Lung Function Evaluation During Pulmonary Tuberculosis Treatment

BACKGROUND: Pulmonary tuberculosis (TB) has a significant impact on respiratory morbidity and mortality, both during and after completion of treatment. Few studies have described pulmonary function during TB treatment. We sought to characterize pulmonary impairment at two months into TB treatment among participants in the East Africa TB Sentinel Research Network (TB-SRN) of the International epidemiology Databases to Evaluate AIDS (IeDEA).METHODS: Individuals ages 15 and above with pulmonary TB (either clinically diagnosed or bacteriologically confirmed), were prospectively enrolled from the start of TB treatment at TB-SRN sites in Eldoret, Kenya, and Mbarara, Uganda. Spirometry was performed at two months into TB treatment. Spirometry was deferred for those with positive sputum smear at this visit. Spirometry measures were verified and interpreted by a trained clinician according to ATS/ERS guidelines, with oversight and consensus review by two pulmonologists. We described successful spirometry completion, and spirometry was characterized by normal, or restrictive, obstructive or mixed pattern impairment. RESULTS: Spirometry was performed in 117 TB-SRN participants, and 91(78%) had acceptable spirometry by quality grading on all pre- and post-bronchodilator measurements (Table). Of these, 32 (34%) participants had normal spirometry. Among 59 (66%) with pulmonary impairment, 34 (58%) had restriction alone, 5 (8%) had obstruction alone, 19 (32%) had mixed pattern and one (1.7%) had preserved ratio impaired spirometry (PRISm). Exploring findings by key characteristics, abnormal spirometry among women was 20/32 (63%); among youth (ages 15-24) was 10/14 (71%); among those with TB/HIV coinfection was 18/30 (60%); among those with bacteriologic confirmation 51/77 (66%); and among those with previous TB was 15/26 (58%).CONCLUSIONS: In this East African cohort, approximately two-thirds of individuals with pulmonary TB with acceptable spirometry had abnormal pulmonary function, with predominantly restrictive or mixed pattern. An important limitation is that individuals with inadequate spirometry quality grading on any measure were excluded; this may have disproportionately excluded individuals with difficulty completing spirometry due to being highly symptomatic. Future work will include sensitivity analyses to consider the impact of inadequate spirometry completion on these findings. Further analyses will explore potential associations with pulmonary impairment, both during and after TB treatment. KEY WORDS: spirometry; tuberculosis; lung impairment; adolescents, young adults, adults Table. Spirometry findings among individuals with pulmonary TB in the East Africa TB Sentinel Research Network of the International epidemiology Databases to Evaluate AIDS.

Duke Scholars

Author Neelima Navuluri Medicine, Pulmonary, Allergy, and Critical Care Medicine