Post-Tuberculosis Lung Disease: Clinical Review of an Under-Recognised Global Challenge

Allwood, Brian, Byrne, Anthony, Meghji, Jamilah ORCID: https://orcid.org/0000-0002-4693-8884, Rachow, Andrea, van der Zalm, Marieke M and Dagobert Schoct, Otto (2021) 'Post-Tuberculosis Lung Disease: Clinical Review of an Under-Recognised Global Challenge'. Respiration, Vol 100, pp. 751-763.

Text mm_res~1485~08f3299e9213~3~3-2020-10-13-14-48-43.Submitted.docx - Accepted Version Download (187kB)

Abstract

An estimated 58 million people have survived tuberculosis since 2000, yet many of them will suffer from post-tuberculosis lung disease (PTLD). PTLD results from a complex interplay between organism, host and environmental factors, and affects long-term respiratory health.

PTLD is an overlapping spectrum of disorders that affects large and small airways (bronchiectasis, obstructive lung disease), lung parenchyma, pulmonary vasculature, and pleura, and may be complicated by co-infection and haemoptysis. People affected by PTLD have shortened life-expectancy, increased risk of recurrent tuberculosis, but predictors of long-term outcomes are not known. No data is available on PTLD in children and on impact throughout the life-course. Risk-factors for PTLD include multiple episodes of tuberculosis, drug resistant tuberculosis, delays in diagnosis and possibly smoking.

Due to a lack of controlled trials in this population, no evidence-based recommendations for the investigation and management of PTLD are currently available. Empirical expert opinion advocate pulmonary rehabilitation, smoking cessation and vaccinations (pneumococcal, influenza). Exacerbations in PTLD remain both poorly understood and under-recognised. Among people with PTLD the probability of tuberculosis recurrence must be balanced against other causes of symptom worsening. Unnecessary courses of repeated empiric anti-tuberculosis chemotherapy should be avoided.

PTLD is an important contributor to the global burden of chronic lung disease. Advocacy is needed to increase recognition for PTLD and its associated economic, social and psychological consequences and to better understand how PTLD sequelae could be mitigated. Research is urgently needed to inform policy to guide clinical decision making and preventative strategies for PTLD.

Item Type:	Article
Subjects:	WF Respiratory System > WF 140 Diseases of the respiratory system (General) WF Respiratory System > Tuberculosis > WF 200 Tuberculosis (General) WF Respiratory System > Lungs > WF 600 Lungs
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):	https://doi.org/10.1159/000512531
Depositing User:	Elly Wallis
Date Deposited:	07 Jan 2021 12:18
Last Modified:	05 Jan 2022 02:02
URI:	https://archive.lstmed.ac.uk/id/eprint/16602

Statistics

View details

Actions (login required)

Edit Item