Impaired lung function in adolescents with pulmonary tuberculosis during treatment and following treatment completion

Marieke M van der Zalm; Vita W Jongen; Ruan Swanepoel; Klassina Zimri; Brian Allwood; Megan Palmer; Rory Dunbar; Pierre Goussard; H Simon Schaaf; Anneke C Hesseling; James A Seddon

doi:10.1016/j.eclinm.2023.102406

Impaired lung function in adolescents with pulmonary tuberculosis during treatment and following treatment completion

EClinicalMedicine. 2024 Jan 3:67:102406. doi: 10.1016/j.eclinm.2023.102406. eCollection 2024 Jan.

Authors

Affiliations

¹ Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
² Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands.
³ Division of Pulmonology, Department of Internal Medicine, Tygerberg Academic Hospital, Cape Town, South Africa.
⁴ Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, South Africa.
⁵ Paediatric Pulmonology, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
⁶ Department of Infectious Disease, Imperial College London, London, United Kingdom.

Abstract

Background: Little is known about post-tuberculosis lung disease in adolescents. We prospectively assessed lung function in adolescents with microbiologically confirmed pulmonary tuberculosis during treatment and after treatment completion.

Methods: In a prospective study, we enrolled adolescents diagnosed with microbiologically confirmed tuberculosis and healthy tuberculosis-exposed household controls, between October 2020 and July 2021 in Cape Town, South Africa. Spirometry, plethysmography, diffusion capacity lung function tests and 6-min walking test (6MWT) were completed according to international guidelines 2 months into treatment and following treatment completion. Abnormal lung function was defined as abnormal spirometry (z-score < -1.64 for forced expiratory volume in 1 s (FEV₁) and/or forced vital capacity (FVC) and/or FEV₁/FVC), plethysmography (total lung capacity (TLC) < 80% of predicted, residual volume over TLC of >45%) and/or diffusion capacity (DLCO z-score < -1.64).

Findings: One-hundred adolescents were enrolled; 50 (50%) with tuberculosis and 50 (50%) healthy tuberculosis-exposed controls. Of the 50 adolescents with tuberculosis, ten had multidrug-resistant tuberculosis. Mean age of the group was 14.9 years (SD 2.7), 6 (6.0%) were living with HIV and 9 (9.0%) were previously treated for tuberculosis. Lung function improved over time; during treatment abnormal lung function was found in 76% of adolescents with tuberculosis, compared to 65% after treatment completion. Spirometry indices were lower in adolescents with tuberculosis compared to controls, both at 2 months and after treatment completion. Plethysmography in adolescents with tuberculosis showed that air-trapping was more common during treatment than in controls (12% vs 0%, respectively, p = 0.017); which improved following treatment completion. Adolescents with tuberculosis both during and after treatment completion walked a shorter distance than controls.

Interpretation: Adolescents with tuberculosis have impaired lung function even after treatment completion. It is crucial to include adolescents in trials on the prevention and treatment of tuberculosis-associated respiratory morbidity.

Funding: EDCTP, National Institute of Health, Medical Research Council, BMBF.

Keywords: Adolescents; Lung health; Morbidity; Post-tuberculosis; Tuberculosis.

Abstract

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