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Patient outcomes associated with post-tuberculosis lung damage in Malawi: a prospective cohort

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Meghji, Jamilah, Lesosky, Maia, Joekes, Elizabeth, Banda, Peter, Rylance, Jamie ORCID: https://orcid.org/0000-0002-2323-3611, Gordon, Stephen ORCID: https://orcid.org/0000-0001-6576-1116, Jacob, Joseph, Zonderland, Harmien, MacPherson, Peter ORCID: https://orcid.org/0000-0002-0329-9613, Corbett, Elizabeth, Mortimer, Kevin ORCID: https://orcid.org/0000-0002-8118-8871 and Squire, Bertie ORCID: https://orcid.org/0000-0001-7173-9038 (2020) 'Patient outcomes associated with post-tuberculosis lung damage in Malawi: a prospective cohort'. Thorax, Vol 75, Issue 3, pp. 269-278.

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Abstract

Background Post-tuberculosis lung damage (PTLD) is a recognised consequence of pulmonary TB (pTB). However, little is known about its prevalence, patterns and associated outcomes, especially in sub-Saharan Africa and HIV-positive adults.

Methods Adult (≥15 years) survivors of a first episode of pTB in Blantyre, Malawi, completed the St George’s Respiratory Questionnaire, 6-minute walk test, spirometry and high-resolution CT (HRCT) chest imaging at TB treatment completion. Symptom, spirometry, health seeking, TB-retreatment and mortality data were collected prospectively to 1 year. Risk factors for persistent symptoms, pulmonary function decline and respiratory-related health-seeking were identified through multivariable regression modelling.

Results Between February 2016 and April 2017, 405 participants were recruited. Median age was 35 years (IQR: 28 to 41), 77.3% (313/405) had had microbiologically proven pTB, and 60.3% (244/403) were HIV-positive. At pTB treatment completion, 60.7% (246/405) reported respiratory symptoms, 34.2% (125/365) had abnormal spirometry, 44.2% (170/385) had bronchiectasis ≥1 lobe and 9.4% (36/385) had ≥1 destroyed lobe on HRCT imaging. At 1 year, 30.7% (113/368) reported respiratory symptoms, 19.3% (59/305) and 14.1% (43/305) of patients had experienced declines in FEV1 or FVC of ≥100 mL, 16.3% (62/380) had reported ≥1 acute respiratory event and 12.2% (45/368) had symptoms affecting their ability to work.

Conclusions PTLD is a common and under-recognised consequence of pTB that is disabling for patients and associated with adverse outcomes beyond pTB treatment completion. Increased efforts to prevent PTLD and guidelines for management of established disease are urgently needed. Low-cost clinical interventions to improve patient outcomes must be evaluated.

Item Type: Article
Subjects: WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WF Respiratory System > Tuberculosis > WF 200 Tuberculosis (General)
WF Respiratory System > Lungs > WF 600 Lungs
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Clinical Sciences & International Health > International Public Health Department
Clinical Sciences & International Health > Malawi-Liverpool-Wellcome Programme (MLW)
Education
Digital Object Identifer (DOI): https://doi.org/10.1136/thoraxjnl-2019-213808
Depositing User: Stacy Murtagh
Date Deposited: 12 Mar 2020 14:34
Last Modified: 22 Jul 2020 11:37
URI: https://archive.lstmed.ac.uk/id/eprint/13673

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