Pulmonary function and respiratory health after successful treatment of drug-resistant tuberculosis

• Type of Material: Article
• Authors: Sergo A. Vashakidze, National Center for Tuberculosis and Lung Diseases; Jordan Kempker, Emory University; Nino A. Jakobia, National Center for Tuberculosis and Lung Diseases; Shota G. Gogishvili, National Center for Tuberculosis and Lung Diseases; Ketino A. Nikolaishvili, National Center for Tuberculosis and Lung Diseases; Leila M. Goginashvili, National Center for Tuberculosis and Lung Diseases; Matthew James Magee, Emory University; Russell Ryan Kempker, Emory University
• Language: English
• Date: 2019-05-01
• Publisher: Elsevier: Creative Commons Attribution Non-Commercial No-Derivatives License
• Publication Version: Final Published Version
• Copyright Statement: © 2019 The Author(s)
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ijid.2019.02.039
• Title of Journal or Parent Work: International Journal of Infectious Diseases
• ISSN: 1201-9712
• Volume: 82
• Start Page: 66
• End Page: 72
• Grant/Funding Information: During time of work, JAK received support from the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR000454 and KL2 TR000455.; This work was supported in part by the National Institutes of Health Fogarty International Center (D43TW007124) and the National Institute of Allergy and Infectious Diseases (K23AI103044; R21AI122001).
• Keywords: COPD; Impairment; OBSTRUCTION; St. George Respiratory Quality survey; QUALITY; MORTALITY; Pulmonary function; MULTIDRUG; Infectious Diseases; Surgery; Science & Technology; Tuberculosis; Life Sciences & Biomedicine; LUNG-VOLUME; COMPLETION; Lung health
• Research Categories: Health Sciences, Pathology; Health Sciences, Immunology; Health Sciences, Medicine and Surgery

Abstract

Background: Post-treatment morbidity among subjects with drug-resistant tuberculosis (DR-TB) is unclear. Methods: This was a cross-sectional study of patients from Tbilisi, Georgia with cavitary DR-TB and an outcome of cure. Participants had a chest X-ray (CXR), St. George Respiratory Quality (SGRQ) survey, and pulmonary function tests (PFTs) performed. Correlations between SGRQ and PFT results and factors associated with pulmonary impairment were examined. Results: Among 58 subjects (median age 31 years), 40% used tobacco, 59% had prior TB, and 47% underwent adjunctive surgical resection. The median follow-up time was 41 months. Follow-up CXR revealed fibrosis in 30 subjects (52%) and bronchiectasis in seven (12%). The median forced expiratory volume (FEV 1 )/forced vital capacity (FVC) ratio was 0.72, with 24 subjects (41%) having a ratio of ≤0.70. Significant correlations existed between PFT measures and overall and component SGRQ scores. In linear regression, age, prior TB, and CXR fibrosis or bronchiectasis were significantly associated with decreased pulmonary function. Adjunctive surgery was significantly associated with a higher percent predicted FEV 1 and FVC. Conclusions: A high proportion of DR-TB subjects had residual pulmonary impairment, particularly with recurrent TB and severe radiological disease. The association of surgical resection with improved lung function deserves further study. PFTs and SGRQ may both be useful to evaluate lung health.