Performance of spirometry assessment at TB diagnosis

Author:

Rachow A.1,Ivanova O.2,Bakuli A.2,Khosa C.3,Nhassengo P.3,Owolabi O.4,Jayasooriya S.4,Ntinginya N. E.5,Sabi I.5,Rassool M.6,Bennet J.6,Niemann S.7,Mekota A-M.2,Allwood B. W.8,Wallis R. S.9,Charalambous S.10,Hoelscher M.1,Churchyard G.10

Affiliation:

1. Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, Munich, German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany

2. Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, Munich

3. Instituto Nacional de Saúde, Marracuene, Mozambique

4. Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia

5. Mbeya Medical Research Centre, National Institute for Medical Research, Mbeya, Tanzania

6. Clinical HIV Research Unit, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa

7. Leibniz Lung Center, Research Center Borstel, Borstel, Germany

8. Division of Pulmonology, Department of Medicine Stellenbosch University and Tygerberg Hospital, Cape Town

9. The Aurum Institute, Johannesburg

10. The Aurum Institute, Johannesburg, Department of Medicine, Vanderbilt University, Nashville, TN, USA

Abstract

BACKGROUND: Spirometry is considered relevant for the diagnosis and monitoring of post-TB lung disease. However, spirometry is rarely done in newly diagnosed TB patients.METHODS: Newly diagnosed, microbiologically confirmed TB patients were recruited for the study. Spirometry was performed within 21 days of TB treatment initiation according to American Thoracic Society/European Respiratory Society guidelines. Spirometry analysis was done using Global Lung Initiative equations for standardisation.RESULTS: Of 1,430 eligible study participants, 24.7% (353/1,430) had no spirometry performed mainly due to contraindications and 23.0% (329/1,430) had invalid results; 52.3% (748/1,430) of participants had a valid result, 82.8% (619/748) of whom had abnormal spirometry. Of participants with abnormal spirometry, 70% (436/619) had low forced vital capacity (FVC), 6.1% (38/619) had a low ratio of forced expiratory volume in 1 sec (FEV1) to FVC, and 19.1% (118/619) had low FVC, as well as low FEV1/FVC ratio. Among those with abnormal spirometry, 26.3% (163/619) had severe lung impairment.CONCLUSIONS: In this population, a high proportion of not performed and invalid spirometry assessments was observed; this was addressed by removing tachycardia as a (relative) contraindication from the study guidance and retraining. The high proportion of patients with severe pulmonary impairment at the time of TB diagnosis suggests a huge morbidity burden and calls for further longitudinal studies on the relevance of spirometry in predicting chronic lung impairment after TB.

Publisher

International Union Against Tuberculosis and Lung Disease

Subject

Infectious Diseases,Pulmonary and Respiratory Medicine

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