Chronic respiratory symptoms and chronic obstructive pulmonary disease following completion of pulmonary tuberculosis treatment in Uganda

Abstract

Background Prior pulmonary tuberculosis (PTB) is associated with chronic lung impairment, including chronic obstructive pulmonary disease (COPD). We determined the prevalence and associations of chronic respiratory symptoms and COPD following completion of PTB treatment in Uganda. Methods Between August 2022 and December 2022, we consecutively enrolled post-PTB patients who had successfully completed PTB treatment between January 2016 and January 2020 at Mulago National Referral Hospital, Kampala, Uganda. Chronic respiratory symptoms were defined as the presence of at least one of the following symptoms lasting for at least three months within a year: cough or sputum production, shortness of breath, chest pain, or wheezing, along with an FEV1/FVC < 0.70 on spirometry for the definition of COPD. Results We enrolled 326 participants (median age 36 years; IQR: 30 — 43), 182 (55.8%) were male, and 123 (37.7%) were living with HIV. Fifty-one (15.6%) participants had chronic respiratory symptoms, 5 (9.8%) having COPD; 4 GOLD I and 1 GOLD II. Chronic respiratory symptoms were 89% lower among participants whose PTB treatment outcome was “completed” (adjusted Odds Ratio (aOR): 0.11, 95% confidence interval (CI): 0.01 – 0.87, p<0.01) and they were 74% lower among those with alcohol use disorders (aOR: 0.26, 95% CI: 0.12 – 0.57, p <0.001). Non-HIV immunosuppressive conditions such as diabetes mellitus and chronic steroid use, were significantly associated with both chronic respiratory symptoms (aOR:7.72, 95% CI 3.13 – 19.04, p<0.001) and COPD (aOR: 8.42, 95% CI: 1.32 — 53.47, p=0.024). Conclusion Chronic pulmonary symptoms, including COPD, are important and yet under recognized complications of PTB treatment in Uganda. Therefore, screening and management in key sub-groups, such as those with immunosuppressive condition, will improve morbidity and quality of life in this population.