this setting appears acceptable.

Post-tuberculous lung function impairment in a tuberculosis reference clinic in Cameroon

“…We also showed that the median duration of symptoms prior TB diagnosis was greater in patients with LFI than in patient without LFI. These findings are in agreement with previous reports [4,27]. In our setting as well as in other resources-limited countries in Africa, a significant proportion of patients firstly start with self-medication at home or consult traditional healers before going to healthcare services.…”

“…As found in our study, previous studies described pulmonary restriction as the predominant pattern with various proportions [21,23e26]. This restrictive pattern is explained by the destruction of lung parenchyma [27]. On the contrary, other studies showed that airflow obstruction was the most common defect [10,11,22].…”

Chronic lung disease in HIV-infected children established on antiretroviral therapy

“…The features on plain chest radiography are subtle and nonspecific, and high-resolution computed tomography is the definitive imaging modality. The lack of high resolution computed tomography (HRCT) facilities may explain why obliterative bronchiolitis is not recognized in Africa, despite the high prevalence of chronic respiratory symptoms [26–29]. Clinically, obliterative bronchiolitis usually presents as an obstructive lung disease with minimal response to inhaled beta agonists.…”

Is there a rationale for pulmonary rehabilitation following successful chemotherapy for tuberculosis?

“…In Mexico, 127 cured tuberculosis patients underwent spirometry and CXR; 123 (96.85%) exhibited some degree of radiographic abnormalities 23 . The extent of lung damage was measured by dividing the lung parenchyma into four quadrants and scoring it from 0 to 5; the mean number of radiographic abnormalities was 6.45 ± 4.14.…”