Respiratory symptoms and lung function in patients treated for pulmonary tuberculosis in Malawi: a prospective cohort study

• Published in: Thorax Vol. 77; no. 11; pp. 1131 - 1139
• Main Authors: Nightingale, Rebecca, Chinoko, Beatrice, Lesosky, Maia, Rylance, Sarah J, Mnesa, Bright, Banda, Ndaziona Peter Kwanjo, Joekes, Elizabeth, Squire, Stephen Bertel, Mortimer, Kevin, Meghji, Jamilah, Rylance, Jamie
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and British Thoracic Society 01.11.2022; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Age; Bronchodilators; Cohort analysis; HIV; Human immunodeficiency virus; Lung diseases; Radiology; Spirometry; Tuberculosis; Variables; Malawi; tuberculosis
• ISSN: 0040-6376; 1468-3296
• DOI: 10.1136/thoraxjnl-2021-217190

RationalePulmonary tuberculosis (PTB) can cause post-TB lung disease (PTLD) associated with respiratory symptoms, spirometric and radiological abnormalities. Understanding of the predictors and natural history of PTLD is limited.ObjectivesTo describe the symptoms and lung function of Malawian adults up to 3 years following PTB-treatment completion, and to determine the evolution of PTLD over this period.MethodsAdults successfully completing PTB treatment in Blantyre, Malawi were followed up for 3 years and assessed using questionnaires, post-bronchodilator spirometry, 6 min walk tests, chest X-ray and high-resolution CT. Predictors of lung function at 3 years were identified by mixed effects regression modelling.Measurement and main resultsWe recruited 405 participants of whom 301 completed 3 years follow-up (mean (SD) age 35 years (10.2); 66.6% males; 60.4% HIV-positive). At 3 years, 59/301 (19.6%) reported respiratory symptoms and 76/272 (27.9%) had abnormal spirometry. The proportions with low FVC fell from 57/285 (20.0%) at TB treatment completion to 33/272 (12.1%), while obstruction increased from and 41/285 (14.4%) to 43/272 (15.8%) at 3 years. Absolute FEV1 and FVC increased by mean 0.03 L and 0.1 L over this period, but FEV1 decline of more than 0.1 L was seen in 73/246 (29.7%). Higher spirometry values at 3 years were associated with higher body mass index and HIV coinfection at TB-treatment completion.ConclusionSpirometric measures improved over the 3 years following treatment, mostly in the first year. However, a third of PTB survivors experienced ongoing respiratory symptoms and abnormal spirometry (with accelerated FEV1 decline). Effective interventions are needed to improve the care of this group of patients.