Impaired pulmonary function after treatment for tuberculosis: the end of the disease?

Chushkin, Mikhail Ivanovich; Ots, Oleg Nikolayevich

doi:10.1590/S1806-37562016000000053

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ORIGINAL ARTICLE • J. bras. pneumol. 43 (1) • Jan-Feb 2017 • https://doi.org/10.1590/S1806-37562016000000053 copy

Impaired pulmonary function after treatment for tuberculosis: the end of the disease?

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To evaluate the prevalence of pulmonary function abnormalities and to investigate the factors affecting lung function in patients treated for pulmonary tuberculosis.

Methods:

A total of 214 consecutive patients (132 men and 82 women; 20-82 years of age), treated for pulmonary tuberculosis and followed at a local dispensary, underwent spirometry and plethysmography at least one year after treatment.

Results:

Pulmonary impairment was present in 102 (47.7%) of the 214 patients evaluated. The most common functional alteration was obstructive lung disease (seen in 34.6%). Of the 214 patients, 60 (28.0%) showed reduced pulmonary function (FEV₁ below the lower limit of normal). Risk factors for reduced pulmonary function were having had culture-positive pulmonary tuberculosis in the past, being over 50 years of age, having recurrent tuberculosis, and having a lower level of education.

Conclusions:

Nearly half of all tuberculosis patients evolve to impaired pulmonary function. That underscores the need for pulmonary function testing after the end of treatment.

Keywords:
Respiratory function tests; Tuberculosis, pulmonary; Spirometry; Lung diseases, obstructive

Characteristic	Value	Range
Gender^a
Male	132 (61.7)
Female	82 (38.3)
Age, years^b	51.1 (14.2)	20-82
< 40^a	46 (21.5)
40-49	59 (27.6)
50-59	49 (22.9)
60-69	32 (15.0)
≥ 70	28 (13.1)
BMI, kg/m^2b	23.9 (4.4)	14.8-41.5
Education^a,c
College-educated	66 (31.4)
High school only	144 (68.6)
Smoking status^a
Current smoker	112 (52.3)
Former smoker	26 (12.2)
Never-smoker	76 (35.5)
Pulmonary function^b
FVC, % of predicted	99.7 (21.4)	31-143
FEV₁, % of predicted	87.1 (25.0)	23-139
FEV₁/VC ratio	70.3 (13.5)	28.7-97
PEF, % of predicted	81.9 (28.7)	21-151
MMEF, % of predicted	61.9 (33.3)	5.4-161
TLC, % of predicted	99.9 (17.8)	38-136
FRC, % of predicted	111.4 (27.9)	45-191
RV, % of predicted	103.9 (30.2)	34-253
IC, % of predicted	91.2 (24.2)	27-165
RV/TLC ratio	34.7 (10.0)	16-74

Variable	(n = 214)
Type of impairment
Normal	112 (52.4)
Obstructive pattern (FEV₁/VC ratio < LLN and TLC ≥ LLN)	74 (34.6)
Restrictive pattern (TLC < LLN and FEV₁/VC ratio ≥ LLN)	18 (8.4)
Mixed pattern (TLC and FEV₁/VC ratio < LLN)	8 (3.7)
Nonspecific pattern (TLC ≥ LLN, FEV₁/VC ratio ≥ LLN, and FEV₁ or FVC < LLN)	2 (0.9)
Reduced pulmonary function (FEV₁ < LLN)	60 (28)
FEV₁
< 35% of predicted	9 (4.2)
35-49% of predicted	11 (5.1)
50-59% of predicted	15 (7.0)
60-69% of predicted	19 (8.9)
≥ 70% of predicted and < LLN	6 (2.8)
≥ LLN	154 (72)

