Date Published: May 23, 2019
Publisher: Public Library of Science
Author(s): Akshay N. Gupte, Mandar Paradkar, Sriram Selvaraju, Kannan Thiruvengadam, Shri Vijay Bala Yogendra Shivakumar, Krithikaa Sekar, Srinivasa Marinaik, Ayesha Momin, Archana Gaikwad, Premkumar Natrajan, Munivardhan Prithivi, Gomathy Shivaramakrishnan, Neeta Pradhan, Rewa Kohli, Swapnil Raskar, Divyashri Jain, Rani Velu, Bharath Karthavarayan, Rahul Lokhande, Nishi Suryavanshi, Nikhil Gupte, Lakshmi Murali, Sundeep Salvi, William Checkley, Jonathan Golub, Robert Bollinger, Vidya Mave, Chandrasekaran Padmapriyadarasini, Amita Gupta, HASNAIN SEYED EHTESHAM.
Burden, phenotype and risk-factors of lung function defects in successfully treated tuberculosis cases are unclear.
We performed spirometry with bronchodilators in new drug-sensitive adult (≥18 years) pulmonary tuberculosis cases during the 12 months following successful treatment in India. Airflow obstruction was defined as pre-bronchodilator FEV1/FVC<5th percentile of Global Lung Initiative mixed-ethnicity reference (lower limit of normal [LLN]). Chronic obstructive pulmonary disease (COPD) was defined as post-bronchodilator FEV1/FVC
Tuberculosis disease (TB) is the leading infectious killer worldwide with over 10 million incident cases and 1.5 million deaths in 2017. Pulmonary TB, the most common form of the disease, is curable with multi-drug therapy and most high burden countries report cure rates exceeding 80%. However, microbiological cure may not prevent pulmonary complications of TB and there is increasing evidence to suggest lung injury can persist despite TB treatment, leading to chronic pulmonary sequelae and disability[2–5].
Of the 204 participants enrolled, 172 (84%) were included in the analysis; we excluded 11 (5%) participants who failed treatment, 7 (3%) with recurrent TB and 14 (7%) with poor quality spirometry. Nearly 70% (119 of 172) of participants underwent spirometry evaluations within 6 months of completing treatment. The median (IQR) age at enrollment was 32 (23–39) years and 82 (48%) participants were female. The median (IQR) body mass index (BMI) was 18.1 (16.0–20.5) kg/m2 and 87 (51%) participants were underweight (BMI<18.5kg/m2). Ever-smoking was reported by 34 (20%) participants with a median (IQR) exposure of 3.5 (0.2–9.9) pack-years. Overall, 113 (66%) participants had culture confirmed TB, 22 (13%) had diabetes, 7 (4%) had HIV and 56 (33%) had cavitary disease at treatment initiation. The median (IQR) duration of illness prior to treatment initiation was 30 (20–60) days. (Table 1). We found an alarmingly high burden of previously undiagnosed lung function defects (exceeding 75%) that were associated with delays in TB treatment, smear grade at treatment initiation, female sex and diabetes in an Indian cohort of young and predominantly never-smoking adult TB cases who successfully completed treatment. AO and RSP were detected in 24% and 52% participants respectively; over 50% of participants with AO had COPD. While obstruction was predominantly irreversible, 21% of treated TB cases with AO had a clinically meaningful response to short-acting bronchodilators and therefore are likely to benefit from bronchodilator therapy. Our study finding of a disproportionately high burden of AO, a subset of which may respond to bronchodilator therapy, in a population that is typically overlooked during screening for chronic lung diseases due to the absence of conventional risk-factors suggests urgent changes are needed to the current paradigm of TB management which largely ignores follow-up after treatment. We recommend routine screening for chronic lung diseases following TB treatment and linkage to appropriate respiratory health services in all TB cases regardless of their age, smoking exposure and treatment outcomes. Source: http://doi.org/10.1371/journal.pone.0217289