Assessment of Lung Function using Spirometry and Radiological findings in Post Tuberculosis Cases
Lung Functions and Radiology in Post Tb Cases
Abstract
Objective: To assess the prevalence of abnormal radiological changes and their impact on lung function in post tuberculosis cases.
Study Design: Descriptive cross-sectional study.
Place and Duration of Study: The study was conducted in medical Outpatient Department (OPD) of CMH, Quetta from 30th Nov 2018 to 30th May 2019.
Materials and Methods: A total of sixty treated cases of pulmonary tuberculosis, presenting in medical OPD of CMH Quetta for regular follow-up, were included in the study. The subjects were recruited by non-probability consecutive sampling technique according to predefined inclusion criteria. Demographic data including age, gender, post treatment duration, clinical features and history of asthma, atopy, rhinitis, biomass exposure, coalmine exposure, animal and pet exposure was collected. Their lung function was assessed using spirometry and radiological changes were assessed by either chest X-ray or high resolution CT chest.
Results: Among the 60 patients, mean age was 36.32 + 9.95 years. The majority (70%) of subjects were males (n=42).The mean duration post treatment was 4.79 + 4.25 years. Among the study population 51.7% (n=31) were symptomatic, 73.3% (n=44) had abnormal lung function tests. With those having abnormal lung functions tests, 23.3% (n=14) had obstructive, 43.3% (n=26) had restrictive and 6.7% (n=4) had mixed airway disease. The radiological investigations were abnormal in 80% (n=48) of the patients showing various radiological changes such as reticular shadows, nodules, pleural thickening, collapse, fibrotic bands, hilar calcifications, lung volume reduction and traction bronchiectasis.
Conclusion: Our study showed that the restrictive pattern was most common finding on spirometry while, fibrotic bands were the most common radiological findings in post tuberculosis cases in our population.
References
Glaziou P, Floyd K, Raviglione MC. Global Epidemiology of Tuberculosis. Seminars in respiratory and critical care medicine. 2018; 39: 271-85.
Khan AH. Tuberculosis control in Sindh, Pakistan: Critical analysis of its implementation. Journal of Infection and Public Health. 2017; 10: 1-7.
Hunter RL. Tuberculosis as a three-act play: A new paradigm for the pathogenesis of pulmonary tuberculosis. Tuberculosis. 2016; 97: 8-17.
Pasipanodya JG, Miller TL, Vecino M, Munguia G, Garmon R, Bae S, et al. Pulmonary Impairment After Tuberculosis. Chest. 2007; 131: 1817-24.
Sarkar M, Srinivasa, Madabhavi I, Kumar K. Tuberculosis associated chronic obstructive pulmonary disease. The Clinical Respiratory Journal. 2017; 11: 285-95.
Ngahane BH, Nouyep J, Nganda Motto M, Mapoure Njankouo Y, Wandji A, Endale M, et al. Post-tuberculous lung function impairment in a tuberculosis reference clinic in Cameroon. Respiratory Medicine. 2016; 114: 67-71.
Ravimohan S, Kornfeld H, Weissman D, Bisson GP. Tuberculosis and lung damage: from epidemiology to pathophysiology. European Respiratory Review. 2018; 27: 170077.
Kistan J, Laher F, Otwombe K, Panchia R, Mawaka N, Lebina L, et al. Pulmonary TB: varying radiological presentations in individuals with HIV in Soweto, South Africa. Transactions of The Royal Society of Tropical Medicine and Hygiene. 2017; 111: 132-6.
Di Naso FC, Pereira JS, Schuh SJ, Unis G. Functional evaluation in patients with pulmonary tuberculosis sequelae. Revista Portuguesa de Pneumologia (English Edition). 2011; 17: 216-21.
Nihues SdSE, Mancuzo EV, Sulmonetti N, Sacchi FPC, de Souza Viana V, Netto EM, et al. Chronic symptoms and pulmonary dysfunction in post-tuberculosis Brazilian patients. The Brazilian Journal of Infectious Diseases. 2015; 19: 492-7.
Vecino M, Pasipanodya JG, Slocum P, Bae S, Munguia G, Miller T, et al. Evidence for chronic lung impairment in patients treated for pulmonary tuberculosis. Journal of Infection and Public Health. 2011; 4: 244-52.
Byrne AL, Marais BJ, Mitnick CD, Lecca L, Marks GB. Tuberculosis and chronic respiratory disease: a systematic review. International Journal of Infectious Diseases. 2015; 32: 138-46.
Mkoko P, Naidoo S, Mbanga LC, Nomvete F, Muloiwa R, Dlamini S. Chronic lung disease and a history of tuberculosis (post-tuberculosis lung disease): Clinical features and in- hospital outcomes in a resource-limited setting with a high HIV burden. South African Medical Journal. 2019; 109: 169- 73.
Singla R, Mallick M, Mrigpuri P, Singla N, Gupta A. Sequelae of pulmonary multidrug-resistant tuberculosis at the completion of treatment. Lung India. 2018; 35: 4-8.
Kim CJ, Yoon HK, Park MJ, Yoo KH, Jung KS, Park JW, et al. Inhaled indacaterol for the treatment of COPD patients with destroyed lung by tuberculosis and moderate-to-severe airflow limitation: results from the randomized INFINITY study. Int J Chron Obstruct Pulmon Dis. 2017; 12: 1589-96.
Pasipanodya JG, Miller TL, Vecino M, Munguia G, Garmon R, Bae S, et al. Pulmonary impairment after tuberculosis. Chest. 2007; 131: 1817-24.
Agarwala A, Maikap MK, Panchadhyayee P, Mandal P, Roy PP. Chronic airway obstruction in post tubercular fibrosis cases:a serious lung function changes. International Journal of Research in Medical Sciences. 2016; 4: 5294-6.
Manji M, Shayo G, Mamuya S, Mpembeni R, Jusabani A, Mugusi F. Lung functions among patients with pulmonary 268-73.
Vargha G. Fifteen year follow-up of lung function in obstructive and non-obstructive pulmonary tuberculosis.
Acta medica Hungarica. 1983; 40: 271-6.
Menon B, Nima G, Dogra V, Jha S. Evaluation of the radiological sequelae after treatment completion in new cases of pulmonary, pleural, and mediastinal tuberculosis. Lung India. 2015; 32: 241-5.
EIKngton PT, Friedland JS. Matrix metalloproteinases in destructive pulmonary pathology. Thorax. 2006; 61: 259-66.
Sailaja K, Rao HN. Study of pulmonary function impairment by spirometry in post pulmonary tuberculosis. ournal of Evolution of Medical and Dental Sciences. 2015; 4: 7365-71.
Khan R, Malik NI, Razaque A. Imaging of Pulmonary Post- Tuberculosis Sequelae. Pak J Med Sci. 2020; 36: S75-S82.
