Persistent chronic respiratory symptoms despite TB cure is poorly correlated with lung function
Brian Allwood, Marie Stolbrink, Nicola Baines, Elizabeth H. Louw, Dillon T. Wademan, Alison Lupton‐Smith, Samantha Nel, David Maree, Stellah Mpagama, Muhammad Osman, Florian M. Marx, Graeme Hoddinott, Maia Lesosky, Jamie Rylance, Kevin Mortimer, on behalf of the lung health in Africa across
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.