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The impact of tuberculosis on pulmonary health in Maputo, Mozambique
The impact of tuberculosis on pulmonary health in Maputo, Mozambique
Background Pulmonary tuberculosis (PTB) is curable but is still a major health problem. PTB is associated to chronic lung impairment even after microbiological cure. The type, severity and risk factor for lung impairment (LI) are poorly described. The prevalence of LI and reference equations have not been established in Mozambican healthy population. Methods A cohort of PTB patients was followed for 52 weeks after TB diagnosis (2014 to 2016), spirometry and 6-Minute Walk Test was assessed at weeks 8, 26 and 52 of follow-up, in Mavalane, Maputo. Saint George Respiratory Questionnaire (SGRQ) was evaluated during treatment. In 2017, the prevalence of lung impairment and 6-Minute Walk Test were evaluated in healthy volunteers from the same neighbourhood. Results The proportion of LI is 73,3% on week 8, declining to 67,7% at week 26 and 61,3% (26% of moderate-severe) at week 52 in PTB patients. On week 52 the mean Vital Capacity (FVC) is 2.65l (66.7% of predicted) in participants with LI versus 3.68l (90% of predicted) in participants without LI. All study participants suffered from pulmonary restriction (except one). Female sex (RRR = 5), higher CD4 in HIV positives (RRR: 7.33) were significantly associated with LI. The increase of haemoglobin was protective (RRR = 0.61). The PTB patients travelled a mean distance of 442 meters on week 52 and a mean total score of 5.58 in SGRQ. The proportion of LI in the Healthy volunteers was 20%, with 19,35% of restriction (one case of obstruction) mean FVC of 3.27l (89.4% of predicted) and FEV1 of 2.7l (93.80% of predicted). Conclusion Pulmonary restriction occurs in a fifth of healthy volunteers, it develops early during TB disease or treatment affecting more than half of the PTB patients. There is a need of more studies on lung outcome in PTB and to establish reference equation in healthy volunteers.
Post TB Lung disease, TB Sequel, Lung impairment, Spirometry, 6 Minute Walk Test Mozambique
Khosa, Celso
2019
English
Universitätsbibliothek der Ludwig-Maximilians-Universität München
Khosa, Celso (2019): The impact of tuberculosis on pulmonary health in Maputo, Mozambique. Dissertation, LMU München: Faculty of Medicine
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Abstract

Background Pulmonary tuberculosis (PTB) is curable but is still a major health problem. PTB is associated to chronic lung impairment even after microbiological cure. The type, severity and risk factor for lung impairment (LI) are poorly described. The prevalence of LI and reference equations have not been established in Mozambican healthy population. Methods A cohort of PTB patients was followed for 52 weeks after TB diagnosis (2014 to 2016), spirometry and 6-Minute Walk Test was assessed at weeks 8, 26 and 52 of follow-up, in Mavalane, Maputo. Saint George Respiratory Questionnaire (SGRQ) was evaluated during treatment. In 2017, the prevalence of lung impairment and 6-Minute Walk Test were evaluated in healthy volunteers from the same neighbourhood. Results The proportion of LI is 73,3% on week 8, declining to 67,7% at week 26 and 61,3% (26% of moderate-severe) at week 52 in PTB patients. On week 52 the mean Vital Capacity (FVC) is 2.65l (66.7% of predicted) in participants with LI versus 3.68l (90% of predicted) in participants without LI. All study participants suffered from pulmonary restriction (except one). Female sex (RRR = 5), higher CD4 in HIV positives (RRR: 7.33) were significantly associated with LI. The increase of haemoglobin was protective (RRR = 0.61). The PTB patients travelled a mean distance of 442 meters on week 52 and a mean total score of 5.58 in SGRQ. The proportion of LI in the Healthy volunteers was 20%, with 19,35% of restriction (one case of obstruction) mean FVC of 3.27l (89.4% of predicted) and FEV1 of 2.7l (93.80% of predicted). Conclusion Pulmonary restriction occurs in a fifth of healthy volunteers, it develops early during TB disease or treatment affecting more than half of the PTB patients. There is a need of more studies on lung outcome in PTB and to establish reference equation in healthy volunteers.