Assessment of lung function in successfully treated tuberculosis reveals high burden of ventilatory defects and COPD

Akshay N. Gupte, Mandar Paradkar, Sriram Selvaraju, Kannan Thiruvengadam, Shri Vijay Bala Yogendra Shivakumar, Krithikaa Sekar, Srinivasa Marinaik, Ayesha Momin, Archana Gaikwad, Premkumar Natrajan, Munivardhan Prithivi, Gomathy Shivaramakrishnan, Neeta Pradhan, Rewa Kohli, Swapnil Raskar, Divyashri Jain, Rani Velu, Bharath Karthavarayan, Rahul Lokhande, Nishi SuryavanshiNikhil Gupte, Lakshmi Murali, Sundeep Salvi, William Checkley, Jonathan Golub, Robert Bollinger, Vidya Mave, Chandrasekaran Padmapriyadarasini, Amita Gupta

Research output: Contribution to journalArticle

Abstract

Background Burden, phenotype and risk-factors of lung function defects in successfully treated tuberculosis cases are unclear. Methods We performed spirometry with bronchodilators in new drug-sensitive adult (≥18 years) pulmonary tuberculosis cases during the 12 months following successful treatment in India. Airflow obstruction was defined as pre-bronchodilator FEV1/FVC<5th percentile of Global Lung Initiative mixed-ethnicity reference (lower limit of normal [LLN]). Chronic obstructive pulmonary disease (COPD) was defined as post-bronchodilator FEV1/FVC<LLN among participants with obstruction. Restrictive spirometry pattern was defined as FVC<LLN among participants without obstruction. Multivariable logistic and linear regression was used to identify risk-factors for obstruction, restriction and low lung function despite successful treatment. Results Of the 172 participants included in the analysis, 82 (48%) were female, 22 (13%) had diabetes and 34 (20%) ever-smoked with a median (IQR) exposure of 3.5 (0.2-9.9) pack-years. Median (IQR) age and body-mass index (BMI) at enrollment was 32 (23-39) years and 18.1 (16.0-20.5) kg/m2 respectively. Airflow obstruction was detected in 42 (24%) participants; of whom 9 (21%) responded to short-acting bronchodilators and 25 (56%) had COPD; and was associated with duration of illness prior to treatment (aOR = 1.32 per 30-days, 95%CI 1.04-1.68, p = 0.02). A restrictive spirometry pattern was detected in 89 (52%) participants and was associated with female sex (aOR = 3.73, 95%CI 1.51-9.17, p = 0.004) and diabetes (aOR = 4.06, 95%CI 1.14-14.42, p = 0.03). Higher HbA1c at treatment initiation was associated with greater odds of a restrictive spirometry pattern (aOR = 1.29 per unit higher HbA1c, 95%CI 1.04 to 1.60, p = 0.02). Conclusion We found a high burden of lung function defects and COPD in tuberculosis cases who successfully completed treatment. Screening for chronic lung diseases following treatment and linkage to respiratory health clinics should be included in the routine management plan of all tuberculosis cases in India, regardless of conventional COPD risk-factors such as older age and smoking.

Original languageEnglish (US)
Article numbere0217289
JournalPloS one
Volume14
Issue number5
DOIs
StatePublished - May 2019

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General

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    Gupte, A. N., Paradkar, M., Selvaraju, S., Thiruvengadam, K., Shivakumar, S. V. B. Y., Sekar, K., Marinaik, S., Momin, A., Gaikwad, A., Natrajan, P., Prithivi, M., Shivaramakrishnan, G., Pradhan, N., Kohli, R., Raskar, S., Jain, D., Velu, R., Karthavarayan, B., Lokhande, R., ... Gupta, A. (2019). Assessment of lung function in successfully treated tuberculosis reveals high burden of ventilatory defects and COPD. PloS one, 14(5), [e0217289]. https://doi.org/10.1371/journal.pone.0217289