Evaluation of Pulmonary Status of Post-Tuberculosis Patients with Spirometry and Chest X-Ray

Akhil Paritala; Muthukumaran Lakshmanan; Meenakshi Narasimhan; Sridhar Rathinam

doi:10.52756/ijerr.2024.v40spl.019

Akhil Paritala Department of Respiratory Medicine, Chettinad Hospital and Research Institute, Tamil Nadu, India https://orcid.org/0009-0006-2309-7687
Muthukumaran Lakshmanan Department of Respiratory Medicine, Chettinad Hospital and Research Institute, Tamil Nadu, India https://orcid.org/0000-0001-6400-6733
Meenakshi Narasimhan Department of Respiratory Medicine, Chettinad Hospital and Research Institute, Tamil Nadu, India https://orcid.org/0000-0002-8743-149X
Sridhar Rathinam Department of Respiratory Medicine, Chettinad Hospital and Research Institute, Tamil Nadu, India https://orcid.org/0000-0001-7661-2351

DOI: https://doi.org/10.52756/ijerr.2024.v40spl.019

Keywords: Post-pulmonary tuberculosis, pulmonary function test, quality of life

Abstract

In 2022, 7.5 million new cases of tuberculosis were reported worldwide. Mycobacterium tuberculosis results in tuberculosis, an infectious disease mostly affecting the lungs. However, many completely treated post-tubercular patients experience persistent changes in lung anatomy (bronchial and parenchymal structure), Increasing their risk of lung complications and early death. These changes affect the airway's size, leading to higher resistance and decreased airflow. Our study aimed to assess the overall clinical status and lung function of treated post tuberculosis patients using spirometry. The study constituted patients over the age of 18 who presented to the Outpatient department of the Pulmonary Medicine Department, Chettinad Hospital and research institute, Kelambakkam, after receiving complete treatment and being certified cured. Convenience sampling technique was used, 87 patients participated in this trial. The Institutional Ethical Committee approved the study, which lasted 18 months. A proforma was used to collect a complete socio-demographic history and clinical history, particularly in terms of pulmonary symptomatology, and information about previous anti-tb treatment. Each of these patients had chest radiography, smear microscopy, and lung function testing. Mean age was 44.1± 15.2 years, mean BMI was 22.27 ± 3.66 kg/m2. There were 66.2% men and 33.8% females. 42% employed and 52% literate. In the current study, 41(53.25%) of the individuals reported dyspnea and 22(28.57%) had dry cough, cough with expectoration 12(15.58%), Fever 8(10.4%), Haemoptysis 7(9%), chest pain 2(2.6%). Following Post tuberculosis treatment, 38(44%) had normal chest radiographs, 31(35.6%) of the patients had fibrosis/Fibrotic strand, 8(9.1%) had consolidation, 5(5.7%) had ectatic changes, 3(3.4%) had fibrocavity, 1(1%) had calcification and cicatricial collapse. In the current study, we found that 31(40.25%) had normal spirometry followed by 23(29.87%) had mixed pattern and 12(15.6%) had restrictive pattern findings, 11(14.28%) had obstructive pattern findings. In spite of appropriate suggestions, the majority of post-tb pulmonary impairment individuals suffer in quiet or undergo poor medical care. As a result, comprehensive recommendations for patient follow-up following tuberculosis treatment are required in order to monitor lung function and provide appropriate care to improve quality of life.

References

Allwood, B. W., Byrne, A., Meghji, J., Rachow, A., van der Zalm, M. M., & Schoch, O. D. (2021). Post-Tuberculosis Lung Disease: Clinical Review of an Under-Recognised Global Challenge. Respiration, 100(8), 751–763. https://doi.org/10.1159/000512531

Amaral, A. F., Coton, S., Kato, B., Tan, W. C., Studnicka, M., Janson, C., Gislason, T., Mannino, D., Bateman, E. D., Buist, S., Burney, P. G., & BOLD Collaborative Research Group (2015). Tuberculosis associates with both airflow obstruction and low lung function: BOLD results. The European Respiratory Journal, 46(4), 1104–1112. https://doi.org/10.1183/13993003.02325-2014

