An Observational Study to Assess Lung Function of Post Tuberculosis Obstructive Airway Disease in Rural vs Urban Population

Abstract Introduction- Tuberculosis is a public health problem in developing countries and in spite of receiving adequate anti-tuberculous therapy, patients often continues to have several post-tubercular sequelae, especially airflow limitation. Many studies have found that treatment outcome of Post-TB lung disease is worse than COPD in spite of almost similar presentation and treatment. Post TB lung disease patients need more frequent follow-up for early identification and prevention of bad outcomes. Aim- To evaluate pulmonary function by spirometry among post Pulmonary tuberculosis cases in rural vs urban population. Materials and Methods- It was an observational and comparative study, carried out at Department of Pulmonary Medicine, SRN Hospital, MLN Medical College, Prayagraj, India. All patients who attended the pulmonary medicine Department OPD and IPD with respiratory complaints and had completed adequate anti-tuberculous therapy for pulmonary tuberculosis in past were taken up for study and enrolled as per inclusion and exclusion criteria. They were evaluated with clinical history, sputum examination and chest X-ray PA view. Patients with no evidence of tuberculosis underwent spirometry and parameters were compared between urban and rural population. Result- This prospective study was done with a sample size of urban 69 and rural 116 patients who had a prior history of pulmonary TB and treatment completed. On spirometry examination obstructive pattern was found in 52.17% in urban cases and 41.38% in rural cases, restrictive pattern in 18.84% of urban cases and 27.59% of rural cases, mixed abnormality was found in 15.94% in urban cases and 17.24% in rural cases. Normal spirometry was in 13.04% in urban cases and 13.79% in rural cases. Comparison of post-bronchodilator FEV1, FVC, FEV1/FVC between smokers and non-smokers in rural and urban population show statistically significant difference. Conclusion- Majority of patients with post-tuberculous obstructive airway disease have associated obstructive component in both urban and rural population. Smoking causes significant alteration in pulmonary function among such patients. Patients in urban areas, particularly those who smoke and have other conditions such as diabetes, have poorer initial lung function and experience less improvement after bronchodilator use than patients in rural areas Keywords: Post TB lung disease, COPD, Spirometry