Posttuberculosis Lung Disease in Adolescents in Lima, Peru
Silvia S. Chiang, Savvas Andronikou, Betsabe Roman Sinche, Michael Furman, H. Simon Schaaf, Clemax C. Sant’Anna, Hansel J. Otero, Joshua Ray Tanzer, Leonid Lecca, Anthony L. ByrneOBJECTIVE
Few studies have described long-term respiratory sequelae of adolescent (people aged 10–19 years) tuberculosis (TB) survivors. We hypothesized that compared with healthy adolescents with no history of TB, survivors of adolescent pulmonary TB have greater respiratory impairment (reduced lung function) and disability (symptoms and activity limitations).
METHODS
In this prospective cohort study in Lima, Peru, we used spirometry, oscillometry, and the St George’s Respiratory Questionnaire (SGRQ) to evaluate, on 2 separate occasions, the lung health of adolescents successfully treated for pulmonary TB and matched healthy controls. TB survivors with abnormal lung function underwent chest computed tomography (CT). Using mixed-effects regression with an interaction term for time since treatment completion and random effects for individual and matched pairs, we modeled changes in lung function and disability over 24 months from treatment completion, comparing findings between TB survivors and controls.
RESULTS
Compared with 101 controls (median age 17 years, 56% male), 101 TB survivors (median age 18 years, 56% male) had less favorable forced expiratory volume in 1 second, forced vital capacity, total airway resistance (R5), small airway resistance (R5-20), and reactance area (AX). Over the study period, AX, R5, and R5-20 improved for TB survivors but remained worse than controls. TB survivors had persistently greater respiratory disability (measured by SGRQ). Chest CTs of TB survivors demonstrated architectural distortion, reticular patterns, nodules, and bronchiectasis.
CONCLUSION
Adolescent TB survivors experience persistent, symptomatic chronic lung disease despite bacteriological cure. Our findings highlight the need for respiratory assessments beyond treatment completion.