Báez-Saldaña, R., López-Arteaga, Y., Bizarrón-Muro, A., Ferreira-Guerrero, E., Ferreyra-Reyes, L., Delgado-Sánchez, G., Cruz-Hervert, L. P., Mongua-Rodríguez, N., & García-García, L. (2013). A novel scoring system to measure radiographic abnormalities and related spirometric values in cured pulmonary tuberculosis. PloS One, 8(11), e78926. https://doi.org/10.1371/journal.pone.0078926

Choi, C. J., Choi, W. S., Lee, S. Y., & Kim, K. S. (2017). The Definition of Past Tuberculosis Affects the Magnitude of Association between Pulmonary Tuberculosis and Respiratory Dysfunction: Korea National Health and Nutrition Examination Survey, 2008-2012. Journal of Korean Medical Science, 32(5), 789–795. https://doi.org/10.3346/jkms.2017.32.5.789

Chung, K. P., Chen, J. Y., Lee, C. H., Wu, H. D., Wang, J. Y., Lee, L. N., Yu, C. J., Yang, P. C., & TAMI Group (2011). Trends and predictors of changes in pulmonary function after treatment for pulmonary tuberculosis. Clinics (Sao Paulo, Brazil), 66(4), 549–556. https://doi.org/10.1590/s1807-59322011000400005

de Vallière, S., & Barker, R. D. (2004). Residual lung damage after completion of treatment for multidrug-resistant tuberculosis. The international journal of tuberculosis and lung disease : the official Journal of the International Union against Tuberculosis and Lung Disease, 8(6), 767–771.

Dey, S., & Guha, P. (2020). A brief review on cigarette induced cellular. Int. J. Exp. Res. Rev., 23, 18-26. https://doi.org/10.52756/ijerr.2020.v23.002

Di Naso, F. C., Pereira, J. S., Schuh, S. J., & Unis, G. (2011). Avaliação funcional em pacientes com sequela pulmonar de tuberculose [Functional evaluation in patients with pulmonary tuberculosis sequelae]. Revista Portuguesa de Pneumologia, 17(5), 216–221. https://doi.org/10.1016/j.rppneu.2011.06.010

Gai, X., Allwood, B., & Sun, Y. (2023). Post-tuberculosis lung disease and chronic obstructive pulmonary disease. Chinese Medical Journal, 136(16), 1923–1928. https://doi.org/10.1097/CM9.0000000000002771

Gupta, P., Singh, P., Das, A., & Kumar, R. (2023). Determinants of tuberculosis: an example of high tuberculosis burden in the Saharia tribe. Frontiers in Public Health, 11, 1226980. https://doi.org/10.3389/fpubh.2023.1226980

Hwang, Y. I., Kim, J. H., Lee, C. Y., Park, S., Park, Y. B., Jang, S. H., Kim, C. H., Shin, T. R., Park, S. M., Sim, Y. S., Kim, D. G., Lee, M. G., Hyun, I. G., & Jung, K. S. (2014). The association between airflow obstruction and radiologic change by tuberculosis. Journal of Thoracic Disease, 6(5), 471–476. https://doi.org/10.3978/j.issn.2072-1439.2014.04.02

Kim, H. Y., Song, K. S., Goo, J. M., Lee, J. S., Lee, K. S., & Lim, T. H. (2001). Thoracic sequelae and complications of tuberculosis. Radiographics : a review publication of the Radiological Society of North America, Inc, 21(4), 839–860. https://doi.org/10.1148/radiographics.21.4.g01jl06839

Lee, J. H., & Chang, J. H. (2003). Lung function in patients with chronic airflow obstruction due to tuberculous destroyed lung. Respiratory Medicine, 97(11), 1237–1242. https://doi.org/10.1016/s0954-6111(03)00255-5

Long, R., Maycher, B., Dhar, A., Manfreda, J., Hershfield, E., & Anthonisen, N. (1998). Pulmonary tuberculosis treated with directly observed therapy: serial changes in lung structure and function. Chest, 113(4), 933–943. https://doi.org/10.1378/chest.113.4.933

Maguire, G. P., Anstey, N. M., Ardian, M., Waramori, G., Tjitra, E., Kenangalem, E., Handojo, T., & Kelly, P. M. (2009). Pulmonary tuberculosis, impaired lung function, disability and quality of life in a high-burden setting. The international journal of tuberculosis and lung disease : the official Journal of the International Union against Tuberculosis and Lung Disease, 13(12), 1500–1506.

