Assessment of lung function in successfully treated tuberculosis reveals high burden of ventilatory defects and COPD.

Autor: Gupte AN; Johns Hopkins University School of Medicine, Baltimore, United States of America., Paradkar M; Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India., Selvaraju S; National Institute for Research in Tuberculosis, Chennai, India., Thiruvengadam K; National Institute for Research in Tuberculosis, Chennai, India., Shivakumar SVBY; Johns Hopkins University India Office, Pune, India., Sekar K; National Institute for Research in Tuberculosis, Chennai, India., Marinaik S; National Institute for Research in Tuberculosis, Chennai, India., Momin A; Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India., Gaikwad A; Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India., Natrajan P; National Institute for Research in Tuberculosis, Chennai, India., Prithivi M; National Institute for Research in Tuberculosis, Chennai, India., Shivaramakrishnan G; National Institute for Research in Tuberculosis, Chennai, India., Pradhan N; Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India., Kohli R; Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India., Raskar S; Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India., Jain D; Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India., Velu R; National Institute for Research in Tuberculosis, Chennai, India., Karthavarayan B; National Institute for Research in Tuberculosis, Chennai, India., Lokhande R; Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, India., Suryavanshi N; Johns Hopkins University School of Medicine, Baltimore, United States of America., Gupte N; Johns Hopkins University School of Medicine, Baltimore, United States of America., Murali L; National Institute for Research in Tuberculosis, Chennai, India., Salvi S; Chest Research Foundation, Pune, India., Checkley W; Johns Hopkins University School of Medicine, Baltimore, United States of America., Golub J; Johns Hopkins University School of Medicine, Baltimore, United States of America., Bollinger R; Johns Hopkins University School of Medicine, Baltimore, United States of America., Mave V; Johns Hopkins University School of Medicine, Baltimore, United States of America., Padmapriyadarasini C; National Institute for Research in Tuberculosis, Chennai, India., Gupta A; Johns Hopkins University School of Medicine, Baltimore, United States of America.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2019 May 23; Vol. 14 (5), pp. e0217289. Date of Electronic Publication: 2019 May 23 (Print Publication: 2019).
DOI: 10.1371/journal.pone.0217289
Abstrakt: Background: Burden, phenotype and risk-factors of lung function defects in successfully treated tuberculosis cases are unclear.
Methods: We performed spirometry with bronchodilators in new drug-sensitive adult (≥18 years) pulmonary tuberculosis cases during the 12 months following successful treatment in India. Airflow obstruction was defined as pre-bronchodilator FEV1/FVC<5th percentile of Global Lung Initiative mixed-ethnicity reference (lower limit of normal [LLN]). Chronic obstructive pulmonary disease (COPD) was defined as post-bronchodilator FEV1/FVCResults: Of the 172 participants included in the analysis, 82 (48%) were female, 22 (13%) had diabetes and 34 (20%) ever-smoked with a median (IQR) exposure of 3.5 (0.2-9.9) pack-years. Median (IQR) age and body-mass index (BMI) at enrollment was 32 (23-39) years and 18.1 (16.0-20.5) kg/m2 respectively. Airflow obstruction was detected in 42 (24%) participants; of whom 9 (21%) responded to short-acting bronchodilators and 25 (56%) had COPD; and was associated with duration of illness prior to treatment (aOR = 1.32 per 30-days, 95%CI 1.04-1.68, p = 0.02). A restrictive spirometry pattern was detected in 89 (52%) participants and was associated with female sex (aOR = 3.73, 95%CI 1.51-9.17, p = 0.004) and diabetes (aOR = 4.06, 95%CI 1.14-14.42, p = 0.03). Higher HbA1c at treatment initiation was associated with greater odds of a restrictive spirometry pattern (aOR = 1.29 per unit higher HbA1c, 95%CI 1.04 to 1.60, p = 0.02).
Conclusion: We found a high burden of lung function defects and COPD in tuberculosis cases who successfully completed treatment. Screening for chronic lung diseases following treatment and linkage to respiratory health clinics should be included in the routine management plan of all tuberculosis cases in India, regardless of conventional COPD risk-factors such as older age and smoking.
Competing Interests: The authors declare no conflict of interest.
Databáze: MEDLINE
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