Chronic lung disease in adult recurrent tuberculosis survivors in Zimbabwe: a cohort study

Abstract

SUMMARY OBJECTIVE: To examine the prevalence and magnitude of chronic lung disease (CLD) and its association with empiric anti-tuberculosis treatment (due to lack of bacteriologic confirmation) among recurrent tuberculosis (TB) survivors in a human immunodeficiency virus (HIV) prevalent setting. METHODS: Prospective cohort study of retreatment TB survivors in Harare, Zimbabwe. At median follow-up of 2 years post-treatment initiation, we characterized mortality, respiratory impairment, and mental health. RESULTS: Among 175 retreatment TB survivors, 65% of whom were HIV-positive and 21% had been empirically treated, multiparameter CLD was noted at follow-up among 14% of patients (95%CI 9.0–19.7), with a six-fold increase in age-adjusted death in the first year following treatment completion. Empirically treated TB (relative risk [RR] 3.4, 95%CI 1.4–8.3) was associated with CLD, as was the number of previous anti-tuberculosis treatment courses in dose-dependent fashion (three vs. one, RR 6.2, 95%CI 1.7–22.1). Among retreatment TB survivors, 33% (95%CI 26.0–40.1) had persistent respiratory symptoms (Chronic Obstructive Pulmonary Disease Assessment Test score ⩾ 10); 26% (95%CI 19.8–33.0) significant deficits in exercise capacity (median incremental shuttle walk test distance, 550 m; Q1–Q3 440–730 m); 83% (95%CI 75.7–89.7) residual radiographic abnormalities on chest X-ray; 12% (95%CI 6.6–16.1%) moderate-to-severe obstruction on spirometry; and 13% (95%CI 7.6–17.5%) major depression. CONCLUSIONS: Despite successful treatment, retreatment TB survivors retain a substantial risk of morbidity and mortality.

Assessment of lung function in successfully treated tuberculosis reveals high burden of ventilatory defects and COPD

“…The association between treated TB and chronic lung diseases has been described previously[5, 12]. Studies from North and South America[4, 11, 13], sub-Saharan Africa[28–31] and East Asia have found a high burden of ventilatory defects in participants with a prior history of TB[9, 32, 33]. However, the epidemiology and prevalence of TB and chronic lung diseases likely differs by study setting and similar studies in the Indian context, particularly among individuals with low risk of pre-existing lung disease, are lacking.…”

Patient outcomes associated with post-tuberculosis lung damage in Malawi: a prospective cohort study

“…Post-tuberculosis lung damage (PTLD) is a recognised consequence of pulmonary TB (pTB) disease: adult pTB-survivors have two-to-four-fold higher odds of persistently abnormal spirometry (airway obstruction and restriction) compared with those without previous TB disease,2–4 with parenchymal and airway abnormalities seen on imaging,5 6 and associated respiratory symptoms and reduced quality of life 7–10. However, there are few estimates of the burden of disease at pTB treatment completion, and few prospective data on the medium or long-term consequences of PTLD or risk factors for adverse patient outcomes.…”

More should be done now for patients with TB-associated chronic lung disease

“…While sputum culture for common and atypical pathogens is not feasible in many areas, sputum smear examination for acid-fast bacilli to identify M. tuberculosis and non-tuberculous mycobacteria is widely available. The importance of such investigation is supported by our finding of undiagnosed recurrent TB among 5 % ( 95 % confidence interval 2.4–8.8) of study participants, 1 none of whom felt that their symptomatology was unusual enough to revisit their local outpatient clinics.…”

“…We thank the correspondents for their comments on our study of chronic lung disease (CLD) in adult recurrent tuberculosis (TB) survivors in Zimbabwe. 1 We agree that chronic pulmonary dysfunction, as well as other consequent comorbidities, including psychiatricq illness, are critically underappreciated in this group. Given an estimated 8.2 million people with ‘cured’ TB annually, and a majority of cases occurring among young to middle-aged adults, these sequelae are an enormous contributor to the global burden of disease and economic impact attributable to TB.…”