Maiti, M., & Samanta, G. (2018). Relationship between physical activity and smoking behavior among college students. Int. J. Exp. Res. Rev., 15, 39-43. https://doi.org/10.52756/ijerr.2018.v15.006

Manji, M., Shayo, G., Mamuya, S., Mpembeni, R., Jusabani, A., & Mugusi, F. (2016). Lung functions among patients with pulmonary tuberculosis in Dar es Salaam - a cross-sectional study. BMC Pulmonary Medicine, 16(1), 58. https://doi.org/10.1186/s12890-016-0213-5

Mbatchou Ngahane, B. H., Nouyep, J., Nganda Motto, M., Mapoure Njankouo, Y., Wandji, A., Endale, M., & Afane Ze, E. (2016). Post-tuberculous lung function impairment in a tuberculosis reference clinic in Cameroon. Respiratory Medicine, 114, 67–71. https://doi.org/10.1016/j.rmed.2016.03.007

Meghji, J., Lesosky, M., Joekes, E., Banda, P., Rylance, J., Gordon, S., Jacob, J., Zonderland, H., MacPherson, P., Corbett, E. L., Mortimer, K., & Squire, S. B. (2020). Patient outcomes associated with post-tuberculosis lung damage in Malawi: a prospective cohort study. Thorax, 75(3), 269–278. https://doi.org/10.1136/thoraxjnl-2019-213808

Meghji, J., Simpson, H., Squire, S. B., & Mortimer, K. (2016). A Systematic Review of the Prevalence and Pattern of Imaging Defined Post-TB Lung Disease. PloS one, 11(8), e0161176. https://doi.org/10.1371/journal.pone.0161176

Menezes, A. M., Hallal, P. C., Perez-Padilla, R., Jardim, J. R., Muiño, A., Lopez, M. V., Valdivia, G., Montes de Oca, M., Talamo, C., Pertuze, J., Victora, C. G., & Latin American Project for the Investigation of Obstructive Lung Disease (PLATINO) Team (2007). Tuberculosis and airflow obstruction: evidence from the PLATINO study in Latin America. The European Respiratory Journal, 30(6), 1180–1185. https://doi.org/10.1183/09031936.00083507

Menon, B., Nima, G., Dogra, V., & Jha, S. (2015). Evaluation of the radiological sequelae after treatment completion in new cases of pulmonary, pleural, and mediastinal tuberculosis. Lung India : official organ of Indian Chest Society, 32(3), 241–245. https://doi.org/10.4103/0970-2113.156233

Miller, M. R., Hankinson, J., Brusasco, V., Burgos, F., Casaburi, R., Coates, A., Crapo, R., Enright, P., van der Grinten, C. P., Gustafsson, P., Jensen, R., Johnson, D. C., MacIntyre, N., McKay, R., Navajas, D., Pedersen, O. F., Pellegrino, R., Viegi, G., Wanger, J., & ATS/ERS Task Force (2005). Standardisation of spirometry. The European Respiratory Journal, 26(2), 319–338. https://doi.org/10.1183/09031936.05.00034805

Pandey, A., Agrawal, R., Agarwal, R., Kumar, A., Gupta, U., & Sharma, D. (2020). Assessment of symptomatic post- tuberculosis patients by spirometry and chest X-ray. Inter J Contemporary Med. Res., 7(1), A1-A6. https://doi.org/10.21276/ijcmr.2020.7.1.21

Pasipanodya, J. G., McNabb, S. J., Hilsenrath, P., Bae, S., Lykens, K., Vecino, E., Munguia, G., Miller, T. L., Drewyer, G., & Weis, S. E. (2010). Pulmonary impairment after tuberculosis and its contribution to TB burden. BMC Public Health, 10, 259. https://doi.org/10.1186/1471-2458-10-259

