Chronic Airflow Obstruction Syndrome Due to Pulmonary Tuberculosis Treated with Directly Observed Therapy - a Serious Changes in Lung Function

The origin of Chronic airflow obstruction (CAO) syndrome in active Tuberculosis (TB), despite significant similarities with chronic obstructive pulmonary disease (COPD), still remains unknown. The aim of the study was to examine the potential causes and risks for the development of CAO syndrome in new cases of pulmonary TB. Design: Prospective, nest case-control study. Patients: 40 patients with newly detected cavitary pulmonary TB and initial normal respiratory function, diagnosed and treated according to DOTS strategy. Measurements and results: The average values of Sniderʹs radiological score during TB treatment were significantly reduced (p<0.001), as well as average values of non-specific systemic serum markers of inflammation. The average values of FEV1(%), both before, during and at the end of completion of TB treatment were significantly decreased (p<0.05;). Linear regression analysis confirmed a statistically significant association between changes in the values of FEV1(%), resulting in TB treatment completion, and the value of Sniderʹs radiological score and the sputum culture conversion rate. From the initial findings of normal pulmonary ventilation tests, upon the completion of TB treatment 35.0% of observed patients developed the CAO syndrome. Logistic regression analysis confirmed a positive familiar burden for COPD, Sniderʹs radiological score at the beginning of TB treatment and sputum conversion rate on culture, as statistically significant predictors, while multivariate logistic regression analysis confirmed Sniderʹs radiological score at the beginning of TB treatment and sputum conversion rate on culture as most significant risk factors for CAO syndrome occurrence and development. Conclusion: The CAO syndrome is often a consequence and significant functional impairment of the respiratory system, during the reparative processes in active TB, even in the absence of risk factors for COPD. Only microbiological cure of TB patients with underlying risks for disorders of lung function, is not sufficient and effective approach for prevention of their further potential health deterioration.