Role of Corticosteroids in Tubercular Pleural Effusion: A Prospective Interventional Study from a Tertiary Care Teaching Hospital, Telangana, India

Abstract

Introduction: Tuberculosis is a major public health problem in majority of the developing countries. Pleural effusion develops when fluid accumulates between the parietal and visceral pleura. Aim: To evaluate the efficiency of corticosteroids in rapid clinical and radiological resolution of Tubercular Pleural Effusion (TPE). Also to study the recurrence of pleural effusion and find incidence of pleural fibrosis in patients treated with corticosteroids. Materials and Methods: This prospective interventional study was conducted at Government Chest Diseases and TB hospital (tertiary care teaching hospital), Telangana, India, from October 2014 to October 2016. Total 80 patients with TPE were divided into two groups. Steroid group (n=40), patients received standard Antitubercular Treatment (ATT) that was alternate day regimen along with prednisolone 0.75 mg/kg body weight per day for two weeks there after tapering of the dose done every second weekly in next four weeks. Non steroid group (n=40), patients received standard ATT alone that was alternate day regimen under Directly Observed Treatment Short course (DOTS) therapy based on Revised National TB Control Programme (RNTCP) guidelines respectively. All patients were followed in the Outpatient Department at the end of second, fourth, sixth, 24th week. At every follow-up visit, history obtained from patients regarding symptoms and chest radiographs for comparison of reabsorption of pleural fluid between two groups. At the end of treatment ultrasound of the chest was performed to confirm the presence of pleural thickening seen on chest radiograph. Descriptive measures obtained included as mean and standard deviation. The association between two categorical variables done by using Chisquare test. The p-values <0.05 was considered as statistically significant. Results: There was early initiation of symptomatic relief in patients treated with steroid group as compared to non steroid group (p-value <0.001). Average duration for symptomatic relief in steroid group was 3.42 days (range 1-7 days) and in non steroid group 8.3 days (range 1-42 days). There was significant difference between two groups in duration taken for symptomatic relief (p-value <0.001). Conclusion: Results of the present study suggest that corticosteroids still play some role in the treatment of TPE. Addition of the corticosteroids to the standard ATT exerts more rapid relief of clinical symptoms. The rapidity in pleural fluid absorption is not influenced significantly by adding corticosteroids to the ATT. There was no recurrence of pleural effusion after addition of corticosteroids to ATT. The incidence of pleural thickening was not influenced by steroids.

Keywords

• extrapulmonary
• pleural fibrosis
• pleural thickening
• prednisolone
• tuberculous pleuritis