Changes in lung function according to disease extent before and after pulmonary tuberculosis

Y, Ko; Lee, YM; Hy, Lee; Ys, Lee; Song, JW; Gy, Hong; My, Kim; Lee, Hyun Kyung; Sj, Choi; Ej, Shim

doi:10.5588/ijtld.14.0454

Cited by 14 publications

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“…Large cross-sectional studies from multiple countries have identified an independent association between a history of TB and OLD [ 41 – 45 ]. Additionally, retrospective studies have found a history of TB to be associated with excess loss of lung function [ 46 – 48 ]. Our study is among the first to prospectively assess excess lung function decline in HIV-infected individuals with a history of TB.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with pulmonary impairment in HIV-infected South African adults

et al. 2017

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BackgroundHIV-infected individuals have increased risk of developing obstructive lung disease (OLD). Studies from developed countries report high viral load, low CD4 counts, and anti-retroviral therapy (ART) to be associated with OLD; but these findings may not be generalizable to populations in resource-limited settings.MethodsWe conducted a prospective cohort study of lung function in 730 HIV-infected black South African adults. Pre-bronchodilator spirometry was performed at enrollment and repeated annually for three years. Logistic regression models were used to identify factors associated with OLD, defined as FEV1/FVC<0.70, at enrollment. Excess annual declines in FEV1 and FVC were modelled as the product-term of follow-up time and exposures using random effects regression.ResultsMedian (IQR) age at enrollment was 36 (32–41) years, 85% were female and 30% ever-smoked with a median (IQR) exposure of 3 (1–6) pack-years. Median (IQR) CD4 count and viral load at enrollment were 372 (261–518) cells/mm3 and 2655 (91–13,548) copies/mL respectively. Overall, 25% were receiving ART at enrollment, 16% of whom reported at least 6 months of ART receipt. OLD was found in 35 (5%) at enrollment. Increasing age (aOR = 2.08 per 10-years [95%CI 1.22–3.57], p = 0.007), current smoking (aOR = 3.55 [95%CI 1.20–10.53], p = 0.02), and CRP (aOR = 1.01 per unit-increase [95%CI 1.00–1.03], p = 0.04) were significantly associated with OLD at enrollment; while increasing CD4 count (aOR = 1.02 per-100 cells/mm3 [95%CI 0.85–1.22], p = 0.82), viral load (aOR = 0.67 per log-increase [95%CI 0.43–1.10], p = 0.12) and receipt of ART (aOR = 0.57 [95%CI 0.18–1.75], p = 0.32) were not. The median (IQR) follow-up time was 18 (12–24) months. Participants with a history of tuberculosis (TB) had a 35 mL (95%CI 2–68, p = 0.03) and 57 mL (95%CI 19–96, p = 0.003) per year excess loss of FEV1 and FVC respectively.ConclusionPrevalent OLD was associated with older age, current smoking and higher CRP levels, but not CD4 counts and ART, in HIV-infected South African adults. Better understanding of the long-term effects of TB, smoking and inflammation on lung function in HIV-infected populations is urgently needed.

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Section: Discussionmentioning

confidence: 99%

Factors associated with pulmonary impairment in HIV-infected South African adults

et al. 2017

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“… 26 These findings are also supported by the smaller cross-sectional, cohort, and case-control studies. 6 , 22 , 27 …”

Section: Discussionmentioning

confidence: 99%

Changes in respiratory function impairment following the treatment of severe pulmonary tuberculosis – limitations for the underlying COPD detection

Radović¹,

Ristic²,

Ćirić³

et al. 2016

COPD

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BackgroundDuring the treatment phase of active pulmonary tuberculosis (PTB), respiratory function impairment is usually restrictive. This may become obstructive, as a PTB-associated airflow obstruction (AFO) or as a later manifestation of underlying COPD.PurposeThe aim of the study was to examine the potential causes and risks for AFO development in PTB by exploring the aspects of spirometry limitations and clinical implications for the underlying COPD detection, taking into account various confounding factors.Patients and methodsProspective, nest case–control study on 40 new cases of PTB with initial restrictive respiratory function impairment, diagnosed and treated according to the directly observed treatment short course (DOTS) strategy.ResultsFrom all observed patients, 37.5% of them developed AFO upon the completion of PTB treatment, with significantly increased average of forced vital capacity (%) (P<0.01). Their changes in forced expiratory volume in the first second (%) during the PTB treatment were strongly associated with the air pollution exposure in living (0.474%–20.971% for 95% confidence interval [CI]; P=0.041) and working environments (3.928%–20.379% for 95% CI; P=0.005), initial radiological extent of PTB lesions (0.018%–0.700% for 95% CI; P=0.047), leukocyte count (0.020%–1.328% for 95% CI; P=0.043), and C-reactive protein serum level (0.046%–0.205% for 95% CI; P=0.003) compared to the other patients. The multivariate logistic regression analysis model shows initial radiological extent of pulmonary tuberculosis lesions (OR 1.01–1.05 for 95% CI; P=0.02) and sputum conversion rate on culture (OR 1.02–1.68 for 95% CI; P=0.04) as the most significant predictors for the risk of AFO development.ConclusionAFO upon PTB treatment is a common manifestation of underlying COPD, which mostly occurs later, during the reparative processes in active PTB, even in the absence of major risk factors, such as cigarette smoking and biomass fuel dust exposure. Initial spirometry testing in patients with active PTB is not a sufficient and accurate approach in the detection of underlying COPD, which may lead to their further potential health deterioration.