Pasipanodya, J. G., Miller, T. L., Vecino, M., Munguia, G., Garmon, R., Bae, S., Drewyer, G., & Weis, S. E. (2007). Pulmonary impairment after tuberculosis. Chest, 131(6), 1817–1824. https://doi.org/10.1378/chest.06-2949

Plit, M. L., Anderson, R., Van Rensburg, C. E., Page-Shipp, L., Blott, J. A., Fresen, J. L., & Feldman, C. (1998). Influence of antimicrobial chemotherapy on spirometric parameters and pro-inflammatory indices in severe pulmonary tuberculosis. The European Respiratory Journal, 12(2), 351–356. https://doi.org/10.1183/09031936.98.12020351

Rajasekaran, S., Savithri, S., & Jeyaganesh, D. (2001). Post-tuberculosis bronchial asthma. Ind. J. Tub., 48, 139-42. https://doi.org/10.18203/2320-6012.ijrms20173563

Ramos, L. M., Sulmonett, N., Ferreira, C. S., Henriques, J. F., & de Miranda, S. S. (2006). Functional profile of patients with tuberculosis sequelae in a university hospital. Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia, 32(1), 43–47. https://doi.org/10.1590/s1806-37132006000100010

Ravimohan, S., Kornfeld, H., Weissman, D., & Bisson, G. P. (2018). Tuberculosis and lung damage: from epidemiology to pathophysiology. European respiratory review : an official Journal of the European Respiratory Society, 27(147), 170077. https://doi.org/10.1183/16000617.0077-2017

Sadhu, S., Karmakar, T., Chatterjee, A., Kumari, U., Mondal, P., Sarka, S., Sur, T., & Tarafdar, S. (2022). Determination of the antagonistic efficacy of silver nanoparticles against two major strains of Mycobacterium tuberculosis. Int. J. Exp. Res. Rev., 29, 67-72. https://doi.org/10.52756/ijerr.2022.v29.007

Sarkar, B., Biswas, P., Acharya, C.K., Ghorai, S.K., Nahar, N., Jana, S.K., Ghosh, S., Sarkar, D., Behera, B., & Madhu, N.R. (2021). Knowledge of Traditional Indian Medicinal Plants for the Management of COPD. Chettinad Health City Medical Journal, 10(4), 184 – 189. https://doi.org/10.36503/chcmj10(4)-05

Snider, G.L., Doctor, L., Demas, T.A., & Shaw, A.R. (2015). Obstructive airway disease in patients with treated pulmonary tuberculosis. The American Review of Respiratory Disease, 103 5, 625-40. https://doi.org/10.1164/ARRD.1971.103.5.625

Swain, S., Pothal, S., Behera, A., Manjhi, R., Dutta, P., & Pradhan, G. (2021). Treatment outcome among Post-TB obstructive airways diseases and COPD: A prospective cohort study. Journal of family Medicine and Primary Care, 10(9), 3411–3416. https://doi.org/10.4103/jfmpc.jfmpc_2391_20

Turnbull, L., Bell, C., & Child, F. (2017). Tuberculosis (NICE clinical guideline 33). Archives of Disease in Childhood-Education and Practice, 102(3), 136-142.https://doi.org/10.1136/archdischild-2016-310870

van Kampen, S. C., Wanner, A., Edwards, M., Harries, A. D., Kirenga, B. J., Chakaya, J., & Jones, R. (2018). International research and guidelines on post-tuberculosis chronic lung disorders: a systematic scoping review. BMJ Global Health, 3(4), e000745. https://doi.org/10.1136/bmjgh-2018-000745

Weiner, H. (1963). Changes in employment status associated with hospitalization for tuberculosis: I. Analysis of 163 consecutively admitted males. American Review of Respiratory Disease, 87(1), 17-22. https://doi.org/10.1164/arrd.1963.87.1.17

Willcox, P. A., & Ferguson, A. D. (1989). Chronic obstructive airways disease following treated pulmonary tuberculosis. Respiratory Medicine, 83(3), 195–198. https://doi.org/10.1016/s0954-6111(89)80031-9