Journal Article

Patient outcomes associated with post-tuberculosis lung damage in Malawi: a prospective cohort study

Squire, Stephen Bertel, Meghji, Jamilah, Lesosky, Maia, Rylance, Jamie, Gordon, Stephen, MacPherson, Peter, Corbett, Elizabeth L, Banda, Peter, Jacob, Joseph, Joekes, Elizabeth, Zonderland, Harmien, Mortimer, Kevin

2020

Overview

BackgroundPost-tuberculosis lung damage (PTLD) is a recognised consequence of pulmonary TB (pTB). However, little is known about its prevalence, patterns and associated outcomes, especially in sub-Saharan Africa and HIV-positive adults.MethodsAdult (≥15 years) survivors of a first episode of pTB in Blantyre, Malawi, completed the St George’s Respiratory Questionnaire, 6-minute walk test, spirometry and high-resolution CT (HRCT) chest imaging at TB treatment completion. Symptom, spirometry, health seeking, TB-retreatment and mortality data were collected prospectively to 1 year. Risk factors for persistent symptoms, pulmonary function decline and respiratory-related health-seeking were identified through multivariable regression modelling.ResultsBetween February 2016 and April 2017, 405 participants were recruited. Median age was 35 years (IQR: 28 to 41), 77.3% (313/405) had had microbiologically proven pTB, and 60.3% (244/403) were HIV-positive. At pTB treatment completion, 60.7% (246/405) reported respiratory symptoms, 34.2% (125/365) had abnormal spirometry, 44.2% (170/385) had bronchiectasis ≥1 lobe and 9.4% (36/385) had ≥1 destroyed lobe on HRCT imaging. At 1 year, 30.7% (113/368) reported respiratory symptoms, 19.3% (59/305) and 14.1% (43/305) of patients had experienced declines in FEV1 or FVC of ≥100 mL, 16.3% (62/380) had reported ≥1 acute respiratory event and 12.2% (45/368) had symptoms affecting their ability to work.ConclusionsPTLD is a common and under-recognised consequence of pTB that is disabling for patients and associated with adverse outcomes beyond pTB treatment completion. Increased efforts to prevent PTLD and guidelines for management of established disease are urgently needed. Low-cost clinical interventions to improve patient outcomes must be evaluated.

• Publisher: BMJ Publishing Group Ltd and British Thoracic Society,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Adult / Age / Airway management / bronchiectasis / Bronchiectasis - diagnostic imaging / Bronchiectasis - epidemiology / Bronchiectasis - microbiology / Chronic Disease / clinical epidemiology / Clinical outcomes / Cohort analysis / Coinfection - epidemiology / Cough - epidemiology / Cough - microbiology / Disease / Dyspnea - epidemiology / Dyspnea - microbiology / Episode of Care / Female / Forced Expiratory Volume / Health Surveys / HIV / HIV Infections - epidemiology / Hospitals / Human immunodeficiency virus / Humans / Illnesses / Low income groups / Lung Injury - diagnostic imaging / Lung Injury - epidemiology / Lung Injury - microbiology / Lung Injury - physiopathology / Malawi - epidemiology / Male / Mortality / Prevalence / Prospective Studies / Quality control / Questionnaires / Radiography, Thoracic / Recovery of Function / Respiratory Infection / Socioeconomic factors / Spirometry / Studies / Symptom Flare Up / Time Factors / Tomography, X-Ray Computed / Tuberculosis / Tuberculosis, Pulmonary - complications / Tuberculosis, Pulmonary - diagnostic imaging / Tuberculosis, Pulmonary - physiopathology / Vital Capacity / Walk Test / Young Adult