Patient outcomes associated with post-tuberculosis lung damage in Malawi: a prospective cohort study

Meghji, J. et al. (2020) Patient outcomes associated with post-tuberculosis lung damage in Malawi: a prospective cohort study. Thorax, 75(3), pp. 269-278. (doi: 10.1136/thoraxjnl-2019-213808) (PMID:32102951) (PMCID:PMC7063395)

Abstract

Background: Post-tuberculosis lung damage (PTLD) is a recognised consequence of pulmonary TB (pTB). However, little is known about its prevalence, patterns and associated outcomes, especially in sub-Saharan Africa and HIV-positive adults. Methods: Adult (≥15 years) survivors of a first episode of pTB in Blantyre, Malawi, completed the St George's Respiratory Questionnaire, 6-minute walk test, spirometry and high-resolution CT (HRCT) chest imaging at TB treatment completion. Symptom, spirometry, health seeking, TB-retreatment and mortality data were collected prospectively to 1 year. Risk factors for persistent symptoms, pulmonary function decline and respiratory-related health-seeking were identified through multivariable regression modelling. Results: Between February 2016 and April 2017, 405 participants were recruited. Median age was 35 years (IQR: 28 to 41), 77.3% (313/405) had had microbiologically proven pTB, and 60.3% (244/403) were HIV-positive. At pTB treatment completion, 60.7% (246/405) reported respiratory symptoms, 34.2% (125/365) had abnormal spirometry, 44.2% (170/385) had bronchiectasis ≥1 lobe and 9.4% (36/385) had ≥1 destroyed lobe on HRCT imaging. At 1 year, 30.7% (113/368) reported respiratory symptoms, 19.3% (59/305) and 14.1% (43/305) of patients had experienced declines in FEV1 or FVC of ≥100 mL, 16.3% (62/380) had reported ≥1 acute respiratory event and 12.2% (45/368) had symptoms affecting their ability to work. Conclusions: PTLD is a common and under-recognised consequence of pTB that is disabling for patients and associated with adverse outcomes beyond pTB treatment completion. Increased efforts to prevent PTLD and guidelines for management of established disease are urgently needed. Low-cost clinical interventions to improve patient outcomes must be evaluated.

• Item Type: Articles
• Additional Information: Funded by a Wellcome Trust PhD Training Fellowship to JM (106065/Z/14/A). Additional support from The Wellcome Trust (Clinical Career Development Fellowship to PM (206575/Z/17/Z), Clinical Career Development Fellowship to JJ (209553/Z/17/Z), Senior Research Fellowship to ELC (200901/Z/16/Z), Malawi-­Liverpool-Wellcome Trust Core Award to SG (206545/Z/17/Z)), an EDCTP2 Senior Fellowship (TMA2017SF-1959) and Academy of Medical Sciences Newton Advanced Fellowship (NAF\R2\180681) to ML and support to ML, BS and KM from the NIHR Global Health Research Unit on Lung Health and TB in Africa at the Liverpool School of Tropical Medicine (16/136/35).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: MacPherson, Professor Peter
• Authors: Meghji, J., Lesosky, M., Joekes, E., Banda, P., Rylance, J., Gordon, S., Jacob, J., Zonderland, H., MacPherson, P., Corbett, E. L., Mortimer, K., and Squire, S. B.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
• Journal Name: Thorax
• Publisher: BMJ Publishing Group
• ISSN: 0040-6376
• ISSN (Online): 1468-3296
• Published Online: 26 February 2020
• Copyright Holders: Copyright © Author(s) (or their employer(s)) 2020
• First Published: First published in Thorax 75(3):269-278
• Publisher Policy: Reproduced under a Creative Commons licence