Post-tuberculosis health-related quality of life, lung function and exercise capacity in a cured pulmonary tuberculosis population in the Breede Valley District, South Africa

Abstract

Background Pulmonary tuberculosis (PTB) remains a major concern worldwide. Albeit curable, PTB continues to negatively affect patients’ health-related quality of life (HRQoL) and functioning even after cure. Objectives To describe the demographics, respiratory symptoms, pulmonary airflow patterns, HRQoL and exercise capacity of cured PTB patients, in the Breede Valley district of South Africa. Methods A cross-sectional study conducted at five primary health care facilities included adult patients diagnosed with PTB, who had completed anti-tuberculosis treatment. Post-treatment bronchodilator lung function, HRQoL and 6-min walk distance (6MWD) were measured. Results Three hundred and twenty-four patients were screened. Specific challenges resulted in 45 patients being included (male n = 25 [56%]; mean population age 39.9 [± 10.2]). HRQoL was assessed using the short-form 12v2, part of the burden of lung disease core questionnaire. In general, self-reported physical scores (physical health component summary score = 45) were higher than mental scores (mental health component summary score = 39). The mean 6MWD was 294.5 m (± 122.7) m (range 110 m – 600 m), which is well below normal reference values. Forty-eight percent (48%) of the sample presented with abnormal lung function, including obstructive ( n = 9; 21%), restrictive ( n = 11; 25%) and mixed ( n = 1; 2%). Conclusions This pilot study suggests that most cured PTB patients have decreased HRQoL, exercise capacity and abnormal lung function. This study is the first to describe the combination of these three outcomes in a South African population. Clinical implications Clinicians must recognise that holistic management of PTB patients is required after cure.

Impact of post-tuberculosis lung disease on health-related quality of life in patients from two tertiary hospitals in Lagos, Nigeria

“…A study by Pasipanodya et al [25] reported a 13-point increase (worsening QoL) in total SGRQ score after TB treatment. This was corroborated by a study by Daniels et al [27] who used a different HRQoL assessment tool, the Short Form 12 (SF-12) health survey questionnaire, and reported poor HRQoL post-TB in a South African population. Similar to our findings, these studies also report lower HRQoL in relation to the physical domain compared with the mental domain that was independent of gender.…”

Persistent chronic respiratory symptoms despite TB cure is poorly correlated with lung function

“… 16 A similar study in rural South Africa found comparatively more preserved lung function and fewer symptoms but much reduced 6MWD (mean: 294 m) compared to our population. 17 A Malawian cohort demonstrated lower symptom burden than our population, with 12% having symptom-related impairment in their ability to work 1 year after treatment completion, with a mean 6MWD of 611 m. 7 Whether there is an effect of urbanisation on PTLD needs to be established.…”

Platelet Activation and the Immune Response to Tuberculosis

“…Affected patients can have restrictive, obstructive, or mixed patterns on spirometric testing ( 34 ) and this can manifest as various chronic lung diseases including pulmonary fibrosis, emphysema, and bronchiectasis ( 35 ). Consequently, TB survivors have shortened life expectancies, with one model predicting an average loss of 3.6 years of life ( 36 ), and this is associated with a reduced perceived mental health-related quality of life (HRQoL) even after microbiological cure ( 37 ). The extent of radiological disease severity at diagnosis is the most important determinant of residual pulmonary function post treatment ( 33 , 38 , 39 ), however the mechanisms that link initial bacterial infection to the development of fibrosis are poorly understood.…”