A study of the spectrum of lung disorders in TBsurvivors.

BACKGROUND: The impact of pulmonary tuberculosis persists despite successful treatment and poses a significant burden on healthcare. Post-tuberculosis lung disease (PTLD) is defined as "evidence of a chronic respiratory abnormality, with or without symptoms, attributable at least in part to prior tuberculosis". The abnormalities include residual lung lesions on imaging, lung function abnormalities, and complications such as haemoptysis, relapse, bronchiectasis and destroyed lung among others. These lung disorders have been studied independently but a comprehensive approach to PTLD has not yet been studied. Our research was conducted to emphasise the burden of PTLD and correlate this with comorbidities.

METHODS: A hospital based cross sectional observational study was conducted in Department of Respiratory Medicine, MMIMSR using a self-designed proforma. A total of 150 patients with history of previously treated tuberculosis were enrolled for this study over 2 years based on the inclusion/exclusion criteria. Patient demographic information, symptomatology, comorbidities and smoking status were entered in the proforma. Chest Xray, CT chest, PFT and 2D echo findings were also collected. Data was analysed and statistically correlated using SPSS PC 25 version. P value&#xa0;<&#xa0;0.05 was considered significant.

RESULTS: The mean age of the patients was 50.25&#xa0;&#xb1;&#xa0;15.89 years with more males (55&#xa0;%) than females (45&#xa0;%). Comorbidities included anaemia (43&#xa0;%), diabetes (28&#xa0;%) and COPD (24&#xa0;%) among others. Radiological sequelae were found in 147/150 patients. These included pulmonary fibrosis (79&#xa0;%%), total collapse (13.6&#xa0;%) multiple cavities (34.7&#xa0;%), pleural involvement (44.2&#xa0;%), bronchiectasis (40&#xa0;%) and destroyed lung (10.2&#xa0;%). On spirometry 48&#xa0;% showed a restrictive pattern, while a mixed obstructive and restrictive pattern was seen in 34&#xa0;% of cases. Tuberculosis associated obstructive pulmonary disease (TOPD) was observed in 49&#xa0;%, haemoptysis in 25&#xa0;% and relapse in 13.6&#xa0;% patients. Significant associations included diabetes with haemoptysis (p&#xa0;<&#xa0;0.01), hypertension with type II respiratory failure (p&#xa0;=&#xa0;0.01) and haemoptysis with bronchiectasis (p&#xa0;<&#xa0;0.01) and aspergilloma (p&#xa0;=&#xa0;0.001).

CONCLUSION: our study underscores the wide range of lung disorders and dysfunction experienced by TB survivors, which are exacerbated by comorbidities. Hence, patient care and follow up must not end with successful treatment of TB. Digitalization of patient records is emphasized to enable follow up for identifying sequalae that may arise in future. Moreover, management of PTLD should be standardised and included in national guidelines by policy makers.