Divya Roy, A (2020) The Effect of Appropriate Anti Tuberculous Treatment on Recovery of Pulmonary and Pleural Tuberculosis and the Impact of Tuberculosis on Lung Function and Quality Of Life in Newly Diagnosed patients. Masters thesis, Christian Medical College, Vellore.
|
Text
201701120dhivya_roy.pdf Download (6MB) | Preview |
Abstract
BACKGROUND AND AIM: Lung function impairment after pulmonary tuberculosis (PTB) is a recognized phenomenon which adds to morbidity in these patients. However how the lung function changes over the course of illness is not studied. So our study aimed at assessing the change in lung function from the time of diagnosis through the course of illness to treatment completion and also to identify the individuals with lung function impairment after achieving microbiological cure and the risk factors associated with it. METHODS: This is a prospective observational cohort study conducted in the department of pulmonary medicine in a tertiary care Centre. Our study participants were recruited from February 2018 to February 2019 and were followed up for a period of 6 months. 92 patients were recruited of which 84 patients had pulmonary Tuberculosis and 8 patients had pleural tuberculosis. Spirometry was performed at baseline and complete pulmonary function test at the end of intensive phase and end of treatment. Change in lung function over course of illness and persistent lung function impairment after treatment was analysed. Other parameters like smear conversion, radiological resolution, improvement in quality of life with lung function change was also assessed. RESULTS: At baseline, 2nd month and 6th month, 7 patients (8.64%), 5 patients (8.06%) and 6 patients (8.57%) had obstructive ventilatory defect respectively. At the same time points 44(54.32%) patients, 33(53.22%) patients and 31(44.28%) patients had restrictive ventilatory defect. So after treatment completion 37 (52.8%) patients had ventilatory defects of which 31(44.28%) patients had restrictive pattern and 6(8.57%) had and obstructive pattern. The mean improvement in FEV1 % from baseline to 6th month was 5.76±10.56 (p-value <0.001), the mean improvement in FVC% was 5.88±11.78 (p-value <0.001) and TLC% was 4.31± 15.54(p-value 0.03) which were statistically significant. The mean improvement in DLCO% was 1.49±16.94 (p-value 0.49) which was not statistically significant. At 2nd month 33 patients were diagnosed to have restriction by FVC and 29 patients by TLC, indicating 4 were over diagnosed by FVC alone. At 6th month 31 patients were diagnosed to have restriction by FVC and 26 patients by TLC. Out of the 84 pulmonary TB patients 43 had cavity at the time of diagnosis and 11 had residual cavity while completing treatment. The Total chest x-ray score before starting treatment in those with lung function impairment and those who had normal lung function were 44 and 36 respectively ( p-value 0.02) and after completing treatment it was 15 and 11 (p-value 0.004). The mean total score in quality of life questionnaire reduced from 41.45 ± 16.92 before treatment to 13.34±7.65 after completing ATT. The difference in total SGRQ score who had normal lung function and lung function impairment was statistically significant (p-value 0.04). CONCLUSION: In our study we conclude that there is significant impairment in lung function in pulmonary TB patients which persist despite microbiological cure. The predominant defect is restriction (44%) and our study showed a lower incidence of obstructive defect (9%) in contrast to many others. Using FVC alone over diagnosed restriction in few patients, hence it is ideal to do TLC to identify true restriction. There is significant improvement in chest x-ray and quality of life with anti-tuberculous treatment which correlates with lung function. Our study results show the need for lung function testing in TB patients. Hence it is advisable to do spirometry atleast while completing treatment, for early identification of those with impaired lung function due to TB.
| Item Type: | Thesis (Masters) |
|---|---|
| Additional Information: | 201727204 |
| Uncontrolled Keywords: | Appropriate Anti Tuberculous Treatment, Recovery of Pulmonary and Pleural Tuberculosis, Lung Function, Quality Of Life, Newly Diagnosed patients. |
| Subjects: | MEDICAL > Tuberculosis and Respiratory Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 04 Feb 2021 16:46 |
| Last Modified: | 04 Feb 2021 16:46 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/13817 |
Actions (login required)
 |
View Item |
