Assessment of the acute bronchodilator test and the efficacy of the course of treatment with Glycopyrronium bromide in patients with pulmonary tuberculosis associated with chronic obstructive pulmonary disease

Background. Despite significant progress in the fight against tuberculosis, the number of new cases in the world remains relatively stable, and amounts are more than 10 million annually. Chronic obstructive pulmonary disease (COPD) negatively affects the quality of life in patients with pulmonary tuberculosis and reduces the effectiveness of chemotherapy. Correction of bronchial obstruction in pulmonary tuberculosis remains an actual problem.
 Aim. To assess the acute bronchodilator test with glycopyrronium bromide, pulmonary function test parameters changing within 24 hours after inhalation, as well as the effect of a 23-month course of treatment with glycopyrronium bromide on the same parameters and the quality of life in patients with pulmonary tuberculosis associated with chronic obstructive pulmonary disease.
 Material and methods. A prospective cohort study of 38 patients with active pulmonary tuberculosis associated with the chronic obstructive pulmonary disease treated with anti-tuberculosis chemotherapy was carried out. The pulmonary function test parameters were assessed before inhalation, 15, 30, 120 min, 23 h 45 min after a single inhalation of glycopyrronium bromide, as well as after 1, 2 and 3 months of treatment. Quality of life was assessed by using CAT (COPD Assessment Test), SF-36 (Short Form-36 Health Survey Questionnaire), SGRQ (St. Georges Respiratory questionnaire).
 Results. A single inhalation of 50 g glycopyrronium bromide led to a significant increase in forced expiratory volume in 1 second by +15.2%, +18.3%, +22.8% and +11.2% after 15, 30, 120 minutes and 23 h 45 min, respectively. The change in forced expiratory volume in 1 second after 1, 2 and 3 months of treatment was +13.1%, +9.3% and +11.7%, respectively. The overall CAT score after 3 months decreased by 7. The mental health index SF-36 increased by 9.2 points. A decrease in SGRQ parameters was revealed: symptoms by 21.7 points, physical activity by 14.8 points, impact by 18.2 points.
 Conclusion. Inhaled glycopyrronium bromide 50 g once daily can be recommended for the treatment of patients with active pulmonary tuberculosis associated with chronic obstructive pulmonary disease.