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Allwood BW, Stolbrink M, Baines N, Louw E, Wademan DT, Lupton-Smith A, Nel S, Maree D, Mpagama S, Osman M, Marx FM, Hoddinott G, Lesosky M, Rylance J, Mortimer K. Persistent chronic respiratory symptoms despite TB cure is poorly correlated with lung function. Int J Tuberc Lung Dis 2021; 25:262-270. [PMID: 33762069 PMCID: PMC8009599 DOI: 10.5588/ijtld.20.0906] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND: Persistent respiratory symptoms and lung function deficits are common after patients with TB. We aimed to define the burden of post-TB lung disease (PTLD) and assess associations between symptoms and impairment in two high TB incidence communities.METHODS: This was a cross-sectional survey of adults in Cape Town, South Africa who completed TB treatment 1-5 years previously. Questionnaires, spirometry and 6-minute walking distance (6MWD) were used to assess relationships between outcome measures and associated factors.RESULTS: Of the 145 participants recruited (mean age: 42 years, range: 18-75; 55 [38%] women), 55 (38%) had airflow obstruction and 84 (58%) had low forced vital capacity (FVC); the mean 6MWD was 463 m (range: 240-723). Respiratory symptoms were common: chronic cough (n = 27, 19%), wheeze (n = 61, 42%) and dyspnoea (modified MRC dyspnoea score 3 or 4: n = 36, 25%). There was poor correlation between FVC or obstruction and 6MWD. Only low body mass index showed consistent association with outcomes on multivariable analyses. Only 19 (13%) participants had a diagnosis of respiratory disease, and 16 (11%) currently received inhalers.CONCLUSION: There was substantial burden of symptoms and physiological impairment in this "cured" population, but poor correlation between objective outcome measures, highlighting deficits in our understanding of PTLD.
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Affiliation(s)
- B W Allwood
- Division of Pulmonology, Department of Medicine, Stellenbosch University & Tygerberg Hospital, Tygerberg, South Africa
| | - M Stolbrink
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - N Baines
- Division of Pulmonology, Department of Medicine, Stellenbosch University & Tygerberg Hospital, Tygerberg, South Africa
| | - E Louw
- Division of Pulmonology, Department of Medicine, Stellenbosch University & Tygerberg Hospital, Tygerberg, South Africa
| | - D T Wademan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - A Lupton-Smith
- Department of Science and Innovation-National Research Foundation South African Centre for Excellence in Epidemiological Modelling and Analysis (SACEMA), Faculty of Science, Stellenbosch University, Stellenbosch, South Africa
| | - S Nel
- Department of Physical Medicine and Rehabilitation, School of Medicine, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - D Maree
- Division of Pulmonology, Department of Medicine, Stellenbosch University & Tygerberg Hospital, Tygerberg, South Africa
| | - S Mpagama
- Kibong´oto Infectious Diseases Hospital, Kilimanjaro, Tanzania
| | - M Osman
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - F M Marx
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, Department of Science and Innovation-National Research Foundation South African Centre for Excellence in Epidemiological Modelling and Analysis (SACEMA), Faculty of Science, Stellenbosch University, Stellenbosch, South Africa
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - M Lesosky
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, South Africa, Liverpool School of Tropical Medicine, Liverpool, UK
| | - J Rylance
- Lung Health Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi, Liverpool School of Tropical Medicine, Liverpool, UK
| | - K Mortimer
- Liverpool School of Tropical Medicine, Liverpool, UK
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