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

Nightingale, Rebecca, Chinoko, Beatrice, Lesosky, Maia ORCID: https://orcid.org/0000-0002-2026-958X, Rylance, Sarah, Mnesa, Bright, Banda, Ndaziona Peter Kwanjo, Joekes, Elizabeth, Squire, Bertie ORCID: https://orcid.org/0000-0001-7173-9038, Mortimer, Kevin ORCID: https://orcid.org/0000-0002-8118-8871, Meghji, Jamilah ORCID: https://orcid.org/0000-0002-4693-8884 and Rylance, Jamie ORCID: https://orcid.org/0000-0002-2323-3611 (2021) 'Respiratory symptoms and lung function in patients treated for pulmonary tuberculosis in Malawi a prospective cohort study'. Thorax. (In Press)

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Abstract

Rationale Pulmonary 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.

Objectives To 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.

Methods Adults 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 results We 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.

Conclusion Spirometric 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.

Item Type: Article
Subjects: WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
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/10.1136/thoraxjnl-2021-217190
Depositing User: Debbie Jenkins
Date Deposited: 24 Jan 2022 11:16
Last Modified: 29 Jun 2022 11:01
URI: https://archive.lstmed.ac.uk/id/eprint/19778

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