Influence of antimicrobial chemotherapy on spirometric parameters and pro-inflammatory indices in severe pulmonary tuberculosis

Abstract

Patients who have completed a treatment for severe pulmonary tuberculosis (TB) are often left with severe respiratory disability. There have been few prospective studies assessing the effect of treatment on lung function in such patients. The influence of antimicrobial chemotherapy on lung function was investigated over a six month period in patients with newly diagnosed pulmonary TB to test the hypothesis that treatment improves lung function, as well as to identify factors that may influence lung function outcome. Seventy-six patients were recruited into the study, of whom 74 completed the treatment programme. Forty-two were current smokers and 13 seropositive for the human immunodeficiency virus. Improvement in lung function occurred in 54% of patients, but residual airflow limitation or a restrictive pattern was evident in 28% and 24% of patients, respectively. The extent of lung infiltration (radiographic score) both at the outset and after chemotherapy was significantly and negatively related to forced expiratory volume in one second (FEV1) (% pred) (r=-0.41, and r=-0.46, respectively). The post-treatment serum C-reactive protein and alpha1-protease inhibitor levels were negatively associated with FEV1 (% pred) (r=-0.30 and r=-0.35, respectively). These findings demonstrate that, while antimicrobial chemotherapy may lead to improved lung function in patients with pulmonary tuberculosis, a large proportion of patients has residual impairment. The most significant factor influencing post-treatment lung function status, as measured by forced expiratory volume in one second (% predicted), is the pretreatment and post-treatment radiographic score, which acts as a marker of the extent of pulmonary parenchymal involvement in tuberculosis.

Perfil funcional de pacientes portadores de seqüela de tuberculose de um hospital universitário

“…(1) When there are PF alterations due to pleural TB sequelae, mild restrictive ventilatory disorder is predominant, and pleural thickening of at least 10 mm increases the probability reduced lung volumes. (5,14) We had only two cases of pleural TB sequelae and access to the chest X-ray in only one of those two cases. The same situation was encountered in the three cases of pleuropulmonary TB sequelae, and it was not possible to evaluate the data found.…”

Alteraciones espirométricas en pacientes con secuela de tuberculosis pulmonar

“…Lastarria y Salazar (23) han podido realizar espirometrías en pacientes con TBP activa, demostrando respuesta adecuada a broncodilatadores del tipo salbutamol y bromuro de ipratropio. Estos resultados han sido evaluados por Plit (24), quien reporta que la utilización de fármacos antituberculosos mejora la función pulmonar, al disminuir el daño parenquimal y con ello los índices pro-inflamatorios. En nuestro estudio, hemos encontrado que la alteración obstructiva sin reversibilidad o con reversibilidad parcial a los broncodilatadores fue la más frecuente.…”

“…Estos hallazgos, que relacionan la existencia de enfermedad obstructiva de la vía aérea por espirometría en pacientes con secuelas de tuberculosis pulmonar están de acuerdo con lo descrito previamente en otros estudios. (4,5,8,17,19,21,23,24,26,27).…”

Evaluation of Pulmonary Impairment by Spirometry in Post Pulmonary Tuberculosis Patients

“…Association between moderate and far advanced radiological lesions and lung function abnormalities like reduced PEFR has been reported in some studies 15 . Plit et al has found that the radiographic score at the beginning and after completion of treatment was related to Forced Expiratory Volume in first second 16 . A bronchodilator response is reported to be lesser in post tuberculosis patients compared to other obstructive airway disorders 17 .…”