Age, years	Gender	n	Any impairment	Pattern of impairment^b,c			Reduced pulmonary function^d
Age, years	Gender	n	Any impairment	Obstructive	Restrictive	Mixed
20-29	Male	7	1 (7.1)	1 (7.1)	0 (0)	0 (0)	0 (0)
	Female	7
	Total	14
30-39	Male	22	10 (31.3)	6 (18.8)	2 (6.3)	1 (3.1)	4 (12.5)
	Female	10
	Total	32
40-49	Male	39	25 (42.4)	24 (40.7)	1 (1.7)	0 (0)	12 (20.3)
	Female	20
	Total	59
50-59	Male	36	31 (63.3)	21 (42.9)	7 (14.3)	3 (6.1)	21 (42.9)
	Female	13
	Total	49
60-69	Male	18	18 (56.3)	13 (40.6)	2 (6.25)	2 (6.3)	12 (37.5)
	Female	14
	Total	32
≥ 70	Male	10	17 (60.7)	9 (32.1)	6 (21.43)	2 (7.1)	11 (39.3)
≥ 70	Female	18	17 (60.7)	9 (32.1)	6 (21.43)	2 (7.1)	11 (39.3)
Total	28

Variable	Condition		p
	Previous culture result^a
	Positive	Negative
	(n = 105)	(n = 90)
FVC, % of predicted^b	96.7 (22.9)	106.0 (16.8)	0.006
FEV₁, % of predicted^b	81.8 (24.9)	96.6 (22.0)	< 0.001
FEV₁/VC ratio^b	67.9 (13.8)	73.6 (12.5)	0.002
TLC, % of predicted^b	98.4 (19.4)	103.8 (12.7)	0.106
Any impairment^c	58 (55.2)	30 (33.3)	0.002
Reduced pulmonary function^c	39 (37.1)	13 (14.4)	0.004
	Number of episodes of pulmonary tuberculosis
	Two or more	One
	(n = 26)	(n = 188)
FVC, % of predicted^b	90.6 ± 28.9	100.9 ± 20.0	0.140
FEV₁, % of predicted^b	71.7 ± 27.9	89.2 ± 23.9	0.002
FEV₁/VC ratio^b	63.3 ± 12.8	71.2 ± 13.4	0.003
TLC, % of predicted^b	92.3 ± 25.6	100.9 ± 16.2	0.12
Any impairment^c	20 (76.9)	82 (43.6)	0.001
Reduced pulmonary function^c	15 (57.7)	45 (23.9)	< 0.001
	Smoking
	Ever	Never
	(n = 138)	(n = 76)
FVC, % of predicted^b	100.2 ± 20.6	98.7 ± 23.0	0.979
FEV₁, % of predicted^b	85.6 ± 23.7	89.7 ± 27.1	0.151
FEV₁/VC ratio^b	67.9 ± 13.3	74.6 ± 12.9	< 0.001
TLC, % of predicted^b	102.0 ± 16.0	96.0 ± 20.2	0.072
Any impairment^c	74 (53.6)	28 (36.8)	0.019
Reduced pulmonary function^c	43 (31.2)	17 (22.4)	0.171

Risk factor	OR	95% CI	p
Recurrence of tuberculosis: yes vs. no.	4.33	1.86-10.11	< 0.001
Age: < 50 years vs. ≥ 50 years	3.77	1.95-7.25	< 0.001
Positive culture in the past^b: yes vs. no	3.5	1.72-7.11	< 0.001
Education: high school only vs. college education	2.11	1.03-4.33	0.04
Smoking: ever vs. never	1.57	0.82-3.0	0.17
Gender: male vs. female	1.49	0.79-2.81	0.21

Sociedade Brasileira de Pneumologia e Tisiologia SCS Quadra 1, Bl. K salas 203/204, 70398-900 - Brasília - DF - Brasil, Fone/Fax: 0800 61 6218 ramal 211, (55 61)3245-1030/6218 ramal 211 - São Paulo - SP - Brazil
E-mail: jbp@sbpt.org.br

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[1] Correspondence to: Mikhail Chushkin. Laboratory of Pulmonary Physiology, Research Institute of Phthisiopulmonology, Sechenov First Moscow State Medical University, 4 bld Dostoevsky, 127994, Moscow, Russia. Tel.: 7 915 485-76-50. E-mail: mchushkin@yandex.ru