Trends and predictors of changes in pulmonary function after treatment for pulmonary tuberculosis

Abstract

OBJECTIVES:The present study aimed to investigate the trends in changes in pulmonary function and the risk factors for pulmonary function deterioration in patients with pulmonary tuberculosis after completing treatment.INTRODUCTION:Patients usually have pulmonary function abnormalities after completing treatment for pulmonary tuberculosis. The time course for changes in pulmonary function and the risk factors for deterioration have not been well studied.METHODS:A total of 115 patients with 162 pulmonary function results were analyzed. We retrieved demographic and clinical data, radiographic scores, bacteriological data, and pulmonary function data. A generalized additive model with a locally weighted scatterplot smoothing technique was used to evaluate the trends in changes in pulmonary function. A generalized estimating equation model was used to determine the risk factors associated with deterioration of pulmonary function.RESULTS:The median interval between the end of anti-tuberculosis treatment and the pulmonary function test was 16 months (range: 0 to 112 months). The nadir of pulmonary function occurred approximately 18 months after the completion of the treatment. The risk factors associated with pulmonary function deterioration included smear-positive disease, extensive pulmonary involvement prior to anti-tuberculosis treatment, prolonged anti-tuberculosis treatment, and reduced radiographic improvement after treatment.CONCLUSIONS:After the completion of anti-tuberculosis TB treatment, several risk factors predicted pulmonary function deterioration. For patients with significant respiratory symptoms and multiple risk factors, the pulmonary function test should be followed up to monitor the progression of functional impairment, especially within the first 18 months after the completion of anti-tuberculosis treatment.

A Systematic Review of the Association between Pulmonary Tuberculosis and the Development of Chronic Airflow Obstruction in Adults

“…Chung et al [16], also in a tertiary referral hospital setting, reported an even higher association between TB and AFO than in the above studies. They examined, retrospectively, the case notes of all patients who had had positive TB cultures and had completed treatment for TB at their institution.…”

“…Short-term studies of this nature have confirmed both restriction and AFO during the treatment phase [28,29,30,31,32,33,34]. Two studies have reported worsening after completion of medical treatment [11,12] and another 3 suggested continued progression of AFO in the post-treatment period [9,16,35]. [].…”

Evidence for chronic lung impairment in patients treated for pulmonary tuberculosis

“…Many patients with pulmonary tuberculosis undergo anatomical changes secondary to the illness, such as parenchymal structural damage including bronchovascular distortion, bronchiectasis, emphysematous and fibrotic band formations, and other well-described histologic and anatomic changes [3]. These anatomical changes result in radiographic and functional alterations that may remain after microbiologic cure and may be even more prevalent in patients with treated multidrug resistant tuberculosis (TB) [4][5][6][7][8][9][10][11]. Pulmonary impairment after TB (PIAT), which is presumably a result of these anatomical changes, has been shown to be common in patients who have completed at least 20 weeks of tuberculosis treatment [9].…”

“…Previous studies have shown that individuals with pulmonary tuberculosis frequently have pulmonary impairment with varied patterns and severity [4][5][6][7][8][9][10][11]. If pulmonary impairment after tuberculosis was permanent, this would provide additional support for strategies to prevent TB, routine testing for impairment after the completion of TB treatment and treatments to mitigate PIAT.…”

Pesquisas em pneumologia recentemente publicadas em revistas brasileiras

“…According to Chung et al, (28) various risk factors can predict pulmonary function deterioration following tuberculosis treatment. The authors stated that patients with significant respiratory symptoms and multiple risk factors require pulmonary function testing in order to monitor the progression of functional impairment, especially within the first 18 months after the completion of the treatment.…”