12-month Respiratory Outcomes in Children and Adolescents Treated for Pulmonary Tuberculosis

Abstract Rationale: Despite high treatment success rates, the long-term consequences of pulmonary tuberculosis (TB) in children and adolescents who are successfully treated have yet to be clearly defined. Evidence suggests that these young people continue to experience significant post-treatment respiratory complications, such as reduced lung function and persistent symptoms. However, comprehensive data on respiratory health outcomes in young pulmonary TB survivors are limited, especially in regions with a high disease burden. Methods: We conducted a prospective cohort study in The Gambia, enrolling children and adolescents aged 19 years and younger who had completed treatment for pulmonary TB at National TB Programme clinics. Participants were recruited within six weeks after treatment completion and were assessed at three time-points: baseline (treatment completion), six months, and 12 months later. The evaluations included comprehensive clinical assessment, chest X-rays, and spirometry following the American Thoracic Society guidelines. Lung volume measurements (zFEV1 and zFVC) were calculated using the Global Lung Function Initiative 2012 reference equations for African American populations. To analyze longitudinal changes in lung function and identify factors associated with persistent respiratory impairment, we employed mixed-effects logistic regression models. Results: Of the 79 participants, 52% were female, and the median age was 15.6 years (IQR 11.8-17.9). At baseline, 57% (95% CI 45-68%) had abnormal spirometry results, primarily showing restrictive patterns. This prevalence remained relatively stable at 12 months, with 59% (95% CI 47-71%; p=0.61) still exhibiting abnormal results. While median zFVC improved over time (p=0.02), 10% experienced a significant decline in zFEV1 at six and 12 months. The proportion of participants with abnormal chest X-rays decreased from 47% at baseline to 38% at 12 months (p=0.05). Cough and sputum production were the most frequent symptoms, persisting in 21% of participants at 12 months. Significant predictors of abnormal spirometry at six months included baseline stunting (aOR 15.8, 95% CI 1.2-211.5; p=0.04), fibrosis on baseline chest X-ray (aOR 6.5, 95% CI 1.0-41.2; p=0.05), and abnormal baseline spirometry (aOR 31.2, 95% CI 6.6-146.6; p<0.001). After 12 months, abnormal baseline spirometry remained the strongest predictor of ongoing impairment (aOR 13.3, 95% CI 3.4-52.1; p<0.001). Conclusion: This study shows that children and adolescents treated for pulmonary TB in The Gambia continue to experience significant lung function impairment up to 12 months post-treatment. National TB programs should incorporate end-of-treatment spirometry evaluation and follow-up monitoring to mitigate long-term respiratory complications and improve patient outcomes.