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“…2020;46(2):e20180198 3/9 Investigation of changes in pulmonary function after completion of treatment for PTB has been gaining prominence in the literature. (6,7,9,(11)(12)(13)(14)(15)26,27) In our study, the most common functional change in the LDS− group was RLD (24.7%). Cruz et al (15) also described RLD as the main functional change after treatment for PTB; however, that study included patients who underwent more than one treatment for PTB.…”

Section: Discussionmentioning

confidence: 54%

“…However, in a recent study, chest CT and chest X-ray were in disagreement in only 7% of the examinations in patients with PTB sequelae. (26) In addition, chest X-ray is inexpensive and is available at tuberculosis treatment centers in Brazil, in contrast to chest CT, to which access is limited. Another limitation is that pulmonary function was assessed by spirometry only, without plethysmography or DLCO measurement.…”

Section: Discussionmentioning

confidence: 99%

Spirometry results after treatment for pulmonary tuberculosis: comparison between patients with and without previous lung disease: a multicenter study

Mancuzo¹,

Netto²,

Sulmonett³

et al. 2020

J Bras Pneumol.

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Objective: To compare patients with and without previous lung disease, in terms of the spirometry results after they had been treated for pulmonary tuberculosis (PTB) and cured, as well as to analyze risk factors related to functional severity. Methods: This was a cross-sectional, multicenter study conducted at four referral centers in Brazil. Patients were divided into two groups: those with a history of lung disease or smoking (LDS+ group); and those with no such history (LDS− group). Patients underwent spirometry (at least six months after being cured). Sociodemographic and clinical data were collected. Results:A total of 378 patients were included: 174 (46.1%) in the LDS+ group and 204 (53.9%) in the LDS− group. In the sample as a whole, 238 patients (62.7%) had spirometric changes. In the LDS+ group, there was a predominance of obstructive lung disease (in 33.3%), whereas restrictive lung disease predominated in the LDS− group (in 24.7%). Radiological changes were less common in the LDS− group than in the LDS+ group (p < 0.01), as were functional changes (p < 0.05). However, of the 140 (79.1%) LDS− group patients with a normal or minimally altered chest X-ray, 76 (54%) had functional changes (p < 0.01). The risk factors associated with functional severity in the LDS− group were degree of dyspnea (p = 0.03) and moderate or severe radiological changes (p = 0.01). Conclusions: Impaired pulmonary function is common after treatment for PTB, regardless of the history of lung disease or smoking. Spirometry should be suggested for patients who develop moderate/severe dyspnea or relevant radiological changes after treatment for PTB.

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Changes in lung function according to disease extent before and after pulmonary tuberculosis

Cited by 14 publications

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Factors associated with pulmonary impairment in HIV-infected South African adults

Factors associated with pulmonary impairment in HIV-infected South African adults

Changes in respiratory function impairment following the treatment of severe pulmonary tuberculosis – limitations for the underlying COPD detection

Spirometry results after treatment for pulmonary tuberculosis: comparison between patients with and without previous lung disease: a multicenter study

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Changes in lung function according to disease extent before and after pulmonary tuberculosis

Cited by 14 publications

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Factors associated with pulmonary impairment in HIV-infected South African adults

Factors associated with pulmonary impairment in HIV-infected South African adults

Changes in respiratory function impairment following the treatment of severe pulmonary tuberculosis &ndash; limitations for the underlying COPD detection

Spirometry results after treatment for pulmonary tuberculosis: comparison between patients with and without previous lung disease: a multicenter study

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Changes in respiratory function impairment following the treatment of severe pulmonary tuberculosis – limitations for the underlying COPD detection