Histologically confirmed tuberculosis-associated obstructive pulmonary disease

Allwood, B W; Rigby, Jonathan; Griffith‐Richards, Stephanie; Kanarek, David J.; Preez, LJ du; Mathot, Bas J.; Koegelenberg, C F N; Irusen, Elvis

doi:10.5588/ijtld.18.0722

Cited by 16 publications

(15 citation statements)

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“…These changes include gas trapping (33%) and reduced DLCO (25%) and this correlates with gas trapping evidenced in radiological images [27]. Histological study in these patients confirmed distortion of small pathways and blood vessels, conforming a phenotype other than COPD associated with smoking [28,29].…”

Section: The Epidemiological Basis Of Topdsupporting

confidence: 58%

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Tuberculosis Obstructive Pulmonary Disesase (TOPD)

González¹

2021

Clin Res Trials

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Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Tobacco smoking is established as a major risk factor. However, especially in the last 20 years, there are studies have shown that long-term exposure to biomass fuel smoke to cook and heat homes, also carries a high risk for the development of COPD. This occurs particularly in developing countries and it´s estimated that 25-45% of patients with COPD have never smoked and the burden of COPD not associated with smoking is possibly higher than previously believed. Although exposure to biomass is the major risk factor for COPD not associated with smoking, there are other associated factors such as occupational exposure to dust and gases, HIV/AIDS, lower respiratory tract infection (particularly in the childhood), chronic asthma, external pollution, poverty, and history of pulmonary tuberculosis (PTB). PTB affects more than 9 million people and kills 1.5 million people each year. Prevalence of airflow obstruction varies from 28% to 68% of patients with PTB and the association occurs mainly with the COPD phenotype. Such infection is associated with airway fibrosis, and the immune response to mycobacteria can result in airway inflammation, which is characteristic of COPD. The degree of airflow obstruction is correlated with the extent of the disease. This review exposes the evidence of this association (TOPD), and some clinical, functional, anatomopathological and therapeutic aspects and particularly the need for preventive interventions to face this other side of the entity (COPD not associated with smoking) that seems to be increasing.

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Section: The Epidemiological Basis Of Topdsupporting

confidence: 58%

“…Small airways disease. In a recent publication, Allwood reported in a young patient, non-smoker, with sequelae of PTB, the anatomopathological confirmation of small airways disease (28). In COPD, myofibroblast populations increase in smokers and patients with COPD contributing to small airway fibrosis and obliteration.…”

Section: Vitamin D Deficiency (Vdd)mentioning

confidence: 94%

Tuberculosis Obstructive Pulmonary Disesase (TOPD)

González¹

2021

Clin Res Trials

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“…A study emphasised that small airway dysfunction preceded both the spirometric evidence of COPD and detection of emphysema by CT and considered as a precursor of COPD and asthma 31. The mechanisms are potential involvement of vasculature within the bronchovascular bundle in and around small airways after TB 32. Health professionals should possibly play a more active role in the detection of small airway dysfunction after pulmonary TB.…”

Section: Discussionmentioning

confidence: 99%

Airflow obstruction and small airway dysfunction following pulmonary tuberculosis: a cross-sectional survey

Xing

Sun

Janssens

et al. 2022

Thorax

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ObjectivesPulmonary function impairment and chronic respiratory symptoms after tuberculosis are relatively common in low-income and middle-income countries. We aimed to estimate the impact of post-tuberculosis (post-TB) on pulmonary function.MethodsThis large cross-sectional, population-based study included subjects aged 15 years or older with technically acceptable postbronchodilator spirometry measurements. Post-TB was diagnosed on the basis of radiological evidence and/or medical history. Airflow obstruction was defined as a postbronchodilator forced expiratory volume in 1 s/forced vital capacity ratio below the lower limit of normal of Global Lung Function Initiative (GLI) lung function equations. Small airway dysfunction was diagnosed if at least two of the following indicators were less than 65% of predicted: maximal mid-expiratory flow, forced expiratory flow (FEF) 50% or FEF 75%.ResultsIn this population sample (N=8680, mean age: 40.1 years), 610 (7.0% (95% CI 6.5 to 7.6) participants were post-TB. Post-TB subjects had more frequent respiratory symptoms (46.8% vs 28.3%). Among post-TB subjects, 130 (21.3% (95% CI 18.1 to 24.8)) had airflow obstruction; OR of airflow obstruction was significantly associated with post-TB after adjustment for other confounding factors (OR 1.31, 95% CI 1.05 to 1.62). Post-TB was also associated with small airway dysfunction (OR 1.28, 95% CI1.07 to 1.53), which was present in 297 (48.9% (95% CI 33.9 to 53.0)) post-TB subjects.ConclusionsOur findings support existing knowledge that post-TB is positively associated with pulmonary function impairment and make for frequent respiratory symptoms. Post-TB should be considered as a potentially important cause of airflow obstruction and respiratory symptoms in patients originating from countries with a high burden of tuberculosis.

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“…There is now unequivocal evidence of the association between previous tuberculosis and COPD (35)(36)(37), which in many settings is stronger than the association between smoking and COPD (38)(39)(40). The mechanism of chronic airflow limitation is likely to involve the small airways primarily, and may be distinct from smoking related COPD (41,42); however, the two conditions may co-exist within an individual. The association between tuberculosis and COPD is strongest in high incidence countries, the young and never smokers (35,37).…”

Section: Infectionsmentioning

confidence: 99%