Long-term follow-up of tuberculosis-destroyed lung patients after surgical treatment

Abstract

Background To monitor dypsnea and mortality at 5 and 10 years, respectively, after surgical treatment of tuberculosis-destroyed lung (TDL) patients. Methods TDL patients treated surgically at Beijing Chest Hospital from November 2007 to June 2019 were monitored in this observational study. Follow-up assessments of respiratory function indicators and survival conducted 5 and 10 years post-surgery led to patient grouping based on mMRC score into a dyspnea group (mMRC ≥ 1) and a non-dyspnea group (mMRC = 0). Cox regression analysis detected effects of patient demographics, clinical characteristics, surgical factors and respiratory function on 5 year post-surgical survival. Results By study completion (June 30, 2020), 32 of 104 patients were lost and 72 completed follow-up for a study total of 258.9 person-years. 45 patients (62.5%, 45/72) had mMRC scores of 0, while 12 (16.7%, 12/72), 21 (36.2%, 21/58) and 27 (60.0%, 27/45) patients exhibited dyspnea by 1, 3 and 5 years post-surgery, respectively. Low lung carbon monoxide diffusion score (DLCO% pred) and scoliosis contributed to dyspnea occurrence. Conclusions Most TDL patients lacked subjective dyspnea signs post-surgery, while dyspnea rates increased with time. Preoperative low lung diffusion function and Scoliosis were associated with factors for postoperative dyspnea. Surgical treatment increased TDL patient survival overall.

Destroyed Lung Syndrome in a Young Indian Male: A Case Report

“…Radiological studies help in establishing the diagnosis and are characterized by a remarkably reduced ventilation-to-perfusion ratio [ 10 ]. Tuberculosis is reported as the commonest cause of a destroyed lung, and it could happen after a primary disease or reinfection [ 4 , 11 ]. However, there is a paucity of literature related to it, and there is no exact prevalence or incidence known.…”

“…The clinical presentations are mostly chronic, but acute cases are also documented [ 13 ]. The patient may present with prolonged and frequent episodes of respiratory illnesses, purulent (yellow-colored) expectoration, chronic low-grade fever, dyspnea, chest tightness, and generalized ill health and may be complicated with episodes of recurrent hemoptysis [ 4 , 11 , 13 ]. Acute symptoms of septicemia, massive hemoptysis, or respiratory failure may also be present [ 11 ].…”

“…Moreover, there are no definite treatment guidelines available [ 4 ]. Conservative management involves symptomatic treatment with the use of long-acting muscarinic antagonists or long-acting beta-2 agonists plus inhaled corticosteroids leading to bronchodilatory effects [ 17 ].…”

“…However, post-treatment complications due to lung damage caused by the disease have remained unheeded. There is a paucity of data related to the complications post anti-tubercular treatment [ 4 , 5 ]. Some of these complications involve dyspnea either at rest or on exertion, recurrent hemoptysis, and persistent chest pain [ 6 ].…”

Comparison of clinical effects between regional arterial embolization combined with surgery and simple surgery in the treatment of tuberculosis-destroyed lung—a retrospective comparative cohort study

“…For patients with tuberculosis-destroyed lung without surgical contraindications, the removal of the diseased lung in the operation provides the possibility for the complete cure of the disease ( 10 ). However, due to the long course and large lesion area of the tuberculosis-destroyed lung, most cases of pleural cavity adhesion are severe, and even tuberculous empyema and pleural collapse of the affected side can occur ( 11 ).…”