Respiratory symptoms and health-related quality of life in post-tuberculosis subjects with physician-diagnosed bronchiectasis: a cross-sectional study

Residual respiratory disability after successful treatment of pulmonary tuberculosis: a systematic review and meta-analysis

Background

Pulmonary tuberculosis (PTB) can result in long-term health consequences, even after successful treatment. We conducted a systematic review and meta-analysis to estimate the occurrence of respiratory impairment, other disability states, and respiratory complications following successful PTB treatment.

Methods

We identified studies from January 1, 1960, to December 6, 2022, describing populations of all ages that successfully completed treatment for active PTB and had been assessed for at least one of the following outcomes: occurrence of respiratory impairment, other disability states, or respiratory complications following PTB treatment. Studies were excluded if they reported on participants with self-reported TB, extra-pulmonary TB, inactive TB, latent TB, or if participants had been selected on the basis of having more advanced disease. Study characteristics and outcome-related data were abstracted. Meta-analysis was performed using a random effects model. We adapted the Newcastle Ottawa Scale to evaluate the methodological quality of the included studies. Heterogeneity was assessed using the I² statistic and prediction intervals. Publication bias was assessed using Doi plots and LFK indices. This study is registered with PROSPERO (CRD42021276327).

Findings

61 studies with 41,014 participants with PTB were included. In 42 studies reporting post-treatment lung function measurements, 59.1% (I² = 98.3%) of participants with PTB had abnormal spirometry compared to 5.4% (I² = 97.4%) of controls. Specifically, 17.8% (I² = 96.6%) had obstruction, 21.3% (I² = 95.4%) restriction, and 12.7% (I² = 93.2%) a mixed pattern. Among 13 studies with 3179 participants with PTB, 72.6% (I² = 92.8%) of participants with PTB had a Medical Research Council dyspnoea score of 1-2 and 24.7% (I² = 92.2%) a score of 3-5. Mean 6-min walk distance in 13 studies was 440.5 m (I² = 99.0%) in all participants (78.9% predicted, I² = 98.9%) and 403.0 m (I² = 95.1%) among MDR-TB participants in 3 studies (70.5% predicted, I² = 97.6%). Four studies reported data on incidence of lung cancer, with an incidence rate ratio of 4.0 (95% CI 2.1-7.6) and incidence rate difference of 2.7 per 1000 person-years (95% CI 1.2-4.2) when compared to controls. Quality assessment indicated overall low-quality evidence in this field, heterogeneity was high for pooled estimates of nearly all outcomes of interest, and publication bias was considered likely for almost all outcomes.

Interpretation

The occurrence of post-PTB respiratory impairment, other disability states, and respiratory complications is high, adding to the potential benefits of disease prevention, and highlighting the need for optimised management after successful treatment.

Funding

Canadian Institutes of Health Research Foundation Grant.

Epidemiology of adult chronic cough: disease burden, regional issues, and recent findings

Chronic cough is a common medical condition that has a significant impact on patients' quality of life. Although it was previously considered a symptom of other disorders, it is now regarded as a pathologic state that is characterized by a deviation from the intrinsic protective functions of the cough reflex, especially in adults. There are several factors that may underlie the cough reflex hypersensitivity and its persistence, such as age, sex, comorbidities, viral infection, exposure to irritants or environmental pollutants, and their interactions may determine the epidemiology of chronic cough in different countries. With a deeper understanding of disease pathophysiology and advanced research methodology, there are more attempts to investigate cough epidemiology using a large cohort of healthcare population data. This is a narrative overview of recent findings on the disease burden, risk factors, Asia-Pacific issues, and longitudinal outcomes in adults with chronic cough. This paper also discusses the approaches utilizing routinely collected data in cough research.