Title: Evaluation of Pulmonary Impairment by Spirometry in Post Pulmonary Tuberculosis Patients

Authors: Santhosh Kumar P.V, Lisha P.V

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i5.84

Abstract

Background: Tuberculosis has been stated as a risk factor for development of COPD in the GOLD guidelines. It is important to know the relative burden of lung function impairment brought about by tuberculosis because there is a high prevalence of tuberculosis and smoking in the country

Aim of the Study: Toanalyze the spirometric abnormalities in a cohort of post tuberculosis patients

To know the factors associated with the spirometric abnormalities

Study Method: The study was conducted in the Dept of Pulmonary Medicine, Govt Medical College, Kozhikode in the period between 2009 and 2013. An analysis of records maintained under RNTCP is made. All new sputum smear positive cases during the period 2002 to 2006who had completed 5 years after their treatment for smear positive tuberculosis were identified and called to the OPD. History, physical examination and investigations including chest X-ray, sputum AFB smear and spirometry was done in all patients.

Results: A total of 82 patients were available for final analysis. The age of the patients ranged from 24 to 80 years and mean age was 51.29. 74 (90.2%) were males and 8 (9.8%) were females. At 5 years after treatment completion 61 (74.4%) were symptomatic and 21 (25.6%) were asymptomatic. Radiological sequelae were present in 54 (65.9%) patients.59 (72%) patients were smokers 23 (28%) were nonsmokers. Spirometry revealed obstructive pattern in 37 patients (45.1%), restrictive pattern in 21 patients (25.6%). it revealed a mixed pattern or normal results in 24 patients (29.3%).

Conclusion: Abnormal spirometry was found in 58 (70%) patients. Obstructive pattern was the most common abnormality. Restrictive pattern was the main abnormality in nonsmokers. Presence of radiological sequelae correlated with the presence of spirometric abnormality. The obstructive pattern showed significant association with presence of radiologic sequelae,smoking and persistent chest symptoms after completion of ATT.

References

1.      World Health Organization. Global TB control: surveillance, planning, financing. WHO Report 2008, Geneva, 2008. Available from

http://www.who.int/tb/publications/global_report/2008/

2.      World Health Organization. Global Tuberculosis Control-WHO Report 2010. Available from: http://www.who.int/tb/publications/global_report/2010/ (Accessed December 16th, 2010).

3.      Mohamed ManjiEmail author, Grace Shayo, Simon Mamuya, Rose Mpembeni, Ahmed Jusabani and Ferdinand Mugusi. Lung functions among patients with pulmonary tuberculosis in Dar es Salaam – a cross-sectional study. BMC Pulmonary MedicineBMC series April 2016

4.      Global Institute for Chronic Obstructive Lung Disease. Geneva, Switzerland: 2008. [accessed on 17 Sep 2009]. Workshop report: global strategy for diagnosis, management, and prevention of COPD. Available at http://www.goldcopd.org.

5.      American Thoracic Society. Standard-ization of Spirometry, 1994 Update. American Thoracic Society. Am J Respir Crit Care Med. 1995; 152:1107–1136. [PubMed]

6.      Dheda K, Booth H, Huggett JF, Johnson MA, Zumla A, Rook GA. Lung remodeling in pulmonary tuberculosis. J Infect Dis. 2005; 192:1201–9. 10.1086/444545 [PubMed]

7.      Curtis JK. The significance of bronchiectasis associated with pulmonary tuberculosis. Am J Med. 1957; 22:894–903. 10.1016/0002-9343(57)90025-6 [PubMed]

8.      Willcox PA, Ferguson AD. Chronic obstructive airways disease following treated pulmonary tuberculosis. Respir Med. 1989; 83:195–8. 10.1016/S0954-6111(89)80031-9 [PubMed]

9.      Plit ML, Anderson R, Van Rensburg CE, Page-Shipp L, Blott JA, Fresen JL, et al. Influence of antimicrobial chemotherapy on spirometric parameters and pro-inflammatory indices in severe pulmonary tuberculosis. EurRespir J. 1998; 12:351–6. 10.1183/09031936.98.12020351 [PubMed]

10.  Pasipanodya JG, Miller TL, Vecino M, Munguia G, Garmon R, Bae S, et al. Pulmonary impairment after tuberculosis. Chest. 2007 Jun; 131:1817–24. 10.1378/chest.06-2949 [PubMed]

11.  Verma SK, Narayan KV, Kumar S. A Study on Prevalence of Obstructive Airway Diseaseamong Post Pulmonary Tuberculosis Patients [Internet]. Pulmon; 2009 [cited 2014 Jan 15

12.  Menezes AMB, Hallal PC, Perez-Padilla R, Jardim JRB, Muiño A, Lopez MV, et al., Latin American Project for the Investigation of Obstructive Lung Disease (PLATING) Team Tuberculosis and airflow obstruction: evidence from the PLATINO study in Latin America: EurRespir J 2007; 30:1180-1185

13.  Canetti G. Present aspects of bacterial resistance in tuberculosis. Am Rev Respir Dis. 1965;92:687–703. [PubMed] [Ref list]

14.  Hallett WY, Martin CJ. The diffuse obstructive pulmonary syndrome in a tuberculosissanatorium. . etiologic factors. Ann Intern Med. 1961 Jun 1;54(6):1146–55.

15.  Rajasekharan S, Savitri S, Jeyaganesh D. Post tuberculosis bronchial Asthma. Ind J Tub 2001; 48: 139.

16.  Plit ML, Anderson R, Van Rensburg CEJ, Page-Shipp L, Blott JA, Fresen JL, Feldman C. Influence of antimicrobial chemotherapy on spirometric parameters and pro-inflammatory indices in severe pulmonary tuberculosis. EurRespir J 1998; 12: 351-356.

17.  Lee JH, Chang JH. Lung function in patients with chronic airflow obstruction due to tuberculous destroyed lung. Respir Med. 2003; 97:1237–1242. [PubMed] [Ref list]

18.  Hnizdo E, Singh T, Churchyard GJ. Chronic pulmonary function impairment caused by initial and recurrent pulmonary tuberculosis following treatment. Thorax 2000; 55: 32-38.

19. WHO Fact sheet. The top ten causes of death. 2017.

Corresponding Author

Santhosh Kumar P.V

Dept. of Pulmonary Medicine

Institute of Chest Diseases, Medical College, Calicut

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.