PLoS ONE (Jan 2019)

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

  • Akshay N Gupte,
  • Mandar Paradkar,
  • Sriram Selvaraju,
  • Kannan Thiruvengadam,
  • Shri Vijay Bala Yogendra Shivakumar,
  • Krithikaa Sekar,
  • Srinivasa Marinaik,
  • Ayesha Momin,
  • Archana Gaikwad,
  • Premkumar Natrajan,
  • Munivardhan Prithivi,
  • Gomathy Shivaramakrishnan,
  • Neeta Pradhan,
  • Rewa Kohli,
  • Swapnil Raskar,
  • Divyashri Jain,
  • Rani Velu,
  • Bharath Karthavarayan,
  • Rahul Lokhande,
  • Nishi Suryavanshi,
  • Nikhil Gupte,
  • Lakshmi Murali,
  • Sundeep Salvi,
  • William Checkley,
  • Jonathan Golub,
  • Robert Bollinger,
  • Vidya Mave,
  • Chandrasekaran Padmapriyadarasini,
  • Amita Gupta

DOI
https://doi.org/10.1371/journal.pone.0217289
Journal volume & issue
Vol. 14, no. 5
p. e0217289

Abstract

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BackgroundBurden, phenotype and risk-factors of lung function defects in successfully treated tuberculosis cases are unclear.MethodsWe 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/FVCResultsOf 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).ConclusionWe 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.